The role of cross-system collaboration in implementation of evidence-based substance use practices in child welfare

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PROJECT SUMMARY The overall goal of this mentored career award is to establish my independent research career centered on using community engagement strategies in implementation of evidence-based practices (EBPs) in order to improve service provision for vulnerable populations with substance use disorders (SU), specifically, parents with SU involved in child welfare services (CWS). Parental SU is the primary reason for recent increases in CWS cases, and parental SU is associated with worse outcomes, such as repeated child maltreatment; however, engaging parents in SU services is challenging. Service provision requires collaboration across multiple systems (CWS, treatment agencies) and multiple steps from initial identification of treatment need and treatment referral to treatment engagement and eventual CWS case closure; as such, there are multiple points where parents can fall out of care. The project proposes that poor outcomes for parents in CWS are due to (1) challenges in effectively tracking care processes and identifying service gaps and (2) poor collaboration across CWS and SU providers. Moreover, evidence-based practices (EBPs) that address service deficits exist, but collaboration across systems and involvement from the community is needed for successful implementation. The project seeks to improve SU service provision for parents in CWS through use of community engagement and data-driven strategies in EBP adoption and implementation planning. The Research Aims of the project include defining a SU care cascade for parents in CWS and calculating cascade outcomes (e.g., rates of treatment completion, etc.) using administrative data (Aim 1); identifying facilitators and barriers to cascade service provision through qualitative interviews with parents involved in CWS and CWS personnel, SU providers, and community partners (Aim 2); and using Aim 1 and 2 data to identify an area of the cascade to improve, select an appropriate EBP to address the need, and develop an implementation plan (Aim 3). These aims will be will be carried out by a community alliance which will be established in Aim 1 and engaged throughout the project. Proposed research activities include using community engagement strategies and establishing a community alliance; conducting administrative, qualitative, and mixed methods analyses; and using implementation mapping to develop an implementation plan. I have identified critical gaps in my training and assembled a strong mentorship team to address these deficits through the following Training Goals: (1) develop expertise in CWS and conducting research with CWS (Drs. Saldana, Wiehe); (2) become proficient in use of administrative data (Dr. Monahan); (3) develop expertise in using community engagement strategies in implementation (Drs. Wiehe, Aalsma, Saldana); and (4) gain advanced training in research ethics (Dr. Aalsma). These training goals align with the proposed project and are necessary for my success as an independent researcher. This project is the first step towards developing a larger research program that seeks to improve services for parents involved in CWS and other vulnerable populations with SU.