POPF P8640 COLUMBIA Program Evaluation Logic Model & Process Evaluation P8640 Methods in Program Evaluation Take Home Assignment 1 Part 1: Logic Model C
POPF P8640 COLUMBIA Program Evaluation Logic Model & Process Evaluation P8640 Methods in Program Evaluation
Take Home Assignment 1
Part 1: Logic Model
Considering your chosen program case study “CONNECTIONS TO CARE” (C2C), develop a 1-page logic model, using the template below.
Part 2: Process Evaluation
Considering your chosen program case study “CONNECTIONS TO CARE” (C2C), respond to the following questions:
Part 2 can be a maximum of 2 pages.
1.) Based on the activities/processes identified in your logic model, in your own words, provide a definition for a) Dose delivered; b) Dose received; c) Reach and d) Fidelity, related to these program activities. Make sure you identify the activities you are referring to.
2.) In the chart below, list 4-6 process evaluation questions that could be asked about the program. Determine what indicators you will use to answer your questions and where this information can be found. Be specific about your primary or secondary data sources, including whether they are qualitative or quantitative, and how the data have been/will be collected. Determine who is best positioned to support data collection and what timeline is feasible.
Part 2: Assumptions annex:
If you encounter additional unknowns as you develop the log frame, process evaluation, or final evaluation proposal, make and state your assumptions in an annex. Assumptions can address inputs, activities, or other aspects of the case study. The annex can be a maximum of 1 page. Bulleted statements of assumptions are adequate. P8640 Methods in Program Evaluation
Connections to Care Program Updates
1. ThriveNYC Update:
Source: The City of New York. (2018) ThriveNYC Year Two Update.
Connections to Care (C2C) integrates mental health services into programs already serving lowincome communities, where people may not know they need help, or are reluctant to access it.
Community-based organizations (CBOs) are especially important partners, as their staff interacts
regularly with people who may be struggling with unmet mental health needs. Individual
organizations that provide services to low-income families, expectant mothers, parents of young
children, unemployed and out of school teenagers and young adults, and unemployed and
underemployed New Yorkers often encounter significant behavioral health obstacles to good
outcomes. The City is committed to helping staff of community-based organizations become
mental health champions through the Connections to Care program. The City selected 15 CBOs
ranging from employment training programs to childrens centers to family shelters, to partner
with mental health providers. Those providers train CBO staff members in mental health
interventions they can use in their daily work, including screenings, Mental Health First Aid,
motivational interviewing and psychoeducation. Because of this training and continuing support
from the local mental health provider, participants of the CBOs can get mental health help in
safety from people they already know in places they are comfortable. Progress to Date:
Connections to Care CBOs and their partners have trained more than 1,400 staff members in at
least one of the four core mental health interventions, and those staffers have served more than
23,000 individuals. Provider data show that 28 percent of all clients screened for a mental health
condition screened positive. Additionally, 69 percent of clients referred to care kept their
appointments. These early data demonstrate that with training and continuing support from their
local mental health provider, CBOs are helping clients get the mental health services they need.
2. RAND Corporation Update:
Source: Ayer L, Dunbar MS, Martineau M, Stevens C, Schultz D, Chan WY, Abbott M, Weir R,
Liu HH, Siconolfi D, Towe V. (2018) Evaluation of the Connections to Care (C2C) Initiative
Interim Report. Santa Monica: Rand Corporation.
In any given year, at least one in five adults in New York City is likely to meet the criteria for a
mental health diagnosis, yet most do not receive mental health services to treat these problems
(City of New York, Office of the Mayor, 2015). Problems such as depression and anxiety
disproportionately affect historically underserved segments of the population, such as
racial/ethnic minority and low-income individuals, that are most likely to have an unmet need for
mental health services (Kataoka, Zhang, and Wells, 2002). To help close these gaps of unmet
need, the Connections to Care (C2C) Collaborativethe Mayors Fund to Advance New York
City (Mayors Fund), the Mayors Office for Economic Opportunity, and the New York City
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P8640 Methods in Program Evaluation
Department of Health and Mental Hygienedeveloped the C2C program. C2C is an innovative
model that uses task shifting, an approach to extending evidence-informed health care skills to
community-based partners, to integrate mental health support into the work of community-based
organizations (CBOs) that do not focus on clinical health care. As one of New York Citys
ThriveNYC initiatives,1 C2C aims to remove barriers to mental health care and, ultimately, build
community resilience through responsiveness to individual and community needs.
The C2C program recognizes that mental health treatment and behavioral health interventions
can involve a wide spectrum of activities to improve individual functioning and promote wellbeing. Such activities do not necessarily have to involve clinical treatment or occur in a clinical
setting. In fact, a range of barriers, including lack of transportation, mental health stigma, and a
lack of linguistic or cultural competency among clinicians, may deter some individuals from
seeking care in clinical settings, where the majority of mental health services are delivered.
Given additional barriers, including a shortage of trained mental health professionals and the
costs of treatment that are prohibitive for many low-income populations, it is critical to build
capacity in the mental health treatment system in a way that addresses these issues.
Increasing access to mental health supports in nonclinical settings through task shifting is an
approach that may directly reduce barriers and expand access to mental health care services. In
addition to decreasing logistical barriers such as transportation (clients already work with the
nonclinical CBOs), this approach may also decrease the stigma people associate with seeking
clinical treatment and help identify groups with mental health needs that may otherwise be
missed by the mental health system. By making mental health supports available outside the
clinical environment, task shifting may promote earlier needs identification and improve timely
access to services that are appropriately matched to needs. In turn, this approach may reduce the
adverse effects of treatable behavioral health conditions, enabling individuals to more quickly
improve aspects of their quality of life, including their employment and education, and improve
overall community well-being.
To build an intervention that operates through nonclinical settings, C2C integrates delivery of
mental health skills into social services at 15 CBOs located throughout the city. C2C leverages
the existing trusted relationships that New Yorkers already have with participating CBOs. The
participating CBOs already provide a variety of services, such as career development, youth
services, homeless and domestic violence services, adult education, early childhood services, and
services for immigrants. Each CBO contracts with a mental health provider (MHP), developing a
close, working relationship essential to ensuring the effectiveness of C2C. The MHP advises
CBO staff on effective, evidence-informed interventions, while the CBO tailors the
implementation of those interventions to its own context.
1
ThriveNYC is an $850 million commitment by the City of New York to address the mental health needs
of New Yorkers, launched in 2015.
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P8640 Methods in Program Evaluation
In C2C, CBO staff receive training, ongoing coaching, and resources to implement four initial
core C2C mental health skills (hereafter, C2C skills): mental health screening, mental health
first aid (MHFA), motivational interviewing (MI), and psychoeducation. As their programs
mature, CBOs may add other skills beyond these four core skills. CBOs also develop and
strengthen pathways to clinical care (e.g., through their MHP partners) that are appropriately
matched to individual client needs. C2C, during its five years of operation, expects to serve up to
40,000 low-income New Yorkers (based on goals provided by participating CBOs) among its
target populations: (1) young adults between the ages of 16 and 24 who are not attending school
and are not employed; (2) unemployed or underemployed adults age 18 or older; and (3)
parents/caregivers who are expecting or who have children four years of age or younger.
Each CBO is required to meet certain implementation requirements, such as establishing a
formal relationship with an MHP, training staff members in the four core C2C mental health
skills, and providing ongoing support and supervision to CBO staff to deliver core C2C skills to
clients. By design, the program allots CBOs a great deal of flexibility in site-specific
implementation. A CBO has the latitude to navigate its individual relationship with an MHP, set
up culturally relevant training and coaching, ramp up staff readiness, and deliver the C2C
supports to clients in a way that makes sense for its own organization.
The C2C program calls on both CBOs and MHPs to assume new roles that capitalize on their
strengths and capabilities to increase capacity for and reduce barriers to providing mental health
services. Their roles were designed so that each would learn from the other: For instance, CBOs
could benefit from the mental health expertise of MHPs; in return, MHPs could learn from CBO
expertise addressing social determinants of health. CBOs and MHPs become not only service
providers, but also teachers who share their expertise. CBO staff leverage trusted relationships
with community members and knowledge of community needs to deliver a range of mental
health care supports as part of the everyday work they already do, making care more accessible.
By integrating the four core C2C skills into their existing services, CBOs may gain more
accurate knowledge about mental health and also expand capacity help promote mental health
and well-being. C2C equips CBOs to deliver culturally responsive, evidence-informed
behavioral health interventions that promote mental health and well-being and identify
individuals who need more specialized care and connect them to it. MHPs support CBOs new
capabilities and skills by consulting on implementation design; performing training, ongoing
coaching, and monitoring activities; applying clinical judgment to appropriately match mental
health services to needs; and providing clinical care when necessary.
Working together, CBO-MHP partners identify clients needs, select and adapt interventions, and
share in both learning and quality improvement. Staff from both types of organizations may also
be challenged through training and practice to confront or evolve their attitudes toward mental
health issues (e.g., mental health stigma), the way mental health services are typically delivered,
and who delivers them. The hope is that C2Cs efforts can begin influencing community wellbeing more broadly, first by the diffusion of knowledge about mental health by trained CBO lay
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P8640 Methods in Program Evaluation
staff, who often live in the communities they serve, and second through the potential downstream
effects of CBO clients who have benefited from C2C, as better supporters of their families and
neighbors, or even a resource for where to get mental health support.
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Connections to Care: Increasing Mental Health Services for New Yorkers
One in five adult New Yorkers is estimated to experience a mental health disorder annually, with
rates of predictors of mental health disorders similarly alarming among children and adolescents.i
The distribution of mental illness throughout New York City varies strongly by income, race, and
ethnicity. For example, serious mental illness is more than twice as common for adults who live
below 200 percent of the federal poverty level compared to those living 200 percent above it. New
York City is tackling this public health crisis through ThriveNYC, a mental health roadmap to
address the need for a comprehensive, unified approach to mental health services. Connections to
Care (C2C), one of the 54 initiatives of ThriveNYC, is an innovative strategy that integrates mental
health support into the work of community-based organizations (CBOs) that serve low-income
New Yorkers and populations at-risk of having unmet mental health needs. It is expected that C2C
will also increase clients ability to achieve other targeted program-specific outcomes in areas such
as employment, housing stability and independence.
The Center manages C2C in partnership with the Mayors Fund to Advance NYC (Mayors Fund)
and the NYC Department of Health and Mental Hygiene (DOHMH), supported by a grant from
the federal Social Innovation Fund at the Corporation for National and Community Service
(CNCS) and private donors. C2C supports two key principles of ThriveNYC: Partner with
Communities and Close Treatment Gaps.
Through partnerships between CBOs and Mental Health Providers (MHPs), C2C integrates a core
set of evidence-based mental health interventions into social service agencies. The programs target
at-risk populations engaged in services, including low-income (1) parents of children 0-4; (2) out
of work, out of school young adults ages 16-24; and (3) unemployed and underemployed adults
ages 18 and over. Through C2C, CBO staff are trained by their MHP partners to employ a core
package of mental health skills that includes, but is not limited to:
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Screenings for common mental health and substance use and misuse disorders;
Motivational interviewing: directive, participant-centered counseling style for eliciting
behavior change by helping participants to explore and resolve ambivalence;
Mental Health First Aid: a national program to teach the skills to recognize and respond
to the signs of mental illness and substance use disorders and misuse; and
Psychoeducation: providing individuals with a mental health condition and their families
with information that empowers them to understand the condition and deal with it in an
optimal way.
MHPs provide ongoing training and coaching of CBO staff, and provide direct care to participants
with significant mental health needs. The CBO/MHP relationship facilitates care coordination,
ensuring participants are connected to appropriate treatments. Together, this package of services
is designed to address the needs of participants along a chain of care, and improve mental health
and social service outcomes for low-income participants.
CBOs participating in C2C were competitively selected after submitting responses to a Request
for Proposals issued by the Mayors Fund in September 2015.
Connections to Care Partnerships
Community Based
Organization
Mental Health Provider
Primary Target Population
Arab American Association of
New York
NYU Lutheran Family Health
Centers
All
Bedford Stuyvesant Restoration
Corporation
Brooklyn Community Services
Unemployed/Underemployed Adults
CAMBA
Jewish Board of Family and
Childrens Services
Parents of Young Children
Center for Employment
Opportunities
CASES
Unemployed/Underemployed Adults
The Committee for Hispanic
Children and Families
Comunilife
Parents of Young Children &
Unemployed/Underemployed Adults
The Door
University Settlement
Out of School, Out of Work Youth
Hetrick-Martin Institute
Mount Sinai Adolescent Health
Center
Brookdale Hospital Center
Out of School, Out of Work Youth
The HOPE Program
Hudson Guild
Northern Manhattan
Improvement Corporation
Red Hook Initiative
Safe Horizon
Hudson Guild Paula Balser
Clinic
Dean Hope Center, Teachers
College, Columbia University
NYU Lutheran Family Health
Centers
Safe Horizon Counseling Center
Unemployed/Underemployed Adults
Parents of Young Children
Unemployed/Under employed
Adults, Out of School, Out of Work
Youth
Out of School, Out of Work Youth
Parents of Young Children
Sheltering Arms Children and
Family Services
Safe Space
Parents of Young Children
STRIVE International
Union Settlement Association
Hunter College Silberman School
of Social Work
Unemployed/Underemployed Adults
Voces Latinas
Catholic Charities of Brooklyn
and Queens
Parents of Young Children & Out of
School, Out of Work Youth
As of December 2016, private donors to the Mayors Fund include the Altman Foundation, Astoria
Energy, Benificus Foundation, Chapman Perelman Foundation, Ford Foundation, Haas
Foundation, Kresge Foundation, J.P. Morgan Chase Foundation, New York Community Trust,
New York State Health Foundation, Rockefeller Foundation, Simons Foundation, and the Tiger
Foundation. Additional funders provide support directly to the CBO providers.
i
ThriveNYC, published by the NYC Department of Health and Mental Hygiene in November 2015. Available for
download at http://www1.nyc.gov/nyc-resources/thrivenyc.page
CONNECTIONS
TO C A R E (C2C)
Evaluating an Initiative Integrating Mental Health
Supports into Social Service Settings
The Connections to Care (C2C) program integrates mental health supports into social
service agencies working with low-income New Yorkers. A RAND Corporation team will
be working with New York City government partners to assess the cost and impact of
C2C and how the program can be implemented most effectively and efficiently. This
brief highlights how C2C works, the evaluation RAND will undertake, and some thoughts
from participating organizations at the outset of the program.
CONNECTIONS TO CARE
BACKGROUND
New York City estimates that at least one in five adult New Yorkers is likely
to experience a mental health issue in any given year, but that many do not
receive mental health services to treat these issues. For example, at any
given time, more than half a million adult New Yorkers are estimated to have
depression, yet less than 40 percent receive care for it.* In response, the
city launched ThriveNYC, a set of 54 initiatives to combat this crisis, in 2015.
New York Citys First Lady, Chirlane McCray, announces the
community-based organizations that will participate in the
Connections to Care program.
The Connections to Care (C2C) program, one initiative of ThriveNYC, is
an innovative strategy that integrates mental health support into the work
of community-based organizations to improve mental health and other
outcomes of low-income and at-risk New Yorkers. This $30 million publicprivate partnership, which is a project of the federal Social Innovation
Fund (SIF) will reach up to 40,000 New Yorkers over five years through
collaboration between community-based organizations (CBOs) and mental
health providers (MHPs).
In addition to providing services that address immediate mental health needs, C2C and stakeholdersincluding the cityaim to
develop evidence over the long term for new strategies to improve community-based supports for mental health, and to identify,
assess, treat, and refer those with mental health disorders among low-income New Yorkers. This brief introduces the C2C program
and its partners, and gives a glimpse into the hopes and concerns of CBO staff as they begin to implement C2C.
THE C2C PARTNERS
The city launched C2C to increase awareness of mental health needs and access to services by equipping community-based
social service providers with new capacity to recognize and begin to address clients mental health needs, and to link those with
the most serious needs to additional clinical treatment. The Mayors Fund to Advance New York City (Mayors Fund) partnered
with the citys Center for Economic Opportunity (the Center) to win a grant from the federal SIF of the Corporation for National and
Community Service to fund the project, with matching funds provided by private donors. The Mayors Fund, the Center, and the
citys Department of Health and Mental Hygiene (DOHMH) jointly developed the C2C model, and together they lead and oversee
implementation of the program. The RAND Corporation (RAND) is leading a five-year evaluation of the program, and New York
Universitys McSilver Institute for Poverty Policy and Research (McSilver) is providing technical assistance to CBOs to support the
implementation of C2C in their organizations and to participate in the C2C evaluation.
In the fall of 2015 and winter of 2016, the Mayors Fund worked with the Center and DOHMH to choose, through a competitive
process, 15 CBOs operating throughout New York City to participate in the C2C program. The 15 CBOs and their mental health
provider partners selected are:
COMMUNITY-BASED ORGANIZATIONS
MENTAL HEALTH PROVIDER PARTNERS
Arab American Association of New York
Bedford Stuyvesant Restoration Corporation
CAMBA
Center for Employment Opportunities
The Committee for Hispanic Children and Families
Hetrick-Martin Institute
Hudson Guild
NYU Lutheran Family Health Centers
Brooklyn Community Services
Jewish Board of Family and Children’s Services
Center for Alternative Sentencing and Employm…
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