title: A mixed methods multiple case study of implementation as usual in children's social service organizations: study protocol.
abstract: BACKGROUND
  Improving quality in children's mental health and social service settings will require implementation strategies capable of moving effective treatments and other innovations (e.g., assessment tools) into routine care. It is likely that efforts to identify, develop, and refine implementation strategies will be more successful if they are informed by relevant stakeholders and are responsive to the strengths and limitations of the contexts and implementation processes identified in usual care settings. This study will describe: the types of implementation strategies used; how organizational leaders make decisions about what to implement and how to approach the implementation process; organizational stakeholders' perceptions of different implementation strategies; and the potential influence of organizational culture and climate on implementation strategy selection, implementation decision-making, and stakeholders' perceptions of implementation strategies.
  
  
  METHODS
  This study is a mixed methods multiple case study of seven children's social service organizations in one Midwestern city in the United States that compose the control group of a larger randomized controlled trial. Qualitative data will include semi-structured interviews with organizational leaders (e.g., CEOs/directors, clinical directors, program managers) and a review of documents (e.g., implementation and quality improvement plans, program manuals, etc.) that will shed light on implementation decision-making and specific implementation strategies that are used to implement new programs and practices. Additionally, focus groups with clinicians will explore their perceptions of a range of implementation strategies. This qualitative work will inform the development of a Web-based survey that will assess the perceived effectiveness, relative importance, acceptability, feasibility, and appropriateness of implementation strategies from the perspective of both clinicians and organizational leaders. Finally, the Organizational Social Context measure will be used to assess organizational culture and climate. Qualitative, quantitative, and mixed methods data will be analyzed and interpreted at the case level as well as across cases in order to highlight meaningful similarities, differences, and site-specific experiences.
  
  
  CONCLUSIONS
  This study is designed to inform efforts to develop more effective implementation strategies by fully describing the implementation experiences of a sample of community-based organizations that provide mental health services to youth in one Midwestern city.
authors: Brown School, Washington University in St, Louis, Campus Box 1196, One Brookings Drive, St, Louis, MO 63130, USA. bjpowell@wustl.edu
authors: Byron J
authors: BJ
authors: Powell
authors: Enola K
authors: EK
authors: Proctor
authors: Charles A
authors: CA
authors: Glisson
authors: Patricia L
authors: PL
authors: Kohl
authors: Ramesh
authors: R
authors: Raghavan
authors: Ross C
authors: RC
authors: Brownson
authors: Bradley P
authors: BP
authors: Stoner
authors: Christopher R
authors: CR
authors: Carpenter
authors: Lawrence A
authors: LA
authors: Palinkas
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D003659:Decision Making, Organizational; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D015279:Organizational Culture; D010465:Perception; D012947:Social Work; D013223:Statistics as Topic; D014481:United States
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