Abstract
Little is known about how to effectively implement behavioral health programs in low-resource communities. Leaders from 20 community-serving behavioral health organizations in Flint, MI, were asked about their organizations and the barriers that they, and the populations they serve, face in providing and accessing behavioral health services. Barriers are reported using a mixed-methods analysis, reporting the number and percentage of organizations that experienced the barrier along with example quotations from the organization leaders. The most frequently reported barrier to providing services was finding adequate funding (50%) while the most frequently reported barrier for accessing services was finding adequate and reliable transportation (30%). Comparisons of these findings with barriers reported by providers in different settings and those seeking services are discussed. These comparisons may provide an important next step in identifying areas where providers perceptions and the needs of the population are misaligned and for systemic improvements more broadly.
Similar content being viewed by others
References
Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality. Publication Number PEP20-07-01-001, September, 2020. Available at https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf. Accessed 11 November, 2020.
Yapa HM, Bärnighausen T. Implementation science in resource-poor countries and communities. Implementation Science. 2018;13(1):154. https://doi.org/10.1186/s13012-018-0847-1.
Hailemariam M, Bustos T, Montgomery B, et al. Evidence-based intervention sustainability strategies: A systematic review. Implementation Science. 2019;14(1):57. https://doi.org/10.1186/s13012-019-0910-6.
Hodge LM, Turner KM. Sustained implementation of evidence-based programs in disadvantaged communities: A conceptual framework of supporting factors. American Journal of Community Psychology. 2016;58(1-2):192-210. https://doi.org/10.1002/ajcp.12082.
Ceptureanu SI, Ceptureanu EG. Community-based healthcare programs sustainability impact on the sustainability of host organizations: A structural equation modeling analysis. International Journal of Environmental Research and Public Health. 2019;16(20):4035. https://doi.org/10.3390/ijerph16204035.
Grant SB, Hunter SR, Pedersen EA, et al. Practical factors determining adolescent substance use treatment settings: Results from four online stakeholder panels. Journal of Substance Abuse Treatment. 2020;109:34-40. https://doi.org/10.1016/j.jsat.2019.11.007.
Hager K, Kading M, Yapel A, et al. Bridging Community Mental Health and Primary Care to Improve Medication Monitoring and Outcomes for Patients With Mental Illness Taking Second-Generation Antipsychotics—HDC/DFMC Bridge Project, Phase 1: Group Concept Mapping. The Primary Care Companion for CNS Disorders. 2019;21(4):19m02452. https://doi.org/10.4088/PCC.19m02452.
Moloney RM, Messner DA, Tunis SR. The increasing complexity of the core outcomes landscape. Journal of Clinical Epidemiology. 2019;116:150-154. https://doi.org/10.1016/j.jclinepi.2019.05.016.
May J, Kazee N, Castillo S, et al. From silos to an innovative health care delivery and patient engagement model for children in Medicaid. Healthcare. 2018;6(1):67-73. https://doi.org/10.1016/j.hjdsi.2016.12.008.
Moreland-Russell S, Combs T, Polk L, et al. Assessment of the sustainability capacity of a coordinated approach to chronic disease prevention. Journal of Public Health Management and Practice. 2018;24(4):17-24. https://doi.org/10.1097/PHH.0000000000000663.
Saxe-Custack A, Lofton HC, Hanna-Attisha M, et al (2019) Caregiver experiences with an innovative farmers’ market incentive program for children in Flint, Michigan. Global Pediatric Health. 6:2333794X19870989. https://doi.org/10.1177/2333794X19870989.
Sadler RC, Gilliland JA, Arku G. A food retail-based intervention on food security and consumption. International Journal of Environmental Research and Public Health. 2013;10(8):3325-3346. https://doi.org/10.3390/ijerph10083325.
Sadler RC, Highsmith AR. Rethinking Tiebout: The contribution of political fragmentation and racial/economic segregation to the Flint water crisis. Environmental Justice. 2016;9(5):143-151. https://doi.org/10.1089/env.2016.0015.
Hanna-Attisha M, LaChance J, Sadler RC, et al. Elevated blood lead levels in children associated with the Flint drinking water crisis: A spatial analysis of risk and public health response. American Journal of Public Health. 2016;106:283-290. https://doi.org/10.2105/AJPH.2015.303003.
United States Census Bureau. QuickFacts: Flint city, Michigan. Available online at https://www.census.gov/quickfacts/fact/table/flintcitymichigan/INC910218#INC910218. Accessed October 12, 2020.
Sadler RC, Furr-Holden D. The epidemiology of opioid overdose in Flint and Genesee County, Michigan: Implications for public health practice and intervention. Drug and Alcohol Dependence. 2019; 204:107560. https://doi.org/10.1016/j.drugalcdep.2019.107560.
Heard-Garris NJ, Roche J, Carter P, et al. Voices from flint: Community perceptions of the flint water crisis. Journal of Urban Health. 2017;94:776-779. https://doi.org/10.1007/s11524-017-0152-3.
Stoddard SA, Montgomery BW, Maschino LD, et al (2020) Establishing the Effectiveness of Enhanced Implementation Methods in Preventative Behavioral Health. Medrxiv. 2020. Available online at https://www.medrxiv.org/content/medrxiv/early/2020/09/27/2020.09.25.20200444.full.pdf Accessed October 12, 2020. https://doi.org/10.1101/2020.09.25.20200444.
Furr-Holden D, Innocent MA (2018) Building Health Equity in Flint, Michigan. In APHA’s 2018 Annual Meeting & Expo (Nov. 10-Nov. 14) 2018 Nov 12.
License Lists. Michigan Department of Licensing and Regulatory Affairs. Available online at https://www.michigan.gov/lara/bureau-list/bpl/lists. Accessed November 19, 2017.
Timko C (1994) Residential Substance Abuse and Psychiatric Programs Inventory (RESPPI) Handbook for Users. Center for Health Care Evaluation
Sridhar A, Drahota A, Walsworth K. Facilitators and barriers to the utilization of the ACT SMART Implementation Toolkit in community-based organizations: a qualitative study. Implementation Science Communications. 2021; 2(1):55. https://doi.org/10.1186/s43058-021-00158-1.
Miles MB, Huberman AM. Qualitative data analysis: An expanded sourcebook. Sage. 1994. https://doi.org/10.1016/s0272-4944(05)80231-2.
Campbell JL, Quincy C, Osserman J, et al. Coding in-depth semistructured interviews: Problems of unitization and intercoder reliability and agreement. Sociological Methods & Research. 2013;42(3):294-320. https://doi.org/10.1177/0049124113500475.
Pullen E, Oser C. Barriers to substance abuse treatment in rural and urban communities: counselor perspectives. Substance Use & Misuse. 2014;49(7):891-901. https://doi.org/10.3109/10826084.2014.891615.
Tan K, Black BP. A systematic review of health care provider-perceived barriers and facilitators to routine HIV testing in primary care settings in the Southeastern United States. Journal of the Association of Nurses in AIDS Care. 2018;29(3):357-370. https://doi.org/10.1016/j.jana.2017.12.006.
Spetz J, Chapman S, Tierney M, et al. Barriers and facilitators of advanced practice registered nurse participation in medication treatment for opioid use disorder: A mixed methods study. Journal of Nursing Regulation. 2021;12(2):5-22. https://doi.org/10.1016/S2155-8256(21)00052-1.
Ashford RD, Brown AM, Curtis B. Systemic barriers in substance use disorder treatment: A prospective qualitative study of professionals in the field. Drug and Alcohol Dependence. 2018;189:62-69. https://doi.org/10.1016/j.drugalcdep.2018.04.033.
Browne T, Priester MA, Clone S, et al. Barriers and facilitators to substance use treatment in the rural south: A qualitative study. The Journal of Rural Health. 2016;32(1):92-101. https://doi.org/10.1111/jrh.12129.
Priester MA, Browne T, Iachini A, et al. Treatment access barriers and disparities among individuals with co-occurring mental health and substance use disorders: An integrative literature review. Journal of Substance Abuse Treatment. 2016;61:47-59. https://doi.org/10.1016/j.jsat.2015.09.006.
Dickson C, Ramsay J, VandeBurgh J. Barriers for ethnic minorities and low socioeconomic status pediatric patients for behavioral health services and benefits of an integrated behavioral health model. Pediatric Clinics. 2021;68(3):651-658. https://doi.org/10.1016/j.pcl.2021.02.013.
Morckel V, Terzano K. Legacy city residents’ lack of trust in their governments: An examination of Flint, Michigan residents’ trust at the height of the water crisis. Journal of Urban Affairs. 2019;41(5):585-601. https://doi.org/10.1080/07352166.2018.1499415.
Sobeck J, Smith-Darden J, Hicks M, et al. Stress, coping, resilience and trust during the Flint water crisis. Behavioral Medicine. 2020;46(3-4):202-216. https://doi.org/10.1080/08964289.2020.1729085.
Baruch Y, Holtom BC. Survey response rate levels and trends in organizational research. Human Relations. 2008;61(8):1139-1160. https://doi.org/10.1177/0018726708094863.
Cycyota CS, Harrison DA. What (not) to expect when surveying executives: A meta-analysis of top manager response rates and techniques over time. Organizational Research Methods. 2006;9(2):133-160. https://doi.org/10.1177/1094428105280770.
Acosta J, Chinman M, Ebener P, et al. An intervention to improve program implementation: Findings from a two-year cluster randomized trial of Assets-Getting To Outcomes. Implementation Science. 2013;8(1):1-6. https://doi.org/10.1186/1748-5908-8-87.
Cannon JS, Gilbert M, Ebener P, et al. Influence of an implementation support intervention on barriers and facilitators to delivery of a substance use prevention program. Prevention Science. 2019;20(8):1200-1210. https://doi.org/10.1007/s11121-019-01037-x.
Hawkins JD, Oesterle S, Brown EC, et al. Results of a type 2 translational research trial to prevent adolescent drug use and delinquency: A test of Communities That Care. Archives of Pediatrics & Adolescent Medicine. 2009;163(9):789-798. https://doi.org/10.1001/archpediatrics.2009.141.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Montgomery, B.W., Maschino, L.D., Felton, J.W. et al. Organizational Leaders Perceptions of Barriers to Accessing Behavioral Health Services in a Low-Resource Community. J Behav Health Serv Res 50, 36–48 (2023). https://doi.org/10.1007/s11414-022-09801-8
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11414-022-09801-8