Embedding Early Childhood Behavioral Health Services in Community Settings: An Implementation Science Perspective

Introduction:

Community-based settings are increasingly called upon to implement developmental surveillance and integrated behavioral health services for young children as part of system-wide efforts to promote well-being and reduce risk for mental health concerns. With this trend, it is important to understand what leads to successful and sustainable uptake of these supports from the perspective of multiple stakeholders in order to develop effective service delivery models. 

 

Method:

Data comes from our work embedding early childhood developmental and behavioral screening and behavioral health services (i.e., brief evaluation and referral service for children who screened positive) into pediatric primary care clinics serving high-risk children and families.  Individual interviews were conducted with members of the Implementation Team (e.g., program coordinator, behavioral health specialist) on six occasions (N = 7, N = 12, N = 16, N = 13, N = 15, N = 13) and with Community Partners (e.g., pediatricians, nurses) on two occasions (N = 29, N = 28).  All interviews used open-ended prompts and semi-structured interviewing techniques; interviews with Community Partners also included 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; approximately half of the interviews were double coded and consensus rated to ensure accuracy (kappa > .80).

Results:

Results outline the impact of integrated early childhood screening and behavioral health supports on community settings (e.g., changes to provider practices, increased accessibility of supports) and services that were (and were not) well-received by the pediatric clinics.  Results also describe the barriers and facilitators for implementation over time, including: organizational resources and infrastructure (e.g., space, materials, financial viability), staff resources (e.g., time, supervision), staff competencies (e.g., professional competence, readiness to change), organizational culture and climate, leadership support, and communication and collaboration within and between the Implementation Team and Community Partners.  As implementation activities and grant funding neared their conclusion, considerable discussion oriented towards sustainability of services and the barriers and facilitators of long-term sustainability.

Conclusion:

These results are consistent with themes from the implementation science literature and likely generalize to a range of community prevention programming.  Lessons learned highlight strategies for facilitating successful and sustainable implementation in community settings.