Further, both proximity of location from the home site and the substantial
organization structural variation from the home site affected diffusion efforts and the level of training required. Home site administrators
note that the lack of proximity between the home site and program
replication sites presented some challenges in terms of the
mentorship and ongoing training and support of team members and contributed
to the dearth of experiential components in both the initial training
and ongoing support efforts. Organization structural variation from
the home site included a patient population that was largely culturally
different from home site and the need to partner with outside care agencies
to conduct the IPCP. The partner agency was unstable, resulting in
complex, conflicted relationships, organizational divisions and geographic
distance between care team members. They describe feeling
battle weary in the wake of a program implementation process that has
been fraught with scattered management styles and intense struggles,
both within the organization and between their organization and their
partner agency and believe that all of these factors have complicated
their dissemination process