Barriers to Implementing Person-Centered Recovery Planning in Public Mental Health Organizations in Texas: Results from Nine Focus Groups

Abstract

Despite being an established practice in the disabilities service systems, person-centered planning is a relatively new practice in the behavioral health system. As a result, little is known about the barriers that mental health organizations face in implementing person-centered recovery planning (PCRP). To fill this gap, results are presented from a qualitative analysis of nine focus groups at three public mental health organizations in Texas that have been implementing PCRP for at least 2 years. Findings suggest that organizations experienced 12 distinct barriers to PCRP implementation which were categorized into the Consolidated Framework for Implementation Research domains of intervention characteristics, the outer setting, the inner setting, characteristics of individuals, and the implementation process. Half of these 12 barriers fell within the inner setting domain, suggesting that implementation efforts should be flexible and adaptable to organizational culture and context. One-quarter of the barriers fell into the domain of characteristics of individuals involved in the intervention, which further suggests implementation efforts should assess the impact that both staff and consumers have on implementation success.

Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: a systematic integrative review

“…Conversely, an absence of a learning culture can act as a major hindrance to successful implementation [ 36 ]. Organizational cultures comprised of staff who have too much autonomy (i.e., physicians experiencing a high level of autonomy when making decisions about how to treat patients) [ 37 ], are resistant to trial new innovations [ 38 ], or are unclear about organizational values and beliefs [ 39 ] can be barriers to successful implementation. Sites demonstrating high implementation fidelity were marked by a strong culture of innovation, accompanied by positive staff attitudes and behavior toward the new initiative [ 40 ].…”

“…Teamwork was highly relevant in new programs that required participation from professionals in multidisciplinary teams. In a mental health organization where multidisciplinary staff (peer specialists, practitioners) were required to implement a new person-centered recovery program for their patients, poor multidisciplinary teamwork resulted in poor program uptake [ 38 ].…”

“…Leaders work to optimize implementation success by expressing enthusiasm for the change; being present, supportive, and attentive to the implementation process; and demonstrating willingness to ask for feedback from staff regarding the change. Leadership that is lacking in authority and unsupportive of change, or that neglects to hold staff accountable for the change, presents barriers to implementation [ 38 , 51 ]. Staff feel unmotivated to change when leaders were too controlling or unresponsive to requests for more training by staff who were required to implement the practice change [ 40 ].…”

“…Middle managers play a key role in facilitating implementation, and their decisions about which staff should undergo training were a key determinant for implementation success [ 52 ]. High staff turnover is problematic for implementation, creating a never-ending cycle of training seminars and educational sessions that consume a significant amount of time and resources [ 38 , 53 ].…”

“…At the innovation level, staff who perceived the EBP as more time-consuming than usual practice were more reluctant to adopt the EBP [ 57 , 59 ]. Insufficient time for staff training, planning, and staff rescheduling (to implement the EBP) were barriers at the logistics level [ 36 , 38 , 49 ]. Conversely, having adequate time for these activities was positively associated with research use in practice [ 43 , 54 , 60 ].…”