Brown AH (COE Sepulveda), Cohen AN
(COE Sepulveda), Chinman M
(VISN 4 MIRECC), Young AS
VHA is engaged in a major initiative to implement recovery-oriented, evidence-based services in mental health. These services go beyond symptom management to provide support for wellness and employment. In order to maximize the potential for clinician acceptance and adoption of these and other evidence-based services, it is necessary to obtain a baseline understanding of clinicians’ knowledge, attitudes, and beliefs (KAB) about patients’ needs for services. Formative evaluation methods are ideally suited to explore KAB among clinicians in order to maximize the potential for uptake of evidence-based services. The HSR&D QUERI (Quality Enhancement Research Initiative) study, Enhancing QUality of care In Psychosis (EQUIP), used formative evaluation methods in four VA mental health clinics to assess clinicians’ baseline KAB about patients’ needs for services.
Semi-structured interviews with 39 staff were conducted at baseline. In order to evaluate baseline KAB within a social cognitive theoretical framework, respondents were asked to describe the “top three” needs of patients with schizophrenia. They were then asked about their perceptions of supported employment and wellness because these services had been identified as priorities by the participating VISNs. Interview data were analyzed concurrently with fieldnotes using Atlas.ti, and the constant comparison method whereby data were compared within and across sites.
The VISN-identified priorities were not noted as high-priority needs by clinicians. Instead, the top need, mentioned by 20 of the 39 respondents was medication management. Second to this, 14 individuals noted patients’ need for opportunities to engage socially in communities. Ten individuals noted a need for ongoing social support. Stable living situations and work opportunities were each mentioned by eight individuals. Other top needs mentioned by a minority were supported employment, exercise and nutrition education, and education around diagnosis and recovery.
The gap between VISN priorities and the baseline KAB of clinicians in the field guided project efforts to tailor implementation more carefully through education and social marketing. Findings illuminate the challenges that divergences in service priorities may create for VA implementation of evidence-based, recovery-oriented practices.
By gathering baseline data on knowledge, attitudes, and beliefs, adjustments can be made to the roll-out of an intervention such that education and marketing efforts can be targeted effectively and priorities can potentially be shifted when warranted.