John S Lyons

University of Kentucky | UKY · Department of Health Services Management

Translating research into practices and policies is necessary to effectively deliver health care and have a positive impact on society, particularly in helping professions where the goal is to help people live their best lives. However, the gap between research, practice, and policy in helping professions remains a problem that has yet to be solved...

Children and adolescents with serious emotional disturbance represent 7-12 percent of all youth in the United States. In 2017, the State of Idaho implemented the Youth Empowerment Service program, which allows youth with serious emotional disturbance who are younger than age eighteen living in households with income up to 300 percent of the federal...

Purpose: Although spiritual/religious strengths (SRS) are widely believed to be a protective factor for youth physical and mental wellness, scant evidence is available regarding how much and in what direction a person’s past adverse experiences can affect the said protection. The study aims to validate the overall protective effect of SRS on health...

Background Complex social determinants of health may not be easily recognized by health care providers and pose a unique challenge in the vulnerable pediatric population where patients may not be able to advocate for themselves. The goal of this study was to examine the acceptability and feasibility of health care providers using an integrated brie...

Background: Among children enrolled in behavioral health treatment, those with multiple trauma experiences (known as Adverse Childhood Experiences, or ACEs) typically see worse outcomes. In this study, we examine whether having or building strengths can help such children become more resilient and experience better outcomes. Objective: We examined...

Background Children less than five years of age comprised approximately 30% in 2020 of foster care entries in the United States, and they are consistently the largest foster care entry group. Very young children can respond differently to the same adverse life events. Detection of complex interpersonal traumas is core to providing appropriate inter...

This article details an approach to creating the system structures needed to actually manage a system that is trauma informed. Many people are interested in having trauma-informed systems but without proper infrastructure it may not be sustainable. This article discusses an approach to infrastructure development using Transformational Collaborative...

Understanding and addressing the impact of adverse life events is an important priority in the design of helping systems. However, creating trauma-informed systems requires efforts to embed effective trauma-informed work in routine practice. This article discusses a model for developing trauma-informed systems using the Transformational Collaborati...

Background: Children less than five years of age comprise the largest entry into foster care in the United State at approximately 30% in 2020. Very young children can respond differently to the same adverse life events. Detection of complex interpersonal traumas are core to providing appropriate interventions and prevention of reoccurring negative...

Objective: The authors quantified the impact of the use of telehealth services on patient-level clinical outcomes among children with complex behavioral and emotional needs in Idaho during the COVID-19 pandemic by comparing data collected in 2020 with data for the same months in 2019. Methods: Longitudinal statewide data of Child and Adolescent...

This chapter discusses the implications of managing transformational offerings. Initially, I discuss the fundamental differences between managing services and managing transformational offerings. The differences are both subtle and profound. In studying these differences, it becomes clear why we have the challenges we currently experience. However,...

There has been a great deal of progress in the science of implementation over the past several decades. In TCOM, no two implementations are the same and the process of implementation never really stops. In particular aspects of TCOM are generally implemented rather than the entire conceptual framework. However, there are lessons from the field that...

Transformational Collaborative Outcomes Management (TCOM) starts at the individual level. A full implementation of the TCOM approach requires that helping is collaborative with the people to be helped and all the other helpers. A consensus-based (post-triangulation measurement) assessment process is necessary to ensure that the vision of person-cen...

This chapter discusses the measurement theory that underlies the Transformational Collaborative Outcomes Management approach. Communimetrics is an evolution from the clinimetric theory of measurement. The idea of communimetrics is that measurement in practice is primarily used to uniform communication. If that is the primary purpose, then measures...

This chapter introduces Transformational Collaborative Outcomes Management (TCOM). The philosophy, strategies, and tactics associated with this conceptual framework are described and discussed. TCOM starts with person-centered care at the level of the helping transaction. By creating consensus-based assessment process that results in a reliable mea...

Effective collaboration, particularly when it is envisioned to work across levels of a system, requires that everyone gain something from the collaborative process. Programs and agencies benefit from a person-centered approach in a variety of ways. First, it is a strategy to enhance the performance of the program/agency interventions. By shifting t...

This chapter introduces the importance of collaboration to the effective management of the helping sector. There are two important reasons why collaboration is crucial. To understand the first reason, it is necessary to understand the distinction between complicated and complex system. While both systems involve interactions among component parts,...

This chapter presents the case for rethinking how to manage the helping sector. Building off the work of the economists Gilmore and Pine, I describe the types of businesses and discuss how the helping sector is intended to provide transformational offerings. Helping is fundamentally the business of personal change. However, to date the helping sect...

In order to implement a collaborative process, it is important to create an organizational culture and climate that supports collaboration. TCOM uses an approach called ‘safe systems’ that is based on the recent work in safety science. Safety science has successfully help transform very high-risk industries such as aviation and surgical suites. Les...

The idea of TCOM is clearly not about one person doing something that other people replicate. The approach requires large numbers of people working together in different ways to promote the implementation of person-centered care at all levels of the system. To facilitate this vision, a field must be developed. Like any other collaborative process,...

The introduction of TCOM in my book Redressing the Emperor: improving our children’s public mental health system (Lyons, Redressing the Emperor: Improving our children’s public behavioral health system, Praeger, 2004) framed the development of the conceptual framework from the perspective of tensions and syndromes. Tensions are competing, unresolva...

Although TCOM conceptually starts the individual level transaction of helping, the greatest impact of this approach is experienced at the system level. In fact, system transformation is the raison d’etre for the development of this conceptual framework. This chapter tracks the development of TCOM through a series of projects that served to organize...

Objective To develop and test predictive models of admissions to a psychiatric residential treatment facility (PRTF) in transitional age youth using routinely collected health insurance claims and enrollment data. Data Sources We used outpatient service and pharmaceutical claims from Medicaid beneficiaries aged 6-to 21-years old in Kentucky for th...

Surveys, questionnaires, and assessments are the only approved means for measuring outcomes, yet there is a paucity of evidence that these tools can perform well as outcomes measures. A major barrier to utilizing these tools as measures of improvement in care is an inability to recognize when the responses are incomplete, inaccurate, or insincere....

Introduction Despite a rich and developing research literature on the relationships between transportation and healthcare outcomes, the impact of unmet transportation needs on children, particularly on their general psychosocial functioning, is less well understood. We hypothesized that caregiver's transportation needs may be a key point of interve...

Transportation to/from care is a significant barrier to healthcare access and utilization. The novel coronavirus pandemic prompted a widespread expansion of telehealth service delivery throughout much of 2020. We used propensity score matching to generate two comparison groups of children served in a large public mental and behavioral health system...

This book discusses defining, measuring and developing entrepreneurship skills. It identifies essential skills for successful entrepreneurship, describes an assessment tool for measuring these skills in a way that can be acted upon, and discusses how the measurement can be used both for directing impactful skill development and measuring that impac...

Entrepreneur development programs have many choices in terms of how they might elect to measure skills. However, any program that conceptualizes entrepreneurship as a set of skills must make this decision. In order to remain consistent with the TCOM framework and create an efficient and collaborative assessment process, we have created the Readines...

In this chapter, we discuss two major pathways forward: (1) the support of entrepreneurship development programs’ ability to provide a skill development curriculum and learning experiences and (2) encouraging the use of transformational management strategies to enhance the effectiveness of these programs. We describe the RISE and its features as an...

This chapter discusses major recent changes in the way we think about entrepreneurs and how they are developed. It begins with the idea that entrepreneurs are born, not made, and how that theory influenced entrepreneurship education and policy, until it was largely debunked through research, shifting thinking toward the development of entrepreneurs...

In this chapter, we will take up the application of the clinical assessment tool called the RISE to the education of students of entrepreneurship. We will pick up on the discussion of the current model of entrepreneurship education begun in Chapter 1, exploring learning theory, both curriculum and co-curricular activities, and where the RISE might...

This chapter discusses the use of the RISE by the Scheinfeld Center for Entrepreneurship and Innovation at Santa Barbara City College. It describes the Center’s mission, vision, programming, student body, and facilities. The Center has been using the RISE assessment in its Get REAL Accelerator program and in its Scheinfeld Interns Program. The chap...

The Entrepreneurship Program in the Gary W. Rollins College of Business at the University of Tennessee at Chattanooga is using the RISE to help it implement a strategy that focuses on building the entrepreneurship skills of its students. It is taking its long-standing curriculum and closely integrating it with the co-curricular activities of its ne...

In this chapter, we lay out a conceptual framework for a skill development perspective to entrepreneurship development. We argue that entrepreneurship development should be considered a transformational offering that requires mass customization. Developing entrepreneurs necessitate a skills-based complex system. For this purpose, we describe a conc...

Despite a rich and developing research literature on the relationships between transportation and healthcare outcomes, the impact of unmet transportation needs on children, particularly on their general psychosocial functioning, is less well understood. We hypothesized that caregiver's transportation needs may be a key point of intervention for chi...

This book explores the sea change in thinking about how to educate students of entrepreneurship, uses extant theory to develop a conceptual model of entrepreneurship skill development, describes an assessment tool for operationalizing this model, discusses how this tool can be utilized to develop entrepreneurship skills, and offers examples from th...

Purpose The purpose of this paper is to argue that defining, measuring and developing skills are crucial to successful entrepreneurship and that being able to do so can help to build strong rural entrepreneurial ecosystems. Design/methodology/approach The literature on entrepreneurship success and entrepreneurial skills is reviewed, and this knowl...

Executive Summary: The Readiness Inventory for Successful Entrepreneurship (RISE) is a promising practice in entrepreneurial learning. RISE targets entrepreneurial skill-building over the creation of business plans or models as a pathway to entrepreneurship. RISE applies Communimetrics, an innovative theory of measurement, to clinically assess 30 e...

A general description of the background and use of level of care decision algorithms using the Child and Adolescent Needs and Strengths

Objective: The adult INTERMED is used to determine case complexity and psychosocial needs. We developed and validated a pediatric version of the INTERMED for children and adolescents with inflammatory bowel disease (IBD) and assessed its utility in predicting healthcare utilization. Methods: We performed a cross-sectional study of children (aged...

The evidence-base services literature is continually growing, providing the field with rich and important sets of information regarding what works for treating different types of youth and families. Given this burgeoning of information, the PracticeWise Evidence-Based Services (PWEBS) Literature Database has been developed to aid in summarizing and...

In many developed countries around the world residential care interventions for children and adolescents have come under increasing scrutiny. Against this background an international summit was organised in England (spring 2016) with experts from 13 countries to reflect on therapeutic residential care (TRC). The following working definition of TRC...

In many developed countries around the world residential care interventions for children and adolescents have come under increasing scrutiny. Against this background an international summit was organised in England (spring 2016) with experts from 13 countries to reflect on therapeutic residential care (TRC). The following working definition of TRC...

Presentation on the development and impact of level of care decision support algorithms using the Child and Adolescent Needs and Strengths (CANS)

In veel ontwikkelde landen wordt in toenemende mate kritiek geleverd op residentiële interventies bij kinderen en jongeren. Tegen de achtergrond hiervan vond in het voorjaar 2016 in Engeland een internationale conferentie plaats van experts uit 13 landen op het gebied van therapeutische residentiële zorg (TRZ). De volgende werkdefinitie van TRZ was...

While the focus of this consensus statement and the review volume that preceded it (Whittaker, Del Valle, & Holmes, 2014) is on therapeutic residential care (TRC), a specialized form of group care, we view our work as supportive of a much wider effort internationally concerned with the quality of care children receive when, for a variety of reasons...

Traditionally, clinical recommendations for assessing and managing paediatric obesity have relied on anthropometric measures, such as body mass index (BMI), BMI percentile and/or BMI z-score, to monitor health risks and determine weight management success. However, anthropometric measures do not always accurately and reliably identify children and...

While the child serving system has been measuring and monitoring outcomes for more than three decades, the promise of actually using outcomes to support changes in the functioning of the system has not yet lived up to its full potential. In this Editorial, I review what I believe to be a number of ways that we have mistakenly conceptualized outcome...

In order to understand the differential presentation of trauma stress symptoms over the course of development from children to adolescents, a sample of more than 11,000 children and adolescents were studied who were identified as to whether they had experienced multiple trauma experiences prior to placement in child welfare custody. Six age groups...

After children enter the child welfare system, subsequent out-of-home placement decisions and their impact on children's well-being are complex and under-researched. This study examined two placement decision-making models: a multidisciplinary team approach, and a decision support algorithm using a standardized assessment. Based on 3,911 placement...

There is a substantial body of research on delinquent behavior and symptoms of conduct disorder among young males; however, less attention has been dedicated to understanding the female population. The aim of this study is to examine young girls’ severity of needs related to conduct disorder and delinquent behavior in relation to various past traum...

Out-of-home placement decision-making in child welfare is founded on the best interest of the child in the least restrictive setting. After a child is removed from home, however, little is known about the mechanism of placement decision-making. This study aims to systematically examine the patterns of out-of-home placement decisions made in a state...

Emergency department (ED) management of adults with sickle cell disease (SCD) is complex and frustrating. The Emergency Department Sickle Cell Assessment of Needs and Strengths (ED-SCANS) is a research-based decision support and quality improvement (QI) tool to guide management of individual patients with SCD and can also be used to guide the devel...

Abstract Despite decades of eating disorder (ED) research, studies of factors involved in long-term EDs are still lacking. This longitudinal study investigated the role of maintenance variables in a transdiagnostic adolescent ED sample. Participants included 275 adolescents who underwent specialized ED treatment. Hierarchical linear modeling confir...

The present study is designed to identify which types of trauma experiences interact with later development of normal and abnormal sexual behavior in children and adolescents. More specifically, our goal is to determine which types of trauma exposure are related to issues of sexuality, sexually reactive behavior, sexually aggressive behavior, and t...

Several epidemiological studies have reported that large numbers of children and adolescents suffer from diagnosable psychiatric conditions, however most of them do not receive treatment. The schools are a key setting where youth with mental health problems are identified and linked to treatment. In this study we examine the demographic and clinica...

Fire setting is one of the most challenging behaviors for the child welfare system. However, existing knowledge about its prevalence and correlates has been limited to research on single programs. The Illinois Department of Children and Family Services initiated a uniform assessment process at entry into state custody using a trauma-informed versio...

The effectiveness of mental health care services is severely limited when young people run away from residential treatment. This study describes the development of a decision support model for predicting discharge due to running away on the basis of individual characteristics. Subjects include 667 wards of a large Midwestern state between the ages...

Using data gathered for 4,377 patients hospitalized on either a specialty geropsychiatric unit or a general psychiatric inpatient unit, over a six year period (1982-1987), the present study compares younger patients to older patients on diagnostic, demographic, and service data. From these comparisons emerge a number of diagnostic and service relat...

Large numbers of children and adolescents experience diagnosable psychiatric disturbances; however, the majority of those with need do not utilize mental health services. Characteristics of caregivers are important predictors of which youth will access and continue to use services over time. In recent years school-based mental health intervention p...

The concept of incorporating multiple perspectives in measurement is a foundation of program evaluation in human service enterprises, but can place significant challenges on the feasibility and interpretation of projects. This article reviews triangulation methodologies and proposes a new approach to triangulation. It argues that, in order to addre...

A decision support tool may guide emergency clinicians in recognizing assessment, analgesic and overall management, and health service delivery needs for patients with sickle cell disease (SCD) in the emergency department (ED). We aimed to identify data and process elements important in making decisions regarding evaluation and management of adult...

Background / Purpose: In addition to having pain crises, sickle cell disease (SCD) patients are at risk for many life-threatening complications and an emergency department (ED) visit is often a high-risk situation warranting a comprehensive assessment. An easy-to-use tool is needed to guide emergency clinicians in the identification of patient ne...

Medical records of 125 geropsychiatric inpatients were reviewed for a pilot study of the prevalence and medical and psychosocial correlates of chemical dependence and/or abuse. Patients were studied in three groups, each corresponding to the phased implementation of a program to enhance staff awareness of these problems. In contrast to patients wit...

1413 Poster Board I-436 Objectives There are relatively few centers across the United States that either specialize in SCD care or have day hospitals where patients can be evaluated and urgently treated for acute pain crises. While most patients come to the ED for management of an acute pain crisis, SCD patients are at risk for many life-threateni...

This study describes the implementation of three evidence-based treatments addressing traumatic stress symptoms within a wraparound foster care program in Illinois. Child-Parent Psychotherapy (CPP), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) were implement...

The purpose of this study was to determine the extent of and factors associated with recurrent psychiatric crisis episodes among children and adolescents in state custody. A total of 1362 children ages 3 to 16Â years who were in custody of the child welfare agency and underwent a psychiatric crisis screening and services for the first time between...

This study examined the association between organizational climate and changes in internalizing and externalizing behavior for youth in residential treatment centers (RTCs). The sample included 407 youth and 349 front-line residential treatment staff from 17 RTCs in Illinois. Youth behavior was measured using the Child Functional Assessment Rating...

During the last decade medical audit has become an important tool to evaluate and modify clinical practice in both general and mental health care settings. This article reviews the role of audit in Consultation Liaison (C-L) psychiatry. Audit has played a crucial role in helping to better understand the content and the mechanisms of our own work. S...

Exposure to multiple, chronic interpersonal traumas, often referred to as complex trauma exposure, can impact several areas of mental health need and functioning. A comprehensive assessment of needs and strengths is essential to making appropriate service recommendations. This study assessed 4,272 youth within the Illinois child welfare system usin...

The current article proposes that further specification of the system of care concept is required. Based on the assertions that the system of care concept (a) refers to an ideal as opposed to an observable phenomenon, and (b) is engaged in offering transformational experiences, the authors propose that the system of care definition must be expanded...

Objectives: To determine whether traumatic experiences of children entering the child welfare system have an impact on their risk behaviors and whether these behaviors are moderated by children's strengths. Method: The Illinois Department of Children and Family Services administered the Child and Adolescent Needs and Strengths (CANS) measure to 8,1...

A variety of factors are putting great pressure on residential treatment centers to justify their role in the child serving system through evidence of impact on the lives of children, youth, and families. The present study describes the role of residential treatment from an outcomes perspective in a midsized state over the course of a 5 year period...

This book takes the basic premise that in human serving enterprises, the primary purpose of measurement is to communicate. If that's the case, then why not design measures to maximize their communication value. But unlike scientific measurement where communication is restricted to among scientists, in human services, communication involves a large...

Measurement is the foundation of the scientific enterprise. All major scientific breakthroughs were preceded by a revolution in measurement and instrumentation, the methods used to apply a measurement. However, measurement is not solely the purview of science. Measurement is also fundamental to commerce—you can’t manage what you don’t measure. Huma...

This book outlines a theoretical framework with documented effectiveness in support of using structured assessment and the resulting numerical information to guide the evolution of transformational offering in human services enterprises. Not long ago this work might have been expected to have been met with skepticism, perhaps a yawn or a pat on the...

In order to set the stage for understanding communimetrics as a theory of measurement it is important to set the context based on current theories of measurement, of which there are two primary conceptual models—psychometric theories and clinimetric theories. Psychometric theory has two competing approaches within its general framework—classical te...

Governments need a successful economy. A successful economy is dependent on the success of individual business enterprises and their abilities to converge into a successful marketplace. In democracies, politicians generally require economic stability or growth to ensure re-election. In totalitarian states, a poor economy can be the impetus for a co...

As discussed, it is in the design phase that the distinctions between communimetrics and other theories of measurement are the clearest. Psychometric theories of measurement base many major instrument design considerations on the statistical performance of items and sets of items. While statistical relationships can be important, these are not the...

The quality of any measurement process is defined by at least two essential characteristics—the consistency and accuracy with which the measurement process can be applied and the degree to which the measure is capturing the construct or constructs it is purported to measure. These two related measurement characteristics are commonly referred to as...

You could describe the Child and Adolescent Needs and Strengths (CANS) as the first communimetric tool. But actually, the experiences taken from the development and implemention of the CANS led to the creation of the communication-based theory of measurement. The journey from a measure of psychiatric case mix used in a planning study in the late 19...

Engel (1977) proposed the breakthrough biopsychosocial model for the practice of medicine. In his classic treatise, he argued that understanding medicine required the physician to conceptualize more than just the disease state. Good medical care requires consideration of psychological and social variables as well. Since that time there have been ma...

This study examined the extent and correlates of entry into residential care among 603 children and youth in state custody who were referred to psychiatric crisis services. Overall, 27% of the sample was placed in residential care within 12 months after their 1st psychiatric crisis screening. Among the children and youth placed in residential care,...

The challenges of knowledge translation in behavioural health care are unique to this field for a variety of reasons including the fact that effective treatment is invariably embedded in a strong relationship between practitioners and the people they serve. Practitioners' knowledge gained from experience and intuition become an even more important...