Partnership for implementation of evidence-based mental health practices in rural federally qualified health centers: theory and methods.
ABSTRACT Mental health and substance abuse are among the most commonly reported reasons for visits to Federally Qualified Health Centers (CHCs), yet only 6.5% of encounters are with on-site behavioral health specialists. Rural CHCs are significantly less likely to have on-site behavioral specialists than urban CHCs. Because of this lack of mental health specialists in rural areas, the most promising approach to improving mental health outcomes is to help rural primary care (PC) providers deliver evidence-based practices (EBPs). Despite the scope of these problems, no research has developed an effective implementation strategy for facilitating the adoption of mental health EBPs for rural CHCs. We sought to describe the conceptual components of an implementation partnership that focuses on the adaption and adoption of mental health EBPs by rural CHCs in Arkansas.
We present a conceptual model that integrates seven separate frameworks: (1) Jones and Wells' Evidence-Based Community Partnership Model, (2) Kitson's Promoting Action on Research Implementation in Health Services (PARiHS) implementation framework, (3) Sackett's definition of evidence-based medicine, (4) Glisson's organizational social context model, (5) Rubenstein's Evidence-Based Quality Improvement (EBQI) facilitation process, (6) Glasgow's RE-AIM evaluation approach, and (7) Naylor's concept of shared decision making.
By integrating these frameworks into a meaningful conceptual model, we hope to develop a successful implementation partnership between an academic health center and small rural CHCs to improve mental health outcomes. Findings from this implementation partnership should have relevance to hundreds of clinics and millions of patients, and could help promote the sustained adoption of EBPs across rural America.
SourceAvailable from: Emily J Hauenstein[Show abstract] [Hide abstract]
ABSTRACT: Rural health disparities are due in part to access barriers to health care providers. Nursing education has been extended into rural areas, yet a limited rural research and practice literature informs the content and delivery of these educational programs. The University Of Virginia School of Nursing through a grant from the Health Resources and Services Administration developed the Nursing Leadership in Rural Health Care (NLRHC) Program. The transformational nursing leadership in rural health care (TNLRHC) model guided the development of NLRHC program content and teaching methods. This article describes the TNLRHC model and how it has steered the integration of rural content into advanced practice nursing (APN) education. The capacity of the TNLRHC model for promoting innovation in APN education is described. Recommendations regarding the future development of APN education are presented. Copyright © 2014 Elsevier Inc. All rights reserved.Journal of professional nursing: official journal of the American Association of Colleges of Nursing 11/2014; 30(6):463-73. DOI:10.1016/j.profnurs.2014.04.001 · 0.88 Impact Factor
Conference Paper: Transformational leadership in rural health care[Show abstract] [Hide abstract]
ABSTRACT: Background: The need for nursing leaders in rural health care is critical as the nursing workforce adjusts to: severe shortages, growing health disparities, increasing globalization, widespread need for disaster preparedness, and continued shrinking of the healthcare budget. This presentation reports on an advanced nursing education grant preparing leaders in public health nursing, health systems management, and psychiatric mental health nursing with expertise in rural health care to address preventable health problems, improve functioning for those with chronic illness, and to meet the needs of disadvantaged rural populations. Description: Transformational leaders have a clear vision and exert influence as role models who are willing to take risks and are responsive to the needs of the community. Our model for transformational leadership was expanded to address rural healthcare systems in the context of rural population and community characteristics. By recruiting students who are practicing in rural areas and by delivering essential curriculum components electronically, the program promotes education and retention of healthcare resources in rural places. Lessons Learned: It is important to infuse MSN and DNP curriculum with transformational leadership principles, strengthen existing distance-based education modalities, and emphasize rural healthcare concepts. MSN and DNP graduates empowered with transformational skills are prepared to assume leadership in rural communities and to become change agents, influencing the nursing workforce, other disciplines, and communities. Recommendations: Our goal is consistent with the recent report on the future of nursing, which addresses the compelling need for well-trained nursing leaders who practice at the highest level of their education.139st APHA Annual Meeting and Exposition 2011; 11/2011
[Show abstract] [Hide abstract]
ABSTRACT: Objective: Little is known about how primary care providers (PCPs) approach mental health care for low-income rural women. We developed a qualitative research study to explore the attitudes and practices of PCPs regarding the care of mood and anxiety disorders in rural women.Method: We conducted semi-structured interviews with 19 family physicians, internists, and obstetrician-gynaecologists in office-based practices in rural central Pennsylvania. Using thematic analysis, investigators developed a coding scheme. Questions focused on 1) screening and diagnosis of mental health conditions, 2) barriers to treatment among rural women, 3) management of mental illnesses in rural women, and 4) ideas to improve care for this population.Results: PCP responses reflected these themes: 1) PCPs identify mental illnesses through several mechanisms including routine screening, indicator-based assessment and self-identification by the patient; 2) Rural culture and social ecology are significant barriers to women in need of mental healthcare; 3) Mental healthcare resource limitations in rural communities lead PCPs to seek creative solutions to care for rural women with mental illnesses; 4) To improve mental healthcare in rural communities, both social norms and resource limitations must be addressedConclusion: Our findings can inform future interventions to improve women's mental healthcare in rural communities. Ideas include promoting generalist education in mental healthcare and expanding access to consultative networks. In addition, community programs to reduce the stigma of mental illnesses in rural communities may promote healthcare seeking and receptiveness to treatment.Mental Health in Family Medicine 12/2013; 10(4).