Collaborating to Implement Cross-System Interventions in Child Welfare and Substance Use

项目摘要/摘要 由于新出现的国家鸦片类药物危机，儿童福利机构经历了 由于父母使用药物使儿童面临更大的虐待风险，寄养儿童的数量有所增加。 儿童福利机构处于有利地位，可以帮助识别父母并将其与药物使用治疗联系起来。 有希望的循证干预措施强调简短的筛查，与治疗的联系，以及 整合儿童福利和药物使用治疗系统，包括START模式(戒酒 治疗和康复小组)。成功实施《削减战略武器条约》有赖于强有力的协作 物质使用治疗和儿童福利制度之间的关系。改进实施和未来的扩展 首先，有必要制定有效的协作战略，支持整合县儿童福利。 和物质使用治疗系统，这有可能使那些使用高度复杂物质的人受益 其他保健和人类服务系统涉及的服务需求。 我们的长期目标是测试促进采用的协作策略的有效性， 实施和维持《削减战略武器条约》和其他跨系统治疗创新。这项研究开始了 通过为协作战略制定一个多方面的、可行的决策支持指南来实现这一目标 行政领导人的遴选。为此，我们将进行一项多站点纵向混合方法研究 建立在俄亥俄州START项目的基础上，这是一个在17个主要是农村地区自然产生的实施倡议 由俄亥俄州总检察长办公室资助的南部-俄亥俄州县。目标1：在项目的头两年 在研究中，我们将研究与实施《削减战略武器条约》相关的战略(渗透率和保真度)和 服务交付结果(物质使用评估、及时获得治疗、疗程次数)，给出 系统和组织特征。我们将与17个县进行收敛的混合方法研究 并利用工人调查、管理员报告、管理数据和小组访谈。数据将是 采用定性比较分析法(QCA)进行综合分析。目标2：在研究的第二年， 我们将制定决策支持指南，以促进协作战略的选择。专家小组 由执行专家和物质使用治疗儿童福利系统的利益攸关方组成 将召开会议，综合文献和目标1的结果，以具体说明START实施战略。 目标3：在研究的最后阶段，我们将评估以下内容的可接受性、适当性和可行性 《削减战略武器条约》实施战略。我们将把决策支持指南的可行性与一般的 从17县外儿童福利机构负责人的角度支持实施 区域，并在最多3个县试点决策支持指南。拟议中的研究将奠定基础 用于未来的R01应用程序，以测试决策指南在更大规模计划中的有效性。

PROJECT SUMMARY/ABSTRACT As a result of the emerging national opiate crisis, child welfare agencies have experienced an increase in the number of children in foster care as parental substance use puts children at greater risk of maltreatment. Child welfare agencies are well positioned to help identify and connect parents with substance use treatment. Promising evidence-based interventions exist that that emphasize brief screening, linkage to treatment, and integration across child welfare and substance use treatment systems, including the START model (Sobriety Treatment and Recovery Teams). Successful implementation of START depends on strong collaboration between substance use treatment and child welfare systems. To improve implementation and future scale-up of START, there is a need for effective collaborative strategies that support integration of county child welfare and substance use treatment systems, which has potential to benefit those with highly complex substance use service needs involved in other health and human service systems. Our long-term goal is to test the effectiveness of collaborative strategies that promote the adoption, implementation, and sustainment of START and other cross-system treatment innovations. This study begins to address this goal by developing a multifaceted and feasible decision support guide for collaborative strategy selection for executive leaders. To do so, we will conduct a multisite longitudinal, mixed methods study that builds on the Ohio START project, a naturally occurring implementation initiative in 17 predominantly rural southern-Ohio counties funded by the Ohio Attorney General’s Office. Aim 1: During the first two years of the study, we will examine the strategies associated with START implementation (penetration and fidelity) and service delivery outcomes (substance use assessment, timely access to treatment, number of sessions), given system and organizational features. We will conduct a convergent mixed methods study with the 17 counties and draw on worker surveys, administrator reports, administrative data, and group interviews. Data will be integrated and analyzed using Qualitative Comparative Analysis (QCA). Aim 2: In the second year of the study, we will develop a decision support guide to facilitate selection of collaborative strategies. An expert panel comprised of implementation experts, and stakeholders from the substance use treatment child welfare system will convene to synthesize findings from the literature and Aim 1, to specify a START implementation strategy. Aim 3: During the final stage of the study, we will assess the acceptability, appropriateness, and feasibility of the START implementation strategy. We will compare the feasibility of the decision support guide to general implementation supports from the perspective of child welfare agency directors from outside of the 17 county region, and pilot the decision support guide in up to 3 counties. The proposed research will lay the foundation for a future R01 application to test the decision making guide’s effectiveness in a larger scale-up initiative.