A Community-University Partnership to Identify Structural Barriers and Facilitators to Best Practices in a Youth-Centered Primary Care Clinic

Introduction: Mental health problems play a significant role in the burden of disease among adolescents in the United States. With the passing of the Affordable Care Act, primary care visits are expected to significantly increase, thereby providing researchers and clinicians with opportunities to deliver health and mental health preventive services. Yet, the research in this area remains limited. Therefore, the purpose of this study was to develop a fuller understanding of community stakeholders’ perspectives on the structural barriers and facilitators to implementation and uptake of adolescent mental health interventions in a primary care setting.

Methods: A community-based participatory research (CBPR) approach was employed, including the development of a community advisory board (CAB), to ensure community stakeholders were involved in (1) the identification of the problem and proposal preparation and submission, (2) recruitment and engagement of participants, (3) data collection and analysis, and (4) dissemination of findings. A total of 30 adolescents ( age=19.63, SD=1.4, range=17-21) and 17 key informants ( age=36.29, SD=10.98) participated in individual and focus group interviews, respectively. The majority (64%) identified as African American, followed by non-Hispanic white (18%). Data were analyzed using a thematic content analysis to identify structural barriers and facilitators associated with the implementation of mental health best practices.

Results: Emerging themes indicate facilitators of integrated primary and mental health care, including: (1) co-located care provides a “one-stop shop” for adolescents with multiple health and health care needs, (2) a collaborative setting reduces administrative barriers to access health and mental health care. Participants also identified barriers, including the need to: (3) build capacity among staff and primary care clinicians with respect to mental health care practices, and (4) enhance written and verbal communication between clinicians within different specialties to facilitate continuity of care.

Conclusions: A critical step in delivering effective mental health interventions is integrating community stakeholder perspectives on program implementation. With respect to structural facilitators, findings demonstrate the utility of integrative health care in improving adolescent access to mental health services. Additionally, participants identified key structural barriers, including the need to improve communication among multidisciplinary clinicians. With a fuller understanding of barriers and facilitators, future research should examine the feasibility, acceptability and efficacy of implementing an evidence-based mental health intervention in a primary care setting.