Establishing cross-systems collaborations for implementation: protocol for a longitudinal mixed methods study

Abstract

Background: Cross-system interventions can help integrate services across different service delivery systems but require organizations to establish strong collaborative relationships for implementation. Contingency theory suggests that the effectiveness of different collaborative strategies (i.e. specific ways organizations align operations and services) varies by context. This paper describes a study of different strategies for fostering collaboration between child welfare and substance abuse treatment agencies and the conditions under which they are effective for implementation. We also describe the development and piloting of the Collaborating Across Systems for Program Implementation (CASPI) tool-a decision-making guide intended to help researchers and organizational leaders identify and use appropriate collaborative strategies for their context. Methods/design: This multisite longitudinal, mixed methods study, leverages a naturally occurring implementation initiative-in up to 17 Ohio counties-to implement Ohio START (Sobriety Treatment and Reducing Trauma). STAR T is a child welfare model that requires strong collaboration with local substance use treatment organizations to promote integrated services. During the first two years, we will identify collaborative strategies associated with improved START implementation (penetration and fidelity) and service delivery outcomes (timeliness), given system, and organizational features. We will conduct a convergent mixed methods study drawing on worker surveys, agency documents, administrative data, formal partner agreements, and group interviews. Data will be integrated and analyzed using Qualitative Comparative Analysis (QCA). To develop the CASPI, an expert panel comprised of implementation experts, and community stakeholders will convene to synthesize our findings and develop contents (including a decision tree). During the final year of the study, we will assess the acceptability, appropriateness, and feasibility of the CASPI in a randomized vignette experiment, and a pilot-test with 3 child welfare agencies that have not yet implemented START.

Applying the EPIS framework to policy-level considerations: Tobacco cessation policy implementation among California Medicaid managed care plans

“…MCPs highlighted the need for strengthened relational ties between MCPs and DHCS to improve APL information and knowledge sharing, training on APL services, and improved implementation of APL services. Prior research has highlighted the importance of strong relational ties to support policy implementation; however, there is a dearth of evidence for how and when to employ such collaborative strategies ( Bunger et al, 2020 ; Selden et al, 2006 ). The field of policy dissemination and implementation research should further investigate the nature and impact of relational ties that target policy-specific knowledge exchange between Outer Context agencies and Inner Context stakeholders ( Crable et al, 2022b ).…”

Implementation and Mental Health Outcomes of a Service Cascade Linking Child Welfare and Children’s Mental Health Systems: A Case Study of the Gateway CALL Demonstration

“…Together the insights from Gateway CALL and other similar demonstrations suggest that effective collaboration strategies (e.g., co-locating staff, contracts with providers for expedited service access, clearly operationalized referral procedures) are likely essential for implementation success. Additional research on collaboration strategies could clarify how child welfare (and other human service systems) partner effectively with behavioral health organizations to implement cross-system models (Bunger et al, 2020 ; Hurlburt et al, 2004 ). This may be especially useful to child welfare systems partnering with behavioral health and other human service providers to scale up evidence-based parenting, mental health, and substance use treatment programs in communities as part of the Families First Prevention Services Act.…”

Applying Theory to Explain the Influence of Factors External to an Organization on the Implementation of an Evidence-Based Intervention

“…Since organizational structure is a critical determinant of implementation success, they suggest regularly revisiting and adapting implementation strategies to fit how organizations are continuously altering their structure in response to dynamic factors in the inner and outer setting (20). In another example, researchers applied Contingency Theory to inform a study of strategies that foster cross-systems collaborations between child welfare and substance use treatment agencies (21).…”