A Case Study of Implementing Grant-Funded Integrated Care in a Community Mental Health Center
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The US government funds integrated care demonstration projects to decrease health disparities for individuals with serious mental illness. Drawing on the Exploration Preparation Implementation Sustainability (EPIS) implementation framework, this case study of a community mental health clinic describes implementation barriers and sustainability challenges with grant-funded integrated care. Findings demonstrate that integrated care practices evolve during implementation and the following factors influenced sustainability: workforce rigidity, intervention clarity, policy and funding congruence between the agency and state/federal regulations, on-going support and training in practice application, and professional institutions. Implementation strategies for primary care integration within CMHCs include creating a flexible workforce, shared definition of integrated care, policy and funding congruence, and on-going support and training.
This work was funded by the National Institute of Health (TL1TR000422). The methods, observations, and interpretations put forth in this article do not necessarily represent those of the funding agency. The author would like to thank Jean Kruzich, Gunnar Almgren, and Larry Kessler for their guidance in this research project and Kitsap Mental Health Services for partnering on this research adventure.
Compliance with Ethical Standards
was obtained from all interview participants and a selection of the outpatient team. The Human Subjects Division within the University of Washington approved this study #50280.
Conflict of Interest
The author declares no conflict of interest.
- 2.Parks, J., Svendensen, D., Singer, P. et al Morbidity and mortality in people with serious mental illness. Alexandria VA: National Association of State Mental Health Program Directors. 2006. Available on line at https://www.nasmhpd.org/sites/default/files/Mortality%20and%20Morbidity%20Final%20Report%208.18.08.pdf Accessed on January 11, 2019Google Scholar
- 5.Patient Protection and Affordable Care Act, 42 U.S.C. §18001 (2010).Google Scholar
- 11.Aarons, G. A., Hurlburt, M., & Horwitz, S. M. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research. 2011; 38(1): 4–23. Doi: https://doi.org/10.1007/s10488-010-0327-7.CrossRefPubMedGoogle Scholar
- 13.Kaiser Family Foundation (2013). Summary of the Affordable Care Act. behavioral health integrated care. Accessed on January 11, 2019.Google Scholar
- 14.Roosevelt, J., Burke, T., Jean, P. Commentary on Part I: Objectives of the ACA. In The Affordable Care Act as a National Experiment: Health Policy Innovations and Lessons. Ed. Selker, H. & Wasser, J. New York: Springer, 2014.Google Scholar
- 15.Center for Medicare and Medicaid Innovation. (n.d.) CMS (n.d.) Health care innovation awards. Available online at https://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards/index.html. Accessed on January 11, 2019.
- 18.Manderscheild, R., Kathol, R. Fostering sustainable, integrated medical & behavioral health services in medical settings. Annals of Internal Medicine. 2014; 160(1): 61–66.Google Scholar
- 19.Brown Levey, S. M. B., Miller, B. F., deGruy, F. V.. Behavioral health integration: An essential element of population-based healthcare redesign. Translational Behavioral Medicin, 2012; 2(3): 364–371.Google Scholar
- 20.Fixsen, D. L., Naoom, S. F., Blasé, K. A., et al. Implementation research: A synthesis of the literature (FMHI Publication #231). Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network. 2005. Available online at http://nirn.fpg.unc.edu/resources/implementation-research-synthesis-literature. Accessed January 11, 2019.Google Scholar
- 23.MacDonald, M., Pauly, B., Wong, G., et al. Supporting successful implementation of public health interventions: Protocol for a realist synthesis. Systematic Reviews, 2016; 5(54): 1–11.Google Scholar
- 26.Baskarada, S. Qualitative case study guidelines. The Qualitative Report. 2014; 19(24): 1–18.Google Scholar
- 27.Yin, Robert Case study research design and methods. Thousand Oaks: Sage Publications. 2014.Google Scholar
- 28.Gilgun, J. A case for case studies in social work research. Social Work. 1994; 39(4), 371–380.Google Scholar
- 29.Cresswell, J. Research design. Thousand Oaks: Sage Publications. 2014.Google Scholar
- 30.Palinkas, L. A., Horowitz, S., Green, C., et al. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 2015; 42(5): 533–544. doi: https://doi.org/10.1007/s10488-013-0528-y CrossRefGoogle Scholar
- 31.Patton, M. Q. Qualitative research & evaluation methods. Thousand Oaks: Sage Publications. 2002.Google Scholar
- 32.SAMHSA. Primary and behavioral health care integration grants. Available online at https://www.samhsa.gov/sites/default/files/programs_campaigns/samhsa_hrsa/pbhci-performance-profile.pdf. Accessed on January 11, 2019
- 34.Chaudoir, S., Dugan, A., Barr, C. Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient and innovation level measures. Implementation Science. 2013; 8(22): 1–20.Google Scholar
- 35.Damanpour, F. Organizational innovation: A meta-analysis of effects of determinants and moderators. The Academy of Management Journal. 1991; 34(3), 555–590.Google Scholar
- 36.Damschroder, L., Aron, D., Keith, et al. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science. 2009; 4(50): 1–15.Google Scholar
- 40.Nilsen, P. Making sense of implementation theories, models and frameworks. Implementation Science. 2015; 10(53): 1–13.Google Scholar
- 43.Miles, M., Huberman, A. M., Saldaña, J. Qualitative data analysis: A methods sourcebook. Thousand Oaks: Sage Publications. 2014.Google Scholar
- 44.Saldaña, J. The coding manual for qualitative researchers. Thousand Oaks, CA: Sage Publications. 2016.Google Scholar
- 45.Please see SAMHSA website for more information on each EBP: https://www.samhsa.gov/ebp-resource-center. Accessed 28 June 2019.
- 52.McDermott, A., Conway, E., Cafferkey, K. et al. Performance management in context: formative cross-functional performance monitoring for improvement and the mediating role of relational coordination in hospitals. The International Journal of Human Resource Management. 2019; 30(3): 436–456.CrossRefGoogle Scholar