The Impact of Inter-Organizational Alignment (IOA) on Implementation Outcomes

项目总结/摘要 综合护理越来越普遍，但当代实施框架通常 假设一个单一的组织，在这个组织中，系统级的过程影响服务质量， 实施成功。这种观点并不代表现代心理健康的新现实 关心和抑制什么可以了解组织过程中的实施。最近的框架 预测组织间的一致性（即，价值观、特征、活动的相似性 （c）在各组织间实施的方法，可以促进循证实践的实施。 这项拟议中的研究将是第一个实证检验这一预测的研究。通过扩大重点， 实施科学超越了单一的组织，这个项目旨在改善实施的心理 在综合保健环境中提供保健服务。 以学校为基础的精神卫生服务是综合保健的一个重要例子 两个目标不同但相关的组织重叠。SBMH服务最多 通常由学校的临床医生提供，但由外部社区雇用 社区组织（CBO）。因此，典型的SBMH临床医生是在内部发挥作用的人， 实践受到多种组织环境的影响。在综合护理环境中， 这两个重叠的组织对任何单个提供者的综合影响可能因功能而异 提供者如何嵌入到每个设置中。SBMH提供了一个独特的机会， 组织一致性以及嵌入性的影响。 这项研究是第一次检查重叠的组织环境的具体影响， 其中EBP的实现越来越多。我们将进行探索性的混合方法研究， 评估学校和社区组织的组织内和组织间实施环境，因为它们涉及到 心理健康EBP的实施。我们将估计学校和CBO不同方面的影响 对SBMH最关键的实施结果的组织影响（保真度， 可接受性，适当性）。我们还将探讨组织间 协调一致影响执行成果。使用代表绝大多数（>90%） 在两个地理上不同和多样化的地区，我们将实现以下目标： 目标1：使用定量方法，估计（a）每项组织内实施的效果 背景（学校和CBO）和（B）实施结果的组织间协调（IOA）。 目的1a：估计临床医生的学校嵌入程度对目的1效果的调节作用。 目标2：使用顺序混合方法，通过以下步骤检查潜在机制： 哪些IOA促进或阻碍了EBP的实现。

PROJECT SUMMARY / ABSTRACT Integrated care is increasingly common, yet contemporary implementation frameworks typically assume a single organization within which system-level processes influence service quality and implementation success. This perspective does not represent the emerging realities of modern mental health care and inhibits what can be learned about organizational processes in implementation. Recent frameworks predict that inter-organizational alignment (i.e., similarity in values, characteristics, activities related to implementation across organizations) may facilitate the implementation of evidence-based practices (EBP). The proposed study will be the first to empirically examine this prediction. By expanding the focus of implementation science beyond single organizations, this project aims to improve implementation of mental health services in integrated care settings. School-based mental health (SBMH) services provide an important example of an integrated care setting, where two organizations with distinct, but related, objectives overlap. SBMH services are most frequently delivered by clinicians embedded in schools but employed by external community-based organizations (CBOs). Thus, the typical SBMH clinician is someone who functions within – and whose practices are impacted by – multiple organizational contexts. In integrated care settings, the unique and combined impact of the two overlapping organizations on any individual provider are likely to vary as a function of how embedded the provider is within each setting. SBMH provides a unique opportunity to examine organizational alignment as well as the impact of embeddedness. This study is the first to examine the specific impact of overlapping organizational contexts in which EBP implementation increasingly occurs. We will conduct exploratory mixed-methods research to evaluate the intra- and inter-organizational implementation contexts of schools and CBOs as they relate to mental health EBP implementation. We will estimate the effects of different aspects of the school and CBO organizational influences on the implementation outcomes identified as most critical to SBMH (fidelity, acceptability, appropriateness). We also will explore the mechanisms through which inter-organizational alignment influences implementation outcomes. Using a sample that represents the vast majority (>90%) of CBOs in two geographically distinct and diverse regions, we will address the following aims: Aim 1: Using quantitative methods, estimate the effects of (a) each intra-organizational implementation context (school and CBO) and (b) inter-organizational alignment (IOA) on implementation outcomes. Aim 1a: Estimate the moderating effect of clinicians' degree of school embeddedness on Aim 1 effects. Aim 2: Using a sequential mixed methods approach, examine the underlying mechanisms through which IOA facilitates or hinders EBP implementation.