Facilitators of and barriers to County Behavioral Health System Transformation and Innovation: an interview study

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Abstract

Background

Inadequate and inequitable access to quality behavioral health services and high costs within the mental health systems are long-standing problems. System-level (e.g., fee-for-service payment model, lack of a universal payor) and individual factors (e.g., lack of knowledge of existing resources) contribute to difficulties in accessing resources and services. Patients are underserved in County behavioral health systems in the United States. Orange County’s (California) Behavioral Health System Transformation project sought to improve access by addressing two parts of their system: developing a template for value-based contracts that promote payor-agnostic care (Part 1); developing a digital platform to support resource navigation (Part 2). Our aim was to evaluate facilitators of and barriers to each of these system changes.

Methods

We collected interview data from County or health care agency leaders, contracted partners, and community stakeholders. Themes were informed by the Consolidated Framework for Implementation Research.

Results

Five themes were identified related to behavioral health system transformation, including 1) aligning goals and values, 2) addressing fit, 3) fostering engagement and partnership, 4) being aware of implementation contexts, and 5) promoting communication. A lack of fit into incentive structures and changing state guidelines and priorities were barriers to contract development. Involving diverse communities to inform design and content facilitated the process of developing digital tools.

Conclusions

The study highlights the multifaceted factors that help facilitate or hinder behavioral health system transformation, such as the need for addressing systematic and process behaviors, leveraging the knowledge of leadership and community stakeholders, fostering collaboration, and adapting to implementation contexts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-024-11041-9.

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Most cited references 25

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Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Laura Damschroder, David Aron, Rosalind E Keith … (2009)

Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.

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Treatment Access Barriers and Disparities Among Individuals with Co-Occurring Mental Health and Substance Use Disorders: An Integrative Literature Review

Mary Ann Priester, Teri Browne, Aidyn Iachini … (2016)

The purpose of this integrative review is to examine and synthesize extant literature pertaining to barriers to substance abuse and mental health treatment for persons with co-occurring substance use and mental health disorders (COD). Electronic searches were conducted using ten scholarly databases. Thirty-six articles met inclusion criteria and were examined for this review. Narrative review of these articles resulted in the identification of two primary barriers to treatment access for individuals with COD: personal characteristics barriers and structural barriers. Clinical implications and directions for future research are discussed. In particular, additional studies on marginalized sub-populations are needed, specifically those that examine barriers to treatment access among older, non-white, non-heterosexual populations.

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Insurance status, use of mental health services, and unmet need for mental health care in the United States.

Elizabeth Walker, Janet Cummings, Jason M Hockenberry … (2015)

The purpose of this study was to provide updated national estimates and correlates of service use, unmet need, and barriers to mental health treatment among adults with mental disorders.

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Author and article information

Contributors

Xin Zhao: alisa.zhao@seattlechildrens.org

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 9 May 2024

Publication date PMC-release: 9 May 2024

Publication date Collection: 2024

Volume: 24

Electronic Location Identifier: 604

Affiliations

[1 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Psychiatry and Behavioral Sciences, , University of Washington, ; Seattle, USA

[2 ]GRID grid.240741.4, ISNI 0000 0000 9026 4165, Seattle Children’s Research Institute, ; Seattle, USA

[3 ]GRID grid.266093.8, ISNI 0000 0001 0668 7243, Department of Medicine, , University of California, ; Irvine, USA

[4 ]Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, ( https://ror.org/0168r3w48) La Jolla, USA

[5 ]The Design Lab, University of California San Diego, ( https://ror.org/0168r3w48) La Jolla, USA

[6 ]GRID grid.266093.8, ISNI 0000 0001 0668 7243, Department of Psychiatry and Human Behavior, , University of California, ; Irvine, USA

[7 ]GRID grid.266093.8, ISNI 0000 0001 0668 7243, Department of Psychological Science, , University of California, ; Irvine, USA

Article

Publisher ID: 11041

DOI: 10.1186/s12913-024-11041-9

PMC ID: 11080221

PubMed ID: 38720309

SO-VID: 041c1f57-d0d9-4799-85aa-3c1e054ce76f

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 8 February 2024

Date accepted : 24 April 2024

Funding

Funded by: Orange County Health Care Agency

Award ID: MA-042-21011324

Funded by: Institute for Clinical and Translational Sciences

Award ID: UL1TR001414

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: system transformation,behavioral health,value-based payment,payor-agnostic care,digital resource navigation

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: system transformation, behavioral health, value-based payment, payor-agnostic care, digital resource navigation

Facilitators of and barriers to County Behavioral Health System Transformation and Innovation: an interview study

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Abstract

Background

Methods

Results

Conclusions

Supplementary Information

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Tobacco Prevention & Cessation

Most cited references 25

Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Treatment Access Barriers and Disparities Among Individuals with Co-Occurring Mental Health and Substance Use Disorders: An Integrative Literature Review

Insurance status, use of mental health services, and unmet need for mental health care in the United States.

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