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How State Administrative Structures Influence Implementation Outcomes for Wraparound Care Coordination.

Jonathan R Olson1, Kimberly M Estep1, Kimberly A Coviello1

  • 1Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Olson, Bruns); Innovations Institute, University of Connecticut School of Social Work, Hartford (Estep, Coviello); Department of Psychology, Virginia Commonwealth University, Richmond (Linkous).

Psychiatric Services (Washington, D.C.)
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PubMed
Summary

Care management entities (CMEs) demonstrated superior implementation outcomes for wraparound care coordination compared to community mental health centers (CMHCs). Optimizing inner and outer contexts is crucial for effective implementation of complex behavioral health strategies.

Keywords:
adolescents/adolescenceimplementationmental health systems/hospitalsprogram evaluationsystem of carewraparound

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Area of Science:

  • Implementation science
  • Health services research
  • Behavioral health systems

Background:

  • Wraparound care coordination is an evidence-based strategy for youth with complex behavioral health needs.
  • Effective implementation of such strategies is influenced by both organizational (inner) and system (outer) contexts.

Purpose of the Study:

  • To examine how inner-context and outer-context variables affect implementation outcomes for wraparound care coordination.
  • To compare the effectiveness of two state-level administrative structures: care management entities (CMEs) and community mental health centers (CMHCs).

Main Methods:

  • Data from 1,178 providers across 10 states were analyzed.
  • Implementation completeness and duration were assessed using the Stages of Implementation Completion tool.
  • Practice fidelity was measured with the Coaching Observation Measure for Effective Teams.
  • Multilevel models compared CME and CMHC states.

Main Results:

  • CME states exhibited significantly higher practitioner fidelity scores (0.37 vs. 0.24) compared to CMHC states.
  • CME states completed more implementation activities and did so more rapidly.
  • Longer preimplementation phases correlated positively with fidelity, while longer implementation phases correlated negatively.

Conclusions:

  • State-level administrative structures, such as CMEs versus CMHCs, significantly impact the implementation outcomes of wraparound care coordination.
  • Adequate time for planning and implementation, alongside supportive inner and outer contexts, is essential for achieving high-quality service delivery.
  • Designing hospitable organizational and system contexts is critical for implementation efficiency, completeness, and overall quality.