Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4056 — Provider Perspectives from Early to Late Stages of Implementing Supported Employment in Spinal Cord Injury Care

Lead/Presenter: Lisa Ottomanelli, COIN - North Florida/South Georgia and Tampa
All Authors: Ottomanelli L (HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR)) Cotner BA (CINDRR) Danielle DR (CINDRR) Trainer JK (CINDRR)

Objectives:
Seven Spinal Cord Injury teams at Veterans Affairs spinal cord injury (SCI) centers participated in a 5-year VA funded service-directed project to improve employment and quality of life outcomes (PrOMOTE). In a longitudinal qualitative study, we analyzed provider's perceptions of barriers and facilitators to implementing evidence-based supported employment in SCI Care during early, mid, and late implementation stages.

Methods:
On-site semi-structured qualitative interviews (n = 130) were conducted with 82 providers and key stakeholders during a 24-month implementation period. Interviews were digitally recorded and qualitatively analyzed (ATLAS.ti v.7) using a constant comparative method to generate themes.

Results:
Over a 24-month implementation period, 19 themes emerged (12 barriers and 7 facilitators). The themes were then categorized by stage based on whether they emerged during early (months 1-8), mid (months 9-17), or late (months 18-24) implementation.

Implications:
Key facilitators to successful implementation are integration of vocational care into SCI rehabilitation with leadership support. Ongoing barriers include patient specific and program administration factors, such as caseload size and staffing patterns. The emergence of some barriers and facilitators at different stages of implementation suggests the need for adjusting implementation strategies to address barriers as they arise to facilitate successful implementation.

Impacts:
Consideration of barriers and facilitators based on stage of program implementation is important for selecting appropriate strategies to facilitate spread of evidence-based supported employment services for veterans with disabilities.