Inter-organizational alignment and implementation outcomes in integrated mental healthcare for children and adolescents: a cross-sectional observational study.

Publisher: BioMed Central Country of Publication: England NLM ID: 101258411 Publication Model: Electronic Cited Medium: Internet ISSN: 1748-5908 (Electronic) Linking ISSN: 17485908 NLM ISO Abbreviation: Implement Sci Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2006-

Delivery of Health Care, Integrated*/organization & administration ; Organizational Culture*; Humans ; Adolescent ; Cross-Sectional Studies ; Child ; Female ; Male ; Leadership ; Evidence-Based Practice/organization & administration ; Implementation Science ; Mental Health Services/organization & administration ; School Mental Health Services/organization & administration ; Adult ; School Health Services/organization & administration

Background: Integrated care involves care provided by a team of professionals, often in non-traditional settings. A common example worldwide is integrated school-based mental health (SBMH), which involves externally employed clinicians providing care at schools. Integrated mental healthcare can improve the accessibility and efficiency of evidence-based practices (EBPs) for vulnerable populations suffering from fragmented traditional care. However, integration can complicate EBP implementation due to overlapping organizational contexts, diminishing the public health impact. Emerging literature suggests that EBP implementation may benefit from the similarities in the implementation context factors between the different organizations in integrated care, which we termed inter-organizational alignment (IOA). This study quantitatively explored whether and how IOA in general and implementation context factors are associated with implementation outcomes in integrated SBMH.
Methods: SBMH clinicians from community-based organizations (CBOs; n clinician  = 27) and their proximal student-support school staff (n school  = 99) rated their schools and CBOs (clinician only) regarding general (organizational culture and molar climate) and implementation context factors (Implementation Climate and Leadership), and nine common implementation outcomes (e.g., treatment integrity, service access, acceptability). The levels of IOA were estimated by intra-class correlations (ICCs). We fitted multilevel models to estimate the standalone effects of context factors from CBOs and schools on implementation outcomes. We also estimated the 2-way interaction effects between CBO and school context factors (i.e., between-setting interdependence) on implementation outcomes.
Results: The IOA in general context factors exceeded those of implementation context factors. The standalone effects of implementation context factors on most implementation outcomes were larger than those of general context factors. Similarly, implementation context factors between CBOs and schools showed larger 2-way interaction effects on implementation outcomes than general context factors.
Conclusions: This study preliminarily supported the importance of IOA in context factors for integrated SBMH. The findings shed light on how IOA in implementation and general context factors may be differentially associated with implementation outcomes across a broad array of integrated mental healthcare settings.
(© 2024. The Author(s).)

Update of: Res Sq. 2024 Jan 02:rs.3.rs-3745830. doi: 10.21203/rs.3.rs-3745830/v1. (PMID: 38260462)

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F31 MH011069 United States MH NIMH NIH HHS; R21MH11069 United States MH NIMH NIH HHS

Keywords: General organizational context; Implementation context; Integrated mental healthcare; Inter-organizational alignment; Organizational implementation context

Date Created: 20240527 Date Completed: 20240528 Latest Revision: 20240718

20240719

PMC11129427

10.1186/s13012-024-01364-w

38802827