Journal Article

Specifying cross-system collaboration strategies for implementation: a multi-site qualitative study with child welfare and behavioral health organizations

Chuang, Emmeline, Aarons, Gregory A., Millisor, Jennifer, Girth, Amanda M., Willauer, Tina, Lancaster, Kathryn E., Smith, Rebecca, Martin, Jared, McClellan, Jen, Saldana, Lisa, Bunger, Alicia C., Powell, Byron J., Himmeger, Marla J., Gadel, Fawn, Phillips, Rebecca J.

2024

Overview

Background Cross-system interventions that integrate health, behavioral health, and social services can improve client outcomes and expand community impact. Successful implementation of these interventions depends on the extent to which service partners can align frontline services and organizational operations. However, collaboration strategies linking multiple implementation contexts have received limited empirical attention. This study identifies, describes, and specifies multi-level collaboration strategies used during the implementation of Ohio Sobriety Treatment and Reducing Trauma (Ohio START), a cross-system intervention that integrates services across two systems (child welfare and evidence-based behavioral health services) for families that are affected by co-occurring child maltreatment and parental substance use disorders. Methods In phase 1, we used a multi-site qualitative design with 17 counties that implemented Ohio START. Qualitative data were gathered from 104 staff from child welfare agencies, behavioral health treatment organizations, and regional behavioral health boards involved in implementation via 48 small group interviews about collaborative approaches to implementation. To examine cross-system collaboration strategies, qualitative data were analyzed using an iterative template approach and content analysis. In phase 2, a 16-member expert panel met to validate and specify the cross-system collaboration strategies identified in the interviews. The panel was comprised of key child welfare and behavioral health partners and scholars. Results In phase 1, we identified seven cross-system collaboration strategies used for implementation. Three strategies were used to staff the program: (1) contract for expertise, (2) provide joint supervision, and (3) co-locate staff. Two strategies were used to promote service access: (4) referral protocols and (5) expedited access agreements. Two strategies were used to align case plans: (6) shared decision-making meetings, and (7) sharing data. In phase 2, expert panelists specified operational details of the cross-system collaboration strategies, and explained the processes by which strategies were perceived to improve implementation and service system outcomes. Conclusions We identified a range of cross-system collaboration strategies that show promise for improving staffing, service access, and case planning. Leaders, supervisors, and frontline staff used these strategies during all phases of implementation. These findings lay the foundation for future experimental and quasi-experimental studies that test the effectiveness of cross-system collaboration strategies.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Abused children / Access / Child / Child Abuse / Child abuse & neglect / Child Protective Services / Child Welfare / Children / Children's services / Collaboration / Collaborative approach / Comorbidity / Content analysis / Counties / Cross-system interventions / Data / Decision making / Disorders / Evidence-based medicine / Group decision making / Health Administration / Health behavior / Health boards / Health care industry / Health Informatics / Health Policy / Health Promotion and Disease Prevention / Health services / Health Services Research / Humans / Implementation / Implementation strategies / Information sharing / Integrated delivery networks / Intervention / Interviews / Management / Medicine / Medicine & Public Health / Mental health / Mental health services / Methods / Organizational effectiveness / Parent-child relations / Planning / Psychiatric services / Public Health / Qualitative Research / Quasi-experimental methods / Shared decision making / Sobriety / Social aspects / Social factors / Social services / Staffing / Strategies / Substance abuse / Substance use disorder / Substance-Related Disorders - therapy / Supervisors / Teams / Trauma