Establishing Cross-Systems Collaborations for Implementation: Protocol for a Longitudinal Mixed Methods Study

Bunger, Alicia C.; Chuang, Emmeline; Girth, Amanda M.; Lancaster, Kathryn E.; Gadel, Fawn; Himmeger, Marla; Saldana, Lisa; Powell, Byron J.; Aarons, Gregory A.

doi:10.21203/rs.3.rs-29980/v2

Cited by 4 publications

(5 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…MCPs highlighted the need for strengthened relational ties between MCPs and DHCS to improve APL information and knowledge sharing, training on APL services, and improved implementation of APL services. Prior research has highlighted the importance of strong relational ties to support policy implementation; however, there is a dearth of evidence for how and when to employ such collaborative strategies (Bunger et al, 2020; Selden et al, 2006). The field of policy dissemination and implementation research should further investigate the nature and impact of relational ties that target policy-specific knowledge exchange between Outer Context agencies and Inner Context stakeholders (Crable et al, 2022b).…”

Section: Discussionmentioning

confidence: 99%

Applying the EPIS framework to policy-level considerations: Tobacco cessation policy implementation among California Medicaid managed care plans

Economou

Kaiser

Yoeun

et al. 2022

Implementation Research and Practice

View full text Add to dashboard Cite

Background In 2016, the California Department of Healthcare Services (DHCS) released an “All Plan Letter” (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage among Medicaid beneficiaries. However, implementation remains poor. We apply the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify barriers and facilitators to fidelity to APL 16-014 across California Medicaid MCPs. Methods We assessed fidelity through semi-structured interviews with MCP health educators ( N = 24). Interviews were recorded, transcribed, and reviewed to develop initial themes regarding barriers and facilitators to implementation. Initial thematic summaries were discussed and mapped onto EPIS constructs. Results The APL (Innovation) was described as lacking clarity and specificity in its guidelines, hindering implementation. Related to the Inner Context, MCPs described the APL as beyond the scope of their resources, pointing to their own lack of educational materials, human resources, and poor technological infrastructure as implementation barriers. In the Outer Context, MCPs identified a lack of incentives for providers and beneficiaries to offer and participate in tobacco-cessation programs, respectively. A lack of communication, educational materials, and training resources between the state and MCPs (missing Bridging Factors) were barriers to preventing MCPs from identifying smoking rates or gauging success of tobacco-cessation efforts. Facilitators included several MCPs collaborating with each other and using external resources to promote tobacco cessation. Additionally, a few MCPs used fidelity monitoring staff as Bridging Factors to facilitate provider training, track providers’ identification of smokers, and follow-up with beneficiaries participating in tobacco-cessation programs. Conclusions The release of the evidence-based APL 16-014 by California's DHCS was an important step forward in promoting tobacco-cessation services for Medicaid MCP beneficiaries. Improved communication on implementation in different environments and improved Bridging Factors such as incentives for providers and patients are needed to fully realize policy goals. Plan Language Summary In 2016, the California Department of Healthcare Services (DHCS) in California released an “All Plan Letter” (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage to address tobacco use among Medicaid beneficiaries. We conducted semi-structured interviews with health educators in California Medicaid MCPs to explore the barriers and facilitators to implementing the APL using the Exploration, Preparation, Implementation, Sustainment framework. According to MCPs, barriers included a lack of clarity in the APL guidelines; a lack of resources, including educational materials, infrastructure to identify smokers, and human resources; and a lack of incentives or penalties for providers to provide tobacco-cessation materials to beneficiaries. Facilitators included collaboration between MCPs and state and/or national public health programs. Overall, our findings can provide avenues for improving the implementation of tobacco-cessation services within Medicaid MCPs.

show abstract

Section: Discussionmentioning

confidence: 99%

Applying the EPIS framework to policy-level considerations: Tobacco cessation policy implementation among California Medicaid managed care plans

Economou

Kaiser

Yoeun

et al. 2022

Implementation Research and Practice

View full text Add to dashboard Cite

show abstract

“…CCMs have also started to make prominent appearances within the health services research and implementation science literatures. CCMs, for example, were used in a recent Cochrane Review to identify conditions directly linked with successful implementation of schoolbased interventions for asthma self-management [4], featured as an innovative member of the mixed-methods repertoire in a major methodological review in public health [5], highlighted as a central method in newly published implementation science protocols [6,7], and applied to determine different pathways for federally qualified health centers to achieve patient-centered medical home status [8]. CCMs were also featured in a dedicated chapter in the 2020 Handbook on Implementation Science [9].…”

Section: Introductionmentioning

confidence: 99%

Coincidence analysis: a new method for causal inference in implementation science

Whitaker¹,

Sperber

Baumgärtner

et al. 2020

Implementation Sci

View full text Add to dashboard Cite

Background Implementation of multifaceted interventions typically involves many diverse elements working together in interrelated ways, including intervention components, implementation strategies, and features of local context. Given this real-world complexity, implementation researchers may be interested in a new mathematical, cross-case method called Coincidence Analysis (CNA) that has been designed explicitly to support causal inference, answer research questions about combinations of conditions that are minimally necessary or sufficient for an outcome, and identify the possible presence of multiple causal paths to an outcome. CNA can be applied as a standalone method or in conjunction with other approaches and can reveal new empirical findings related to implementation that might otherwise have gone undetected. Methods We applied CNA to a publicly available dataset from Sweden with county-level data on human papillomavirus (HPV) vaccination campaigns and vaccination uptake in 2012 and 2014 and then compared CNA results to the published regression findings. Results The original regression analysis found vaccination uptake was positively associated only with the availability of vaccines in schools. CNA produced different findings and uncovered an additional solution path: high vaccination rates were achieved by either (1) offering the vaccine in all schools or (2) a combination of offering the vaccine in some schools and media coverage. Conclusions CNA offers a new comparative approach for researchers seeking to understand how implementation conditions work together and link to outcomes.

show abstract

“…Parents who participate in the Ohio START program receive intensive case management and expedited referrals to treatment. Further, they are paired with family peer mentors who enhance coordination of resources and supports for participating families through weekly visits (Bunger et al, 2020; Yoon et al, 2021). Since implementation in 2017, the program is currently available in 52 counties across the state.…”

Section: Methodsmentioning

confidence: 99%

“…Since implementation in 2017, the program is currently available in 52 counties across the state. More information about the intervention and its implementation are reported elsewhere (Bunger et al, 2020; Yoon et al, 2021).…”

Section: Methodsmentioning

confidence: 99%

Benchmarking Trauma in Child Welfare: A Brief Report

Dellor

Yoon

Bunger

et al. 2021

J Interpers Violence

Self Cite

View full text Add to dashboard Cite

Trauma exposure is common; however, considerably higher rates are reported in some vulnerable groups including adults and children involved in child welfare systems. In this context, early screening and service linkage may ameliorate its negative impact on the physical and mental well-being of adults and children alike. Using data from two Ohio-based child welfare interventions targeting co-occurring maltreatment and substance use (Ohio START 1 and EPIC2), the purpose of this brief report was to first describe the rate of trauma exposure among participating adults (Adverse Childhood Experiences or ACEs, N = 402), children 0–5 years (CTAC, N = 271) and youth 6–18 years (CTAC, N = 177), and second to benchmark observed rates against reported rates in other child welfare or similar populations across the United States. Results show that adults were exposed to 4.2 ACEs on average, a 24% increase over previous child welfare estimates. While mean CTAC scores were not significantly different among young children ages 0–5, older children reported on average 5.6 exposures which is 27% higher than previously reported estimates. Our findings highlight the difference in risk profiles between families involved child welfare due primarily to substance misuse and those without substance misuse concerns, or where substance misuse was not the primary cause of entry. We discuss implications for service provision and time-sensitive child welfare requirements.

show abstract

Establishing Cross-Systems Collaborations for Implementation: Protocol for a Longitudinal Mixed Methods Study

Cited by 4 publications

References 8 publications

Applying the EPIS framework to policy-level considerations: Tobacco cessation policy implementation among California Medicaid managed care plans

Applying the EPIS framework to policy-level considerations: Tobacco cessation policy implementation among California Medicaid managed care plans

Coincidence analysis: a new method for causal inference in implementation science

Benchmarking Trauma in Child Welfare: A Brief Report

Contact Info

Product

Resources

About