Advancing Collaborative Practice Between Substance Abuse Treatment and Child Welfare Fields: What Helps and Hinders the Process?

Abstract

This study explores factors that facilitate and impede the process of developing successful collaboration between child welfare, substance abuse treatment, and dependency courts based on in-depth qualitative interviews with professionals (N = 49) from five California counties. Findings describe specific preconditions, organizational changes, and operational factors in the development of successful collaboration. Study participants also described factors that hindered collaborative practice, such as problems in cross-systems communication and fragmentation of services, as well as strategies that were employed to address or minimize these problems. Findings underscore the value of “lessons learned” from communities that have established successful collaborative programs, policies, and practices.

Keywords:

• child welfare
• substance abuse treatment
• collaboration
• qualitative methods
• family
• social services

INTRODUCTION

Research on families in child welfare, parents in treatment, and families of substance-exposed infants suggests that a majority of families involved or at risk for involvement in the child welfare system in the United States are impacted by parental substance abuse problems (Boles, Young, Moore, & DiPirro-Beard, 2007; Carter & Myers, 2007; Connell-Carrick, 2007; Smith, Johnson, Pears, Fisher, & DeGarmo, 2007; Vanderploeg, Caron, Saunders, Katz, & Tebes, 2007; Young, Boles, & Otero, 2007). Concern over the correlation between substance abuse and child welfare, as well as growing recognition of the importance of consistency in caretaking in child development, has generated a number of policy changes on both national and state levels. The Adoption and Safe Families Act (ASFA), which was enacted in 1997 and reauthorized in 2003, accelerates permanent placements of children in foster care, and amendments to the Child Abuse Prevention and Treatment Act (CAPTA) require that states have a mechanism in place to refer parents of substance-exposed infants to child welfare services for assessment (Young et al., 2007). Some states in the United States have also enacted legislation that allows for further expedited permanency planning for children who meet specific criteria. Methamphetamine use and manufacturing has been identified as a growing challenge to child welfare systems, which require community-based collaborative response and innovation in child welfare practices (Altschuler, 2005; Connell-Carrick, 2007). These recent changes in national and state law that limit timelines for potential reunification, combined with the high prevalence of children of substance abusing families in out-of-home placements, underscore the importance of improving cross-systems collaboration; however, collaboration between systems remains challenging (Green, Rockhill, & Burrus, 2008; Semidei, Feig-Radel, & Nolan, 2001; Smith & Mogro-Wilson, 2008; U.S. Department of Health and Human Services, 1999; Young, Gardner, & Dennis, 1998; Young et al., 2007).

There is some indication that state efforts to address potential problems in the context of ASFA may have increased access to substance abuse treatment for mothers and reduced children's time in foster care (Green, Rockhill, & Furrer, 2006; Rockhill, Green, & Furrer, 2007). Specific models of collaborative practice appear promising in terms of positive outcomes for both parental treatment participation and parent-child reunification, including dependency drug courts (Boles et al., 2007; Green, Furrer, Worcel, Burrus, & Finigan, 2007; Worcel, Furrer, Green, Burrus, & Finigan, 2008); intensive case management with recovery coaches (Choi & Ryan, 2007; Marsh, Ryan, Choi, & Testa, 2006; Ryan, Marsh, Testa, & Louderman, 2006); comprehensive treatment programs for women that address parenting concerns and other specific needs of parents (Carlson, 2006; Grella, Needell, Shi, & Hser, 2009; Kerwin, 2005); and use of multidisciplinary teams and family group conferencing (O'Connor, Morgenstern, Gibson, & Nakashian, 2005; Osterling & Austin, 2008). Evidence-based practices also include use of out-stationed experts in addiction treatment and child welfare systems and home visitation (Osterling & Austin, 2008). Effective cross-systems collaboration are often formalized through institutionalization of formalized interagency agreements, cross-training, and information exchange systems (Hunter, 2003; Osterling & Austin, 2008).

Despite evidence that these models hold promise, few studies explicitly examine factors that may facilitate or impede the development of collaborative models and systems changes related to working with families with alcohol and drug problems who are concurrently involved in the child welfare system. Studies from different large states in the United States have used different survey instruments to examine factors that influence collaboration based on data from purposive samples of both child welfare and substance abuse treatment professionals (Drabble, 2007; Smith & Mogro-Wilson, 2007, 2008). Smith and Magro-Wilson (2007, 2008) found that both individual and organizational variables predicted collaboration, but that individual level variables were particularly important, including knowledge and skills related to collaboration, perceived advantages of collaboration, and perceived number of pro-collaboration policies. Drabble (2007) found both commonalities and differences in values and beliefs between substance abuse and child welfare respondents, as well as greater perceived capacity for collaborative practice in counties with a strong history of collaboration compared to counties earlier in the process of developing collaborative policies and practices. Green, Rockhill, and Burris (2008) examined the role of interagency collaboration between systems based on interviews from key informants in a medium-size city two years after implementation of ASFA. This study found that collaboration served to benefit families through facilitating development of shared values across systems, improving communication, and creating team approaches to support of families. At the same time, providers across systems described ongoing challenges such as misunderstanding between systems, time pressures related to ASFA, and confidentiality concerns.

Although studies on collaboration based on survey data provide useful insights about individual- and systems-level factors associated with collaborative practice, cross-sectional survey designs do not allow for capturing the rich descriptive information about underlying factors and dynamics that have both helped and hindered the development of successful collaboration on policy, program, and practice levels. Studies based on qualitative data from a specific program, a single region, or collaborative endeavors early in development may miss important themes related to factors that facilitate or impede successful collaboration across sites and over a longer period of time.

This study was designed to examine cross-systems collaboration between child welfare, substance abuse treatment, and court systems based on the experience of professionals across five regions in California in which formalized collaborative policies and programs had been developed successfully over time. The study explored the following research questions: What are the factors that facilitated the development of successful collaboration? What are the factors that hindered the development of successful collaboration and how were these overcome?

METHODS

Research Design and Sample

In-depth interviews were conducted with a purposive sample of managers and line staff from difference disciplines including child welfare, substance abuse treatment, and dependency courts who worked in counties with formalized collaborative policies, programs and practices. Recruitment of subjects took place in two phases. First, five counties were recruited for the study based on two criteria: 1) a long history of developing cross-systems collaboration, including adoption of formal collaborative programs, and 2) participation in an earlier study related to cross-systems collaboration based on survey data. Administrators from child welfare and alcohol and drug treatment systems in each county were contacted about the study and all invited counties agreed to participate in the study. For the second phase of recruitment, purposive sampling was used to identify prospective interviewees in each county who had been involved in the evolution of collaborative policy and program development in their county. Prospective interviewees from child welfare, alcohol and drug treatment fields, or other systems were identified through recommendations from key contacts in each county. Prospective interviewees were then contacted by email and/or phone to inform them of the purpose of the study and to invite their participation. Prospective interviewees who did not respond to initial contacts received follow-up emails and phone calls to invite their participation in the study. Only three prospective interviewees (out of 52 individuals contacted) did not respond to communications or declined to participate in the study.

Close to half of the 49 interviewees in the final sample were primarily in the alcohol and drug field (49%, n = 24), over one-third were primarily from child welfare (34.7%, n = 17), and approximately 16% (16.3%, n = 8) were from other fields including the courts or liaison positions between substance abuse, child welfare, and court systems. Approximately 34.8% of all respondents worked in positions that specifically entailed collaborative work or out-stationed work in other fields.

Interview Guide & Data Collection Procedures

The interviews were typically conducted over the phone and took between 45 to 90 minutes. Five interviews were conducted in person. Interviews were structured using an interview guide with seven open-ended questions and several probe questions in the following broad areas: 1) history and structure of local collaborative practices, 2) factors that helped collaboration develop, 3) factors that hindered collaboration, 4) formal and informal mechanisms to facilitate collaboration, 5) reflection on a specific success in collaboration, 6) reflection on a problematic incident in collaboration, and 7) strategies for communicating between systems in daily practice. Interviews were taped with the permission of the interviewee and later transcribed for analysis. The interview guide was developed in consultation with key informants from each system and with special attention to issues identified in analysis of survey data from an earlier study including the same counties (Drabble, 2007).

Analysis

A content analysis of the interviews was conducted to identify key themes across respondents from different counties related to specific factors that have helped or hindered progress toward development of collaborative partnerships between child welfare and substance abuse. Transcribed data were managed with the assistance of a qualitative software program (NUD*IST). Themes were created by developing a provisional coding scheme based on interview observation notes and applying them to the first 10 interviews. The first level of coding was performed by the author and then reviewed by another member of the research team, allowing for comparison to enhance reliability. Initial open coding to conceptualize, compare, and categorize data was followed by an iterative process to further define and identify connections between categories in the data (Strauss, 1987; Strauss & Corbin, 1990). Categories were revised and subcategories were created based on emerging themes from the interview data.

FINDINGS

What are the Factors that Facilitate Development of Collaborative Policies, Practices, and Programs?

Preconditions for collaboration

Four primary themes emerged in relation to essential factors in the origins and early evolution of successful collaboration.

History of prior local collaboration

Respondents who worked as professionals in child welfare or alcohol and drug service delivery systems before the inception of formal collaborative models typically traced the lineage of their innovative programs to earlier cross-system collaboration. For example, a manager in one county described how collaboration with child welfare grew out of cross-trainings initiated by the county alcohol and drug program administration in support of new local treatment services designed for pregnant and parenting women. The cross-trainings brought together leaders and providers in different systems and, over time, leaders identified gaps between substance abuse and child welfare fields as a priority. Respondents in another county described collaborations between child welfare and mental health fields as providing a foundation for collaborative planning that bridged to the substance abuse field.

Leaders and champions

Early innovations were often advanced by the vision and initiative of individuals in leadership. The source of innovation varied between counties. In one county, a dependency court judge sought information about collaborative models and strongly advocated for adoption of a dependency drug court and related collaborative case management services. The director of health and human services in another county required that all social service providers be trained in understanding and intervening in substance abuse. The training initiative was coordinated by managers who were invested in this vision and, in turn, identified additional opportunities to create institutional policies and programs to address alcohol and drug problems among clients in child welfare. Similarly, a direct service provider in the substance abuse treatment field in a third county also described the importance of leadership provided by the county child welfare director, which was ultimately supported fully by the alcohol and drug administrator: “You need a true champion who really understands the problem from the client level; without that, the vision gets lost.”

Leadership at multiple levels was described as crucial to the development, and the maintenance, of collaborative efforts. Respondents made comments like, “You also need people on the second and third levels of staffing to see the value of collaboration,” and “It can ruin the collaboration to include the wrong people in leadership; you can tell if they are going along because they are your subordinate or if they are really into it.” Interviewees also frequently named specific collaborative leaders and line staff whose credibility and integrity were viewed as critical to successful collaboration.

Matching collaboration to mission

A majority of respondents also described a process of recognizing that collaboration was essential to realizing the mission of their service delivery system or program. Whether described as an individual epiphany or a collective realization, respondents articulated a turning point that involved the willingness to step outside “organizational comfort zones,” fueled by the belief that systems and practices could be better aligned to promote better client outcomes. Respondents often described their individual or collective motivation to make changes in their organizations as grounded in the recognition that “what we were doing was just not working” and therefore was no longer tolerable. In addition to its role in the formative stages of collaboration, respondents described the connection to the mission of the organization as the primary “selling point” to encourage other managers, staff, and service providers to embrace the collaborative process and become willing to invest time and other resources into collaborative planning and programming. Several interviewees described how pivotal this point was in overcoming resistance among staff members who were skeptical of collaborations and “who felt 'We've done this before and it hasn't worked, so why bother?” ' Some even described the shift in attitudes among resistant staff in terms of a sudden conversion: “Even the most cynical worker gets that parents can recover when they come to a graduation.”

Commitment from both fields

Another important pre-condition for collaboration and factor for continued collaboration was described as a genuine commitment to collaboration from leaders and representatives from both fields. Although the impetus for collaboration might originate from child welfare/social services, substance abuse treatment, or courts, interviewees often described an early process by which stakeholders in multiple systems commit to the collaborative process. This was also important to ongoing collaboration, and some interviewees observed that momentum for collaborative policies and programs were stalled in their county when there was a change in key leadership positions. In these cases, leaders in other fields once again acted as “champions” by advocating for continued or renewed collaboration.

There were several themes that emerged across interviews describing key factors involved in the successful evolution of collaborative policies and programs between child welfare, substance abuse treatment, and dependency courts systems. Some of these involved organizational change and some involved changed or new operational processes to support the organizational change. Themes in these two broad categories are described below.

Themes about organizational factors for advancing collaboration

Technology transfer

Adoption of specific collaborative program models was often based on innovative models from other counties or states. Interviewees frequently pointed to obtaining information and ideas from other counties or states as pivotal to the adoption of new policies and development of specific programs. In several instances, leaders in different counties visited programs in other states or counties, such as drug dependency courts, to research how such models might be adopted or adapted in their own settings. In turn, some of the respondents described hosting visitors from other parts of the state and country who were interested in starting their own collaborative programs. Respondents from different counties also described obtaining sample policy documents to inform their own work, such as a written memorandum of understanding.

Adoption of specific models for collaboration

All the interviewees pointed to specific models that were institutionalized in their counties to improve access to treatment, improve reunification rates, and expedite permanent placement for children who are not able to reunify with biological parents. Interviewees described the underlying processes that facilitated adoption and expansion of collaborative programs. Several interviewees stressed the importance of selecting a specific program or model to implement in order to initiate, solidify, and grow county collaboration. One manager captured the tone of many of these remarks when reflecting on lessons learned from the local county: “Start small, meaning that if you want to start collaborative efforts, don't start four at the same time. People need to get successes and then build on them.” The starting place for models adopted in different counties generally began with recognition of a gap perceived as pressing by leaders in one or more systems. For example, in one county a dependency court judge took a sabbatical to explore drug dependency court models and subsequently enlisted the support of administrators in child welfare and substance abuse fields to initiate changes in the county.

Interviewees generally described a growing constellation of programming. For example, one county that created a single out-stationed alcohol and drug intervention expert in dependency court later institutionalized this model by hiring other specialists to provide similar intervention services in different regions. Other “gaps” were noted by participants in the collaborative planning process and ideas were generated and eventually funded, including a residential treatment program for parenting women with substance abuse problems who were concurrently involved in child welfare. Early programs were institutionalized and documented successes could, in turn, be used to support proposals for additional funding for expanded or new programming from county, foundation, or federal sources. In many cases, these programs had blended funding or, at minimum, required investment of time or other resources from both child welfare and substance abuse treatment fields.

Formal and informal mechanisms for planning problem solving

One of the key elements for successful collaboration identified by interviewees involved institutionalized mechanisms for both planning and problem solving. All interviewees described some form of ongoing collaborative planning group, which included stakeholders from multiple systems. Formal collaborative groups were crucial to the development of new ideas, planning concrete activities such as trainings, identifying potential problems and solutions in ongoing programs, and ensuring continuity and accountability in service provision.

Members of collaborative groups often pointed to specific facilitators or leaders that helped guide the collaborative group through various phases of formation, maintenance, and change. The group leaders were not necessarily the individuals who initiated collaborative efforts in their counties, but they were recognized by members as having a crucial role in the success of the groups. Having representation from all key systems was identified as essential to the success of collaborative groups. As part of the formal planning and problem-solving process, a number of interviewees commented on the importance of making clear how decisions are made and who has authority to make decisions. A few interviewees specifically noted that it was important that individuals assigned to collaborative committees have the authority to make decisions and commitments for their department or agency. At minimum, successful collaborative efforts required that liaisons to committees had access to decision makers who could provide timely responses to requests. In addition to core collaborative planning groups, interviewees described different models for collaborative case planning such as team decision making (TDM), multidisciplinary case planning meetings, and family case conferencing. Successful systems level collaboration was informed, in part, by feedback from interdisciplinary case planning groups. For example, several counties described initiating systems changes based on problems or gaps that emerged during interdisciplinary case planning sessions.

In addition to these formal mechanisms for collaboration, interviewees stressed the importance of individuals, typically direct line staff, in serving as mediators between systems. Out-stationed staff members who had developed relationships and credibility with programs and people in child welfare, treatment, and the courts were often identified as key players in mediating conflicts about specific cases or facilitating improved communication between systems. One interviewee noted that, “They have relationships on both sides of the house and they are highly regarded by everyone.”

Training and cross training

One of the important processes for building and maintaining collaboration involved continued training and cross training. Interviewees pointed to the importance of professionals in both systems understanding the mandates, policies, practices, and constraints of other system(s). In addition, training was used to prepare professionals in both fields to work successfully in relation to specific collaborative programs and practices. Several interviewees described trainings as critical for fostering values that support collaborative practice and provide an opportunity for people from various systems to develop relationships with colleagues from multiple fields. In this context, training was viewed as an important vehicle for fostering a culture of collaboration beyond the participants in formal collaborative committees.

Interviewees also pointed to specific ways that they used trainings to strategically advance collaborative practice or address barriers to collaboration specific to their own system or to the developmental phase of their collaborative efforts. For example, one county described how they used training about their newly adopted memorandum of understanding (MOU) to both inform providers about the provisions of the document and overcome potential resistance. In this case, training for alcohol and drug service providers (who had expressed skepticism about the MOU) included a presentation from a respected director of a local treatment agency that had experienced success with clients as a result of piloting the MOU. As described by the interviewee, the training was used to help answer the question: “How do we make this a win-win for clients? And by doing so, we make it a win for the agencies.” In the context of larger systems collaboration, many interviewees also described training as important to giving and receiving feedback with provider networks. Trainings provided an opportunity for collaborative leaders to communicate about evolving programs, planning, and policies, and to learn about emerging issues from community partners.

Themes about the everyday workings of collaboration: communication, relationship building, and creating a culture of learning

Development of communication protocols

Across all counties, respondents described the critical role of developing specific mechanisms for communication between fields. On a macro level, agreements about policy-level communication and conflict resolution were spelled out through a written memorandum of understanding (MOU) between fields. County level MOUs were described by many interviewees as an important tool for documenting formal agreements between fields that could then be articulated to providers and line practitioners. Some interviewees pointed to the utility of the MOU when leadership changed in the county. On a day-to-day practice level, each county developed an array of mechanisms to facilitate communication between fields. Release of information forms as well as protocols for obtaining signed forms (e.g., that professionals from both fields would take responsibility for obtaining forms) were described as important tools for collaboration.

Confidentiality requirements, particularly in substance abuse treatment as mandated by federal law, were described as an initial challenge that was overcome, in part, with development of appropriate release forms and training of staff about effective use of forms. A number of interviewees described embarking on a process to address issues of trust concurrent with adoption of communications and protocols, such as discussion of concerns about confidentiality and about how information would be used. For example, if substance abuse providers were to notify child welfare about a positive drug test, stakeholders worked to come to an agreement about how that information would be interpreted in relation to both substance abuse treatment and child safety goals. Finally, respondents described the development of progress report forms to facilitate communication between treatment programs and professionals in both child welfare and dependency courts. Frequently, these report protocols were implemented along with protocols for ensuring accuracy and accountability for the content of reports. The credibility of reports was perceived as critical to the functioning of collaborative processes.

Building relationships

One of the critical processes for successful collaboration involved developing and maintaining good working relationships between multiple stakeholders. Interviewees often identified specific leaders in their counties who were respected and who were perceived as instrumental in the success of collaborative program development and problem solving. These individuals were often facilitators, co-facilitators, or key members of collaborative planning groups. Relationship building within and between all levels of the organization was described as important to the success of collaborative efforts, from administration/management to collaborative planning group members to key line staff in each system. Several interviewees emphasized the importance of role-modeling productive collaborative relationships among leaders from substance abuse treatment and child welfare fields. As a case in point, several interviewees from both child welfare and substance abuse treatment in one county noted that prior to formal collaboration, it had become normative for child welfare staff to dismiss input from substance abuse treatment professionals, in part, because of differences in training (e.g., child welfare staff typically had master's in social work degrees and substance abuse treatment staff typically had certification as substance abuse counselors and life experience but not formal degrees). Interviewees noted that this dynamic began to change when a respected manager and co-facilitator of the collaborative “modeled respect” for her colleagues from the alcohol and drug field, “stood up for people from the alcohol and drug treatment field,” and “made it clear that [AOD staff] were the experts.”

Acculturation to collaborative practice

Interviewees across sites and systems noted the importance of sustaining collaboration and described how existing and new staff were acculturated to collaborative norms of practice through training, supervision, coaching from key staff in liaison positions, and through modeling from peers. Several respondents observed that orienting new staff was not a major challenge once collaborative models were institutionalized because “when new people come on and get trained for their position, it's not an issue, it's just the way that things are done.” Interviewees also described the importance of creating a culture within their collaborative groups and organizations that allowed them to continue learning and problem solving. Some respondents pointed to mixed results in this area and expressed frustration over some systemic issues that had yet to change in permanent or meaningful ways and that might “get worse before it gets better” (such as heavy case loads, barriers to blended funding, and gaps in staff training or supervision to ensure competence in collaborative practice and working with different cultural groups).

What hinders collaborative practice?

Conflicts in values, perspectives and expectations

Interviewees described conflicts between systems and stakeholders who were part of systems as a major issue, particularly in the early stages of collaboration. The conflicts that interviewees described included differences in focal system (e.g., child or adult); mistrust between professionals; confusion about different constraints, mandates, and operations in other systems; and even hostility toward other systems. In general, interviewees described processes in which these differences were surfaced and addressed in group settings, such as collaborative meetings. In some cases, discussion of different values and expectations were facilitated directly. For example, in one county the collaborative team developed a written list of core values to guide their work. In other counties, these issues were addressed even if not labeled as such. “You don't just sit down and say we are going to do values clarification,” observed one county manager. “We just identified projects that needed to be done and in the process we would see some of the values issues … we would even have some heated discussions. Ultimately, we had to work these through to get on with the mission of collaboration.” Some of the specific conflicts in values mentioned by interviewees included concerns from child welfare about whether or not alcohol and drug staff would “protect” parents over concern about child safety, resistance from both child and adult attorneys to advocate for their clients in a collaborative context, concern from alcohol and drug treatment providers as well as child welfare staff about incarceration as a consequence for non-compliant parents, and differences in perception of parents who use substances or who relapse. The narratives from interviewees described a deliberate and sometimes difficult process of “starting up and then going through an evolution” that often began in a context where “everyone wanted to protect their turf and seemed out for their own agencies” and required “a lot of discussion that increased understanding and awareness of different disciplines.”

Communication problems

“The biggest barrier was working out communication systems,” noted one manager. Similar concerns were echoed in nearly all interviews. One concrete issue mentioned by multiple interviewees had to do with developing communication protocols that were consistent with federal regulations designed to protect the privacy of clients in substance abuse treatment. “We had a hard time sharing about specific cases,” observed one interviewee. “Other fields have confidentiality requirements, but alcohol and drug treatment requirements are more restrictive. We needed to develop written releases that allowed for communication … this was a major hurdle.” Interviewees noted that communication protocols were important to collaboration, but that identification of problems or “glitches” in communication, brainstorming of ideas for remedying them, and follow up by supervisors remained an important role for collaborative planning groups.

Funding challenges

Issues in funding and human resources were a universal barrier to collaboration. County departments and community-based nonprofit organizations described by interviewees were already “stretched” in relation to case loads and other staff responsibilities. “If programs are stretched on staffing, every agency wants to take care of their own business first,” typified remarks related to this problem. The demands on staff were perceived as a barrier to participation in collaborative planning and programming, at least until “they get that participating can, in the end, make their job easier or more effective.” Several counties described collaborative efforts reduced because of budget cuts. Interestingly, none of the counties facing severe funding cuts completely eliminated collaborative programs once they were established. Instead, in several counties, collaborative members worked collectively to determine how to prioritize services and maintain core elements of their collaborative models in the context of reduced funding. Although these processes were painful, the collaborative process was used to reduce harm to services (and, by extension, clients) and, in one county, to identify alternative funding for a core collaborative staff position.

Fragmentation of systems

Interviewees noted that fragmentation of services was often a barrier to collaboration. Some counties, particularly smaller counties, worked to reduce fragmentation by creating co-located services. Collaborative planning groups in counties of all sizes functioned to identify strategies to address disconnections and communication problems between systems. However, core dynamics in which service delivery systems remain in “silos” because of separate funding, mandates, and staff were persistent issues that needed to be addressed, not only for substance abuse and child welfare systems, but also for other systems such as probation, public health, mental health, and domestic violence services.

Individual personalities

Many interviewees described the powerful influence that individuals could have on the success of collaborations—both helpful and harmful. Several interviewees described the problems that evolved in collaborative planning groups or processes when one or more key players behaved in a disruptive manner or held values or attitudes that were not conducive to collaboration. Interviewees stressed the importance of developing respectful norms in their collaborative groups. In some instances, members would rely on informal strategies to “work around” problem members or would consider group processes that would allow for surfacing and solving issues that may be a collective problem amplified by specific individuals. In some cases, individuals could have a powerful role in impeding the advancement of collaboration. For example, interviewees in one county described a judge who was skeptical of substance abuse treatment and was, in effect, obstructive in relation to efforts to extend collaborative practices more deeply into the judicial system.

Issues with consistency

Staff turnover and problems with consistency and leadership in collaborative planning groups or in county systems were described by many interviewees as a barrier to effective collaboration. One manager noted that their collaborative planning took longer in formation than initially planned because “the players changed a lot. Once we had a consistent group, we went through the process of learning from one other.” Interviewees from another county expressed a belief that their collaborative planning group would be stronger if they had consistent representation from child welfare line staff (who were often unable to attend regularly because of court appearances). Consistency in leadership was deemed important by many interviewees and is illustrated by the following observation. “If the department head changes on one side, you have to go back and get buy in; it could, depending on the person, stop the collaborative.”

DISCUSSION

This study explored insights from the experience of professionals in child welfare, substance abuse treatment, and court systems who have been involved in evolving collaborative policies, programs, and procedures over an extended period of time in their local counties. Several factors related to successful collaboration emerged in two broad areas: organizational changes and changes in operations for daily practice. The interviews also revealed a number of factors that hinder collaborative practice, along with strategies for mediating problems associated with these factors. The findings from this study affirm the importance of many elements of successful collaboration that are reflected in social work literature: strong leadership; shared vision; structures and processes to facilitate the creation and evolution of collaborative efforts; role clarity; defined goals; attention to member composition, relationship building, and team building; and achievement of interim successes (Bertram, 2008; Dunlop & Holosko, 2004; Ferguson, 2004; Fitch, 2009; Harbert, 1997; Jones, Crook, & Webb, 2007; Reilly, 2001; Slaght & Hamilton, 2005; Spath, Werrbach, & Pine, 2008; Urwin, 1998). The importance of trust, communication, shared vision, and adoption of values consistent with collaboration among stakeholders and facilitators is also reflected in the literature (Bayne-Smith, Mizrahi, & Garcia, 2008; Jones et al., 2007; Potito, Day, Carson, & O'Leary, 2009). Findings from this study are also consistent with other studies that found multiple factors that impede collaboration, such as conflicts in perspectives and priorities, staff turnover, barriers to sharing confidential information, and changes in systems and resources (Altshuler, 2003; Darlington, Feeney, & Rixon, 2005; Han, Carnochan, & Austin, 2007; Ryan, Tracy, Rebeck, Biegel, & Johnsen, 2001; Spath et al., 2008).

The findings of the study are also consistent with research specific to collaboration between child welfare and addiction treatment fields, suggesting that both individual- and systems-level factors are important in cross-systems collaboration (Drabble, 2007; Smith & Mogro-Wilson, 2007) and pointing to the importance of developing shared values, addressing communication and confidentiality concerns, and building effective interdisciplinary practice and policy-development teams (Green et al., 2008; Young & Gardner, 2002). Themes that emerged in the general categories of preconditions and organizational factors that foster collaboration appear to extend prior research by illuminating some of the underlying processes that characterize development of successful change over time. For example, the interplay between emergence of champions for change and the critical roles of technology transfer and early “wins” in adopting specific models for collaborative practice were important across counties—even when the foci of programs, source of knowledge transfer, and location of leadership differed.

Interviewees described the evolution of their collaborative programs from early stages in which leaders became invested in the idea of change through facilitated opportunities for addressing differences between systems and identifying models for change and into implementation of new programs and maintenance (as well as expansion) of efforts. The processes described by interviewees are consistent with specific theoretical frameworks, such as diffusion of innovation (Martinez-Brawley, 1995) and “stages of change” applied to organizations (Prochaska, 2000; Simpson, 2002). Although many theoretical frameworks related to collaboration focus on either developmental dynamics or characteristics that define successful collaboration (Huxham & Vangen, 2000), a growing body of literature in social work administration promote models of collaboration that integrate consideration of both developmental stages and the interplay between complex factors (e.g., context, collaborative processes, outcomes) that characterize functional and effective collaboration (Harbert, 1997; O'Looney, 1994; Reilly, 2001). The findings of this study provide additional support for selecting strategies and defining outcomes in the context of the developmental evolution of a given collaborative endeavor. For example, although maintaining a common vision and clarifying shared values was considered an ongoing process by study respondents, these processes were particularly important during formative phases or during changes in leadership.

There are a number of limitations to this study. First, the qualitative methodology, although suited to obtaining narrative data to answer the research questions, also limits generalizability of findings across different counties. Indeed, the interviews suggested substantial variation among participating counties in terms of historical and political contexts, county size and demographics, as well as the constellation of collaborative programs that were adopted. It is of interest that common themes emerged despite these variations in county context. Generalizability to other states is also limited, as there is substantial variation in policy contexts and how systems are structured in different states. In addition, the study is based on a purposive sample. Although recruitment of appropriate individuals in the five target counties was made possible with the assistance of key leaders who were knowledgeable with the individuals and organizations involved in local collaborations, it is possible that selection bias occurred. For example, it is possible that interviewees identified through this process were particularly positive about local collaboration. The fact that different interviewees within the same counties tended to identify similar strengths and weaknesses as their colleagues suggests that this potential did not substantially impact the validity of the data. Finally, the resources available for the study precluded use of multiple researchers to code qualitative data and examine inter-rater reliability for the themes defined in this report.

Despite some of the limitations of this study, the findings document some important factors that both help and hinder the process of collaboration between substance abuse treatment, child welfare, and dependency court fields that may provide useful directions to administrators interested in forming or furthering their own collaborative efforts. For example, the critical role of technology transfer in starting and evolving collaborative policy and programs suggests that time may be well invested in efforts to explore models, collect sample policies documents, and obtain consultation. Attention to the development of effective collaborative structures and staffing is also fundamental to success, including creation of mechanisms for feedback and problem solving and selection of facilitators who are able to embody and instill values conducive to collaboration. Findings also point to the utility of creating and funding specific positions or programs located in the nexus between systems.

Future research might explicitly examine models of organizational change that may be useful in conceptualizing and guiding collaborative practice across disciplines. The findings also point to the need for cross-site evaluation of collaborative intervention models to create a strong body of evidence to guide the decision making of counties or states deliberating about models that might be adopted or adapted in the process of initiating or advancing formal collaboration. Furthermore, the findings underscore the importance of national, state, and local technical assistance and training resources and other mechanisms that facilitate dissemination of models and lessons learned across regions and systems.