Collaborating to Implement Cross-System Interventions in Child Welfare and Substance Use
Phase: NA
Conditions: Substance Use, Implementation, Child Maltreatment, System Fragmentation
Sponsor: Ohio State University

THE OHIO STATE UNIVERSITY 
Institutional Review Board 
 
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Collaborating to Implement Cross-System Interventions in  
Child Welfare and Substance Use 
NCT03931005 
Document Date: January 22, 2024 
 
 
 

THE OHIO STATE UNIVERSITY 
Institutional Review Board 
 
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Ohio START: Implementation and Collaboration Evaluation 
PI: Bunger 
 
I. Objectives  
The purpose of this study is to assess implementation of a regional initiative in Southern Ohio intended to 
address child maltreatment and opiate addiction. Specifically, we will explore the context for 
implementation and collaboration between behavioral health provider organizations and public child 
welfare agencies. The findings will be used to determine the Ohio START program’s progress toward 
implementation, and identify effective collaboration approaches. 
 
Our specific aims are: 
 
Aim 6: Explore the perceived acceptability, appropriateness, and feasibility of the collaboration 
strategies identified. 
a. Approach: Surveys and focus group with implementation technical assistance providers 
b. Funding: NIDA 
II. Background and Rationale 
 
Ohio child welfare agencies are working at the front-lines of the current opioid epidemic. Children of 
opiate-using caregivers experience a greater risk for maltreatment, trauma, and mental health problems 
(Stith et al, 2009; Staton-Tindall, et al, 2013). As a result, especially in the southern regions of the state, 
public child welfare agencies have experienced an increase in the number of children brought into 
custody due to their parents’ substance use (PCSAO, 2017).  
 
Child welfare workers play a critical role in linking both children and their parents to needed mental 
health and substance use services (Stiffman, Pescosolido, & Cabassa, 2004; Bunger et al 2012; Bunger et 
al 2009). Although improving referrals to treatment may improve access to behavioral health services for 
children and youth involved in the child welfare system, the degree to which their needs are actually met 
depend on the regional behavioral health service delivery system’s capacity. Especially in rural regions, 
formal services are often limited, and children and families encounter unique barriers to services 
including travel distances, workforce shortages, and fees (Cummings et al 2016; Belanger & Stone, 2008; 
Boydell et al 2006). 
 
To address these issues, the Ohio Attorney General’s office has funded the Ohio Sobriety, Treatment, and 
Reducing Trauma (START) project, which launched in April 2017. Ohio START will support public 
county child welfare agencies to address child maltreatment and parental opioid addiction. Ohio START 
is rolling out to Ohio county child welfare agencies in cohorts: 
1. Cohort 1 began planning for implementation in April 2017 and includes 17 counties: Athens, 
Brown, Clinton, Fairfield, Fayette, Franklin, Gallia, Hamilton, Highland, Hocking, Jackson, 
Lawrence, Meigs, Pickaway, Ross, Warren, and Vinton.  
2. Cohort 2 began planning in October 2018 and includes 15 counties: Ashtabula, Butler, 
Carroll, Delaware, Erie, Hardin, Lorain, Mercer, Morrow, Ottawa, Richland, Seneca, Stark, 
Summit, and Trumbull.  
3. Cohort 3 will begin planning in October 2019 and will include 14 counties: Allen, Ashland, 
Auglaize, Cuyahoga, Harrison, Licking, Lucas, Mahoning, Medina, Portage, Tuscarawas, 
Union, Wayne, and Williams. 
4. Cohort 4 will begin planning in October 2020 and will include 15 counties: TBD 
 
START involves the implementation of new screening tools (a trauma screening tool to identify children 
and parents with behavioral health service needs, and a substance use screening to identify parents in need 
of substance use treatment). Successful implementation will depend on a supportive context within child 

THE OHIO STATE UNIVERSITY 
Institutional Review Board 
 
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welfare agencies, as well as strong collaboration with area behavioral health providers. Collaboration 
strategies include contracting out for expertise, co-supervision, co-location, expedited access agreements, 
referral protocols, shared decision-making meetings, and information/data sharing. These strategies have 
been detailed in the Collaborating Across Systems for Program Implementation (CASPI) toolkit which 
can be found here: u.osu.edu/collaborateforchange.  
 
The College of Social Work is collaborating with the Attorney General’s office, and Public Children 
Service Agencies of Ohio (PCSAO), to evaluate the readiness, collaboration, and implementation of Ohio 
START. PCSAO will play a key role in assisting the counties throughout implementation, and facilitating 
the evaluation. This includes providing on-site support for each county by contracted Implementation 
Technical Assistance (TA) providers that report to and are managed by PCSAO. This study is intended to 
inform the ongoing implementation and evaluation of Ohio START. Results will be used to explore 
participating agencies’ progress implementing the program, and establishing behavioral health partners. 
These data will also allow a closer investigation of regional variations in services, collaboration, and 
organizational factors that shape these patterns.  
 
III. Aim 6 (Exploring acceptability, appropriateness, and feasibility of collaboration strategies) 
*Note, this aim is funded by our NIDA grant. 
 
A. Research Design 
This exploratory pilot is a one-group only post-test study that draws on both qualitative and 
quantitative data. Our goal is to better understand the usefulness of the strategies described in 
the toolkit, the CASPI toolkit itself for implementation support professionals, and specific 
areas where providers might need or want additional tools or support. The results will be 
used to identify strategies for which additional supports need to be developed, and refine the 
content, format, and dissemination of the CASPI toolkit. 
 
B. 
Sample 
The participants in this study will consist of up to 20 implementation support professionals 
who are working directly with organizations that are implementing cross-system 
interventions. Implementation support professionals are individual professionals (adults) who 
work as independent consultants to or employees of organizations that are providing 
implementation support to organizations that are adopting, implementing, sustaining, or 
improving new evidence-based interventions. Other role titles include implementation 
technical assistance providers, intermediaries, purveyors, or facilitators. 
 
Inclusion criteria: Employees, contractors, or paid consultants of the Public Children 
Services Association of Ohio (PCSAO), or other health and human service entities (e.g., state 
service agencies, training organizations, organizations that develop evidence-based 
programs) who are currently providing implementation technical assistance or support to 
community-based organizations. This includes coaching, supervision, training, or other 
facilitation work to promote program/intervention implementation and quality. 
 
Exclusion criteria: Individuals who do not, nor have ever worked professionally (as 
employees or consultants) as implementation support professionals. 
 
C. Data Sources/Measurement/Instrumentation 
This study will draw on two data sources: 
 

THE OHIO STATE UNIVERSITY 
Institutional Review Board 
 
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Survey with TA Providers. A brief electronic survey (about 15 minutes) will be administered 
to participants that assesses TA providers’ use and opinions about the strategies detailed in 
the CASPI, and the CASPI toolkit. Key constructs measured include: 
• Participant Background: Participants will be asked 2 questions about their role as an 
implementation TA provider including the types of organizations they work with, and amount of 
time spent working as an implementation TA provider. 
• Purveyor-Strategy Fit (PSF). Participants will be asked 7 questions about each of the 7 main 
collaboration strategies (49 items total) that assess the importance, feasibility, readiness, 
scalability, tension for change, and timeliness. Items are rated on a 4-point Likert scale (0=not at 
all – 3=to a great extent), and summed to create an index score for each strategy.  
• Acceptability, Appropriateness, and Feasibility of Using the CASPI Toolkit. Participants will be 
asked 12 questions about the acceptability (perceived satisfaction), appropriateness (perceived fit 
or compatibility), and feasibility (perceived utility) of the CASPI using validated measures: 
Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and 
the Feasibility of Intervention Measure (FIM) [91]. Each measure contains four items, with 5-
point Likert rating scales that will be averaged to generate a scaled score for each respondent.  
• Demographic Questions. Basic demographic characteristics of each participant will be collected 
including gender, race, ethnicity (3 questions) 
 
Focus Group Discussion. Focus group discussions (about an hour) with implementation 
support professionals will be conducted. The focus group discussion guide will prompt 
participants to discuss the nature of collaboration challenges they discuss with organizations 
that are implementing new interventions, their use of the CASPI toolkit, and 
recommendations for improvement.  
 
D. Detailed Study Procedures 
 
The study PI has been invited by partners at PCSAO to attend a regular meeting of the 
Implementation TA providers to discuss the CASPI toolkit. TA consultants have already 
received links to the online version of the toolkit on our project website since they helped 
draft and review content. The PI will discuss the toolkit’s contents, and invite the TA 
providers to consider using it in their practice over the next 2 months. The PI will also 
introduce this study opportunity and stress the voluntary nature. [No recruitment activities 
will take place at this point] 
 
Survey Recruitment –Approximately two months after the PI visits the TA providers’ 
meeting, PCSAO will forward via email an invitation to all Implementation TA providers 
employed or contracted by PCSAO to participate in the survey (see recruitment email). 
Those who are interested in participating will be instructed to proceed to an online survey 
link that will take them to the informed consent page. Two email reminders will be sent to all 
participants (approximately 1 week after the initial recruitment email).  
 
Focus Group Recruitment - Approximately two weeks after the survey closes, PCSAO will 
email all individuals who are employed or contracted as an Implementation TA provider an 
invitation to participate in the focus group (see recruitment email). Those who are interested 

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Institutional Review Board 
 
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in participating will be instructed to proceed to an online survey link that will take them to a 
registration page. 
 
Incentives. Those who participate in the survey will receive a $35 gift card as an incentive – 
at the end of the survey, participants will be linked to a separate form (that does not link to 
their survey responses) where they can note their preferred email address for receiving the 
gift card. Those who participate in the focus group will receive a $40 gift card. 
 
Confidentiality Safeguards 
 
Plans for Maintenance and Archiving: Data will be maintained throughout the duration of the 
project and for 7 years after to ensure adequate time for reporting and dissemination. 
 
Informed Consent: Survey participants will be asked for their informed consent at the 
beginning of the survey. The informed consent information will be contained on the first 
page of the electronic survey and will describe the purpose of the study, its voluntary nature, 
and how responses will be kept confidential. Those who consent to participating will be 
asked to indicate that they consent. Those who do will proceed to the survey items. Those 
who do not choose to participate will exit the survey. We are requesting a waiver of consent 
documentation for this survey since the consent form would be the only document with 
participants’ identity.  
 
Focus group participants will be asked for their consent at the beginning of the focus group 
(which will be conducted on Zoom). The informed consent form will describe the nature of 
the study, and interview guide, and how responses will be kept confidential. The interviewer 
will read the informed consent script (attached) and ask each individual, “Do you agree to 
participate?” Upon verbal confirmation of consent, the focus group will proceed. The 
interviewer will also offer to send a copy of the informed consent materials via email or mail 
if preferred. If the participant declines, the participant will leave the focus group. 
 
E. Validity 
The sample represents a small but growing group of professionals who facilitate 
implementation. While their perspectives on collaboration strategies might not generalize 
beyond the region or Ohio START intervention broadly, their responses will be useful for 
refining the CASPI and designing local supports (our primary purpose for this assessment).   
  
There is also potential for bias which may occur if participants feel like they are being 
evaluated and their responses may affect their relationship with the agencies they work with. 
This may cause the participants to present socially desirable answers. However, the informed 
consent describes the evaluation study and explains to the participants that all raw data are 
kept confidential in password protected files, all survey responses will be de-identified, and 
all results will be presented in aggregate form, thus preventing their employing agency, 
PCSAO, and other organizations from linking their responses.  
 

THE OHIO STATE UNIVERSITY 
Institutional Review Board 
 
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F. Data Analysis 
Survey. Survey responses will be aggregated. Descriptive statistics (mean, median, mode) 
will be calculated to reflect the general importance and usefulness of the CASPI and 
collaboration strategies described.  
 
Focus Group. Focus group conversation (audio only) will be recorded on the zoom platform 
and professionally transcribed. Transcripts will be reviewed; we will use a content analysis 
approach to identify key themes and recommendations for refining the CASPI toolkit and 
designing future initiatives to support Implementation TA providers. 
 
G. 
Timeline 
Activity 
2023 
2024 
Q4 
Q1 
Q2 
Q3 
Q4 
Share CASPI toolkit with TA 
providers (PI to attend TA provider 
meeting 
X 
 
 
 
 
Recruitment Emails for Survey 
 
X 
 
 
 
Survey Administration 
 
X 
 
 
 
Analyze Survey Data 
 
X 
 
 
 
Recruitment Emails for Focus Group 
 
X 
 
 
 
Conduct Focus Groups 
 
 
X 
 
 
Transcribe Focus Groups 
 
 
X 
 
 
Develop codebook for focus groups 
 
 
X 
 
 
Code focus group transcripts 
 
 
X 
X 
 
Prepare brief report and manuscripts 
 
 
 
X 
X 
 
 
 
 
 
 
IV. References 
Aarons, G.A., Ehrhart, M.G., & Farahnak, L.R (2014). The implementation leadership scale (ILS): 
Development of a brief measure of unit level implementation leadership. Implementation Science, 
9(45) 
 
Aarons, G.A., Fettes, D.L., Sommerfeld, D.H., & Palinkas, L.A. (2012). Mixed methods for 
implementation research: Application to evidence-based practice implementation and staff turnover 
in community-based organizations providing child welfare services. Child Maltreatment, 17(1), 67-
79. 
Belanger, K., & Stone, W. (2008). The social service divide: Service availability and accessibility in rural 
versus urban counties and impact on child welfare outcomes. Child welfare, 87(4), 101. 
 
Boydell, K. M., Pong, R., Volpe, T., Tilleczek, K., Wilson, E., & Lemieux, S. (2006). Family 
perspectives on pathways to mental health care for children and youth in rural communities. The 
Journal of Rural Health, 22(2), 182-188 
Bunger, A. C., Chuang, E., & McBeath, B. (2012). Facilitating mental health service use for caregivers: 
Referral strategies among child welfare caseworkers. Children and Youth Services Review, 34(4), 
696-703. 

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Institutional Review Board 
 
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Bunger, A. C., Stiffman, A. R., Foster, K. A., & Shi, P. (2009). Child welfare workers and connectivity 
and youth’s receipt of services. Advances in Social Work, 10(1), 1–21. 
Collins-Camargo, C., Sullivan, D., & Murphy, A. (2011). Use of data to assess performance and promote 
outcome achievement by public and private child welfare agency staff. Children and Youth Services 
Review, 33(2), 330-339.  
Cummings, J. R., Case, B. G., Ji, X., & Marcus, S. C. (2016). Availability of Youth Services in US 
Mental Health Treatment Facilities. Administration and Policy in Mental Health and Mental 
Health Services Research, 43(5), 717-727. 
Shea CM, Jacobs SR, Esserman DA, Bruce K, Weiner BJ. Organizational readiness for implementing 
change: a psychometric assessment of a new measure. Implement Sci. 2014;9(7):7.  
Stiffman, A. R., Pescosolido, B., & Cabassa, L. J. (2004). Building a Model to Understand Youth Service 
Access: The Gateway Provider Model. Mental Health Services Research, 6(4), 189–198.  
Staton-Tindall, M., Sprang, G., Clark, J., Walker, R., & Craig, C. D. (2013). Caregiver substance use and 
child outcomes: A systematic review. Journal of Social Work Practice in the Addictions, 13(1), 6-
31. 
 
Stith, S. M., Liu, T., Davies, L. C., Boykin, E. L., Alder, M. C., Harris, J. M., ... & Dees, J. E. M. E. G. 
(2009). Risk factors in child maltreatment: A meta-analytic review of the literature. Aggression 
and Violent Behavior, 14(1), 13-29. 
Weiner, B.J., Belden, C.M., Bergmire, D.M., & Johnston, M. (2011). The meaning and measurement of 
implementation climate. Implementation Science, 6(78).