Core Components and Implementation Determinants of Multilevel Service Delivery Frameworks Across Child Mental Health Service Settings.

Multilevel service delivery frameworks are approaches to structuring and organizing a spectrum of evidence-based services and supports, focused on assessment, prevention, and intervention designed for the local context. Exemplar frameworks in child mental health include positive behavioral interventions and supports in education, collaborative care in primary care, and systems of care in community mental health settings. Yet, their high-quality implementation has lagged. This work proposes a conceptual foundation for multilevel service delivery frameworks spanning diverse mental health service settings that can inform development of strategic implementation supports. We draw upon the existing literature for three exemplar multilevel service delivery frameworks in different child mental health service settings to (1) identify core components common to each framework, and (2) to highlight prominent implementation determinants that interface with each core component. Six interrelated components of multilevel service delivery frameworks were identified, including, (1) a systems-level approach, (2) data-driven problem solving and decision-making, (3) multiple levels of service intensity using evidence-based practices, (4) cross-linking service sectors, (5) multiple providers working together, including in teams, and (6) built-in implementation strategies that facilitate delivery of the overall model. Implementation determinants that interface with core components were identified at each contextual level. The conceptual foundation provided in this paper has the potential to facilitate cross-sector knowledge sharing, promote generalization across service settings, and provide direction for researchers, system leaders, and implementation intermediaries/practitioners working to strategically support the high-quality implementation of these frameworks.

Wraparound Team Composition, Youth Self-determination, and Youth Satisfaction in Transition Services.

Wraparound, a team-based planning process for youth and families, has been widely adopted in school-based services for older adolescents and emerging adults with serious mental health conditions transitioning to adulthood. Reservations have been voiced, however, regarding possible drawbacks of teams for these youth, including concerns about difficulties with involving supportive adults, and whether youth might perceive team-based planning as a threat to their developing autonomy. To date, however, no studies have examined the feasibility of involving supports in teams and relationships between team composition and youth's service experiences. The present study examined the relationships between team composition and youth's perceptions of self-determination and service satisfaction among 36 youths in seven school-based programs using a specialized form of wraparound for transition services. Findings showed that meeting participation by caregivers and professionals from both inside and outside of schools was common and that regular participation by combinations of these types of adults was related to youth self-determination and satisfaction.