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The role of organizational context in the implementation of a statewide initiative to integrate mental health services into pediatric primary care

King, Melissa A.; Wissow, Lawrence S.; Baum, Rebecca A.

doi: 10.1097/HMR.0000000000000169

Background: Although there is evidence that mental health services can be delivered in pediatric primary care with good outcomes, few changes in service delivery have been seen over the past decade. Practices face a number of barriers, making interventions that address determinants of change at multiple levels a promising solution. However, these interventions may need appropriate organizational contexts in place to be successfully implemented.

Purpose: The objective of this study was to test whether organizational context (culture, climate, structures/processes, and technologies) influenced uptake of a complex intervention to implement mental health services in pediatric primary care.

Methodology/Approach: We incorporated our research into the implementation and evaluation of Ohio Building Mental Wellness Wave 3, a learning collaborative with on-site trainings and technical assistance supporting key drivers of mental health care implementation. Simple linear regression was used to test the effects of organizational context and external or fixed organizational characteristics on program uptake.

Results: Culture, structure/processes, and technologies scores indicating a more positive organizational context for mental health at the project’s start, as well as general cultural values that were more group/developmental, were positively associated with uptake. Patient-centered medical home certification and use of electronic medical records were also associated with greater uptake. Changes in context over the course of Building Mental Wellness did not influence uptake.

Conclusion: Organizational culture, structures/processes, and technologies are important determinants of the uptake of activities to implement mental health services in pediatric primary care. Interventions may be able to change these aspects of context to make them more favorable to integration, but baseline characteristics more heavily influence the more proximal uptake of program activities.

Practice Implications: Pediatric primary care practices would benefit from assessing their organizational context and taking steps to address it prior to or in a phased approach with mental health service implementation.

Melissa A. King, PhD, MPAff, is Principal, People’s Health Solutions, Los Angeles, California. E-mail:

Lawrence S. Wissow, MD, MPH, is Professor, Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland.

Rebecca A. Baum, MD, is Faculty, Section of Developmental Behavioral Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio.

BMW Wave 3 was supported by the Ohio Colleges of Medicine Government Resource Center with funding from the Ohio Department of Health and the Ohio Department of Medicaid. This research was additionally supported by National Institute of Mental Health Grant P20MH086048 for the Johns Hopkins Center for Mental Health Services in Pediatric Primary Care.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

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