Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA.
Seattle Children's Research Institute, Seattle, USA.
BMC Health Serv Res. 2024 May 9;24(1):604. doi: 10.1186/s12913-024-11041-9.
Inadequate and inequitable access to quality behavioral health services and high costs within the mental health systems are long-standing problems. System-level (e.g., fee-for-service payment model, lack of a universal payor) and individual factors (e.g., lack of knowledge of existing resources) contribute to difficulties in accessing resources and services. Patients are underserved in County behavioral health systems in the United States. Orange County's (California) Behavioral Health System Transformation project sought to improve access by addressing two parts of their system: developing a template for value-based contracts that promote payor-agnostic care (Part 1); developing a digital platform to support resource navigation (Part 2). Our aim was to evaluate facilitators of and barriers to each of these system changes.
We collected interview data from County or health care agency leaders, contracted partners, and community stakeholders. Themes were informed by the Consolidated Framework for Implementation Research.
Five themes were identified related to behavioral health system transformation, including 1) aligning goals and values, 2) addressing fit, 3) fostering engagement and partnership, 4) being aware of implementation contexts, and 5) promoting communication. A lack of fit into incentive structures and changing state guidelines and priorities were barriers to contract development. Involving diverse communities to inform design and content facilitated the process of developing digital tools.
The study highlights the multifaceted factors that help facilitate or hinder behavioral health system transformation, such as the need for addressing systematic and process behaviors, leveraging the knowledge of leadership and community stakeholders, fostering collaboration, and adapting to implementation contexts.
在美国，县一级的精神卫生系统中，提供高质量行为健康服务的机会不足且不公平，同时成本高昂，这些一直是存在已久的问题。系统层面（例如，按服务收费的支付模式、缺乏全民支付者）和个人因素（例如，缺乏对现有资源的了解）都导致了获取资源和服务的困难。美国县一级的行为健康服务系统未能充分满足患者的需求。橙县（加利福尼亚州）的行为健康系统转型项目试图通过解决其系统的两个部分来改善获取资源的途径：制定促进支付者中立护理的基于价值的合同模板（第 1 部分）；开发一个支持资源导航的数字平台（第 2 部分）。我们的目的是评估这些系统变革的每个部分的促进因素和障碍。
我们从县或医疗保健机构的领导、签约合作伙伴和社区利益相关者那里收集了访谈数据。主题是由实施研究综合框架确定的。
确定了与行为健康系统转型相关的五个主题，包括 1）调整目标和价值观，2）解决适配性，3）促进参与和伙伴关系，4）了解实施背景，以及 5）促进沟通。合同制定的障碍包括激励结构和不断变化的州指导方针和优先事项的适配性不足。让不同的社区参与进来为设计和内容提供信息，有助于开发数字工具的过程。
该研究强调了促进或阻碍行为健康系统转型的多方面因素，例如需要解决系统和流程行为、利用领导力和社区利益相关者的知识、促进合作以及适应实施背景。
