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Open Access 01-12-2024 | Research

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

Authors: Xin Zhao, Rachel Varisco, Judith Borghouts, Elizabeth V. Eikey, David Safani, Dana B. Mukamel, Stephen M. Schueller, Dara H. Sorkin

Published in: BMC Health Services Research | Issue 1/2024

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.

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Title: Facilitators of and barriers to County Behavioral Health System Transformation and Innovation: an interview study
Authors: Xin Zhao
Rachel Varisco
Judith Borghouts
Elizabeth V. Eikey
David Safani
Dana B. Mukamel
Stephen M. Schueller
Dara H. Sorkin
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-024-11041-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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