Date of Award

Summer 2021

Document Type

Open Access Dissertation

Department

Psychology

First Advisor

Abraham Wandersman

Abstract

The integration of behavioral health and primary care (i.e., “integrated care”) is a method to improve health equity and improve health outcomes. However, more research is needed to understand the relationship between practice readiness, implementation, and outcomes of integrated care over time. Therefore, this study involves a mixed methods retrospective process evaluation to explore the relationship between readiness factors and outcomes in clinical practices two-and-a-half to three-and-a-half years following a capacity-building program. During that program, practices completed assessments of their readiness to implement integrated care using the Readiness for Integrated Care Questionnaire (RICQ). At follow-up, we conducted surveys, qualitative interviews , and quantitative analyses with eight key informants from eight clinical practices to assess and explore (1) how readiness is associated with (a) sustainability of integrated care, (b) other implementation outcomes in integrated care, and (c) client outcomes in integrated care; (2) which readiness subcomponents are most influential in integrated care; (3) how practices build and/or maintain readiness for integrated care over time; and (4) other contextual factors, including Covid-19, that influenced sustainability of integrated care. Exploratory quantitative analyses suggest that the RICQ total scores were moderately to strongly positively correlated with self-ratings of practice sustainability, acceptability, fidelity, and achievement of client outcomes, and there was a small correlation with implementation cost. Follow-up surveys and interviews indicated the readiness subcomponents that were most influential throughout implementation as facilitators and barriers to implementation, sustainability, and achieving outcomes. Priority, program champion, innovation specific knowledge and skills, and supportive climate were key facilitators to integrated care. This study also highlights strategies practices used to sustain or build readiness, including systematic tracking of data, integrated care training programs, billing practices, top-down mandates for integrated care, regular communication, and hiring practices. Finally, the Covid-19 pandemic’s influence on readiness for integrated care is explained in-depth, along with related readiness-building practices of telehealth and support for staff. This study has implications for the fields of integrated care and implementation science because it generates hypotheses about which elements of readiness impact implementation and sustainability of integrated care and offers strategies to build readiness for integrated care.

Rights

© 2021, Tara Kenworthy

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