Service integration as contributor to program success: A case study of the National Health Initiative in Alaska, 1999--2000

This case study of the National Health Initiative in Alaska during 1999--2000 specifically examines how service integration (between health care facilities and domestic violence agencies) contributes to program success (improved health care response to domestic violence). Twelve multidisciplinary site teams participated in this national demonstration project. Each team attended intensive training in April 1999 and made efforts to institutionalize improved clinical practice in their own communities during the course of the project. Primary data collection efforts included audiotaped interviews and written surveys completed with Site Team Leaders (STLs) and Domestic Violence Advocates (DVAs), and document review during site visits conducted during summers of 1999 and 2000.;This study examined specific components of service integration and site-specific program features as contributors to program success. Levels of service integration investigated included coordination (joint meetings, joint trainings, resource networks, referrals, and telephone consultation), collaboration (number and quality of collaborative efforts, internal communication, willingness to cooperate and mutual respect) and cohesion (staff stability and staff ability to work together). Site-specific program features investigated included community geography, professional experience of both Site Team Leaders and Domestic Violence Advocates, and community awareness, concern and history of collaboration around domestic violence issues. Components of program success investigated included both infrastructure (needs assessment, protocol development, assurance mechanisms) and service (universal screening, safety planning, appropriate referral).;Service Integration was positively related to Program Success, but only a few key factors seemed particularly contributory to success. Joint training (coordination), mutual respect (collaboration) and staff stability (cohesion) all appeared critical to program success. The only site-specific program feature that appeared to have significant impact on service integration (and thus indirectly program success) was Site Team Leader Professional Experience. The other key contributor to program success apparent in analysis was Administrative Support . Sites with experienced Site Team Leaders and with Administrative Support experienced more satisfactory service integration and also the most program success. A revised conceptual framework, and implications and recommendations for research and practice are provided.