There were also differences in organizational context at the network level. For example, they typically assess the clinical setting and organizational context for implementation and engage stakeholders who will be responsible for implementing the innovation, supporting its implementation, or receiving it. There was turnover at every level in key positions such as clinical leaders and PCMHI providers. 2018;241:31924. The report provides policy makers and planners of health services with the rationale and know-how for moving from an institutional model of mental healthcare to a more holistic, comprehensive integrated delivery system at the primary healthcare level. Kislov R, Wilson P, Boaden R. The dark side of knowledge brokering. Journal of the American Board of Family Medicine: Understanding care integration from the ground up: five organizing constructs that shape integrated practices. 2006;1:23. https://doi.org/10.1186/1748-5908-1-23. Regional Office for the Eastern Mediterranean. Describing what facilitators do as a staged process may make it easier to plan for facilitating implementation. See permissionsforcopyrightquestions and/or permission requests. 2017;17(1):593. https://doi.org/10.1186/s12913-017-2537-0. For example, as Network A sites were generally more amenable to the general concept of PCMHI than were Network C sites, in Network A facilitators both did marketing for and enabled sites to do their own marketing; whereas in Network C, facilitators did all the marketing for sites. National Library of Medicine The two interviewers discussed and resolved any differences in their observations; where they were unable to reach consensus, they followed up with the facilitator during the next debriefing to obtain clarification. Has data issue: false Tel: +41 22 791 3855; fax: +41 22 791 4160; email: Department of Mental Health and Substance Abuse, World Health Organization, Geneva; Constitution of the World Health Organization, 1948. WHO Resource Book on Mental Health, Human Rights and Legislation. Indeed, as far back as 1948, WHO's constitution recognised health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.1 Despite this, many primary healthcare systems in countries around the world focus on physical care, failing to provide mental healthcare to their populations. Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province Vietnam. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 3. No Comments have been published for this article. Both IRFs were network level employees who initially had no implementation science or implementation facilitation expertise. A Norwegian-Russian long-standing collaboration initiative has significantly improved treatment for anxiety and depression (A&D), with 58% reliable recovery rate. Hijjeh M, Al Shaikh L, Alinier G, Selwood D, Malmstrom F, Hassan IF. From novice to expert: a qualitative study of implementation facilitation skills. Mental healthcare, available in primary healthcare, means that people are able to access the treatment and care that they need near to their homes, and thus keep their families together, maintain their support systems, remain integrated and active in the community and continue to contribute to household productivity. Roderick SS, Burdette N, Hurwitz D, Yeracaris P. Integrated behavioral health practice facilitation in patient centered medical homes: a promising application. PCMHI models are complex and implementing them requires structural and process changes to care delivery [7,8,9]; changes in providers roles, skills, values, and attitudes [8, 10,11,12]; and changes in organizational culture [13, 14] and work processes [8, 11]. 2020;26(2):57581. . It may be that there are other dimensions of implementation facilitation strategies that should be specified and reported. Sufficient resources (financial and human) are also a pre-requisite for effective mental health treatment at this level of care. Readers will find out how providing mental health care into primary health care settings produces better health outcomes, learn from other countries that have successfully integrated their mental health services into primary health care, and discover 10 common principles that underlie all successful mental health integration, regardless of country resource level. Clearly the provision of effective mental healthcare at primary healthcare level is highly dependent on the pre-existence of a well-functioning primary care system. 2018;6:136. https://doi.org/10.3389/fpubh.2018.00136. https://doi.org/10.1177/1355819616653981. 2016;11(1):113. Facilitators consented to participate in the study and all study activities were carried out in accordance with relevant guidelines and regulations, including the Declaration of Helsinki. Health Serv Res. Integrated behavioral health model: After you talk with Cecelia about her stress and anxiety, you ask your BHC, whose name is Eleanor, to come in for a quick visit. Both interviewers had long-term professional relationships with the expert (JEK). An official website of the United States government. Given the need for facilitators to adapt what they do to local context [50], reporting on the sequence of activities could be challenging and perhaps not helpful. Review of literature using PubMed search terms mental health primary care, MeSH terms Primary Health Care, Mental Health Care and organization and administration, published in the last 5 years, in English. VA researchers' evaluations of the PC-MHI system have shown that integrated mental health care improves access to high-quality treatment, patient engagement, clinical and functional outcomes, and patient satisfaction. Educational Needs for Implementing Iran's Comprehensive Mental and Social Health Services at the District Level. Overviewing countries strategies towards integrating MH services into PHC, their outcomes and challenges. Fam Syst Health. (2023). We explored the facilitation process using a qualitative descriptive study design [42, 43]. It might have also been easier and more rewarding to engage in regional level activities than site level ones as the facilitator was experiencing so much local push back. Ritchie MJ, Parker LE, Kirchner JE. Healthcare organizations have increasingly utilized facilitation to improve implementation of evidence-based practices and programs (e.g., primary care mental health integration). Major Infectious Diseases. Rahimi-Movaghar A, Sharifi V, Motevalian A, Amin-Esmaeili M, Hajebi A, Radgoodarzi R, et al. Bidassie B, Williams LS, Woodward-Hagg H, Matthias MS, Damush TM. We also coded whether facilitators were doing these activities for sites or enabling sites to perform them. Syst Rev. https://doi.org/10.1111/j.1741-6787.2010.00186.x. In this study, activities did not occur according to a defined series of ordered steps or phases but were responsive to context. https://doi.org/10.1186/s12913-023-09598-y, DOI: https://doi.org/10.1186/s12913-023-09598-y. You give him the phone number for the tobacco quit line and schedule a follow-up visit in two months to check his progress. 2021;2(1):82. https://doi.org/10.1186/s43058-021-00180-3. Psychiatric Beds in the Health System of Iran. 25 of 602 articles were selected. To bridge the treatment gap, the World Health Organization developed mhGAP, a guidance package for integrated management of priority MH disorders in lower-income countries. Implement Sci. Getting evidence into practice: the role and function of facilitation. Harvey G, Kitson A. Facilitating implementation of primary care mental health over time and across organizational contexts: a qualitative study of role and process, https://doi.org/10.1186/s12913-023-09598-y, https://doi.org/10.1007/s10488-010-0327-7, https://doi.org/10.1111/j.0887-378X.2004.00325.x, https://doi.org/10.1007/s10488-013-0481-9, https://doi.org/10.1186/s13643-018-0734-5, https://doi.org/10.3122/jabfm.2013.05.130028, https://doi.org/10.3122/jabfm.2015.S1.150054, https://doi.org/10.1080/23288604.2015.1077301, https://doi.org/10.1176/appi.ps.201400054, https://doi.org/10.1007/s11606-018-4581-9, https://doi.org/10.1186/s13012-019-0876-4, https://doi.org/10.1186/s13012-016-0398-2, https://doi.org/10.1111/j.1741-6787.2010.00186.x, https://doi.org/10.1186/s13012-015-0323-0, https://doi.org/10.1186/s13012-015-0252-y, https://doi.org/10.1097/hmr.0000000000000145, https://doi.org/10.1097/xeb.0000000000000008, https://doi.org/10.1046/j.1365-2648.2002.02126.x, https://doi.org/10.1186/s12913-015-0722-6, https://doi.org/10.1186/s12913-017-2537-0, https://doi.org/10.1007/s11606-014-3027-2, https://doi.org/10.1186/s12913-017-2217-0, https://doi.org/10.1002/1098-240X(200008)23:4%3C334, https://openlibrary-repo.ecampusontario.ca/xmlui/bitstream/handle/123456789/296/Principles%20of%20Sociological%20Inquiry.pdf?sequence=1&isAllowed=y, https://doi.org/10.1186/s43058-020-00006-8, https://doi.org/10.1186/s43058-021-00138-5, https://doi.org/10.1186/s43058-021-00180-3, https://doi.org/10.1007/s11606-019-05350-7, https://doi.org/10.1186/s13063-015-1141-z, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, bmchealthservicesresearch@biomedcentral.com. Similarly, as Network C lacked infrastructure support for implementation, facilitators focused more than Network A facilitators on enabling sites to develop policies and the infrastructure needed to support PCMHI adoption. Integrating mental health services into primary care is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. Integrated behavioral health model: After you've discussed the use of varenicline with Bill, you emphasize the importance of concurrent behavioral health support. Lewis CC, Klasnja P, Powell BJ, Lyon AR, Tuzzio L, Jones S, et al. Parchman ML, Noel PH, Culler SD, Lanham HJ, Leykum LK, Romero RL, et al. Cykert S, Keyserling TC, Pignone M, DeWalt D, Weiner BJ, Trogdon JG, et al. 8600 Rockville Pike Elnitsky CA, Powell-Cope G, Besterman-Dahan KL, Rugs D, Ullrich PM. The model can be summed up with the acronym GATHER: generalist, accessible, team-based, high productivity, education, and routine (see GATHER behavioral health integration model).2 (For other models, see Bringing Behavioral Health Into Your Practice Through a Psychiatric Collaborative Care Program, FPM, November/December 2019.). Adm Policy Ment Health. Implementation of safe patient handling in the US Veterans Health System: a qualitative study of internal facilitators perceptions. } Li SA, Jeffs L, Barwick M, Stevens B. Implement Sci. AID-NUR9%3E3.0.CO;2-G. Kim H, Sefcik JS, Bradway C. Characteristics of qualitative descriptive studies: a systematic review. Millbank Q. 2020;1(1):7. https://doi.org/10.1186/s43058-020-00006-8. & Kirchner, J.E. Here are some examples comparing care in the traditional (non-integrated) model and the integrated behavioral health model. The state of the evidence for integrated behavioral health in primary care. Health and mental health policies, plans and laws should all reinforce the development of a strong primary healthcare system as well as the integration of mental health within that system. Using implementation facilitation to foster clinical practice quality and adherence to evidence in challenged settings: a qualitative study. To address this challenge, the facilitator had to spend more time over a longer period in stakeholder engagement and overcoming resistance to change activities. In addition, through a series of best practice case studies of long-standing and successful services from around the world, the report provides specific in formation, direction and recommendations for undertaking effective integration in a number of different country resources settings. The views expressed in this article are those of the authors and do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. Stetler CB, Damschroder LJ, Helfrich CD, Hagedorn HJ. Against the backdrop of renewed international attention on primary healthcare and the upcoming 2008 World Health Report on the same topic, WHO and WONCA are developing a Report on Integrating Mental Health into Primary Health Care. Enabling the implementation of evidence based practice: a conceptual framework. As might be expected, these activities fell into one or more of the following categories: 1) site members would have found them burdensome, 2) site members lacked the requisite skills to perform them (e.g., data collection), and 3) involved recruiting support for change or providing education. Understanding this process can help those planning and applying implementation facilitation to make conscious choices about the facilitation role and the activities that facilitators can use to operationalize this role. for this article. Ritchie, M.J., Parker, L.E. Islamic Republic of Iran. It focused on how the use and intensity of particular facilitation activities changed over time and in response to context. The new model was then proposed to fill these gaps focusing on increasing access, continuity of care, coordination in service delivery, and comprehensiveness of care. 2003;1(2). Iran; Mental Disorders; Mental Health Services; Primary Health Care; Risk Factors. Although the integrated Promoting Action on Implementation Research in Health Services (i-PARIHS) framework assumes that implementation is non-linear and complex and posits that facilitation tailors the implementation process in response to the innovation, its recipients, and the implementation context, the framework describes facilitation activities in sequential phases (i.e., clarifying and engaging, assessing and measuring, action and implementation, and reviewing and sharing) [25]. 2015;18(2):7684. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 1 VA has instituted this beneficial, excellent approach; however, some veterans most vulnerable to suicidal ideation prefer to access care outside VA. Improving patient care: the implementation of change in healthcare. Stetler CB, Legro MW, Rycroft-Malone J, Bowman C, Curran G, Guihan M, et al. Qualitative Research & Evaluation Methods. For example, the Network A IRF was a skilled educator and most comfortable working one-on-one with staff to effect change; the Network C facilitator had substantial experience working in re-engineering and was most comfortable operating at the system level. Thousand Oaks, CA: Sage Publications, Inc.; 2002. New York, NY: Springer; 2013. p. 6598. Our findings are a first step but are intriguing enough, we believe, to suggest that further longitudinal research across a broad range of clinical and organization contexts would help us deepen our understanding of how facilitation fosters evidence-based practice implementation. Certain implementation facilitation activities tended to occur predominantly during particular implementation periods (see Table 1). World Health Organization / World Organization of Family Doctors. 2021 Jun 16;3(9):694-701. doi: 10.1096/fba.2020-00145. We advocate for federal and state funding, new and innovative care delivery and payment models, and a strong mental health and substance use treatment workforce. Facilitators and other implementation support agents need to be aware of the wide variety of activities for which there is no expected pattern of intensity. 2004;82(4):581629. A Danish collaborative care intervention provided high-quality treatment of moderate A&D. FOIA Primary healthcare is the first level of contact of individuals, the family and community with the national health system, the closest and easiest form of care available, located near to peoples' homes and communities.2 In many countries however, psychiatric institutions are the only form of mental health-care available to the population. First Edition. Mental disorders are extremely prevalent in all countries and are responsible for immense suffering, poor quality of life, increased mortality and staggering economic and social costs. psychiatric units, or other healthcare facilities and are in need of SUD services. Alternatively, it is possible that, as others have suggested, it was easier at times for facilitators to slip into doing activities rather than enabling the site to do them [52, 53]. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. official website and that any information you provide is encrypted Department for Mental Health and Substance Abuse. Scholars agree that facilitation is a dynamic process, but little is known about its dynamic nature. Article The https:// ensures that you are connecting to the She meets with Cecelia six times over the next two months and reports to you that during their last meeting Cecelia discussed wanting to start some medications. . https://doi.org/10.1111/1475-6773.13571. 2012;7:9. https://doi.org/10.1186/1748-5908-7-9. 2022 Dec 24;36:171. doi: 10.47176/mjiri.36.171. Up to 75% of primary care visits include mental or behavioral health components.1 This includes behavioral factors related to chronic disease management, mental health issues, substance use, smoking or other tobacco use, and the impact of stress, diet, and exercise on health. Department of Mental Health and Substance Abuse, World Health Organization, Geneva. Bethesda, MD 20894, Web Policies We also found that some activities could be either something that the facilitator did for or enabled the clinic to do for themselves, depending on needs, skills, and other organizational circumstances. Inclusion in an NLM database does not imply endorsement of, or agreement with, To create a list of activities with definitions, they conducted a content analysis of activity definitions in selected articles and combined those that used different labels but described the same actions. government site. National Library of Medicine Terms and Conditions, BMC Health Serv Res 23, 565 (2023). As a library, NLM provides access to scientific literature. 2014;65(5):5779. Using the activity list, they coded the debriefing notes for each clinic by quarter. INTEGRATING MENTAL HEALTHCARE INTO PRIMARY HEALTH CARE SERVICES: A CALL TO STRENGTHEN THE PRIMARY HEALTHCARE LEVEL By Peter Eyram Kuenyefu, Snr. Implement Sci. Kroenke and Unutzer's paper is to be applauded for focusing on the advisability and effectiveness of integrating mental health services into primary care. Mental Health Services Healthcare organization primary health care Mental Health integration. It is not meant to be a handoff of care, but a team-based approach supporting the work of the primary care physician. Implement Sci Commun. https://doi.org/10.1037/fsh0000273. The World Health Organization is paving the way for a shift of public health towards promoting health and well-being. This means, for example, that financial and human resources need to be re-directed from tertiary care towards primary care and that psychotropic medicines should also be made available at primary healthcare level. Our members offer supports to millions of adults, children and families living with mental health and substance use challenges. 2002;37(6):57788. https://doi.org/10.1111/jrh.12398. MH-PHC integration initiatives have seen varying degrees of success. Overviewing countries strategies towards integrating MH services into PHC, their outcomes and challenges. On Monday 29 June 2023, Member States agreed to adopt, the "Global framework for integrating well-being into public health utilizing a health promotion approach", which strives to enable all people to flourish and achieve their full physical and mental health potential . 2013;26(5):588602. Facilitating implementation of primary care mental health over time and across organizational contexts: a qualitative study of role and process. Additionally, scholars have suggested that the activities facilitators conduct to operationalize their roles also lie on a continuum. At the start of the study, Network A had already adopted a model of PCMHI and infrastructure to support it. The project utilized a two-person facilitation team consisting of an expert external facilitator (EF) and an internal regional facilitator (IRF). Bethesda, MD 20894, Web Policies Stop exclusion, dare to care, National Institute for Health Care Excellence, Depression: management of depression in primary and secondary care, Treatment and prevention of mental disorders in low-income and middle-income countries. In addition, WHO has a number of specific recommendations that are fundamental for undertaking successful integration of mental health into primary healthcare. 2018;7(1):72. https://doi.org/10.1186/s13643-018-0734-5. Kwan BM, Nease DE. Data may be available from the corresponding author upon reasonable request and with the permission of the Department of Veterans Affairs.
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