4 - (SYM 32) Team Influences on Implementation of a Mental Health Screening and Referral Protocol in Children's Advocacy Centers: A Matrixed Multiple Case Study

Abstract Body
Children’s Advocacy Centers (CACs) use multidisciplinary, cross-sector teams to provide coordinated interagency responses to sexual abuse and other severe maltreatment. In team-based service settings, aspects of teamwork are likely to affect implementation processes and outcomes. We used explanatory sequential mixed methods to examine how specific dimensions of teamwork influence implementation processes and outcomes in rural CACs implementing a mental health screening/referral protocol.
CACs in a single state (N = 18) implemented a standardized mental health screening/referral protocol, and we quantitatively assessed reach (i.e., screening rates) during the first two years of implementation. We purposively sampled 6 rural/frontier CACs based on variability in reach and conducted qualitative interviews with team members in each CAC (N = 24). Interviews were coded for specific dimensions of teamwork and implementation determinants. We are using the matrixed multiple case study approach (Kim et al., 2020, 2024) to examine variations in teamwork and other implementation determinants and their impact on outcomes. Potential influencing factors were rated as negative, mixed, low positive, moderate positive, or high positive. Final ratings will be organized in a sortable matrix illustrating the valence of influencing factors across sites.
Our quantitative analyses found that teams with greater task interdependence (i.e., reliance on one another to share resources and coordinate workflows) had higher screening rates during the first two years of implementation (r = .55, p < .05). Team performance was also positively associated with screening rates, although the association was not significant in this small sample (r = .34, p = .20). We will conduct within-site and cross-site analysis of matrixed data to identify cross-site trends in associations between influencing factors and implementation success and identify consistent and inconsistent patterns. We will also examine convergence and divergence between quantitative and qualitative findings. 
Identifying how specific dimensions of teamwork affect implementation processes and outcomes informs our understanding of implementation in team-based service settings. Implementation strategies targeting teamwork, especially task interdependence and performance, may improve implementation outcomes in team-based service settings.