Brokering System Change through an Intermediary/Purveyor Organization: Realizing Excellence in Mental Health Care By Incorporating Typically Marginalized Perspectives and Building Capacity to Foster Health Equity

Background & Purpose. Efforts to improve the wellbeing of public mental health and human services users are undermined by the gap between the availability and uptake of evidence-based practices (EBPs). To help spread empirically-supported treatment discoveries, treatment developers, implementation specialists, service system stakeholders and academics have created specialized organizations known as Intermediary/Purveyor Organizations (IPOs). IPOs facilitate dissemination and implementation of EBPs and enhance infrastructure to sustain them in various settings. To date, few studies delineate processes IPOs need to advance their work with systems, and fewer still empirically evaluate the impact of IPO activities. This study’s purpose is twofold; first, to provide a conceptual framework highlighting factors critical to the efficacy of behavioral-health focused IPOs while emphasizing Community-Partnered Participatory principles as a means for IPOs to affect equity and justice, valuing of community expertise, and accountability to community stakeholders as a valued end. Second, this study evaluates a primary IPO objective, supporting knowledge and skill-building at the community, organizational, and individual provider level. Changes in knowledge, skills and confidence in delivering EBPs among service providers was examined based on a collaboration between an IPO and mental health system partners to design and prioritize a training program.

Methods. A novel conceptual model was generated using studies examining EBP implementation in community contexts along with lessons learned from developing a university-based IPO serving a public mental health system. Congruent with knowledge-transfer objectives modeled, IPO staff collaborated with systems partners to design and deliver EBP training to 1,610 providers serving individuals with serious mental illness (SMI) over a one-year period. Data gathered to measure training impact include: 1) self-reported changes in EBP-related skills/knowledge and increased confidence and support in addressing clinical concerns, 2) training satisfaction, and 3) provider demographics. Paired sample t-tests were used to examine whether statistically significant gains in training outcomes were observed from pre-to-post training. Chi-square tests were used to conduct exploratory analyses examining differential gains among provider sub-groups.

Results. Overall, participation in the training was associated with significantly increased provider self-reported skills/knowledge, ability to find effective solutions, confidence in clinical capacity, and clinical support related to serving individuals with SMI. Training outcomes varied by provider position and years of experience; for example, a significantly higher proportion of direct service providers demonstrated training gains than administrators, and a significantly higher proportion of those with 5 years or less experience showed gains than those with 6 or more years, among other sub-group differences.

Conclusions & Implications. This study illustrates ways in which a community-partnered IPO may facilitate knowledge transfer of empirically-supported psychosocial treatment options while also attending to the needs and priorities of the local service system. Results support hypothesized system outcomes impacted by partnered IPO activities, including changes in service provider behavior, knowledge, and skills, which can ultimately effect changes in service recipient behavioral health-related domains and quality of life via improved quality of care.