title: Partnership for implementation of evidence-based mental health practices in rural federally qualified health centers: theory and methods.
abstract: BACKGROUND
  Mental health and substance abuse are among the most commonly reported reasons for visits to Federally Qualified Health Centers (CHCs), yet only 6.5% of encounters are with on-site behavioral health specialists. Rural CHCs are significantly less likely to have on-site behavioral specialists than urban CHCs. Because of this lack of mental health specialists in rural areas, the most promising approach to improving mental health outcomes is to help rural primary care (PC) providers deliver evidence-based practices (EBPs). Despite the scope of these problems, no research has developed an effective implementation strategy for facilitating the adoption of mental health EBPs for rural CHCs. We sought to describe the conceptual components of an implementation partnership that focuses on the adaption and adoption of mental health EBPs by rural CHCs in Arkansas.
  
  
  METHODS
  We present a conceptual model that integrates seven separate frameworks: (1) Jones and Wells' Evidence-Based Community Partnership Model, (2) Kitson's Promoting Action on Research Implementation in Health Services (PARiHS) implementation framework, (3) Sackett's definition of evidence-based medicine, (4) Glisson's organizational social context model, (5) Rubenstein's Evidence-Based Quality Improvement (EBQI) facilitation process, (6) Glasgow's RE-AIM evaluation approach, and (7) Naylor's concept of shared decision making.
  
  
  CONCLUSIONS
  By integrating these frameworks into a meaningful conceptual model, we hope to develop a successful implementation partnership between an academic health center and small rural CHCs to improve mental health outcomes. Findings from this implementation partnership should have relevance to hundreds of clinics and millions of patients, and could help promote the sustained adoption of EBPs across rural America.
authors.affiliation: Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, USA.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Hunt
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Curran
authors.forename: Teresa
authors.initials: T
authors.lastname: Kramer
authors.forename: Sip
authors.initials: S
authors.lastname: Mouden
authors.forename: Susan
authors.initials: S
authors.lastname: Ward-Jones
authors.forename: Richard
authors.initials: R
authors.lastname: Owen
authors.forename: John
authors.initials: J
authors.lastname: Fortney
mesh_terms: D055812:Community-Based Participatory Research / Q000458:organization & administration*; D003159:Community-Institutional Relations; D003299:Cooperative Behavior; D019317:Evidence-Based Medicine; D006302:Health Services Research; D006801:Humans; D008507:Medically Underserved Area; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy; D008603:Mental Health / Q000706:statistics & numerical data; D008605:Mental Health Services / Q000458:organization & administration*; D058996:Quality Improvement; D019035:Rural Health Services / Q000458:organization & administration*