Contributions to the literature
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Successful implementation of cross-system interventions requires cross-system collaboration strategies to improve implementation, service delivery, and client outcomes.
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We identified and specified seven cross-system collaboration strategies. Contracting out, joint supervision, and co-location were used to staff the program. Referral protocols and expedited access agreements were used to promote service access. Shared decision-making meetings and data sharing were used to align case planning.
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Cross-system collaboration strategies were used at the individual- and organizational-levels throughout the preparation, implementation, and sustainment phases.
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Our work on cross-system collaboration strategies advances the specification of functions and forms of bridging factors in implementation.
Background
Cross-system collaboration strategies for implementation
Study purpose and context
Methods
Intervention and setting
Design
Phase 1: qualitative multi-site study
Site selection
Data collection
Site/counties (n = 17) | Participants (n = 104) | |
---|---|---|
Organizational representation | ||
Child welfare | 17 | 52 |
Substance use treatment | 15 | 44 |
Behavioral health boards | 6 | 8 |
Cohort | ||
1 | 9 | 55 |
2 | 8 | 9 |
County type | ||
Urban | 4 | 23 |
Suburban | 2 | 14 |
Rural | 5 | 37 |
Appalachian | 6 | 30 |
County population size (based on all counties in state) | ||
0–25th percentile (< 36,980) | 3 | 14 |
26–50th percentile (36,981–58,552) | 5 | 33 |
51–75th percentile (58,553–126,764) | 3 | 19 |
76–100th percentile (+ 126,765) | 6 | 38 |
Phase 2: expert panel
Results
Strategy/form & definition | Mechanisms | Determinants addressed | Implementation outcomes | Service outcomes | |
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Function: staff the program (administrative collaboration) Actors: agency leaders (including human resource, procurement professionals), supervisors | |||||
1 | Contract out: Contracting out for expertise involves outsourcing a staff role needed to implement a particular program/model to another organization. This entails an agreement that the staff person in this position is employed by another organization for purposes of supporting the EBP/program in the focal organization | Improve flexibility Access new resources | Staff recruitment/retention Staff capacity | Feasibility Speed (launch) Fidelity (overall) Sustainability | – |
2 | Joint supervision: Supervision for a staff person is delivered by individuals from more than one organization. This supervision might be delivered at the same time or separately; specific types of supervision might be split across organizational supervisors | Supportive environment Clarify roles | |||
3 | Co-location: Employees from a partner organization work within another organization and are provided the same organizational resources/supports as other employees (e.g., desk, building access) to facilitate intentional interaction, and communication among staff within and across organizations. Co-location is considered the foundation that helps move toward more seamless coordination and integration | Promote interactions | Service coordination | Fidelity (overall) | – |
Function: promote service access (administrative collaboration) Actors: agency leaders, supervisors | |||||
4 | Referral protocols: Supervisors and other agency leaders develop and carry out agreed-upon procedures for referring clients for services at another external organization. There may or may not be a formal written agreement between the two organizations | Clarify workflows | Referrals Compatibility | Fidelity (access) Appropriateness | Timeliness (access) Engagement |
5 | Expedited access agreements: An explicit and formal agreement between two organizations to provide services to one another’s' clients to implement a new model/program in a particular way, for a specified price/term, and/or other conditions | ||||
Function: align case plans (frontline collaboration) Actors: supervisors, front-line clinicians, and caseworkers (with support from agency leaders) | |||||
6 | Shared decision-making meetings: Joint meetings of all caseworkers, clinicians, staff, peer specialists, family members, and family supporters to discuss the case goals, progress, and plans for a family consistent with a new program/model. These meetings are intended to set objectives and align services for a family | Shared expectations Promote interactions | Service coordination Family engagement | Fidelity (overall) Acceptability | Patient centeredness |
7 | Data sharing: Exchanging information about client case plans, service needs, progress, and completion to implement the new program/model. This can take multiple forms including formal reports shared regularly with partners, inputting data and using a shared data system intended for sharing case files, or more ad hoc information sharing about cases | Promote interactions |
Strategies for staffing the program
Contract out for expertise
It worked out really well when we were recruiting a FPM … [the behavioral health organization] provides peer mentoring services across multiple counties, and it was helpful … because they already knew who was engaged in the recovery community and who wasn’t. -Child welfare agency representative
Joint supervision
The point and purpose of having the co-supervision is so the peer mentors and the staff members working closely with the agencies have a better understanding of the standards and procedures and the practice of child welfare, [which] works very differently than [behavioral health partner] and vice versa. So, it’s again, just to bring everybody up to a common understanding. -Behavioral health provider
Co-locate staff
Our FPMs are co-located in our offices with the child welfare team. They spend more time here than they do in their technical employer’s office. … We do a lot of joint meetings and supervision. I think that has gone very well. -Child welfare agency representative
Strategies for promoting service access
Referral protocols
The referral process is more streamlined with START. It’s really helped to improve coordination in terms of this is somebody who’s being sent as part of the START program, the understanding is there that the weekly reports will be sent out at that point, and it just makes the process much more streamlined.-Behavioral health provider
Expedited access agreements
We signed the contract … in which we would prioritize [child welfare] referrals and get assessments done within a certain timeframe. They were struggling with some of their current providers in the area having long waiting lists. And so, they reached out to us.-Behavioral health provider
Strategies for aligning case plans
Shared decision-making meetings (SDMMs)
I feel like SDMMs help bring everybody that’s involved with the family together and make sure that they’re all on the same page. If they have any questions, they can be answered… it also gives them the chance to have a voice and say what they feel and need to say. … So far, it’s been going great. I think it’s super helpful in helping the case move forward. -Child welfare agency representative
Sharing data/case-level information
I keep open contact and communication with my providers even if I’m having a face-to-face during the week and something’s just not normal with my family. I would send an email directly to the provider so that the provider could talk to that family regarding that type of behavior. I also send assessment tools that I use in my interviews with Ohio START to my providers so that they can also look out the same lens that I’m looking out of, so that we can all stay on the same page. -Child welfare agency representative