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

项目摘要/摘要 综合护理日益普遍，但当代实施框架通常 假设单个组织的系统级流程影响服务质量，并且 实施成功。这一观点并不代表现代心理健康的新兴现实。 关心和禁止在实施过程中可以了解到的组织过程。最近的框架 预测组织间一致性(即价值观、特征、活动方面的相似性) 跨组织实施)可能会促进循证做法的实施。 拟议中的研究将是第一个对这一预测进行实证检验的研究。通过扩大 实施科学超越单一组织，该项目旨在改善智力的实施 综合保健环境中的保健服务。 以学校为基础的精神卫生(SBMH)服务是综合护理的重要范例 环境，其中两个组织具有不同但相关的目标重叠。SBMH的服务最多 通常由嵌入学校的临床医生提供，但受雇于外部社区 组织(CBO)。因此，典型的SBMH临床医生是在内部工作的人-并且他的 实践受到多个组织环境的影响。在综合护理环境中，独特的和 这两个重叠的组织对任何单个提供商的综合影响可能会随着职能的不同而不同 提供程序在每个设置中的嵌入程度。SBMH提供了一个独特的机会来研究 组织一致性以及嵌入性的影响。 这项研究是第一次考察重叠的组织环境在 其中EBP的实施越来越多地发生。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的执行情况，因为它们涉及 心理健康EBP的实施。我们将评估学校和CBO的不同方面的影响 组织对被确定为对SBMH(保真度、 可接受性、适当性)。我们还将探索组织间通过哪些机制 一致性影响实施结果。使用代表绝大多数(&gt；90%)的样本 在两个地理位置不同和不同的区域建立社区组织，我们将实现以下目标： 目标1：使用量化方法，估计(A)每一次组织内实施的效果 背景(学校和社区组织)和(B)组织间协调执行成果。 目的1a：评估临床医生的学校嵌入程度对目标1效果的调节作用。 目标2：使用顺序混合方法，通过 IOA促进还是阻碍了EBP的实施。

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.