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2019 HSR&D/QUERI National Conference Abstract

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1080 — External facilitators' perceptions of internal facilitation skills during implementation of collaborative care for mental health teams

Lead/Presenter: Samantha Connolly,  COIN - Bedford/Boston
All Authors: Connolly SL (VA Boston CHOIR, Harvard Medical School), Sullivan, JL (VA Boston CHOIR, Boston University School of Public Health), Ritchie, MJ (QUERI Program for Team-Based Behavioral Health, Central Arkansas VA; University of Arkansas for Medical Sciences) Kim, B (VA Boston CHOIR, Harvard Medical School) Miller, CJ (VA Boston CHOIR, Harvard Medical School) Bauer, MS (VA Boston CHOIR, Harvard Medical School)

Objectives:
Facilitation may contribute to successful implementation of healthcare innovations. In blended facilitation, external facilitators (EFs) from outside of the implementation setting guide and support internal facilitators (IFs). Developers of the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework propose that successful facilitation requires project management, team/process, and influencing/negotiating skills. It is unclear what IF skills are most important within real-world settings, which could inform recruitment and training. As prior qualitative studies of IF skills have only interviewed IFs, the perspectives of their EF partners are needed. Little is also known regarding the distribution of implementation tasks between IFs and EFs, which could impact sustainability once external support is removed. We therefore: examined IFs' use of i-PARIHS facilitation skills, from EFs' perspectives; identified additional attributes of IFs not encompassed within i-PARIHS; and investigated the relative contributions of IFs and EFs during implementation.

Methods:
Analyses were conducted within a hybrid type II trial using blended facilitation to implement the collaborative care model within mental health teams of nine VAMCs. Each site committed one team and an IF to weekly process design meetings over 12 months. Three EFs conducted initial site assessments, six months of weekly team calls, weekly IF meetings, and six months of step-down facilitation with three sites each. Following study completion, EFs completed semi-structured qualitative interviews reflecting on facilitation, informed by the i-PARIHS facilitation skills. Interviews were analyzed via directed content analysis.

Results:
EFs described the importance of IFs having strong project management, team/process, and influencing/negotiating skills. IFs' personal characteristics (e.g., flexible, confident) were also critical, particularly when faced with team conflict. EFs discussed needing to clearly delineate EF and IF roles, and ultimately shift facilitation responsibilities to IFs.

Implications:
Key IF skills, according to EFs, are aligned with i-PARIHS recommendations, while IFs' personal characteristics also played an important role during facilitation. Transitioning responsibility to IFs is critical to allow for continuity once external support is removed.

Impacts:
Lessons learned from a real-world implementation trial emphasize important traits to consider when selecting IFs, potential focus areas for IF trainings (e.g., conflict management), and factors that may impact long-term sustainability of practices.