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University of Nevada Reno System of Care for Children’s Behavioral Health: Implementation from a Networked Perspective A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Political Science By Jill M. Manit Dr. William L. Eubank, Dissertation Advisor December, 2018 THE GRADUATE SCHOOL We recommend that the dissertation prepared under our supervision by JILL M. MANIT Entitled System Of Care For Children's Behavioral Health: Implementation From A Networked Perspective be accepted in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY William Eubank, Ph.D, Advisor Aleksey Kolpakov, Ph.D., Co-advisor Eric Herzik, Ph.D., Committee Member Thomas Harris, Ph.D., Committee Member Denise Montcalm, Ph.D., Graduate School Representative David W. Zeh, Ph. D., Dean, Graduate School December, 2018 i Abstract Governance models influence the approach public service organizations take when implementing programs, policies and practices. The networked model of governance supports the involvement of multiple actors who span organizational boundaries and roles to implement solutions to address complex social problems. This study examines the implementation of a statewide System of Care for children’s mental health from a networked governance perspective. System of Care is an evidence-based framework that aims to coordinate services in a culturally and linguistically appropriate way and places youth and families at the center of decision making on their care as well as in the design of the system. This descriptive study examines the extent to which the effort to implement a statewide System of Care resembles a networked governance perspective and describes the patterns of relationships that comprise the structure of the network. The study employs a mixed-method approach to identify actors in the network and to describe their patterns of interactions across four network relations. Archival data are collected to first identify the actors in the network (N=107). An “affiliation network” and a “name roster” are constructed for the second phase of the research, a survey of network members. The survey yielded a 53% response rate. Multi-level network analysis techniques are employed to identify and describe the patterns of relationships in the network. Four network relations are the focus of the study: operations (i.e. working together on the implementation), sharing information, ii sharing resources and trust. The data are analyzed at the individual actor level to identify those actors who are most central in the network, at the dyadic level to describe any connections between two actors, at the triadic level to identify the types of relations between three actors and at the whole network level. The data are analyzed using UCINET, Pajek and Excel software programs to run the appropriate analyses at multiple levels. Additionally, UCINET’s NetDraw program is utilized to generate visual depictions of the network including a distinction of the central actors. The findings reveal the network is operating under to two network model types; shared-governance and lead organization. For the shared-governance model, the network is moderately dense for the network relations of operations and sharing information. It becomes sparser and more centralized under the lead organization model for the network relations of sharing resources and trust. The network also has a “team” of central actors consisting of a parent, caregiver, professional staff and administrator. This team maintained high centrality scores across all four of the measured network relations. This study supports the utility of the networked governance perspective in public policy implementation for describing how a network structure can shape opportunities and constraints associated with public policy implementation. However, further analysis is needed. The paper concludes with recommendations for further study of the multiple sub-structures that can be found in a network and the impact the structural configurations can have on achieving public policy and administration goals. iii Acknowledgments I am proof that it takes a team to complete a Ph.D. program. While I knew this going in to the program, I still thought I could get it done on my own. This is probably why it took me so long to get it done! It wasn’t until I embraced a support system and surrounded myself with committed professionals that I was finally able to kick in to gear and complete my dissertation. As such, I am indebted to my central “team” for the completion of this project. Without you, I would not have been able to finish this journey. I thank you for all of your support, encouragement and enthusiasm. Dr. Eubank: I took my first Political Science course from you as a graduate special student a long time ago. I took the course wondering if this was the right field for me. It was your course that confirmed my decision to enter the program and provided the foundation for where I went after that. I thank you for stepping in as my Chair and keeping the fire lit beneath me. You pushed me when I needed and pulled me when I needed that too. You helped me set my priorities with the goal of completion in mind. I appreciate your skill in forcing me to rethink and refine my research … often with a single thought provoking question. I am absolutely certain that I would not be here without you. Thank you for your belief in me. Dr. Kolpakov: I took on a Network Analysis study because I have been arguing its benefits for the study of public policy implementation for years. I didn’t know anything about the approach when I embarked on this research project, but I knew I wanted it to become the basis for my research agenda in the future. I was so pleased to have met you and then I was intimidated when I learned that you had been trained by the best in iv the field of network analysis. You helped my move this project through the final phase and I am so appreciative of the time you took to teach me about the study of networks and how they exist everywhere! Dr. Ostergard: I want to thank you for lighting the fire under me and giving me a deadline to finish my program. It is what I needed, and it is what has lead me to this point today. I appreciate your support during the program and as I neared completion. Your calm reassurance helped me to get through some of those challenging final moments. Dr. Montcalm: Thank you for serving as a committee member and for creating the “space” that I needed to complete my dissertation. I felt like we were in this together and I appreciate your support in making this happen. I appreciate the gentle reminders to keep things moving along and for your patience as I shifted my priorities. Dr. Herzik and Dr. Harris: Thank you for your time and commitment in serving on my committee. I appreciate your support and guidance on this project. The Nevada System of Care: To the youth, family members, professionals and administrators involved in developing and implementing a System of Care to improve access and quality of behavioral health services for children and their families … you have taught me so much about being person-centered in the design of public services; you have taught me what it means to advocate for quality and efficient services and you have shown me the tenacity it takes to embark on a long journey to align public service systems. I admire your commitment to the youth and families of this state and I ask that you keep forging the way. Thank you for allowing me to be a participant with your v group and thank you for trusting me with your information. Thank you for listening to my research ideas and for testing out my survey. I look forward to our continued work together on implementing a true System of Care in Nevada. To my husband: Thank you, thank you, thank you. From proof reading my essays for admission to the final completion of my dissertation, you have been there for me. Thank you so much for taking care of the kids while I spent hours at my computer, for listening to me when I was excited about my surveys coming in and for your unwavering belief that I can get this done. I needed to lean on you and I am so glad you were a pillar for me. I really feel like this became a family affair and don’t think I could have completed it without everyone embracing it. You helped to make it happen and I thank you for that. To my sweet kids: You weren’t even born yet when I started this journey so, in a sense, you were born to do this! You both were so amazing during the last push of my dissertation. You did such a great job taking care of yourself, doing your homework and leaving me alone so I could keep working on it. I found your song “We Don’t Need No Dissertation” especially funny and motivating. Thank you for asking me good questions about my research and for learning about Network Analysis along side of me. I am so proud of you both. To both sets of my parents: I don’t even know where to begin with my gratitude for what you have done for me. You stepped in to help with my family and parent my children while I was mostly absent. I am sorry that I missed so many gatherings and I vi thank you for your understanding. I would not have been able to get this done without your support and encouragement.

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