Community Challenges and Barriers to the Delivery of Behavioral Health Services

Background/Purpose: Key issues in delivering behavioral health services include access, availability, and quality. Despite major funding and policy initiatives, community-based agencies continue to struggle with serving at-risk populations and achieving widespread positive outcomes. As such, a large Midwestern foundation sought to better understand the challenges and barriers faced by community agencies in delivering behavioral health services  This study’s objectives were to 1) uncover the perspective of grantees;, 2) describe challenges across grantees to discern community-wide patterns; and, 3) identify information about contextual conditions that inhibited effective behavioral health service delivery.

Method: The method used in the study was qualitative, and guided by a collective case study design. A purposive sampling strategy was utilized, and included all community-based behavioral health grantees funded by the foundation 2012-2014 that completed final reports for submission at the end of their funding period (2013-2016).  The sample included 59 final reports, where grantees were asked to report on challenges to successful program implementation and service delivery. Three researchers jointly conceptualized the coding structure that would be utilized for analyzing the grantee reports by conducting a preliminary round of reading and grouping of text by randomly selecting five grantee reports for coding development. Following calibration of coding five reports, an additional 10 reports were randomly selected and the researchers recalibrated the original code categories ensuring that the codes captured the needed information, revising the coding guide as indicated by the data. A conceptual schema was developed for coding based on varying levels of grantee experiences which was consistent with the use of ecological systems theory.  Using this framework as a guide, researchers used the following four broad domains as study anchors: individual (client) level, organizational (agency) level, community level and societal law and policy level. Using NVIVO, data were analyzed within and across codes and categories to discern major themes and patterns.

 

Results: The research analyzed 59 agency reports in an effort to identify prevalent challenges and barriers experienced by behavioral health grantee programs.  In order of prevalence, they were: individual client service needs (that the agency had difficulty meeting, such as practical needs for food, housing); workforce dynamics such as turnover, shortages, lack of specialized workforce and secondary traumatization; organizational funding instability, public and private reimbursement of services requirements, funding changes; changing organizational needs related to evidence based practices; community-based issues such as collaboration with other agencies; changes in social policy and laws, and the impacts of these were also negatively impacting the agencies.

Conclusions: This research brings to light the challenges community-based agencies face in implementing funded behavioral health programs. It is clear that the known baseline conditions of the clients and community (lack of psychiatric services, transportation issues and the like) also become the challenges to successful program implementation once funded. When these challenges are encountered within the context of organizational challenges – such as perpetual workforce shortages and turnover —the providers are experiencing constant change that is analogous to the floor shifting beneath their feet.