Challenges Implementing Youth-Focused Evidence-Based Practices in Rural Areas: A Rapid Ethnographic Study

Rural youth face significant mental health challenges, and persistent disparities in access to services exist. Yet, there is limited research on the implementation of evidence-based practices (EBPs) for youth mental health problems in rural community mental health (CMH) centers. This study employed a rapid ethnographic assessment to explore determinants of EBP implementation in a rural CMH agency in the Pacific Northwest. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews with 11 clinic staff and completed site visits to understand the unique contextual factors influencing EBP use. Findings revealed complex challenges in rural mental health service delivery. While respondents generally viewed EBPs positively, they highlighted limitations in traditional EBP models when addressing the multifaceted needs of their high-acuity, socioeconomically disadvantaged client population. Reported barriers included staffing shortages, high clinician burnout, limited local resources, and transportation challenges. Respondents reported offering comprehensive services that extended beyond EBPs to address their clients' challenges. The rural context also significantly impacted EBP implementation, characterized by intergenerational trauma, substance use, and limited community resources. By illuminating the challenges of EBP implementation in rural settings, this research provides critical insights for developing more responsive and comprehensive approaches to supporting EBP implementation and improving rural youth mental health.