Melissa A. King, PhD, MPAff, is Principal, People's Health Solutions, Los Angeles, California. E-mail:
Health Care Manage Rev. 2018 Jul/Sep;43(3):206-217. doi: 10.1097/HMR.0000000000000169.
Although there is evidence that mental health services can be delivered in pediatric primary care with good outcomes, few changes in service delivery have been seen over the past decade. Practices face a number of barriers, making interventions that address determinants of change at multiple levels a promising solution. However, these interventions may need appropriate organizational contexts in place to be successfully implemented.
The objective of this study was to test whether organizational context (culture, climate, structures/processes, and technologies) influenced uptake of a complex intervention to implement mental health services in pediatric primary care.
METHODOLOGY/APPROACH: We incorporated our research into the implementation and evaluation of Ohio Building Mental Wellness Wave 3, a learning collaborative with on-site trainings and technical assistance supporting key drivers of mental health care implementation. Simple linear regression was used to test the effects of organizational context and external or fixed organizational characteristics on program uptake.
Culture, structure/processes, and technologies scores indicating a more positive organizational context for mental health at the project's start, as well as general cultural values that were more group/developmental, were positively associated with uptake. Patient-centered medical home certification and use of electronic medical records were also associated with greater uptake. Changes in context over the course of Building Mental Wellness did not influence uptake.
Organizational culture, structures/processes, and technologies are important determinants of the uptake of activities to implement mental health services in pediatric primary care. Interventions may be able to change these aspects of context to make them more favorable to integration, but baseline characteristics more heavily influence the more proximal uptake of program activities.
Pediatric primary care practices would benefit from assessing their organizational context and taking steps to address it prior to or in a phased approach with mental health service implementation.
尽管有证据表明，在儿科初级保健中提供心理健康服务可以取得良好的效果，但在过去十年中，服务提供方式几乎没有变化。实践中存在许多障碍，因此，多层面解决变革决定因素的干预措施是一种很有前途的解决方案。然而，这些干预措施可能需要适当的组织环境才能成功实施。
本研究旨在检验组织环境（文化、氛围、结构/流程和技术）是否会影响在儿科初级保健中实施心理健康服务的复杂干预措施的采用。
方法/途径：我们将研究纳入俄亥俄州建设心理健康第 3 波的实施和评估中，这是一个学习合作项目，提供现场培训和技术援助，以支持心理健康护理实施的关键驱动因素。我们使用简单线性回归来检验组织环境以及外部或固定组织特征对项目采用的影响。
项目开始时，心理健康方面的组织环境得分较高（文化、结构/流程和技术），以及更注重群体/发展的一般文化价值观与采用呈正相关。以患者为中心的医疗之家认证和电子病历的使用也与更高的采用率相关。建设心理健康过程中环境的变化并没有影响采用率。
组织文化、结构/流程和技术是在儿科初级保健中实施心理健康服务活动采用的重要决定因素。干预措施可能能够改变这些方面的环境，使其更有利于整合，但基线特征更严重地影响了项目活动的更接近的采用。
儿科初级保健实践可以从评估其组织环境并在实施心理健康服务之前或分阶段采取措施来解决该环境中存在的问题中受益。
