Providers' Perspectives on Implementing Mobile Crisis Services for Children and Youth in Connecticut

Background: Mobile crisis (MC) services is a pediatric behavioral health service that diverts those who need a lower level of care away from the Emergency Department (ED), enabling EDs to focus on providing acute behavioral health services. However, despite MC's efficacy, utilization could be enhanced. Implementation science provides an informative analytic framework. Objective: This study explores implementation-related factors from the service providers' perspective using qualitative methods, to ascertain the strengths, challenges, and adaptations made in accord with local factors. Method: Between April and November 2017, seven focus groups were conducted with 33 MC services providers. A semi-structured interview elicited descriptions of program strengths and challenges including micro and macro factors affecting MC services delivery. Transcripts were coded thematically and related to the four implementation science concepts--fidelity, acceptability, penetration, and sustainability. Results: MC providers prioritize safety and family engagement. They are aware of the many community and personal barriers to practice, including the inadequacy of the continuum of care, and intervene accordingly. Conclusions: Implementing a community-based program such as MC requires focused efforts to build relationships with families, agencies, and community organizations. To get families and referring agencies to use MC rather than the ED for youth in behavioral health crisis, practitioners coordinate with EDs, hospitals, and the needed services. By building essential relationships, providers were able to overcome many barriers and challenges, enabling them to successfully implement MC programs throughout the state. Nevertheless, several remaining challenges will need to be addressed to sustain successful program implementation in the future.