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Table 3 Facilitators and barriers to implementation

From: Delivering collaborative mental health care within supportive housing: implementation evaluation of a community-hospital partnership

Facilitators Barriers
1) Shared lenses
“I think if someone who had come in and didn’t share those things we wouldn’t utilize them so I think that would make me feel comfortable with Dr. X, and so, therefore, the tenants feel comfortable, which is great.” (Staff 6-month focus group)
2) Personal characteristics of the psychiatrist
“I appreciate her way that she works. I don’t know if it would be the same with a different psychiatrist.” (Staff final focus group)
3) Shared time and space
a) Joint team meetings
“I think having these joint team meetings has helped me in a way that I could feel like we’re all going to end up on the same page when dealing with certain clients. I think having never worked in this kind of situation before, in a partnership, it’s really been helpful to get everyone’s point of view and opinions and strategies.” (Staff final focus group)
b) Shared space
“She has also started sitting in our office with us, which I have found really great, and I know she actually said the same thing, that it has been nice because we’re very talkative in our office. That’s where we just bring things up, and having her there, she’s right there.” (Staff 6-month focus group)
“Now, with her there, I’ll just be reading an email and be like, hey, can you answer this question? It’s just so much more accessible.” (Staff 6-month focus group)
c) Real-time support
“And I really appreciate the consultation supports that she can offer in real time. I find with community staff and community psychiatrists, there’s always such a lag or a period of time we have to wait to hear back. So, I really appreciate how connected and so in the loop she is and cares to be.” (Staff final focus group)
4) Balance between structure and flexibility
“I feel she’s been open too because I feel we’re almost all figuring it out together because I think part of it was she didn’t know exactly what it looked like here and exactly what it was going to be like. So, we have come to her with things, and she’s been like, sure, yeah and vice versa maybe so that has facilitated the project.” (Staff 6-month focus group)
5) Allowing time to build trust
“I can see it also from more and more staff willing to share more and more, even when there is an insult along the way because they needed to trust how you, as a psychiatrist, would be approaching the work. I don’t know, but to me that’s the most resounding success from creating community partnership.” (Stakeholder final focus group)
6) Logistical support from organizations
7) Embedded evaluation
“I appreciate that you guys are doing focus groups and questionnaires that are all anonymous so that we can actually have open and honest conversations.” (Staff 6-month focus group)
“There is something about structuring reflection and qualitative and quantitative wrap-up and stuff that I think is very, very crucial for us to have this dialogue.” (Stakeholder final focus group)
1) Initial model was driven from leadership via from ground up
“The setup of it has made me feel a little bit like the tenants don’t have a say in what this looks like at all because it really did come from the top down.” (Staff 6-month focus group)
“I think when this collaboration started, I think a lot of the building up of what it was intending to be was done between management, and then some of the higher ups in the various organisations. I remember when it was starting, as a frontline worker, not having a lot of information or clarity about what the program would be, what it would look like, and not necessarily being asked for frontline feedback either.” (Staff final focus group)
2) Confusion and mismatch in initial referral process a) Initial confusion re referral processes
“But I think the process as a whole has been very confusing, specifically around, I think, how and when we’re supposed to access her, because there have been multiple things suggested on how we’re able to use her as a resource here.” (Staff 6-month focus group) b) Mismatch between tenants who want to engage and who stakeholders want to engage“…but it’s like, whoever is yelling the loudest during that time gets the spot. And I felt like that’s how those people were chosen. Not necessarily because we felt that it was a service that they would engage in or exploring other options.” (Staff 6-month focus group)
3) Different workflows across organizations“With the mini-team, I think the structural challenges were mimicking the general bigger program so privacy, confidentiality, different roles that seemingly have a lot of inherent tensions, even when ideally they shouldn’t, but very understandably do in how we sit, and how we form to create a constellation of supports.” (Stakeholder final focus group)
4) Staff turnover
“… there was a lot of turnaround with staff from the workers’ perspective, from management’s perspective and every time there is a new player the dynamic shifts. Not that we have to start from scratch but there was almost taking it back to the basics, which I think we’ve done and done well but we’re still trying to build that up and maintain the expectations and learning from that, what’s working and what’s not working.” (Stakeholder 6-month focus group)