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Newsletters | South Central MIRECC

Spring 2018, Volume 20, Issue 3 - In this Issue

Research to Practice: Implementation of PC-MHI in Challenged Settings - A Qualitative Study
Fall 2017 Motivational Interviewing Training
Dr. Lilian Dindo Selected as New Houston Anchor Site Leader
Clinical Demonstration Project - FLOW
Pilot Study Research Program Applications Due July 2
Implementation, Design and Analysis Support Available for Affiliates

Research to Practice: Implementation of PC-MHI in Challenged Settings - A Qualitative Study

Summary by Sonora Hudson, MA

A recent study by VA researchers explored facilitation methods for implementing one of two evidence-based Primary Care-Mental Health Integration (PC-MHI) care management models in 16 VA primary care clinics considered challenged because of insufficient resources and lack of infrastructure support and process knowledge. The article, by Mona J. Ritchie, Louise E. Parker, Carrie N. Edlund and JoAnn E. Kirchner, reports results of the third study in a series funded by the VA Health Services Research & Development Service and QUERI.

This small study used a matched-pair design to explore whether the implementation facilitation (IF) strategy, which incorporated a blend of external and internal facilitation, could help clinics implement PC-MHI programs. A national expert facilitator worked with and mentored two internal regional facilitators (clinical personnel experienced in PC-MHI practices who dedicated half their time to the project).

Qualitative evaluation of the IF strategy involved one-hour structured telephone interviews at two time points with clinicians and leaders most knowledgeable about the programs implemented at each site. Researchers then created structured interview summaries that were evaluated by national PC-MHI experts to rate the programs on overall quality, adherence to evidence, sustainability and level of improvement. At baseline, none of the sites had a PC-MHI program meeting VA policy requirements and delivering the brief models of care associated with PC-MHI. Networks with a strong mental health service line structure and input were compared to those lacking resources of the same strength.

Key findings include:

  • 7 of 8 IF sites and 4 of 8 comparison sites had implemented a PC-MHI program at the first assessment, with IF clinics’ programs more highly rated, with the exception of one site
  • All 8 IF sites, but just 5 comparison sites, had implemented a PC-MHI program at final assessment
  • IF sites’ programs were again rated as being of higher quality than their matched comparison sites, with one exception
  • Gradually, all ratings improved in 5 of the 7 IF sites and 2 of the 3 comparison sites

The good results of the IF strategy are attributed partly to facilitators’ efforts to involve and engage stakeholders at all organizational levels. Efforts to assess the organizational context and current practices and tailor implementation to site-specific context and needs were identified as instrumental to successful implementation. Additional implementation activities that contributed to overall success included:

  • Providing assistance in acquiring site staff with necessary knowledge and skills
  • Monitoring programs and providing feedback.

However, some clinics in one network still had difficulty implementing the new program due to a lack of VAMC support. The strength of network mental health service line structure also had an impact, leading the authors to surmise that facilitation and strength of leadership structure may synergistically affect ability to implement higher-quality, evidence-based programs.

This article may be accessed at

Citation: Ritchie, M. J., Parker, L. E., Edlund, C. N., Kirchner, J. (2017). Using implementation facilitation to foster clinical practice quality and adherence to evidence in challenged settings: A qualitative study. BMC Health Services Research, 17, 291.


Last updated: December 29, 2022