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Yoon S, Ploss A, Hutzel M, Webb R, Hatfield A, Lee JY, Munshi A, Radney A, McClellan J. Parenting attitudes and behaviors among parents involved with the child welfare system and affected by substance use disorders. CHILD ABUSE & NEGLECT 2024; 149:106657. [PMID: 38262180 DOI: 10.1016/j.chiabu.2024.106657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/13/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Co-occurring parental substance use and child maltreatment is a serious concern in the U.S child welfare system. OBJECTIVE The aim of the study was to examine parenting attitudes and practices among parents who participated in Ohio START (Sobriety, Treatment, And Reducing Trauma), a statewide initiative that provides support to families affected by co-occurring parental substance use and child maltreatment. PARTICIPANTS AND SETTING Study 1 involved quantitative data collected from 73 enrolled parents through pre-test and post-test telephone surveys. Study 2 (parent interviews) involved qualitative data collected through in-depth interviews with 34 enrolled parents. METHODS The paired-sample t-test and the McNemar test were conducted in Study 1 and thematic analysis was conducted in Study 2. RESULTS Quantitative analysis indicated significant improvements in parental expectations of children (t = -3.42, p = .001, Cohen's d = -0.40), parent-child family roles (t = -5.74, p < .001, Cohen's d = -0.67), and children's power and independence (t = -3.42, p = .001, Cohen's d = -0.40). Qualitative analysis revealed six themes related to changes in parenting after participation in Ohio START: (1) Being present for children, (2) Engaging in activities with children, (3) Enjoyment in providing care to children, (4) Maintaining employment for financial stability, (5) Better emotion regulation and stress management, and (6) a sense of pride. CONCLUSIONS Our findings demonstrate positive changes in parenting attitudes and practices among parents who participated in Ohio START and provide further support for the potential merits of this model and its continued expansion throughout Ohio.
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Affiliation(s)
- Susan Yoon
- College of Social Work, The Ohio State University, Columbus, OH, USA; Department of Social Welfare, College of Social Sciences, Ewha Womans University, Seoul, South Korea.
| | - Alexa Ploss
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Margaret Hutzel
- Voinovich School of Leadership and Public Service, Ohio University, Athens, OH, USA
| | - Robin Webb
- Voinovich School of Leadership and Public Service, Ohio University, Athens, OH, USA
| | - Ally Hatfield
- Voinovich School of Leadership and Public Service, Ohio University, Athens, OH, USA
| | - Joyce Y Lee
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Additti Munshi
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Angelise Radney
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Jen McClellan
- Public Children Services Association of Ohio (PCSAO), Columbus, OH, USA
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Bunger AC, Chuang E, Girth AM, Lancaster KE, Smith R, Phillips RJ, Martin J, Gadel F, Willauer T, Himmeger MJ, Millisor J, McClellan J, Powell BJ, Saldana L, Aarons GA. Specifying cross-system collaboration strategies for implementation: a multi-site qualitative study with child welfare and behavioral health organizations. Implement Sci 2024; 19:13. [PMID: 38347639 PMCID: PMC10863233 DOI: 10.1186/s13012-024-01335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/28/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Cross-system interventions that integrate health, behavioral health, and social services can improve client outcomes and expand community impact. Successful implementation of these interventions depends on the extent to which service partners can align frontline services and organizational operations. However, collaboration strategies linking multiple implementation contexts have received limited empirical attention. This study identifies, describes, and specifies multi-level collaboration strategies used during the implementation of Ohio Sobriety Treatment and Reducing Trauma (Ohio START), a cross-system intervention that integrates services across two systems (child welfare and evidence-based behavioral health services) for families that are affected by co-occurring child maltreatment and parental substance use disorders. METHODS In phase 1, we used a multi-site qualitative design with 17 counties that implemented Ohio START. Qualitative data were gathered from 104 staff from child welfare agencies, behavioral health treatment organizations, and regional behavioral health boards involved in implementation via 48 small group interviews about collaborative approaches to implementation. To examine cross-system collaboration strategies, qualitative data were analyzed using an iterative template approach and content analysis. In phase 2, a 16-member expert panel met to validate and specify the cross-system collaboration strategies identified in the interviews. The panel was comprised of key child welfare and behavioral health partners and scholars. RESULTS In phase 1, we identified seven cross-system collaboration strategies used for implementation. Three strategies were used to staff the program: (1) contract for expertise, (2) provide joint supervision, and (3) co-locate staff. Two strategies were used to promote service access: (4) referral protocols and (5) expedited access agreements. Two strategies were used to align case plans: (6) shared decision-making meetings, and (7) sharing data. In phase 2, expert panelists specified operational details of the cross-system collaboration strategies, and explained the processes by which strategies were perceived to improve implementation and service system outcomes. CONCLUSIONS We identified a range of cross-system collaboration strategies that show promise for improving staffing, service access, and case planning. Leaders, supervisors, and frontline staff used these strategies during all phases of implementation. These findings lay the foundation for future experimental and quasi-experimental studies that test the effectiveness of cross-system collaboration strategies.
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Affiliation(s)
- Alicia C Bunger
- Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Emmeline Chuang
- School of Social Welfare, University of California Berkeley, Berkeley, CA, USA
| | - Amanda M Girth
- John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, USA
| | | | - Rebecca Smith
- Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Jared Martin
- Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco, CA, USA
| | - Fawn Gadel
- Public Children Services Association of Ohio, Columbus, OH, USA
| | | | | | | | - Jen McClellan
- Public Children Services Association of Ohio, Columbus, OH, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Lisa Saldana
- Lighthouse Institute, Chestnut Health Systems, Eugene, OR, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Bunger AC, Yoon S, Maguire-Jack K, Phillips R, West KY, Clark-Hammond G, Kranich C. Implementation and Mental Health Outcomes of a Service Cascade Linking Child Welfare and Children's Mental Health Systems: A Case Study of the Gateway CALL Demonstration. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:327-341. [PMID: 36449108 PMCID: PMC9931844 DOI: 10.1007/s10488-022-01238-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/05/2022]
Abstract
The mental health needs of children and youth involved in the child welfare system remain largely unmet. Service cascades are an emerging approach to systematizing mental health screening, assessment, and treatment referral processes. However, evidence is minimal and inconsistent regarding the effectiveness of such approaches for improving mental health service access and outcomes. In an effort to address this gap, this study presents a case-study of the implementation fidelity and treatment outcomes of the Gateway CALL service cascade. Study analyses involved longitudinal data collected as part of a larger evaluation of Gateway CALL. Specifically, descriptive and linear mixed model analyses were conducted to assess the implementation of service cascade components, and changes in mental health outcomes (behavior problems) among 175 children placed out-of-home during the study. Study analyses found that although fidelity was strong early in the service cascade, implementation began to break down once components involved more than one service system (child welfare, mental health). However, results also indicated that parent-reported child behavior problems decreased significantly over time, despite later cascade components being implemented with poor fidelity to the Gateway CALL service model. For children and youth involved in child welfare systems, service cascades like Gateway CALL have the potential to significantly improve both mental health service receipt and outcomes. To maximize the effectiveness of such approaches, later phases of implementation may require increased attention and support, particularly regarding processes and outcomes that cross child welfare and mental health service systems.
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Affiliation(s)
- Alicia C. Bunger
- College of Social Work, The Ohio State University, Columbus, OH 43210 USA
| | - Susan Yoon
- College of Social Work, The Ohio State University, Columbus, OH 43210 USA
| | | | - Rebecca Phillips
- College of Social Work, The Ohio State University, Columbus, OH 43210 USA
| | | | | | - Christiana Kranich
- Government Resource Center, Ohio Colleges of Medicine, Columbus, OH 43210 USA
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Dellor ED, Yoon S, Bunger AC, Himmeger M, Freishtler B. Benchmarking Trauma in Child Welfare: A Brief Report. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP18568-NP18588. [PMID: 34416838 DOI: 10.1177/08862605211038324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
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 START1 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.
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Affiliation(s)
| | - Susan Yoon
- The Ohio State University, United States
| | | | - Marla Himmeger
- Public Children Services Association of Ohio (PCSAO), United States
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Leeman J, Wangen M, Kegler M, Lee M, O'Leary MC, Ko LK, Fernández ME, Birken SA. Applying Theory to Explain the Influence of Factors External to an Organization on the Implementation of an Evidence-Based Intervention. FRONTIERS IN HEALTH SERVICES 2022; 2:889786. [PMID: 36925840 PMCID: PMC10012829 DOI: 10.3389/frhs.2022.889786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022]
Abstract
Despite its widely acknowledged influence on implementation, limited research has been done on how the external environment (i.e., outer setting) determines when organizations adopt and implement new interventions. Determinant frameworks identify several outer setting-level factors such as funding streams, inter-organizational relationships, and peer pressure. However, these frameworks do not explain how or why outer-setting factors influence implementation. To advance research in this area, we argue for the importance of deriving theory-based propositions from organization theory to explain how outer setting factors influence organizations. Drawing on the work of the Organization Theory in Implementation Science (OTIS) project, we identified 20 propositions from five classic organization theories-Complexity Theory, Contingency Theory, Institutional Theory, Resource Dependence Theory, and Transaction Cost Economics. We then applied those propositions to hypothesize relationships among outer setting factors, implementation strategies, and implementation outcomes in five case studies of evidenced-based tobacco control interventions. The five case studies address the implementation of smoke-free policies, community health worker-led tobacco education and cessation programs, 5 A's (Ask, Advise, Assess, Assist, and Arrange), point-of-sale tobacco marketing policy interventions, and quitlines. The case studies illustrate how propositions may be used to guide the selection and testing of implementation strategies. Organization theories provide a menu of propositions that offer guidance for selecting and optimizing high-leverage implementation strategies that target factors at the level of outer setting. Furthermore, these propositions suggest testable hypotheses regarding the mechanisms underlying the influence of outer-setting factors on how and why organizations adopt and implement interventions.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mary Wangen
- Center for Health Promotion / Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michelle Kegler
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health of Emory University, Atlanta, GA, United States
| | - Matthew Lee
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Meghan C O'Leary
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Linda K Ko
- Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
| | - María E Fernández
- Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, United States
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Tolou-Shams M, Holloway ED, Ordorica C, Yonek J, Folk JB, Dauria EF, Lehn K, Ezimora I, Wiley HMF. Leveraging Technology to Increase Behavioral Health Services Access for Youth in the Juvenile Justice and Child Welfare Systems: a Cross-systems Collaboration Model. J Behav Health Serv Res 2022; 49:422-435. [PMID: 35835953 PMCID: PMC9282614 DOI: 10.1007/s11414-022-09808-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 01/07/2023]
Abstract
Behavioral health services access for justice- and child welfare-involved youth is limited despite significant need. Structural interventions to address limited access are nascent. Technology can advance access, but few interventions focus on system-impacted youth and their mental health needs and challenges. This article describes the development, process, and initial outcomes of the Youth Justice and Family Well-Being Technology Collaborative (JTC) that was formed to leverage technology within and across public health and justice-related systems to promote increased behavioral health services access. Cross-system considerations are identified for public health, court, and other key stakeholders to successfully integrate technology into practice to expand access to these critical services.
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Affiliation(s)
- Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General, University of California, 1001 Potrero Ave, Bldg. 5, 7M, San Francisco, CA, 94110, USA.
| | - Evan D. Holloway
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General, University of California, 1001 Potrero Ave, Bldg. 5, 7M, San Francisco, CA 94110 USA
| | - Catalina Ordorica
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General, University of California, 1001 Potrero Ave, Bldg. 5, 7M, San Francisco, CA 94110 USA
| | - Juliet Yonek
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General, University of California, 1001 Potrero Ave, Bldg. 5, 7M, San Francisco, CA 94110 USA
| | - Johanna B. Folk
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General, University of California, 1001 Potrero Ave, Bldg. 5, 7M, San Francisco, CA 94110 USA
| | - Emily F. Dauria
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA USA
| | - Kristiana Lehn
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General, University of California, 1001 Potrero Ave, Bldg. 5, 7M, San Francisco, CA 94110 USA
| | - Ifunanya Ezimora
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General, University of California, 1001 Potrero Ave, Bldg. 5, 7M, San Francisco, CA 94110 USA
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Freisthler B, Maguire-Jack K, Yoon S, Dellor E, Wolf JP. Enhancing Permanency in Children and Families (EPIC): a child welfare intervention for parental substance abuse. BMC Public Health 2021; 21:780. [PMID: 33892671 PMCID: PMC8063333 DOI: 10.1186/s12889-021-10668-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background Across Ohio, parental substance abuse has contributed to a marked increase in the number of children in foster care. Children exposed to parental substance use have a higher likelihood of physical abuse and neglect, and consequently a variety of physical, psychological and cognitive problems. The Enhancing Permanency in Children and Families (EPIC) program is a collaborative effort between the Ohio State University College of Social Work, two county offices of the Ohio Department of Job and Family Services, two juvenile courts and local behavioral health agencies. The goal of EPIC is to use three evidence-based and evidence-informed practices to reduce abusive and neglectful parenting, reduce addiction severity in parents, and improve permanency outcomes for families involved with the child welfare system due to substance abuse. Methods EPIC is a quasi-experimental study. Under the program, child welfare-involved adults who screen positive for substances are matched with a peer recovery supporter. Participants are also incentivized to participate in family treatment drug court, medications for opioid use disorders and home-based parenting supports. Participating adults (N = 250) are matched with comparison groups from counties participating in a separate intervention (Ohio START) and to those receiving treatment as usual, resulting in a final sample of 750 adults. Primary outcomes including addiction severity, child trauma symptoms, resilience, and attachment are assessed at baseline and at program completion. Additional outcomes include timely access to treatment services, length of placement in out-of-home care and recidivism into the child welfare system. Discussion This intervention formalizes cross-system collaboration between child welfare, behavioral health and juvenile courts to support families affected by addiction. The use of three evidence-based or evidence-informed strategies presents the opportunity to determine specific strategies that are most effective for reducing addiction severity. Lastly, the intervention combines several sources of funding to bolster sustainability beyond the life of the Regional Partnership Grant (RPG). Trial registration NCT04700696. Registered January 7, 2021-retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10668-1.
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Affiliation(s)
- Bridget Freisthler
- College of Social Work, The Ohio State University, 208 Stillman Hall, 1947 College Road, Columbus, OH, 43210, USA
| | | | - Susan Yoon
- College of Social Work, The Ohio State University, 208 Stillman Hall, 1947 College Road, Columbus, OH, 43210, USA
| | - Elinam Dellor
- College of Social Work, The Ohio State University, 208 Stillman Hall, 1947 College Road, Columbus, OH, 43210, USA.
| | - Jennifer Price Wolf
- Division of Social Work, Sacramento State University, Sacramento, California, USA.,Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California, USA
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Whitaker RG, Sperber N, Baumgartner M, Thiem A, Cragun D, Damschroder L, Miech EJ, Slade A, Birken S. Coincidence analysis: a new method for causal inference in implementation science. Implement Sci 2020; 15:108. [PMID: 33308250 PMCID: PMC7730775 DOI: 10.1186/s13012-020-01070-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/01/2020] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- Rebecca Garr Whitaker
- Duke-Margolis Center for Health Policy, 100 Fuqua Drive, Box 90120, Durham, NC 27708 USA
| | - Nina Sperber
- Duke University School of Medicine, Department of Population Health Sciences, 215 Morris Street, Durham, NC 27701 USA
| | - Michael Baumgartner
- University of Bergen, Department of Philosophy, Postboks 7805, 5020 Bergen, Norway
| | - Alrik Thiem
- University of Lucerne, Frohburgstrasse 3, P.O. Box 4466, 6002 Lucerne, Switzerland
| | - Deborah Cragun
- Department of Global Health, College of Public Health, University of South Florida, 3802 Spectrum Boulevard, Tampa, FL 33612 USA
| | - Laura Damschroder
- VA Ann Arbor Center for Clinical Management Research, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 18, Ann Arbor, MI 48109-2800 USA
| | - Edward J. Miech
- Center for Health Services Research, Regenstrief Institute, 1101 West 10th Street, Indianapolis, IN 46202 USA
| | - Alecia Slade
- Avalere Health, 1201 New York Avenue NW, Suite 1000, Washington, DC 20005 USA
| | - Sarah Birken
- Department of Implementation Science, Wake Forest School of Medicine, 525@Vine Room 5219, Medical Center Boulevard, Winston-Salem, NC 27157 USA
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