scholarly journals The Implementation of an Interpersonal Violence Screening Program in Primary Care Settings: Lessons Learned

2021 ◽  
pp. 152483992198927
Author(s):  
Erika L. Thompson ◽  
Kimberly G. Fulda ◽  
Jessica Grace ◽  
Annalynn M. Galvin ◽  
Emily E. Spence
Keyword(s):  
Primary Care ◽  
Program Implementation ◽  
Interpersonal Violence ◽  
Health Management ◽  
Screening Program ◽  
Lessons Learned ◽  
Public Health Issue ◽  
Primary Care Settings ◽  
Outer Setting ◽  
Inner Setting

Background Interpersonal violence (IPV) is a public health issue that disproportionately affects women. IPV screening improves likelihood of survivor disclosure and access to additional support. To enhance primary care IPV screening, Technology Enhanced Screening and Supportive Assistance (TESSA) uses integrated technological systems to deliver bidirectional, evidence-informed health navigation, health management, and safety interventions. This study evaluates TESSA implementation in primary care clinics using the Consolidated Framework for Implementation Research (CFIR). Method CFIR is a metatheoretical framework used for evaluating clinical intervention implementation. Salient constructs within CFIR’s five domains (intervention characteristics, outer setting, inner setting, characteristics of individuals, and process) were identified (23 constructs), and pertinent implementation details were examined. Results Key lessons learned included intervention characteristic constructs like intervention source (e.g., selecting tablets that can screen for items integral to the program’s aims) and adaptability (e.g., ensuring tablets worked with electronic medical records for each clinic), process constructs like engaging champions (e.g., garnering buy-in from key clinic stakeholders and staff), outer setting constructs like patient needs and resources (e.g., addressing pertinent patient resource needs) and external policies and incentives (e.g., incentivizing clinics by addressing clinic needs), and inner setting constructs like leadership engagement (e.g., ensuring buy-in from organizational leaders as leadership changed frequently). Conclusions CFIR identifies important implementation factors for programs like TESSA that screen for high-risk populations and implement in primary care settings. The TESSA program implementation permits increased IPV screening among primary health care populations, thus promoting access to resources for otherwise hard-to-reach populations.

scholarly journals Patient and provider perception of appropriateness, acceptability, and feasibility of behavioral health home (BHH) core components based on program implementation in an urban, safety-net health system

2021 ◽  
Vol 2 ◽  
pp. 263348952110437
Author(s):  
Ana M Progovac ◽  
Miriam C Tepper ◽  
H. Stephen Leff ◽  
Dharma E Cortés ◽  
Alexander (Cohen) Colts ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Behavioral Health ◽  
Program Implementation ◽  
Health Management ◽  
Safety Net ◽  
Clinical Settings ◽  
Urban Safety ◽  
Core Components ◽  
Health Home

Background This manuscript evaluates patient and provider perspectives on the core components of a Behavioral Health Home (BHH) implemented in an urban, safety-net health system. The BHH integrated primary care and wellness services (e.g., on-site Nurse Practitioner and Care Manager, wellness groups and tools, population health management) into an existing outpatient clinic for people with serious mental illness (SMI). Methods As the qualitative component of a Hybrid Type I effectiveness-implementation study, semi-structured interviews were conducted with providers and patients 6 months after program implementation, and responses were analyzed using thematic analysis. Valence coding (i.e., positive vs. negative acceptability) was also used to rate interviewees’ transcriptions with respect to their feedback of the appropriateness, acceptability, and feasibility/sustainability of 9 well-described and desirable Integrated Behavioral Health Core components (seven from prior literature and two additional components developed for this intervention). Themes from the thematic analysis were then mapped and organized by each of the 9 components and the degree to which these themes explain valence ratings by component. Results Responses about the team-based approach and universal screening for health conditions had the most positive valence across appropriateness, acceptability, and feasibility/sustainability by both providers and patients. Areas of especially high mismatch between perceived provider appropriateness and measures of acceptability and feasibility/sustainability included population health management and use of evidence-based clinical models to improve physical wellness where patient engagement in specific activities and tools varied. Social and peer support was highly valued by patients while incorporating patient voice was also found to be challenging. Conclusions Findings reveal component-specific challenges regarding the acceptability, feasibility, and sustainability of specific components. These findings may partly explain mixed results from BHH models studied thus far in the peer-reviewed literature and may help provide concrete data for providers to improve BHH program implementation in clinical settings. Plain language abstract Many people with serious mental illness also have medical problems, which are made worse by lack of access to primary care. The Behavioral Health Home (BHH) model seeks to address this by adding primary care access into existing interdisciplinary mental health clinics. As these models are implemented with increasing frequency nationwide and a growing body of research continues to assess their health impacts, it is crucial to examine patient and provider experiences of BHH implementation to understand how implementation factors may contribute to clinical effectiveness. This study examines provider and patient perspectives of acceptability, appropriateness, and feasibility/sustainability of BHH model components at 6–7 months after program implementation at an urban, safety-net health system. The team-based approach of the BHH was perceived to be highly acceptable and appropriate. Although providers found certain BHH components to be highly appropriate in theory (e.g., population-level health management), their acceptability of these approaches as implemented in practice was not as high, and their feedback provides suggestions for model improvements at this and other health systems. Similarly, social and peer support was found to be highly appropriate by both providers and patients, but in practice, at months 6–7, the BHH studied had not yet developed a process of engaging patients in ongoing program operations that was highly acceptable by providers and patients alike. We provide these data on each specific BHH model component, which will be useful to improving implementation in clinical settings of BHH programs that share some or all of these program components.

scholarly journals Using Consolidated Framework for Implementation Research to investigate facilitators and barriers of implementing alcohol screening and brief intervention among primary care health professionals: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Paul Shing-fong Chan ◽  
Yuan Fang ◽  
Martin Chi-sang Wong ◽  
Junjie Huang ◽  
Zixin Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Brief Intervention ◽  
Implementation Research ◽  
Health Professionals ◽  
Alcohol Screening ◽  
Screening And Brief Intervention ◽  
Primary Care Settings ◽  
Facilitators And Barriers ◽  
Inner Setting

Abstract Background Alcohol screening and brief intervention (SBI) is recommended to be implemented in primary care settings to intervene against hazardous/harmful drinking. However, studies showed that the uptake rate was low in many regions/countries. This systematic review presented current findings on the facilitators and barriers of SBI implemented by health professionals in primary care settings using the Consolidated Framework for Implementation Research (CFIR). Methods We included qualitative, quantitative, and mixed-method studies identified through four electronic databases (PubMed, MEDLINE, PsycInfo, and Web of Science) from inception to June 2020. Included articles had to address barriers and facilitators of SBI implementation and provide sufficient details that the CFIR domains could be identified and data were abstracted using a standardized extraction form. Results A total of 74 studies published from 1985 to 2019 were finally analysed and summarized. The most common facilitators were knowledge and positive beliefs about SBI (characteristics of the individuals) and available resources (inner setting). In contrast, the most common barriers were cost related to implementing SBI (intervention characteristics), negative beliefs about SBI (characteristics of the individuals), and lack of self-efficacy in implementing SBI (characteristics of the individuals). It could be observed that factors related to the inner setting and characteristics of individuals were extensively studied whilst the process received the least attention. Conclusions Most of the facilitators and barriers are modifiable. Additionally, most literature focused on various kinds of available assets to implement SBI. To promote the spread of SBI implementation, more high-quality studies on the implementation process are needed. This systematic review could serve as a reference framework for health authorities to devise strategies for improving the implementation of SBI in primary care settings. Trial registration This systematic review was registered in PROSPERO (CRD42021258833).

scholarly journals Counsellors in Primary Care: Benefits and Lessons Learned

2002 ◽  
Vol 47 (9) ◽  
pp. 857-862 ◽  
Author(s):  
Nick Kates ◽  
Anne-Marie Crustolo ◽  
Sheryl Farrar ◽  
Lambrina Nikolaou
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Rating Scale ◽  
Mental Health Problems ◽  
Demographic Data ◽  
Family Physicians ◽  
Lessons Learned ◽  
Primary Care Settings

Objective: To describe a program that integrates mental health counsellors within primary care settings, to present data on the program's impact, and to discuss lessons learned that may apply in other communities. Methods: This paper describes a Canadian program that brings counsellors and psychiatrists into the offices of 87 family physicians in 36 practices in a community of 460 000 in Southern Ontario. It describes the goals and organization of the program and the activities of counsellors when working in primary care. In addition, it summarizes data from the program's evaluation, including demographic data and the individual problems seen and services delivered (all from the program's database) as well as data on patient outcomes using the General Health Questionnaire (GHQ), the Centre for Epidemiological Studies Depression (CESD) Rating Scale, and consumer-satisfaction questionnaires. Results: Each counsellor sees an average of 161 new cases yearly. The major problems are depression, anxiety, and family problems. In fact, over 70% of individuals who are seen show significant improvements in outcomes. The program has led to a significant increase in access to mental health services, a reduction in the use of traditional mental health services, high levels of satisfaction with counsellors and family physicians, and significant improvements in symptoms and functioning of individuals seen. Conclusion: This program has effectively integrated counsellors within primary care settings, increasing the capacity of primary care to handle mental health problems, strengthening links between providers from different sectors, and making mental health care more accessible.

Lessons Learned in Selection and Review of Depression Apps for Primary Care Settings

2020 ◽  
Author(s):  
Margaret R. Emerson ◽  
Shinobu Watanabe-Galloway ◽  
Danae Dinkel ◽  
Suhasini Kotcherlakota ◽  
Louis Fok
Keyword(s):  
Primary Care ◽  
Lessons Learned ◽  
Primary Care Settings

A purveyor team's experience: Lessons learned from implementing a behavioral health care program in primary care settings.

2010 ◽  
Vol 28 (4) ◽  
pp. 356-368 ◽  
Author(s):  
Chad A. Graff ◽  
Paul Springer ◽  
George W. Bitar ◽  
Robert Gee ◽  
Rodolfo Arredondo
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Behavioral Health ◽  
Care Program ◽  
Behavioral Health Care ◽  
Lessons Learned ◽  
Primary Care Settings ◽  
Health Care Program

scholarly journals Integrating a parenting intervention into pediatric primary care: A qualitative pilot study of stakeholders’ perspectives

2020 ◽  
Author(s):  
Ana Baumann ◽  
Meagan Pilar ◽  
Callie Walsh-Bailey
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Problems ◽  
Parenting Intervention ◽  
Health Problems ◽  
Pediatric Primary Care ◽  
Evidence Based ◽  
Primary Care Settings ◽  
Parent Interventions ◽  
Inner Setting

Abstract Background In the U.S., children as early as two years old are being diagnosed with depression and other mental health problems. Children with chronic diseases also struggle with mental health problems. Evidence-based parent interventions can support these families by improving parenting practices. Pediatric primary care practices are ideal settings to provide parent interventions, as they can have broader reach, decrease stigma and improve health and mental health outcomes. There is currently no clear guidance as to how to integrate these interventions.Methods With the scientific premise that primary care settings can be a powerful place to reach families, this study examined barriers and facilitators of implementing an evidence-based parenting intervention within a primary care practice-based network.Results Semi-structured interviews were conducted with 16 community pediatricians in a Midwestern Practice-Based Research Network. The interview guide was developed based on the Consolidated Framework for Implementation Research (CFIR), with a particular emphasis on intervention characteristics and the organization’s inner setting. A codebook was developed using CFIR. Interview transcripts were coded by two independent raters (kappa = 0.93). Data were analyzed using directed content analysis.Conclusions Themes at the outer and inner setting were identified as determinants. Using theory and stakeholder input will help adapt the intervention as well as its strategies to implement parent interventions in primary care settings.

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