Symposia
Dissemination & Implementation Science
Kelsey S. Dickson, Ph.D.
Assistant Professor
San Diego State University
San Diego, California
Care coordination is an evidence-based model increasingly utilized to improve care equity and outcomes. Care coordinators (CC) integrate and support patient care and services spanning multiple care settings.1 Care coordination necessitates proficiency to work in multiple organizational contexts and CC often deliver evidence-based practices (EBPs) targeting multifaceted (e.g., medical, mental health) patient needs, including in areas where they have limited training. This points to the need for tailored implementation strategies to support successful implementation, including EBPs provided within this model. This project describes a needs assessment to inform selection and testing of implementation strategies to improve EBP delivery in a care coordination model at a Federally Qualified Health Center.
As part of our application of Implementation Mapping4 to select implementation strategies, we conducted a mixed-methods needs assessment to characterize training and EBP delivery determinants and existing and additional implementation supports needed for EBP delivery. CC participants (n=8; 75% female, 25% male; 100% identified as Mexican/of Mexican descent) completed a survey regarding perceptions of training and implementation supports using a 5-point Likert scale (1=Not At All; 5=Very Great Extent). We also conducted two focus groups. We used descriptive analyses and in-depth coding to analyze survey and focus group data, respectively.
Results indicated strong organizational support for EBPs (M=4.4) but challenges surrounding implementation (M=3.9) and sustainment (M=4.1). Existing implementation strategies included: provision of trainings and educational materials and changing record systems. Additional strategies needed included ongoing consultation, facilitating clinical data relay, and quality monitoring tools. Corroborating and expanding on survey results, focus group themes indicated the need for: ongoing trainings, culturally relevant psychoeducational materials, adaptation of existing workflows pertaining to mental health, and network weaving between care coordination and mental health.
Despite some training and educational resources, the complexity of providing support to patients with several medical and mental health needs requires a more nuanced approach to training CCs and supporting mental health EBP delivery. Results highlight the importance of development and tailoring of implementation strategies to support the EBP implementation within the context of a care coordination model.