Establishing Cross-Systems Collaborations for Implementation: Study Protocol for Implementation Decision Support
Authors: Bunger Alicia C. , Chuang Emmeline , Girth Amanda , Lancaster Kathryn E. , Gadel Fawn , Himmeger Marla , Saldana Lisa , Powell Byron J. , Aarons Gregory A 
Published: May 2020

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). START 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.Discussion: Our results will lay the groundwork for a larger controlled trial that will test the CASPI’s effectiveness for supporting effective and efficient implementation of cross-system interventions like START. The CASPI is expected to help leaders and researchers select and use collaboration strategies tailored to their context and be applicable in a wide range of settings including rural communities. Our work also advances system-level implementation strategies.Trial Registration: NCT03931005, Registered April 29, 2019, https://clinicaltrials.gov/ct2/show/NCT03931005Contributions to the Literature · Implementing cross-system interventions depends on strong collaboration. Yet, collaborative strategies vary and the conditions under which they are most effective for implementation are unclear. · This study will (1) examine the collaborative strategies associated with implementation of a cross-system intervention that aligns child welfare and substance use treatment systems, (2) develop the Collaborating Across Systems for Program Implementation (CASPI) tool, a flexible decision support for organizational leaders, and (3) pilot test CASPI with organizational leaders. · Our study is intended to advance the effectiveness and efficiency of implementing cross-system interventions by helping leaders identify challenges, and effective collaborative strategies that address them.