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Identifying factors critical to implementation of integrated mental health services in rural VA community-based outpatient clinics

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Abstract

The purpose of this study was to gain a better understanding of the critical components associated with implementing integrated mental health care services in rural VA community-based outpatient clinics (CBOCs). In-person semi-structured interviews were conducted with 20 health care providers and staff within a year after placing a trained advanced practice nurse (APN) to provide mental health/substance abuse (MH/SA) care at 2 rural CBOCs in the southeastern United States. Four raters independently evaluated interview transcripts and conducted content analysis to summarize the interview results. The results indicate that key contextual factors related to leadership, staff attitudes and beliefs, and unique organizational factors of the clinic and the community can affect the success of such clinical innovations. In addition to providing descriptive information about the attitudes, beliefs, and experiences of CBOC personnel regarding implementation of integrated MH/SA services using APNs, the study findings suggest several domains that could be explored in future studies of integrated mental health service delivery to rural veterans through primary care.

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Authors and Affiliations

  1. Clinical Care, VA South Central MIRECC, Central Arkansas Veterans Healthcare System (152/NLR), 2200 Ft Roots Dr, 72114, North Little Rock, AR

    JoAnn E. Kirchner MD (Associate Director)

  2. the Department of Nursing at the Duke University, Durham, NC

    Carla Gene Rapp RN, CRRN, PhD (Assistant Professors)

Authors
  1. JoAnn E. Kirchner MD
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  2. Marisue Cody RN, PhD
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  3. Carol R. Thrush MA
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  4. Greer Sullivan MD, MSPH
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  5. Carla Gene Rapp RN, CRRN, PhD
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Corresponding author

Correspondence to JoAnn E. Kirchner MD.

Additional information

Marisue Cody, RN, PhD, is an Associate Director at the VA HSR&D CeMHOR. She is an affiliate investigator at the VA South Central MIRECC, and is Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Arkansas for Medical Sciences.

Carol R. Thrush, MA, is a Research Associate at the VA HSR&D CeMHOR and in the Department of Psychiatry and Behavioral Sciences at the University of Arkansas for Medical Sciences.

Greer Sullivan, MD, MSPH, is a core investigator at the VA HSR&D CeMHOR. She is Director at the VA South Central MIRECC, and is a Professor in the Department of Psychiatry and Behavioral Sciences at the University of Arkansas for Medical Sciences.

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Kirchner, J.E., Cody, M., Thrush, C.R. et al. Identifying factors critical to implementation of integrated mental health services in rural VA community-based outpatient clinics. The Journal of Behavioral Health Services & Research 31, 13–25 (2004). https://doi.org/10.1007/BF02287335

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