• Mona J Ritchie, JoAnn E Kirchner, James C Townsend, Jeffery A Pitcock, Katherine M Dollar, and Chuan-Fen Liu.
• VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, U.S. Department of Veterans Affairs, North Little Rock, AR, USA. mona.ritchie@va.gov.
• J Gen Intern Med. 2020 Apr 1; 35 (4): 1001-1010.

BackgroundIntegrating mental health services into primary care settings is complex and challenging. Although facilitation strategies have successfully supported implementation of primary care mental health integration and other complex innovations, we know little about the time required or its cost.ObjectiveTo examine the time and organizational cost of facilitating implementation of primary care mental health integration.DesignDescriptive analysis.ParticipantsOne expert external facilitator and two internal regional facilitators who helped healthcare system stakeholders, e.g., leaders, managers, clinicians, and non-clinical staff, implement primary care mental health integration at eight clinics.InterventionImplementation facilitation tailored to the needs and resources of the setting and its stakeholders.Main MeasuresWe documented facilitators' and stakeholders' time and types of activities using a structured spreadsheet collected from facilitators on a weekly basis. We obtained travel costs and salary information. We conducted descriptive analysis of time data and estimated organizational cost.Key ResultsThe external facilitator devoted 263 h (0.09 FTE), including travel, across all 8 clinics over 28 months. Internal facilitator time varied across networks (1792 h versus 1169 h), as well as clinics. Stakeholder participation time was similar across networks (1280.6 versus 1363.4 person hours) but the number of stakeholders varied (133 versus 199 stakeholders). The organizational cost of providing implementation facilitation also varied across networks ($263,490 versus $258,127). Stakeholder participation accounted for 35% of the cost of facilitation activities in one network and 47% of the cost in the other.ConclusionsAlthough facilitation can improve implementation of primary care mental health integration, it requires substantial organizational investments that may vary by site and implementation effort. Furthermore, the cost of using an external expert to transfer facilitation skills and build capacity for implementation efforts appears to be minimal.

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