Cross-system Collaboration Research Articles

Influences of the criminal justice system on use of medications for opioid use disorder: a qualitative study

BackgroundLegal-involved veterans with opioid use disorder (OUD) have lower receipt of medications for opioid use disorder (MOUD) than other veterans served at the Veterans Health Administration (VHA). This qualitative study examined the influence of the criminal justice system on access to MOUD for legal-involved veterans in the U.S.MethodsVHA facilities (n = 14) that varied in their provision of MOUD to legal-involved veterans were selected for qualitative interviews. Interviewees included legal-involved veterans (n = 18), VHA Veterans Justice Programs Specialists (n = 15), substance use disorder treatment providers (n = 5), and criminal justice staff (n = 12). Team members applied codes to meaningful units of analysis (quotations) in the transcribed interviews. Using a matrix approach, team members created a spreadsheet matrix with codes, facility rate of MOUD, and relevant quotations summarized for each participant. Themes and connections between individual participants and cross-interview concepts were explored. Participants were not asked to provide feedback on the findings.ResultsThemes identified were as follows: (1) Veterans Treatment Court policies both enhanced and limited MOUD treatment access and utilization among participants; (2) cross-system collaboration strengths and challenges existed; and (3) criminal justice system treatment preferences and policies both enhanced and limited MOUD in jails and prisons.ConclusionsThe influence of the criminal justice system on MOUD has led to variable access to MOUD for legal-involved veterans. Our findings can help inform recommendations to enhance access to MOUD for veterans within the criminal justice system, including the development of a national database of MOUD education materials for Veterans Treatment Courts, strengthening community-court relationships, allowing individuals to use their own healthcare coverage within jails and prisons and extend Medicaid coverage into criminal justice settings, and applying national quality measures for MOUD to criminal justice settings and develop a national system for tracking these quality measures.

Preventing foster care entry at the community, systems, and societal levels: Recommendations from the child-serving workforce

Child welfare policy and practice in the United States is increasingly concerned with the prevention of child maltreatment and foster care entry. Expanding prevention capacity through new programs and supports will require the buy-in of the current child-serving workforce both in child welfare systems as well as other settings such as mental health, schools, and early childhood services. The purpose of this qualitative study was to identify a set of recommendations for preventing foster care entry from members of the child-serving workforce to gauge their alignment with current strategies and to better understand workers’ priorities for reforming our current approach to promoting child and family wellbeing. Data were collected via interview, focus groups, and open-ended survey questions from a total of 614 participants working in child-serving settings. Through theoretical thematic analysis, we identified a set of 14 recommendations for preventing foster care entry across the community, systems, and societal levels. Broadly, recommendations focused on promoting community connectedness, adopting a public health approach to child maltreatment prevention, shifting child welfare practice to be more proactive in providing resources to families, enhancing cross-systems collaboration, and passing a range of policies to enhance family and child wellbeing with a particular emphasis on income supports. Findings from the study suggest that the current child-serving workforce is strongly committed to the national shift toward maltreatment prevention, and that they endorse strengths-based, data-informed strategies for achieving this objective.

Barriers and facilitators in the implementation of youth and young adult models of mental health care.

It is increasingly recognised that traditional models of mental health (MH) care, with a service transition at age 18 years, may not reflect best practice. The literature supports a move towards youth and young adult focused models of MH care, for young people up to the age of 25, which specifically cater to the unique psychosocial and developmental needs of this population. This service evaluation aimed to explore the facilitators and barriers to the implementation of youth models of MH care across England (UK). Six services participated in separate focus groups pertaining to their experience of implementing youth models of MH care. The interview guide for the focus groups was informed by the Consolidated Framework for Implementation Research (CFIR) and explored barriers and facilitators to implementation and sustainment. The focus groups were recorded, transcribed verbatim and analysed thematically. Seven key themes relevant to the implementation of youth models of MH care were identified: a clear rationale for doing things differently, for young people by young people, "building those relationships is key", service identity development, resource and infrastructure, leadership at multiple levels, and valuing and developing staff. The findings suggest effective communication and leadership, co-production and cross system collaboration contribute to successful implementation of youth models of MH care. The findings will be of interest to those involved in informing and supporting successful implementation and delivery of youth models of mental health care at local and national levels.

From Institution to Community: Implementing the Pathway Home Approach for High-Risk Members With Behavioral Health Needs Transitioning From an Adult Home.

Coordinated Behavioral Care began using its Pathway Home program to serve a subset of New York State Adult Home Settlement class members. Through its multidisciplinary team approach, Pathway Home is utilizing its multiphase model in assisting individuals with Serious Mental Illness leaving an Adult Home to successfully transition and remain in the community. The Pathway Home program is a community-based service and serves class members wherever is needed to assist in their recovery and transition from an Adult Home. This includes meeting class members in Adult Homes and various settings in the community. The New York State Adult Home Settlement presents a variety of systemic, care management, and individual member challenges. Adding the Pathway Home approach to an already existing, yet insufficient care management model strengthens the initiative's goal to transition and retain members safely into the community. Through the approach's adaptability and flexibility in providing community-based care, Pathway Home's successful cross-system collaboration is worthy of replication for other high need populations. A programmatic review for Pathway Home Adult Home+ teams gleaned the following key points for the field to consider in future care management practices. Class member self-efficacy and cross-system collaboration are essential in facilitating a class member's move into the community. Member choice and educating class members on their rights to move and options as well as community exposure prior to transition are important in assessing how a member fares outside of the Adult Home. Members determining their own care can reduce the risk of adverse outcomes and reinstitutionalization. Current low-touch care management programs are insufficient for members with complex needs living in institutions. These care management programs need to be augmented with a whole person approach, delivered by a multidisciplinary team.

Central-Level Cross-System Collaboration in Curriculum Reform Implementation: Revealing Collaborative Dynamics and Adaptation

Central-Level Cross-System Collaboration in Curriculum Reform Implementation: Revealing Collaborative Dynamics and Adaptation

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

BackgroundCross-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.MethodsIn 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.ResultsIn 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.ConclusionsWe 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.

Juvenile justice and child welfare dual system involvement among females with and without histories of commercial sexual exploitation

Commercial sexual exploitation (CSE) is related to both child welfare (CW) and juvenile justice (JJ) system involvement, yet research of CSE largely examines single system involvement. Using a sample of justice involved females with histories in out-of-home care, this study explores dual system contact for females with CSE experiences (n = 225) compared to a matched sample of females without a history of CSE (n = 237). Differences between the samples’ system experiences were compared using chi-square analyses or t-tests of group mean differences. Nearly all females had a history of at least one maltreatment allegation and between 69% and 76% of the samples were classified as dual system females as measured by the justice-involved youth also having a substantiated case of maltreatment. The CSE sample, compared to the no-CSE sample, had significantly more contact with the juvenile justice system including more arrests, petitions filed, bench warrants, and entrances to detention. Findings highlight the extent of dual system involvement among justice involved females with histories of CSE and out-of-home care, and the need for cross-systems collaboration to improve youth outcomes.

Collaborative Actions on Documents Ontology (ColActDOnt)

The analysis and interpretation of collaborative work in the Digital Workplace requires an in-depth understanding of the user actions carried out in Enterprise Collaboration Systems (ECS). The academic discipline of Process Mining (PM) provides us with methods and tools for the analysis of event logs. For PM to work successfully, we need event logs that are formatted using a standard (e.g. XES) that can be processed by existing PM tools. This is a challenge for the analysis of collaborative work because collaboration processes frequently span across multiple software products, which record user activity in their own proprietary log format. The data from different systems needs to be transformed and aggregated before it can be used by PM tools. To address this issue, we developed a novel concept for the harmonisation and aggregation of log files from collaboration systems. In this concept, events are described as user actions on documents. We formalised the concept in the Collaborative Actions on Documents Ontology (ColActDOnt). ColActDOnt specifies the concepts and properties of collaboration events. The ontology has been made publicly available in a machine-readable format and provides a basis for the analysis of cross-system collaboration.

Microsystem Supports, Therapeutic Progress, and Court Reinvolvement: Implications for Juvenile Probation

Objective: Juvenile probation is the most common disposition for court-involved youth. Emerging frameworks for research-informed probation highlight the importance of intervention dosage, adolescent development, and cross-systems approaches, yet research examining these features is limited. Guided by ecological, developmental, and probation practice frameworks, we examined the relationship between microsystem supports (family, school, probation), therapeutic progress, and court reinvolvement among youths on probation. Method: Data were from a moderate-to-high risk sample of diverse youths (N = 3,678) who were administered a validated risk-and-needs assessment tool at probation entry and exit in one jurisdiction in Washington State. We used multivariate regression to examine the direct and indirect effects of family, school, and probation on measures of therapeutic change (motivation and social–emotional skills) and court reinvolvement. Results: Increasing supports across all three microsystems (family, school, and probation) were associated with positive gains in social–emotional skills and motivational processes; an increase in behavioral self-regulation was associated with reduced court reinvolvement. Behavioral self-regulation skill level at probation exit mediated the relationship between microsystem supports and reinvolvement. Conclusions: Findings highlight the importance of adolescent development and cross-systems collaboration for promoting positive outcomes and reduced court reinvolvement for youths on probation. Implications for research and practice are discussed.

“You really need a whole community”: a qualitative study of mothers’ need for and experiences with childcare support during cancer treatment and recovery

PurposeA cancer diagnosis poses unique challenges for moms with young children who must balance illness-management alongside existing paid (e.g., employment) and unpaid (e.g., domestic/caregiving) work. The goal of this study was to improve understanding of the support needs of mothers living with cancer and their experiences receiving psychosocial and childcare support from a community organization, the Nanny Angel Network (NAN).MethodsMothers who accessed NAN services during their cancer treatment and/or recovery (N = 20) participated in qualitative semi-structured interviews. Thematic analysis was used to inductively and deductively identify emerging patterns in the data and theoretical abduction was applied to further interpret participants’ accounts using a feminist political economy framework.ResultsParticipants expressed how balancing the demands of patienthood and parenthood was challenging and how cancer treatment created new needs for support with care work. Mothers explained that NAN offered indispensable family-centered support largely missing from the health care system, promoting improved physical, psychosocial, and relational health for them and their families. While accessible from a cost-perspective, participants identified different pathways, including awareness, cross-system collaboration, and stable funding, that limited timely access to NAN.ConclusionAccess to family-centered care, such as that offered through NAN, was vital to the health and healing of the study participants and their families. Improved collaboration with and investment in community organizations like NAN that have a strong infrastructure to support moms living with cancer offers a practical, feasible, and immediate solution to help address some of the distinct challenges this population faces.

Leveraging Technology to Increase Behavioral Health Services Access for Youth in the Juvenile Justice and Child Welfare Systems: a Cross-systems Collaboration Model

Behavioral health services access for justice- and child welfare-involved youth is limited despite significant need. Structural interventions to address limited access are nascent. Technology can advance access, but few interventions focus on system-impacted youth and their mental health needs and challenges. This article describes the development, process, and initial outcomes of the Youth Justice and Family Well-Being Technology Collaborative (JTC) that was formed to leverage technology within and across public health and justice-related systems to promote increased behavioral health services access. Cross-system considerations are identified for public health, court, and other key stakeholders to successfully integrate technology into practice to expand access to these critical services.

County-Level Factors Matter: The Role of Contextual Factors in Foster Youths' Extended Foster Care Participation and Human Capital Outcomes.

Extended foster care (EFC) is an important policy that supports human capital attainment for foster youth transitioning to adult independence. Previous studies have examined youth- and policy-level factors' influence on EFC participation and human capital outcomes (e.g., education, employment). Still, few studies have examined contextual factors (e.g., county characteristics). We explore how local contexts, or county-level attributes, influence youths' EFC participation and human capital outcomes (i.e., postsecondary education enrollment and earnings). We analyze two datasets from California Youth Transitions to Adulthood Study: survey data with rich youth-level information (n = 529) and state child welfare administrative data with a larger sample size (n = 2392). After controlling for a wide range of youth characteristics and adjusting between-county variations, regression results find that several county characteristics predict youths' EFC participation and human capital outcomes at age 21, such as political atmosphere and worker's satisfaction with cross-system collaboration. We conclude with a discussion of implications for research and practice.

Characterization of multilevel influences of mental health care transitions: a comparative case study analysis

PurposeMental health care transitions are increasingly prioritized given their potential to optimize care delivery and patient outcomes, especially those focused on the transition from inpatient to outpatient mental health care. However, limited efforts to date characterize such mental health transition practices, especially those spanning multiple service setting contexts. Examination of key influences of inpatient to outpatient mental health care transitions across care contexts is needed to inform ongoing and future efforts to improve mental health care transitions. The current work aims to characterize multilevel influences of mental health care transitions across three United States-based mental health system contexts.MethodsA comparative multiple case study design was used to characterize transition practices within the literature examining children’s, non-VA adult, and VA adult service contexts. Andersen’s (1995) Behavioral Health Service Use Model was applied to identify and characterize relevant distinct and common domains of focus in care transitions across systems.ResultsSeveral key influences to mental health care transitions were identified spanning the environmental, individual, and health behavior domains, including: community capacity or availability, cross-system or agency collaboration, provider training and experience related to mental health care transitions, client care experience and expectations, and client clinical characteristics or complexity.ConclusionsSynthesis illustrated several common factors across system contexts as well as unique factors for further consideration. Our findings inform key considerations and recommendations for ongoing and future efforts aiming to plan, expand, and better support mental health care transitions. These include timely information sharing, enhanced care coordination and cross setting and provider communication, continued provider/client education, and appropriate tailoring of services to improve mental health care transitions.

Randomized trial of a diversion program for property offenders with drug use

PurposeThis paper reports findings from a randomized controlled trial of a front-end diversion program for prison-bound individuals with property crime convictions, concurrent substance use problems, and no prior violent crime convictions. MethodsTwo counties in Oregon participated in the trial, labeled “County A" and “County B.” Across counties, 272 individuals (mean age = 32.7 years; 67.6% male) were recruited and randomized to receive either the diversion program (Senate Bill 416 [SB416]) or probation as usual (PAU). The primary outcome was recidivism, defined as any arrest, conviction, or incarceration for a new crime within three years of diversion from prison. ResultsIn County A, SB416 did not outperform PAU on any recidivism outcome. However, in County B, SB416 yielded significantly greater improvements across various configurations of the arrest, conviction, and incarceration outcomes, relative to PAU. ConclusionsSB416 can yield reduced recidivism when implemented in a setting like County B, which when compared to County A, had fewer justice system resources and a limited history of cross-system collaboration. More research on SB416 is needed, including an examination of its mechanisms of change and its cost-effectiveness relative to standard criminal justice system processing.

Critical Synthesis Toward Transformative Collaboration: A Dialectical Analysis of Functionalist and Critical Paradigms

Social workers are required to become effective boundary spanners to address complex social problems with community-based and cross-system collaboration. However, substantial tensions exist in the literature about how to build successful collaboration, stemming from the massive use of the two competing paradigms: functionalist and critical paradigms. Using a dialectical analysis, this article attempted to uncover and synthesize paradoxical understandings of the major elements of successful collaboration. Significant contradictions between the two contrasting paradigms are identified at the multidimensional levels, including (1) member capacity for developing objective/consensus knowledge vs. subjective/dissensus knowledge, (2) unity vs. diversity in membership, (3) centralized vs. decentralized network governance, and (4) stable/standardized vs. flexible/responsive coordination. The results suggest that there is no consensual approach to developing transformative collaboration that promotes members’ critical capacity, equal relations, democratic governance, and empowering coordination. Social workers should identify and utilize inherent contradictions as a catalyst for developing and maintaining transformative collaboration by considering its dynamic process, context, and interconnection with other systems.

Enhancing Behavioral Health Services for Child Welfare-Involved Parents: A Qualitative Study

ABSTRACT Behavioral health issues are prevalent among child welfare-involved parents. Despite associations with parenting challenges and maltreatment, parents’ behavioral health conditions often go untreated. In this study, we explore challenges with addressing behavioral health needs of parents involved in the child welfare system. Focus groups with child welfare and behavioral health providers were conducted to explore gaps and opportunities to enhance behavioral health care for child-welfare involved parents. Three themes were identified: parental motivation and buy-in, behavioral health assessments and screenings, and communication and service coordination. Implications for policy and practice include increased training on measurement-based care and effective cross-system collaboration.

Trauma-Informed Intervention with Children: Integrating the CANS Assessment with the ARC Framework in a Clinical Setting.

Ongoing trauma-focused assessment is critical to developing trauma-informed treatment plans. The current study examines the clinical benefits of utilizing the Child and Adolescent Needs and Strengths (CANS) assessment to guide intervention based on the Attachment, Self-Regulation, and Competency (ARC) model to address children's trauma related symptoms in a rural state. WV CANS was developed by adapting the language of original CANS to be culturally specific to the state's unique situation and culture in consultation with the original CANS developer. This study included the data from children who received mental health services under WV CANS-ARC mapping from 2017 to 2019. Children's trauma-related symptoms are assessed using the WV CANS at intake and every 90days to identify any changes in their symptoms. In order to examine the changes of traumatic symptoms over time, the study was limited to children who have at least three time points, with a total of 362 children used for the current analyses using Multilevel modeling with SAS PROC MIXED. The study found that children's trauma related symptoms significantly decreased in all ARC outcome domains over time after adjusting for basic demographic variables. The current study contributes to the evidence on treatment for children's trauma-related symptoms, especially with the application of the CANS-ARC mapping in a real-world clinical setting. The findings have significant implications for clinicians in integrating the assessment and treatment process using CANS-ARC mapping and for cross-system collaboration with continuity of care serving children who have experienced trauma.

Enhancing Permanency in Children and Families (EPIC): a child welfare intervention for parental substance abuse

BackgroundAcross Ohio, parental substance abuse has contributed to a marked increase in the number of children in foster care. Children exposed to parental substance use have a higher likelihood of physical abuse and neglect, and consequently a variety of physical, psychological and cognitive problems. The Enhancing Permanency in Children and Families (EPIC) program is a collaborative effort between the Ohio State University College of Social Work, two county offices of the Ohio Department of Job and Family Services, two juvenile courts and local behavioral health agencies. The goal of EPIC is to use three evidence-based and evidence-informed practices to reduce abusive and neglectful parenting, reduce addiction severity in parents, and improve permanency outcomes for families involved with the child welfare system due to substance abuse.MethodsEPIC is a quasi-experimental study. Under the program, child welfare-involved adults who screen positive for substances are matched with a peer recovery supporter. Participants are also incentivized to participate in family treatment drug court, medications for opioid use disorders and home-based parenting supports. Participating adults (N = 250) are matched with comparison groups from counties participating in a separate intervention (Ohio START) and to those receiving treatment as usual, resulting in a final sample of 750 adults. Primary outcomes including addiction severity, child trauma symptoms, resilience, and attachment are assessed at baseline and at program completion. Additional outcomes include timely access to treatment services, length of placement in out-of-home care and recidivism into the child welfare system.DiscussionThis intervention formalizes cross-system collaboration between child welfare, behavioral health and juvenile courts to support families affected by addiction. The use of three evidence-based or evidence-informed strategies presents the opportunity to determine specific strategies that are most effective for reducing addiction severity. Lastly, the intervention combines several sources of funding to bolster sustainability beyond the life of the Regional Partnership Grant (RPG).Trial registrationNCT04700696. Registered January 7, 2021-retrospectively registered.

Integrating Trauma-Informed Care and Collective Impact: Perspectives of Service Providers Working with Cross-System Youth

Objective: Organizations have adopted trauma-informed care (TIC) to guide service provision for vulnerable populations. There is little research, however, on TIC in cross-system collaborations. The collective impact (CI) framework offers insight into cross-system collaboration, but there are few studies on CI, and none have examined it in relationship to TIC. This paper proposes the use of an aligned TIC and CI framework and presents findings from a qualitative study as an illustrative example. Method: We conducted focus groups and interviews with 35 homeless services, child welfare, and school social work providers working with cross-system youth (i.e., youth involved in multiple social systems). We used inductive and deductive approaches to analyze data and identify how providers incorporate TIC and CI in their practice to serve cross-system youth. Results: Findings emphasized the widespread adoption of TIC among social service organizations, as well as providers’ aspirational conceptions of CI. Providers also stressed the importance of trust in cross-system collaboration and the need for sufficient resources. Conclusions: Providers felt a need for CI but also identified constraints that limited the alignment of TIC and CI in practice. Findings hold implications for practice and policy to address trauma through multisystem collaboration.

Preliminary Findings of a Ten-Item Scale to Assess the Commitment of Low-Income Owners to Their Companion Animals

ABSTRACT While there is a substantive body of research on benefits conveyed via the human–animal bond (HAB), less is understood about disruptions to HAB and how to potentially prevent such. The construct of commitment can elucidate such scenarios and may also help inform related interventions; however, there are few empirical measures of commitment to a companion animal, and none specific to low-income owners. The Commitment to Pets measure was created to address this gap. The scale was included in a mixed methods study of food security administered to 392 low-income adults utilizing food pantries in a Northeastern city in the United States. Of this number, 258 (66%) owned pets. Data collection included a self-administered questionnaire about demographics, food security, health, and wellbeing, and for those with pets, animal attachment, commitment, and animal information. Qualitative interviews were conducted with 15 pet-owning individuals who completed the questionnaire and agreed to be contacted and interviewed over the phone about food security and their pets. Exploratory factor analyses found three underlying factors: financial costs/burdens; pet behaviors and problems; family problems. These subscales associated with attachment in that higher attachment was correlated with greater commitment. However, the value of the correlations suggests they are different constructs. Moreover, analysis of the qualitative interviews supported these underlying constructs and suggested that unexpected financial costs of veterinary care and food was a major factor in considering ongoing pet ownership, even when there was a deep level of attachment between humans and their animals. Commitment is a complex construct, and additional measurement studies are needed. Findings suggest community outreach models using cross–systems collaboration have potential to support low-income pet-owning families in their commitment to pets and may aid in prevention of surrenders and HAB disruptions.