Partnering for Success: Provider Perspectives of an Inter-agency Initiative between Child Welfare and Mental Health Systems.

The Partnering for Success (PfS) inter-agency initiative was implemented in the U.S. to ensure children involved in child welfare (CW) services received effective mental health (MH) treatments. CW strategies included use of standardized MH screening assessments, facilitating referrals to MH treatment, and tracking MH treatment progress. MH providers were trained in Cognitive Behavioral Therapy – Plus Trauma-Focused CBT (CBT +), which targets common child MH disorders (i.e., anxiety, behavioral difficulties, depression, traumatic stress). A web-based monitoring system, ongoing consultation, joint training, inter-agency team meetings, and post-training transfer activities further supported implementation. This study presents the perspectives of CW and MH frontline, supervisory, and administrative staff regarding the perceived benefits and challenges of implementing PfS. CW (n = 15) and MH (n = 14) staff from the first three PfS implementation cohorts (2014–2017) participated in n = 6 focus groups and n = 10 individual interviews (60–90 min long) conducted via audio-recorded web-based conference calls. Throughout the analysis process, authors used Consensual Qualitative Research strategies. The current study focused on questions related to providers’ perceived benefits and challenges when using PfS (i.e., What are the benefits of using the PfS model in your practice? What are the challenges?). Providers perceived benefits and challenges along five core ideas: practice change, workload burden, referrals, client engagement, and provider engagement. Providers reported improved frontline, supervisory, and interprofessional practice which enhanced client care and symptom reduction. However, limited training opportunities and individual provider characteristics limited agency-wide practice change. CW and MH staff reported mixed reactions regarding the influence of PfS on workload burden: while some tasks became easier, PfS also generated additional work. Workload burden also increased due misalignment with MH billing structures, provider characteristics, turnover, and client crises. Providers reported an enhanced and expedited referral process as more MH therapists were trained. However, limited training, high turnover, provider and client characteristics hampered processes. PfS resources and tools, and the time-limited nature of CBT + , engaged clients, while families struggling with child behavioral problems were hardest to engage. Provider engagement grew as more providers became trained, observed PfS benefits, and shared experiences. However, more experienced providers expressed greater difficulties engaging in PfS and altering practice, compared to less experienced providers. Findings are situated within the Practical, Robust, Implementation, and Sustainability Model (PRISM) framework to support broader applicability, alignment with prior research, and further refinement of the PRISM conceptual model. The combination of technology (e.g., web-based monitoring systems), effective MH treatments, and inter-agency relationship-building activities can promote positive experiences for CW and MH providers. However, pre-existing difficulties inherent in U.S. publicly funded CW and MH services (e.g., turnover) and client population (e.g., multiple crises) dampen enthusiasm. Findings largely reinforce the natural salience of PRISM domains within complex implementation efforts.