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Many communities have implemented systems of care in an effort to better coordinate and integrate mental health and other social services for children and youths, while simultaneously managing existing funding sources more effectively. Systems of care represent a fundamentally different way of delivering mental health services and accordingly require new approaches for both developing and sustaining collaboration. This article examines obstacles to collaboration and addresses key factors required to build and sustain collaboration.

Wraparound is a family-driven, youth guided, team-based process for planning and implementing services and supports (Miles et al. 2006). The National Wraparound Initiative (NWI) has identified ten elements of wraparound (i.e., family voice and choice, team based, natural supports, collaborative, community based, culturally competent, individualized, strengths based, persistence and outcomes based) and four phases through which teams consisting of the identified youth, his/her parents or caregivers, family members, community members, mental health professionals, and others are expected to move as they develop and implement a single plan of care. The plan of care includes the services and supports necessary to build on the strengths of the youth and his/her family and addresses the complex needs of the youth involved in the wraparound process.Emerging evidence supports the effectiveness of wraparound for youth who have needs in multiple life domains (e.g., home, school and community). Nine controlled studies of wraparound (see Bruns and Suter 2010;Suter and Bruns 2009) found improved outcomes for youth in wraparound compared to similar youth in other programs, with effect sizes similar to those found in studies of other evidence based interventions implemented in real world practice (Suter and Bruns 2009). However, only one of the nine studies considered the relationship between wraparound fidelity and outcomes (Bruns et al. 2006). Research on other evidencebased practices has repeatedly found that fidelity to the practice model is vital to outcomes (e.g., Henggeler et al. 1997;McGrew et al. 1994;Walton 2006). Additional research on wraparound that includes a measure of fidelity as well as further research on the factors that predict successful outcomes for youth involved in the wraparound process are needed Cox et al. 2010

OBJECTIVE We describe the use of implementation science at the unit level and organizational level to guide an intervention to reduce central-line-associated bloodstream infections (CLABSIs) in a high-volume, regional, burn intensive care unit (BICU). DESIGN A single center observational quasi-experimental study. SETTING A regional BICU in Maryland serving 300-400 burn patients annually. INTERVENTIONS In 2011, an organizational-level and unit-level intervention was implemented to reduce the rates of CLABSI in a high-risk patient population in the BICU. At the organization level, leaders declared a goal of zero infections, created an infrastructure to support improvement efforts by creating a coordinating team, and engaged bedside staff. Performance data were transparently shared. At the unit level, the Comprehensive Unit-based Safety Program (CUSP)/ Translating Research Into Practice (TRIP) model was used. A series of interventions were implemented: development of new blood culture procurement criteria, implementation of chlorhexidine bathing and chlorhexidine dressings, use of alcohol impregnated caps, routine performance of root-cause analysis with executive engagement, and routine central venous catheter changes. RESULTS The use of an implementation science framework to guide multiple interventions resulted in the reduction of CLABSI rates from 15.5 per 1,000 central-line days to zero with a sustained rate of zero CLABSIs over 3 years (rate difference, 15.5; 95% confidence interval, 8.54-22.48). CONCLUSIONS CLABSIs in high-risk units may be preventable with the a use a structured organizational and unit-level paradigm. Infect Control Hosp Epidemiol 2017;38:1306-1311.

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