BARRIERS AND FACILITATORS TO IMPLEMENTATION IN STATE-RUN SYSTEMS FOR SERIOUS MENTAL ILLNESS: A CASE STUDY

The presence of evidence-based programs (EBPs) in serious mental illness (SMI) titled populations have been an important subject within clinical implementation research in recent years. The SMI population represents 24% of incarcerated persons, as well as has the highest rates of homelessness, sexual and physical abuse victimization, unemployment, and suicide; thus, this population presents specific challenges over other commonly studied implementation populations. Despite some advances, most existing literature has yet to take into account that many SMI titles individuals receive services through state-run systems. To build upon this gap in research and practice, a qualitative case study was performed on the barriers and facilitators to implementation in a state-run organization providing services solely to a large SMI population in the state of Arizona. Results indicate that what appears to be important about this population is not so much specific barriers that other populations do not encounter, but how barriers or facilitators are related. Important implementation barrier relationships were between organization and standardization and measurement, and between communication and attitudes. For facilitators, accountability and approach to service appeared to be interrelated. Researchers hypothesize that these distinct barriers and facilitators may be present due to the high presence of court-mandated individuals and limits of service depth and breadth in a state-run system.