4 - (SYM 76) Barriers and Facilitators to Implementing an Evidence-based Community Health Worker Model and Implications for Mental Health Care

Community health worker (CHW) programs improve health outcomes, increase quality of life, and reduce hospitalizations and cost of care. However, knowledge is limited on the barriers and facilitators associated with scaling evidence-based CHW programs to maximize their public health impact. In this presentation, I will discuss mental health implications of a recently-published qualitative study investigating the barriers and facilitators to implementing IMPaCT, an evidence-based CHW model. Given the recent legislature (as of January 2024) allowing for Medicaid reimbursement for services rendered by CHWs, there may be vast potential for CHWs in supporting mental health needs. In this project, we identified barriers and facilitators to implementing IMPaCT at five institutionally and geographically diverse health systems across the United States. 39 interviewees (mean [SD] age, 45.0 [12.6] years; 30 women, 9 men) included program staff (health system leaders, program managers, CHWs) and patients receiving the intervention. Program staff were recruited via purposive sampling, and patients were recruited via convenience sampling (41 individuals contacted; 95% response rate). Interview guides were informed by the Consolidated Framework for Implementation Research. A rapid qualitative analytic technique was used to identify key themes, which were categorized into barriers and facilitators associated with framework ecological domains. Barriers included high program cost, insufficiently tailored materials for certain populations, economic and policy constraints, clinical integration challenges, and CHW difficulty maintaining boundaries with patients. Facilitators included the model’s strong evidence base, supportive implementation team, program design that enabled relationship-building and engagement, and the interpersonal skills and life experiences of the CHWs. Additional themes were cited as both barriers and facilitators, including the COVID-19 pandemic, organizational leadership, IMPaCT training, and program fidelity. There is growing recognition of the importance of CHWs to improving health equity and population health. Barriers identified point to important considerations regarding the potential role of CHWs in supporting mental health. Further, they point to policy and practice implications for CHW programs more broadly, including the need for continued attention to improving clinical integration and the need for sustainable program financing in order to preserve the longevity of this workforce.