Implementing Early Childhood Screening and Mental Health Consultation in Community Settings: Barriers, Facilitators, and Promising Approaches

Community organizations and treatment settings are increasingly implementing evidence-based prevention programs and practices (EBPs) that promote well-being and reduce risk for mental health concerns among children and families.  Unfortunately, when EBPs are implemented in these “real world” settings, they typically yield smaller effect sizes than those found in clinical trials and/or are underutilized over time.  This is likely due to limited guidance about how to implement EBPs sustainably and with fidelity.  Thus, it is important to identify the barriers and facilitators of successful implementation as this will lead to the development of effective service delivery and implementation models for community settings.  Ultimately, this line of research can increase the public health impact of EBPs. 

Data comes from our work embedding universal early childhood screening and early childhood mental health consultation into community pediatric primary care clinics serving high-risk children and families.  Mixed methods were used to understand the implementation process.  Individual interviews were conducted with members of the Implementation Team on four occasions (N = 7, N = 12, N = 16, N  = 13) and with Community Partners from the pediatric clinics midway into service delivery (N = 29).  All interviews used open-ended prompts and semi-structured interviewing techniques; interviews with Community Partners also included some close-ended responses.  Interviewers took detailed notes, which were used to identify key themes based on the implementation science literature.  For Implementation Team interviews, themes were identified on an emergent basis.  For Community Partner interviews, themes were identified using a coding system; the first 9 interviews (31%) were double-coded and consensus rated to ensure accuracy (kappa > .80).

Results suggested barriers and facilitators for implementing universal early childhood screening and mental health consultation in pediatric primary care.  These include organizational resources and infrastructure (e.g., space, materials, organizational structure and hierarchy), staff resources (e.g., time, schedule, support, supervision), staff competence and engagement (e.g., professional competence, readiness to change, cultural competence), organizational culture and climate, leadership support, and communication/collaboration within and between the Implementation Team and Community Partners.  These results are consistent with emerging themes from the implementation science literature and likely generalize to a range of community-based prevention programming.  Implications for the development of strategies to facilitate the successful and sustainable implementation of EBPs in community settings will be discussed.