Development of a Facilitated Cross‐Agency Mentoring Strategy to Support Scale‐up and Spread of a Pediatric Behavioral Health Integration Model

Abstract

Research ObjectiveCommunities of Practice and Learning Collaboratives have gained momentum as approaches to practice improvement and implementation utilizing shared learning to facilitate change across organizations. These models promote knowledge transfer through data sharing, in‐person activities, and affinity groups; however, efforts can often only be classified as “helping it happen” in the spread of innovations. Facilitated cross‐agency mentoring is a promising approach to advancing shared learning within collaborative improvement networks and furthering spread of innovations. The current objective focuses on the development of a cross‐agency mentorship approach to support scale‐up of TEAM UP for Children, a pediatric behavioral health integration (BHI) model, within a learning community (LC).Study DesignThe TEAM UP LC is divided into two phases: initial and scale‐up. Development of a cross‐agency mentoring approach utilized a modified practice profile methodology. Methods were aimed at identifying learnings and best practices among early adopting agencies in the initial phase. A data gathering form was created to systematically elicit feedback on elements critical to model integration. Key programmatic documents were collected from agencies and reviewed to identify common and exemplar best practice approaches. Qualitative interviews were conducted with participants to understand barriers and facilitators to implementation. Findings were utilized to develop iterative mentoring strategies and establish areas of expertise upon which mentoring activities could be facilitated.Population StudiedThe LC includes seven community health centers (CHCs) delivering pediatric primary care to urban populations across eastern Massachusetts. Teams from each CHC include a project manager, clinical champions, billing champion, IT analyst, pediatric providers, behavioral health clinicians, and community health workers. Three CHCs began in the initial phase, and an additional four were added for the scale‐up phase. Early implementation and planning has been the focus to date of activities within the scale‐up phase.Principal FindingsKey findings from qualitative interviews published in the Journal of Pediatrics and data forms highlighted barriers and facilitators to implementation of the BHI model, including leadership engagement, billing optimization, and EMR system improvement. CHCs where exemplar best practices were identified were matched for one‐on‐one mentoring based on the needs of new CHCs and shared characteristics, like EMR systems. Best practice approaches were highlighted during interactive Web‐based and in‐person forums, and through facilitated speed‐sharing and mentoring match‐up activities. Feedback was solicited throughout early implementation and planning via structured evaluations and discussion to understand the impact of strategies piloted and promote necessary adaptation.ConclusionsWork to elicit learnings and best practice among early adopting CHCs in the initial phase resulted in the development of a facilitated cross‐agency mentoring approach to support scale‐up of the TEAM UP model. Utilizing multiple forms of qualitative data and an iterative process of feedback and evaluation, diverse strategies were developed to promote early implementation of the BHI model across CHCs engaged in the LC.Implications for Policy or PracticeCross‐agency mentoring strategies are applicable across settings to support implementation and scale‐up of a wide variety of evidence‐based approaches. These approaches show particular promise in driving the spread of complex care delivery models, taking advantage of experience and learnings of early adopters to promote implementation within new agency settings.Primary Funding SourcePrivate Foundations.