TY - JOUR
KW - Brief Psychotherapy
KW - Implementation facilitation
KW - Research
KW - service delivery
AU - E. N. Woodward
AU - K. L. Drummond
AU - K. A. Oliver
AU - M. K. Bartnik
AU - S. S. Meit
AU - R. R. Owen
AU - B. C. Wright
AU - R. E. Hicks
AU - J. Kirchner
A1 - 
AB - OBJECTIVE: Implementation facilitation is an effective strategy that increases uptake of behavioral health interventions. Facilitation is grounded in partnerships with leadership and clinical stakeholders. Researchers have documented some negative consequences of facilitation-time, financial, and opportunity costs. Clinical leaders often agree to facilitation with the promise of increased implementation of an intervention. This study examined whether unintended positive consequences of facilitation might offset known costs. METHODS: This study was part of a stepped-wedge, hybrid type 2, pragmatic trial that used implementation facilitation to implement primary care mental health integration (PCMHI) via telehealth technology in six satellite Veterans Health Administration (VHA) clinics. Two facilitators provided facilitation for at least 6 months. This study included a focused analysis of an emerging phenomenon captured through weekly debriefing interviews with facilitators: unintended positive consequences of implementation facilitation, termed "lagniappes" here. A rapid content analysis was conducted to identify and categorize these consequences. RESULTS: The authors documented unintended positive consequences of the facilitation across the six VHA sites and categorized them into three clinically relevant domains: supporting PCMHI outreach at other clinics not in the original catchment area (e.g., providing tools to other sites), strengthening patient access (e.g., resolving unnecessary patient travel), and improving or modifying work processes (e.g., clarifying suicide assessment protocols). The positive consequences benefited sites and strengthened ongoing partnerships. CONCLUSIONS: Documenting unintended positive consequences of implementation facilitation may increase leadership engagement. Facilitators should consider leveraging unintended positive consequences as advantages for the site that may add efficiency to facility processes and workflows.
AD - Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Woodward, Drummond, Oliver, Bartnik, Owen); Department of Psychiatry, University of Arkansas for Medical Sciences College of Medicine, Little Rock (Woodward, Drummond, Owen, Kirchner); Mental Health Service, Central Arkansas Veterans Healthcare System, North Little Rock (Meit, Wright); Mental Health Service, Jesse Brown VA Medical Center, Chicago (Hicks); Program for Team-Based Behavioral Health, Quality Enhancement Research Initiative, Department of Veterans Affairs Little Rock Regional Office, North Little Rock, Arkansas (Kirchner).; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Woodward, Drummond, Oliver, Bartnik, Owen); Department of Psychiatry, University of Arkansas for Medical Sciences College of Medicine, Little Rock (Woodward, Drummond, Owen, Kirchner); Mental Health Service, Central Arkansas Veterans Healthcare System, North Little Rock (Meit, Wright); Mental Health Service, Jesse Brown VA Medical Center, Chicago (Hicks); Program for Team-Based Behavioral Health, Quality Enhancement Research Initiative, Department of Veterans Affairs Little Rock Regional Office, North Little Rock, Arkansas (Kirchner).; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Woodward, Drummond, Oliver, Bartnik, Owen); Department of Psychiatry, University of Arkansas for Medical Sciences College of Medicine, Little Rock (Woodward, Drummond, Owen, Kirchner); Mental Health Service, Central Arkansas Veterans Healthcare System, North Little Rock (Meit, Wright); Mental Health Service, Jesse Brown VA Medical Center, Chicago (Hicks); Program for Team-Based Behavioral Health, Quality Enhancement Research Initiative, Department of Veterans Affairs Little Rock Regional Office, North Little Rock, Arkansas (Kirchner).; Center for Ment(TRUNCATED)
BT - Psychiatric services
C5 - HIT & Telehealth
CP - 1
CY - United States
DO - 10.1176/appi.ps.202000151
IS - 1
JF - Psychiatric services
LA - eng
M1 - Journal Article
N2 - OBJECTIVE: Implementation facilitation is an effective strategy that increases uptake of behavioral health interventions. Facilitation is grounded in partnerships with leadership and clinical stakeholders. Researchers have documented some negative consequences of facilitation-time, financial, and opportunity costs. Clinical leaders often agree to facilitation with the promise of increased implementation of an intervention. This study examined whether unintended positive consequences of facilitation might offset known costs. METHODS: This study was part of a stepped-wedge, hybrid type 2, pragmatic trial that used implementation facilitation to implement primary care mental health integration (PCMHI) via telehealth technology in six satellite Veterans Health Administration (VHA) clinics. Two facilitators provided facilitation for at least 6 months. This study included a focused analysis of an emerging phenomenon captured through weekly debriefing interviews with facilitators: unintended positive consequences of implementation facilitation, termed "lagniappes" here. A rapid content analysis was conducted to identify and categorize these consequences. RESULTS: The authors documented unintended positive consequences of the facilitation across the six VHA sites and categorized them into three clinically relevant domains: supporting PCMHI outreach at other clinics not in the original catchment area (e.g., providing tools to other sites), strengthening patient access (e.g., resolving unnecessary patient travel), and improving or modifying work processes (e.g., clarifying suicide assessment protocols). The positive consequences benefited sites and strengthened ongoing partnerships. CONCLUSIONS: Documenting unintended positive consequences of implementation facilitation may increase leadership engagement. Facilitators should consider leveraging unintended positive consequences as advantages for the site that may add efficiency to facility processes and workflows.
PP - United States
PY - 2021
SN - 1557-9700; 1075-2730
SP - 31
EP - 36
EP - 
T1 - Lagniappes: "A Little Something Extra" or Unintended Positive Consequences of Implementation Facilitation
T2 - Psychiatric services
TI - Lagniappes: "A Little Something Extra" or Unintended Positive Consequences of Implementation Facilitation
U1 - HIT & Telehealth
U2 - 33138706
U3 - 10.1176/appi.ps.202000151
VL - 72
VO - 1557-9700; 1075-2730
Y1 - 2021
Y2 - Jan 1
ER -