The Florida Coordinated Intake and Referral (CI&R) Learning Collaborative was established by Healthy Start Coalitions to streamline service delivery, resources utilization, and collectively track participation and referrals using universal prenatal-newborn risk screens. CI&R systems improvements can help to improve access to community-wide services and supports tailored to the needs of pregnant women and families with newborns.

A multi-year CI&R implementation evaluation identified relationships between Consolidated Framework for Implementation Research (CFIR) domains at baseline and will establish how CFIR domains influence CI&R processes and outcomes over time.

Evaluation activities included focus groups, implementation surveys, and a social network analysis (PARTNER). Transcripts from focus groups and social network data were analyzed to enrich and add context to quantitative survey results. Coincidence Analysis (CNA) of survey data categorized the 23 coalitions across CFIR domains and identified potential relationships between CFIR domains.

Baseline focus group comments confirmed that coalition members believe CI&R is important and will improve family services, and revealed positive attitudes and commitment to CI&R across most sites. Concerns were contractual obligations, external pressure, and uncertainty/unpreparedness for implementation. Three categories of sites were identified: high in all CFIR domains; mixed low-high; and mostly low domains with high-to-medium individual characteristics. CNA found that strong networks and cooperation between agencies consistently contributed to consideration of client and community needs, which together with highly committed, capable, knowledgeable and positive individuals resulted in higher functioning CI&R teams (inner setting). Alternatively, without competition across agencies for resources or referrals, then the presence of strong individuals leading consideration of client and community needs also contributed to high functioning CI&R teams (regardless of networks/cooperation). PARTNER illustrated a range of network size and density, but this did not correspond with CFIR domains.

This is among the first studies to identify relationships between CFIR domains. Results suggest that there may be two routes whereby features of the outer setting and characteristics of individuals lead to high functioning CI&R inner settings, which may be used to guide future capacity-building efforts. Next steps involve analyzing CI&R data to identify site characteristics and CFIR domains associated with success, and process strengths, gaps and bottlenecks.