title: Identifying factors critical to implementation of integrated mental health services in rural VA community-based outpatient clinics.
abstract: The purpose of this study was to gain a better understanding of the critical components associated with implementing integrated mental health care services in rural VA community-based outpatient clinics (CBOCs). In-person semi-structured interviews were conducted with 20 health care providers and staff within a year after placing a trained advanced practice nurse (APN) to provide mental health/substance abuse (MH/SA) care at 2 rural CBOCs in the southeastern United States. Four raters independently evaluated interview transcripts and conducted content analysis to summarize the interview results. The results indicate that key contextual factors related to leadership, staff attitudes and beliefs, and unique organizational factors of the clinic and the community can affect the success of such clinical innovations. In addition to providing descriptive information about the attitudes, beliefs, and experiences of CBOC personnel regarding implementation of integrated MH/SA services using APNs, the study findings suggest several domains that could be explored in future studies of integrated mental health service delivery to rural veterans through primary care.
authors.affiliation: VA South Central MIRECC, Central Arkansas Veterans Healthcare System (152/NLR), 2200 Ft Roots Dr, North Little Rock, AR 72114, USA. KirchnerJoAnnE@uams.edu.
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Kirchner
authors.forename: Marisue
authors.initials: M
authors.lastname: Cody
authors.forename: Carol R
authors.initials: CR
authors.lastname: Thrush
authors.forename: Greer
authors.initials: G
authors.lastname: Sullivan
authors.forename: Carla Gene
authors.initials: CG
authors.lastname: Rapp
mesh_terms: D001291:Attitude of Health Personnel; D003156:Community Mental Health Services / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003863:Depression / Q000451:nursing; D017831:Diagnosis, Dual (Psychiatry) / Q000451:nursing; D006787:Hospitals, Veterans; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009722:Nurse Practitioners; D011568:Psychiatric Nursing / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration*; D015144:Southeastern United States; D019966:Substance-Related Disorders / Q000451:nursing; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*