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.