Examining the Implementation of Mental Health Task Sharing Community-Based Aging Services for Older Chinese Adults: A Multiple Case Study

Background and Purpose: Older Chinese adults are the fastest-growing population among older immigrants and have low utilization rates despite a high prevalence of mental health disorders. To address this problem, mental health task sharing has been developed in the U.S. and globally to share a range of care with non-mental health clinicians, including screening, psychoeducation, and psychosocial treatment. However, there has been limited research on implementing this practice to engage older Chinese adults in services and to explain organizational differences in outcomes. This study examined multilevel factors impacting the implementation of mental health task sharing for delivering mental health task sharing in community-based services and how these impact implementation outcomes using a matrixed multiple case study approach.

Methods: This mixed-method study was set within social care settings serving older adults in New York City, and each organization participating in the study was treated as a case. Qualitative and quantitative data were collected from 28 service providers in 14 community-based organizations implementing mental health task sharing, including senior centers, social adult day care (SADC), Naturally Occurring Retirement Communities (NORCs), and supportive geriatric mental health programs. The semi-structured interview guide was informed by Consolidated Framework for Collaboration Research(CFIR), and qualitative findings from framework analysis informed quantitative survey questionnaires that focused on mental health-related service provision, and potential influence factors (implementation leadership, implementation climate, cross-sector collaboration, mental health literacy, mental health service skills, and teamwork). Implementation outcome was defined as referral rates (multiplying the percentage of clients identified with mental health needs through screening and the proportion of clients referred to licensed mental health professionals). Descriptive and bivariate analyses were performed in STATA 17 to examine site differences in referral rates. A matrix table was created to integrate qualitative and quantitative data, with each row representing an organization to highlight patterns across and within organizations and to explain differences in referral rates.

Results: Referral rates were significantly different across organizations (F(13, 14) = 5.04, p = .0025). Within-case analysis revealed that enabling factors across all sites that facilitate implementation, including co-located mental health specialists, access to new funding, designated personnel, high mental health literacy and skills level, supportive leadership, and employment of engagement strategies, were present in organizations with higher referral rates. Cross-case analysis found that access to new funding, designated personnel, and high mental health skills levels differentiated sites from having high versus low referral rates.

Conclusion:

This study used a systematic mixed-method approach and identified multilevel factors, including organizational, individual, and implementation strategy levels, that contribute to heterogeneities of referral rates across organizations. The results highlighted the importance of securing organizational resources, building staff skills, and improving service integration to improve mental health services across diverse communities. More research is needed to systematically evaluate strategies that address the unique needs and circumstances of black, indigenous, and other people of color (BIPOC) groups, potentially leading to more tailored and effective mental health service implementation.