The Impact of Competence and Compliance Fidelity on The Delivery of an Integrated Adolescent Behavioral Health Screening, Assessment, and Brief Intervention In Five Distinct Primary Care Settings.

Recent literature indicates that behavioral health disorders among youth are increasing and costly to treat. Ineffective care due to the traditional fragmentation of the nation’s health care system has contributed to the increased prevalence rates and costs. Many health and mental health professionals have worked diligently to increase their efforts of collaboration. The growing field of collaborative health care is evidence of these efforts.

Many studies suggest that primary care is a prime portal of entry for youth seeking help with behavioral health problems. Thus, MFTs and other mental health professionals have focused attention on researching the integration of mental health and primary care services. Despite these efforts, many youth suffering from behavioral health disorders still go unrecognized and untreated. Several researchers have identified multiple barriers to integration that must be overcome in order for youth to benefit fully from collaborative health care. Some of these barriers to integration include: (1) time constraints placed on primary care providers (PCPs); (2) PCPs’ lack of training in screening, assessing, and treating behavioral health disorders; and (3) implementing evidence-based behavioral health interventions in primary care settings with fidelity.

To date, much of the MFT research has focused on increasing collaboration between family physicians and family therapists, assessing the effectiveness of family interventions in treating various behavioral health disorders, and developing of family-centered, collaborative, biopsychosocial models of health care. However, few MFT studies have been conducted that specifically focus on the fidelity of implementing evidence-based youth behavioral health screening, assessment, and brief interventions into primary care settings. This study is important to the MFT field because it addresses the systemic challenges of transporting evidence-based interventions into real world settings that Sprenkle (2002) identified. Data used for this study are part of the Texas Adolescent Behavioral Health in Primary Care Initiative (TABHPCI) feasibility study.

While the overall conceptualization of the study is grounded in systemic ideas much of the analyses in this document have to do with the specifics of how the study was carried out. The purpose of this study was to evaluate the extent to which compliance fidelity (i.e., the extent to which PCPs utilized core intervention components of the TABHPCI Clinical Model) and competence fidelity (i.e., the level of skill demonstrated by PCPs in utilizing the core components of the clinical model) influenced the implementation of an integrated adolescent behavioral health screening, assessment, and brief intervention program. The findings of this study indicate that primary care providers (PCPs) at the feasibility study sites experienced difficulty adhering to the standardized clinical model with an adequate level of fidelity. Implementation research requires knowledge of how organizational systems are embedded within many different contexts. To be successful, many of the barriers to integration must be overcome. Despite efforts to utilize an evidence-based implementation framework to minimize the complexity of measuring fidelity, the author was unable to fully evaluate the fidelity of the implementation of the adolescent behavioral health intervention. This study highlights the importance of developing interventions that are clearly defined and evaluable. The overall findings from this study suggest that PCPs level of competence in administering, scoring, and interpreting behavioral health screening and assessment measures influenced their levels of compliance to the TABHPCI Clinical Model. Moreover, the findings call for more MFT research that addresses the systemic nature of implementing evidence-based interventions in real world settings.