Using the Collaborative Intervention Planning Framework to Adapt a Health Care Manager Intervention to Hispanics with Serious Mental Illness

Background and Purpose. Implementing health interventions in public mental health clinics is a pressing need since people with serious mental illness (SMI) face serious health disparities.  Health care manager interventions designed to enhance care coordination between primary care and mental health providers and to engage clients in their health care can improve the health of people with SMI.  Few studies exist describing the systematic steps that can be used to adapt existing health care manager intervention for routine practice in minority communities. The aim of this federally-funded study is to describe the application of a collaborative approach to inform the adaptation of a health care manager intervention to a new population (Hispanics) and provider group (social workers) to enhance its use in public mental health clinics. 

Methods. The study was conducted in a public mental health clinic that serves Hispanic clients.  A community advisory board (CAB) composed of researchers and stakeholders (e.g., social workers, primary care physicians, peer specialists) used the collaborative intervention planning framework, an approach that combines community-based participatory research principles and intervention mapping procedures (IM), to inform intervention adaptations.   The CAB goals were to maximize the fit of the intervention to its new context by incorporating community knowledge and to involve stakeholders in the adaptation process to enhance their skills, confidence, and capacity to deliver the intervention. The CAB use IM, a step-by-step process that uses core group activities (e.g., brainstorming) and visual tools (e.g., logic models) to inform the adaptation process.

Results.  The adaptation process included four steps: fostering collaborations between CAB members; understanding the needs of the local population through a mixed-methods needs assessment, literature reviews, and group discussions; reviewing intervention objectives to identify targets for adaptation; and developing the adapted intervention. This process enabled the CAB to identify cultural and provider level-adaptations without compromising core intervention elements.  Surface-level cultural adaptations involved customizing intervention content, messages, and approaches to the observable cultural characteristics of the local Hispanic population, including using bilingual health care managers, delivering the program in the mental health clinic, and adding health education materials in Spanish and English.  Deep-level cultural adaptations entailed incorporating clients’ cultural values, norms, and preferences into the intervention by training health care managers to display cultural norms valued by Hispanics, adding a client activation checklist to counteract cultural norms in the Hispanic community dictating that people should show deference to authority figures to avoid disagreements in the medical encounter, and adding an adapted cultural formulation interview to help health care mangers systematically assess clients’ sociocultural context to inform treatment decisions.  Provider adaptations focused on facilitating social workers’ delivery of the intervention by modifying health assessment tools and developing a local care coordination plan and a training curriculum for social workers.

Conclusions and Implications.  Reducing health disparities in people with SMI requires community engagement.  Our study illustrates one approach that can be used to involve community stakeholders in the adaptation process to enhance the transportability of a health care manager intervention to improve the health of people with SMI.