Organizational readiness and program sustainability within juvenile justice and community mental health: the mediating role of cross-system collaboration

BACKGROUND: Evidence-based system-level intervention is needed to address the problem of poor connection to behavioral health (BH) services among justice-involved youth. System preparedness to implement evidence-based practices (EBP) or interventions, i.e. "organizational readiness," is theoretically predictive of the sustainability of these practices. Cross-system collaboration-crucial for the connection of justice-involved youth between juvenile justice (JJ) to BH agencies-is theoretically related to organizational readiness and EBP sustainability, as the process of EBP implementation requires individual and shared efforts from involved systems. Despite strong theoretical justification, there has been minimal quantitative investigation into the relationships among organizational readiness, program sustainability, and cross-system collaboration. The current paper aimed to examine a) the association between organizational readiness and EBP sustainability, and b) the mediational role of cross-system collaboration in that association. METHODS: Data were derived from a hybrid type II effectiveness-implementation trial in eight counties in one Midwest state of partnered JJ and community mental health center (CMHC) agencies. Throughout the study, JJ and CMHC personnel participated in five waves of survey data collection measuring organizational readiness (Organizational Readiness to Implement Change; ORIC), sustainability (Program Sustainability Assessment Tool; PSAT), and cross-system collaboration (Cultural Exchange Inventory process and output scales; CEI). The final analyzable dataset included 274 participants with 529 observations. Linear mixed-effects models were conducted to account for the cluster-randomized, stepped-wedge design and repeated participant measurement. RESULTS: Organizational readiness was significantly positively associated with program sustainability (B = 0.79, 95% Confidence Interval [CI] 0.68-0.90), and the association was weakened when including the mediator CEI process subscale (B = 0.69, 95% CI 0.58-0.80). CEI process was significantly associated with program sustainability (B = 0.21, 95% CI 0.15-0.28) and accounted for 17.4% of the association between organizational readiness and sustainability. Results were comparable when examining the second mediating subscale, CEI output, which accounted for 17.2% of the observed association between organizational readiness and sustainability. CONCLUSIONS: Results supported the findings that organizational readiness was positively associated with sustainability, with cross-system collaboration partially mediating the association. Although our study is observational, cross-system collaboration may serve as a promising intervention target to rigorously examine in future implementation studies between JJ and BH agencies. TRIAL REGISTRATION: The study was preregistered as a clinical trial (Clinicaltrials.gov identifier: NCT04499079) on 30 July 2020.