DOI: 10.1177/26334895261499392 ISSN: 2633-4895

Team Influences on Implementation Outcomes: A Mixed-Methods Study of Rural Children's Advocacy Centers

Elizabeth A. McGuier, Jaely D. Wright, Kristine A. Campbell, David J. Kolko, Brooks R. Keeshin, Lindsay D. S. Abdulahad, Kara A. Byrne, Gregory A. Aarons
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Background

Teamwork influences implementation processes and outcomes, but knowledge of how specific dimensions of teamwork affect implementation is limited. We used explanatory sequential mixed methods to examine how teamwork influenced implementation outcomes in rural Children's Advocacy Center (CAC) multidisciplinary teams.

Method

CACs across a single state implemented the Care Process Model for Pediatric Traumatic Stress (CPM-PTS), a mental health screening/referral protocol. We purposively sampled six rural/frontier CACs with variability in reach and interviewed team members in each CAC ( N  = 24). Interview data were coded for potential influencing factors, which were then categorized as general teamwork or innovation-specific teamwork. Influencing factors at each CAC were rated as negative, mixed, or low/moderate/high positive. Ratings and implementation outcomes were organized into a sortable matrix and color-coded to identify patterns. Qualitative and quantitative findings were integrated in a joint display.

Results

Both general and innovation-specific teamwork were related to implementation outcomes. Problems in affective/behavioral functioning (e.g., trust, conflict management) impaired implementation efforts. Shared goals facilitated faster time to adoption, especially when the CPM-PTS was viewed as advancing the team's goals. Teams with better overall performance achieved better reach. Team members were generally supportive of the CPM-PTS despite limited knowledge, but their knowledge and beliefs had little influence on implementation outcomes. Sites where screening results were intentionally and consistently shared with team members had better reach and a quicker time to adoption than sites where results were intentionally or passively withheld from team members.

Conclusions

In team-based service settings, team performance and shared goals facilitate better implementation outcomes. Positive affective/behavioral functioning may be a necessary precondition for successful implementation but insufficient on its own to improve outcomes. Teams that already work closely together may seek more active involvement in new practices, and their involvement can enhance implementation outcomes.

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