Assessing Organizational Role and Perceptions of Programmatic Success in Policy Implementation

• Author: Rebecca A. Smith,Margaret Hutzel,Amanda M. Girth
• DOI: 10.1177/00953997211011624
• Published date: 01 November 2021
• Date: 01 November 2021
• Subject Matter: Articles

https://doi.org/10.1177/00953997211011624

Administration & Society

2021, Vol. 53(10) 1512 –1546

© The Author(s) 2021

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/00953997211011624

journals.sagepub.com/home/aas

Article

Assessing Organizational

Role and Perceptions of

Programmatic Success in

Policy Implementation

Rebecca A. Smith1, Amanda M. Girth1,

and Margaret Hutzel2

Abstract

This study utilizes the Strategic Action Field (SAF) framework as a lens

to study implementation effectiveness of Ohio START, a multiactor and

multilevel implementation process. We examine the extent to which

perceptions of successes and challenges vary across organizational roles in

county-level child welfare agencies during Ohio START implementation.

Preliminary findings reveal that perceptions of implementation effectiveness

differ based on organizational role.

Keywords

human service organizations, implementation, strategic action fields

Introduction

Opioid misuse has become a national public health crisis. In 2018, there were

more than 67,300 drug overdose deaths across the United States, with almost

70% of these deaths related to opioid misuse (Centers for Disease Control and

Prevention [CDC], 2020a). Ohio has the fifth-highest number of drug-related

1The Ohio State University, Columbus, USA

2Ohio University, Athens, USA

Corresponding Author:

Rebecca A. Smith, John Glenn College of Public Affairs, The Ohio State University, Page Hall,

1810 College Road, Columbus, OH 43210-1132, USA.

Email: smith.11906@osu.edu

1011624AAS0010.1177/00953997211011624Administration & SocietySmith et al.

research-article2021

Smith et al. 1513

overdose deaths in the country with 3,980 deaths occurring in 2018, almost

three times the national average (CDC, 2020a, 2020b). The impact of the opi-

oid epidemic is widespread and detrimental across society. In Ohio, the epi-

demic costs the state between $4 and $5 billion every year due to reduced

economic growth and loss of productivity, increased demands on the health

care system for addiction treatment and related physical and mental health

issues, and increased crime and violence (Ioannou, 2019).

Children are among the most vulnerable victims of the opioid crisis. They

are significantly affected by their parents’ substance use disorders (SUDs) as

they experience the trauma of physical and emotional neglect and abuse, in

addition to enduring parental incapacitation, incarceration, or overdose death

(Annie E. Casey Foundation, 2018). From 2013 to 2017, the number of chil-

dren in the Ohio foster care system increased by almost 3,000 to more than

15,550 (Public Children Services Association of Ohio [PCSAO], 2018).

Approximately 50% of children are in foster care due to abuse and neglect as

the result of parental substance abuse issues (PCSAO, 2018). This is partly due

to the effects of the state-wide opioid epidemic and as the epidemic continues,

the number of children is expected to pass 20,000 in 2020 (PCSAO, 2018).

This epidemic has spillover effects into multiple public domains, and there

is increasing demand on public organizations to coordinate efforts to mitigate

the effects of this public health emergency through education, prevention,

treatment, and rehabilitation efforts. In an attempt to serve Ohio families

affected by the opioid crisis, the Ohio Attorney General and the Public

Children Services Agencies of Ohio (PCSAO) developed Ohio START

(Sobriety, Treatment, and Reducing Trauma) (Annie E. Casey Foundation,

2018; Ohio START, 2019; PCSAO, 2018). Ohio START is a shift toward

rapid and integrated delivery of services to treat parental addiction, improve

parental capacity, and ensure child safety and well-being through the creation

of networked partnerships.

The purpose of this exploratory analysis is to improve understanding of

implementation effectiveness in human service organizations (HSOs) by

examining child welfare agency (CWA) workers’ perceptions of Ohio START

implementation. We ask: How do perceptions of successes and challenges

vary across organizational roles in child welfare agencies during implemen-

tation of Ohio START? We address our research question by analyzing pri-

mary data from interviews with CWA administrators, caseworkers, and

family peer mentors in Ohio START counties. We use the Strategic Action

Field (SAF) framework (Moulton & Sandfort, 2017) to understand how a

multilevel policy system that requires multiple organizational actors is

affected by the introduction of a new program technology. Implementation

often involves a change in system operations to produce a change in target

1514 Administration & Society 53(10)

population behavior or conditions (Moulton & Sandfort, 2017). For Ohio

START, the introduction of this program technology leads to a change in

system operations, which then leads to a change in target population (parent)

behavior.

Our study advances knowledge by using the SAF framework to examine a

new policy intervention in response to the opioid crisis, one of the nation’s

most pressing public health issues. We assess whether there is variation by

worker role or by county-level CWA, with the understanding that their per-

ceptions of successes and challenges can inform implementation effective-

ness. Ohio START implementation provides a foundation to develop

propositions for future research in policy implementation. This is particularly

relevant for the study of implementation in public organizations as HSOs

must balance implementation efforts with providing complex services to

match a variety of needs and must coordinate across multiple policy areas,

sectors, and organizations, all with different capabilities, expertise, funding

structures, and missions (Bunger & Lengnick-Hall, 2019; Hasenfeld, 2009).

The article proceeds as follows. First, we describe the programmatic ele-

ments of Ohio START. Next, we present a literature review of policy imple-

mentation research and the SAF framework used to address our research

question on implementation effectiveness. We describe our research design,

data, and method, then share preliminary findings from our analysis. Finally,

we discuss the potential implications of our study and directions for future

research.

Ohio START

An emerging issue in the child welfare system is managing parental SUD

(Smith & Mogro-Wilson, 2007) as caseworkers are not trained or equipped to

manage individuals with SUDs. Traditional child welfare approaches do not

account for caregiver addiction and traditional substance abuse treatment

often does not address parenting skills (Bosk et al., 2019). The co-occurrence

of SUDs and child maltreatment within a single family creates overlap in

both systems. This requires an integrated approach that addresses both the

structural and individual-level (or system-level and service-level) challenges

(Bosk et al., 2019; Marsh et al., 2011) that exist with managing parental SUD

treatment and ensuring the safety and well-being of children. This intersec-

tion has created an opportunity for both systems to work together to provide

integrated services to simultaneously address multiple problems using an

approach that is not specific to a single sector or organization (Bosk et al.,

2019; Huebner et al., 2017). A service integration model provides compre-

hensive services for clients and may reduce barriers that exist when each