Exploring Determinants of Effective Implementation of an Innovation Within Health Care: Qualitative Insights from Program Champions on Implementing One-at-a-Time Therapy Within Addictions and Mental Health Services in New Brunswick.

Autor: Keeler-Villa NR; Department of Psychology, Memorial University of Newfoundland, 230 Elizabeth Ave, St. Johns, NL, A1B 3X9, Canada., Beaulieu D; Department of Psychology, University of New Brunswick, Fredericton, Canada., Harris-Lane LM; Department of Psychology, Memorial University of Newfoundland, 230 Elizabeth Ave, St. Johns, NL, A1B 3X9, Canada., Bérubé S; Department of Health, Government of New Brunswick, Fredericton, Canada., Burke K; Department of Health, Government of New Brunswick, Fredericton, Canada., Churchill A; Stepped Care Solutions, Mount Pearl, Canada., Cornish P; Stepped Care Solutions, Mount Pearl, Canada.; Student Mental Health, University of California Berkeley, Berkeley, USA., Goguen B; Department of Health, Government of New Brunswick, Fredericton, Canada.; Stepped Care Solutions, Mount Pearl, Canada., Jaouich A; Stepped Care Solutions, Mount Pearl, Canada., Michaud M; Department of Health, Government of New Brunswick, Fredericton, Canada., Losier A; Department of Health, Government of New Brunswick, Fredericton, Canada., Snow N; Faculty of Nursing, Memorial University of Newfoundland, St. Johns, Canada., Rash JA; Department of Psychology, Memorial University of Newfoundland, 230 Elizabeth Ave, St. Johns, NL, A1B 3X9, Canada. jarash@mun.ca.
Jazyk: angličtina
Zdroj: Administration and policy in mental health [Adm Policy Ment Health] 2024 Nov 23. Date of Electronic Publication: 2024 Nov 23.
DOI: 10.1007/s10488-024-01423-w
Abstrakt: Government of New Brunswick implemented One-at-a-Time (OAAT) therapy, a single-session approach to care, within Addiction and Mental Health (A&MH) services. We conducted interviews to understand determinants of implementation from program champions. Champions of the OAAT therapy implementation (N = 19; Child/Youth n = 8, Adult n = 11) working within A&MH services and school districts were recruited through the provincial implementation team. Transcripts were synthesized using thematic analysis. Determinants were organized as facilitators and barriers in accordance with the Consolidated Framework for Implementation Research (CFIR). Thematic analysis resulted in 18 themes and 5 recommendations. Facilitators within the inner setting included: (1) need for change and perceived benefits of OAAT therapy; (2) compatibility of OAAT therapy with previous practice and service processes; and (3) support received from champions and colleagues. Insufficient resources (e.g., staff and physical infrastructure), and a culture that favored long-term therapy were barriers. Navigating age of consent, and implementation around COVID-19 were barriers within the outer setting. Facilitators within the implementation process domain included: (1) interconnected teams across sites, regions and the province; (2) collaborative implementation planning; (3) flexibility to tailor implementation at sites; and (4) mentorship provided by champions. Insufficient standardization of the implementation and limited representation among affected parties (e.g., community partners) were barriers within the implementation process. This study elucidated determinants that influenced implementation of a new service delivery within an Eastern Canadian provincial health care system. Findings can serve as a heuristic for organizations looking to enact similar implementation initiatives.
Competing Interests: Declarations. Conflict of interest: P. Cornish is the founder and former president of Stepped Care Solutions, and currently receives financial compensation for consulting services. A. Churchill, and A. Jaouich are employed with Stepped Care Solutions. Stepped Care Solutions is a not-for-profit mental health system consultancy group and is the developer of the Stepped Care 2.0 model. Stepped Care Solutions provided online training as an in-kind contribution to the project. As a result of Determinants of effective implementation within Addiction and Mental Health Services competing interests, Cornish, Churchill, and Jaouich were not involved in data collection and initial synthesis in order to minimize potential for bias. The other authors declare that they have no competing interests. Ethical Approval: The procedures of this research were approved by the Newfoundland and Labrador Health Research Ethics Board (HREB#2022.048). Informed Consent: Individuals provided informed consent electronically before participating in the associated research.
(© 2024. The Author(s).)
Databáze: MEDLINE
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