Barriers and Facilitators to the Implementation of the Pathways to Comorbidity Care (PCC) Training Package for the Management of Comorbid Mental Disorders in Drug and Alcohol Settings

Eva Louie; Vicki Giannopoulos; Andrew Baillie; Gabriela Uribe; Katie Wood; Maree Teesson; Steven Childs; David Rogers; Paul S Haber; Kirsten C Morley

doi:10.3389/frhs.2021.785391

Barriers and Facilitators to the Implementation of the Pathways to Comorbidity Care (PCC) Training Package for the Management of Comorbid Mental Disorders in Drug and Alcohol Settings

Front Health Serv. 2021 Nov 24:1:785391. doi: 10.3389/frhs.2021.785391. eCollection 2021.

Authors

Eva Louie¹, Vicki Giannopoulos², Andrew Baillie³, Gabriela Uribe⁴, Katie Wood¹, Maree Teesson⁴, Steven Childs⁵, David Rogers⁶, Paul S Haber^{1

2}, Kirsten C Morley¹

Affiliations

¹ Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
² Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
³ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
⁴ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia.
⁵ Central Coast Local Health District, Drug and Alcohol Clinical Services, Gosford, NSW, Australia.
⁶ Drug and Alcohol Services, Mid North Coast Local Health District, Port Macquarie, NSW, Australia.

Abstract

Background: We have previously reported that the Pathways to Comorbidity Care (PCC) training program for alcohol and other drug (AOD) clinicians improved identification of comorbidity, self-efficacy, and attitudes toward screening and monitoring of comorbidity. We aimed to identify barriers and facilitators of implementation of the PCC training program in drug and alcohol settings. Methods: The PCC training program was implemented across 6 matched sites in Australia as per (1), and 20 clinicians received training. PCC training included seminar presentations, workshops conducted by local "clinical champions," individual clinical supervision, and access to an online information portal. We examined barriers and facilitators of implementation according to the Consolidated Framework for Implementation Research. Results: Barriers included inner setting (e.g., allocated time for learning) and characteristics of individuals (e.g., resistance). Facilitators included intervention characteristics (e.g., credible sources), inner setting (e.g., leadership), and outer setting domains (e.g., patient needs). Clinical champions were identified as an important component of the implementation process. Conclusions: Barriers included limited specific allocated time for learning. A credible clinical supervisor, strong leadership engagement and an active clinical champion were found to be facilitators of the PCC training program.

Keywords: barriers; comorbidity; facilitators; implementation; training.