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Abstract：
Multilevel service delivery frameworks are approaches to structuring and organizing a spectrum of evidence-based services and supports, focused on assessment, prevention, and intervention designed for the local context. Exemplar frameworks in child mental health include positive behavioral interventions and supports in education, collaborative care in primary care, and systems of care in community mental health settings. Yet, their high-quality implementation has lagged. This work proposes a conceptual foundation for multilevel service delivery frameworks spanning diverse mental health service settings that can inform development of strategic implementation supports. We draw upon the existing literature for three exemplar multilevel service delivery frameworks in different child mental health service settings to (1) identify core components common to each framework, and (2) to highlight prominent implementation determinants that interface with each core component. Six interrelated components of multilevel service delivery frameworks were identified, including, (1) a systems-level approach, (2) data-driven problem solving and decision-making, (3) multiple levels of service intensity using evidence-based practices, (4) cross-linking service sectors, (5) multiple providers working together, including in teams, and (6) built-in implementation strategies that facilitate delivery of the overall model. Implementation determinants that interface with core components were identified at each contextual level. The conceptual foundation provided in this paper has the potential to facilitate cross-sector knowledge sharing, promote generalization across service settings, and provide direction for researchers, system leaders, and implementation intermediaries/practitioners working to strategically support the high-quality implementation of these frameworks.
摘要：
多级服务交付框架是构建和组织一系列基于证据的服务和支持的方法，专注于评估，预防,和针对当地情况设计的干预。儿童心理健康的典型框架包括积极的行为干预和教育支持，初级保健中的协作护理，和社区心理健康环境中的护理系统。然而，他们的高质量实施滞后。这项工作为涵盖各种心理健康服务环境的多层次服务提供框架提供了概念基础，可以为战略实施支持的发展提供信息。我们借鉴了现有的文献，在不同的儿童心理卫生服务设置中的三个示例性多层次服务提供框架，以（1）确定每个框架共同的核心组件，和(2)突出与每个核心组件接口的突出实现决定因素。确定了多层次服务交付框架的六个相互关联的组成部分，包括,(1)系统级方法，（2）数据驱动的问题解决和决策，(3)使用循证实践的多层次服务强度，(4)服务部门的交叉联系，（5）多个提供商一起工作，包括团队，和（6）内置的实施策略，以促进整体模型的交付。在每个上下文级别确定了与核心组件接口的实现决定因素。本文提供的概念基础有可能促进跨部门知识共享，促进跨服务设置的泛化，并为研究人员提供指导，系统领导者,和实施中介机构/从业人员致力于从战略上支持这些框架的高质量实施。
