scholarly journals State Adoption of Incentives to Promote Evidence-Based Practices in Behavioral Health Systems

2018 ◽  
Vol 69 (6) ◽  
pp. 685-688 ◽  
Author(s):  
Rebecca E. Stewart ◽  
Steven C. Marcus ◽  
Trevor R. Hadley ◽  
Brian M. Hepburn ◽  
David S. Mandell
2020 ◽  
Vol 1 ◽  
pp. 263348952093998
Author(s):  
Alex R Dopp ◽  
Marie-Rachelle Narcisse ◽  
Peter Mundey ◽  
Jane F Silovsky ◽  
Allison B Smith ◽  
...  

Background: Increased availability of evidence-based practices (EBPs) is essential to alleviating the negative public health and societal effects of behavioral health problems. A major challenge to implementing and sustaining EBPs broadly is the limited and fragmented nature of available funding. Method: We conducted a scoping review that assessed the current state of evidence on EBP financing strategies for behavioral health based on recent literature (i.e., post-Affordable Care Act). We defined financing strategies as techniques that secure and direct financial resources to support EBP implementation. This article introduces a conceptualization of financing strategies and then presents a compilation of identified strategies, following established reporting guidelines for the implementation strategies. We also describe the reported level of use for each financing strategy in the research literature. Results: Of 23 financing strategies, 13 were reported as being used within behavioral health services, 4 had potential for use, 5 had conceptual use only, and 1 was potentially contraindicated. Examples of strategies reported being used include increased fee-for-service reimbursement, grants, cost sharing, and pay-for-success contracts. No strategies had been evaluated in ways that allowed for strong conclusions about their impact on EBP implementation outcomes. Conclusion: The existing literature on EBP financing strategies in behavioral health raises far more questions than answers. Therefore, we propose a research agenda that will help better understand these financing strategies. We also discuss the implications of our findings for behavioral health professionals, system leaders, and policymakers who want to develop robust, sustainable financing for EBP implementation in behavioral health systems. Plain language abstract: Organizations that treat behavioral health problems (mental health and substance use) often seek to adopt and use evidence-based practices (EBPs). A challenge to adopting EBPs broadly is the limited funding available, often from various sources that are poorly coordinated with one another. To help organizations plan effectively to adopt EBPs, we conducted a review of recent evidence (i.e., since the passage of the 2010 Affordable Care Act) on strategies for financing EBP adoption in behavioral health systems. We present definitions of 23 identified strategies and describe each strategy’s reported (in the research literature) level of use to fund EBP adoption in behavioral health services. Of the 23 financing strategies, 13 strategies had evidence of use, 4 had potential for use, 5 had conceptual use only, and 1 was potentially contraindicated. Examples of strategies with evidence of use include increased fee-for-service reimbursement, grants, cost sharing, and pay-for-success contracts. This comprehensive list of EBP financing strategies may help guide decision-making by behavioral health professionals, system leaders, and policymakers. The article also presents a research agenda for building on the current research literature by (1) advancing methods to evaluate financing strategies’ effects, (2) partnering with stakeholders and decision-makers to examine promising financing strategies, (3) focusing on strategies and service systems with the greatest needs, (4) improving methods to guide the selection of financing strategies, and (5) paying greater attention to sustainable long-term financing of EBPs.


2021 ◽  
Vol 2 ◽  
pp. 263348952110188
Author(s):  
Byron J Powell ◽  
Kayne D Mettert ◽  
Caitlin N Dorsey ◽  
Bryan J Weiner ◽  
Cameo F Stanick ◽  
...  

Background: Organizational culture, organizational climate, and implementation climate are key organizational constructs that influence the implementation of evidence-based practices. However, there has been little systematic investigation of the availability of psychometrically strong measures that can be used to assess these constructs in behavioral health. This systematic review identified and assessed the psychometric properties of measures of organizational culture, organizational climate, implementation climate, and related subconstructs as defined by the Consolidated Framework for Implementation Research (CFIR) and Ehrhart and colleagues. Methods: Data collection involved search string generation, title and abstract screening, full-text review, construct assignment, and citation searches for all known empirical uses. Data relevant to nine psychometric criteria from the Psychometric and Pragmatic Evidence Rating Scale (PAPERS) were extracted: internal consistency, convergent validity, discriminant validity, known-groups validity, predictive validity, concurrent validity, structural validity, responsiveness, and norms. Extracted data for each criterion were rated on a scale from −1 (“poor”) to 4 (“excellent”), and each measure was assigned a total score (highest possible score = 36) that formed the basis for head-to-head comparisons of measures for each focal construct. Results: We identified full measures or relevant subscales of broader measures for organizational culture ( n = 21), organizational climate ( n = 36), implementation climate ( n = 2), tension for change ( n = 2), compatibility ( n = 6), relative priority ( n = 2), organizational incentives and rewards ( n = 3), goals and feedback ( n = 3), and learning climate ( n = 2). Psychometric evidence was most frequently available for internal consistency and norms. Information about other psychometric properties was less available. Median ratings for psychometric properties across categories of measures ranged from “poor” to “good.” There was limited evidence of responsiveness or predictive validity. Conclusion: While several promising measures were identified, the overall state of measurement related to these constructs is poor. To enhance understanding of how these constructs influence implementation research and practice, measures that are sensitive to change and predictive of key implementation and clinical outcomes are required. There is a need for further testing of the most promising measures, and ample opportunity to develop additional psychometrically strong measures of these important constructs. Plain Language Summary Organizational culture, organizational climate, and implementation climate can play a critical role in facilitating or impeding the successful implementation and sustainment of evidence-based practices. Advancing our understanding of how these contextual factors independently or collectively influence implementation and clinical outcomes requires measures that are reliable and valid. Previous systematic reviews identified measures of organizational factors that influence implementation, but none focused explicitly on behavioral health; focused solely on organizational culture, organizational climate, and implementation climate; or assessed the evidence base of all known uses of a measure within a given area, such as behavioral health–focused implementation efforts. The purpose of this study was to identify and assess the psychometric properties of measures of organizational culture, organizational climate, implementation climate, and related subconstructs that have been used in behavioral health-focused implementation research. We identified 21 measures of organizational culture, 36 measures of organizational climate, 2 measures of implementation climate, 2 measures of tension for change, 6 measures of compatibility, 2 measures of relative priority, 3 measures of organizational incentives and rewards, 3 measures of goals and feedback, and 2 measures of learning climate. Some promising measures were identified; however, the overall state of measurement across these constructs is poor. This review highlights specific areas for improvement and suggests the need to rigorously evaluate existing measures and develop new measures.


2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Rebecca E. Stewart ◽  
Danielle R. Adams ◽  
David S. Mandell ◽  
Gayatri Nangia ◽  
Lauren Shaffer ◽  
...  

2018 ◽  
Vol 69 (3) ◽  
pp. 286-292 ◽  
Author(s):  
Ramaris E. German ◽  
Abby Adler ◽  
Sarah A. Frankel ◽  
Shannon Wiltsey Stirman ◽  
Paola Pinedo ◽  
...  

2016 ◽  
Vol 67 (5) ◽  
pp. 496-503 ◽  
Author(s):  
Eric J. Bruns ◽  
Suzanne E. U. Kerns ◽  
Michael D. Pullmann ◽  
Spencer W. Hensley ◽  
Ted Lutterman ◽  
...  

2019 ◽  
Vol 21 (1) ◽  
pp. 19-30
Author(s):  
Melissa Neal Stein

People of color are disproportionately impacted by the criminal justice system. Many jurisdictions attempt to reduce racial disparities; however, they often do not incorporate strategies to effectively address institutional and structural racism. Resulting data reveal no effect or an exacerbating effect on disparities. This commentary attempts to translate three mistaken assumptions from the field of behavioral health, so that they apply to criminal justice system reforms. The mistaken assumptions for criminal justice are that system-wide reform efforts will naturally reduce disparities, current reforms meet the needs of diverse communities, and evidence-based practices have been tested for their impact on diverse groups. These may be countered with the following recommendations: apply critical race theory, respond to communities' needs, and adapt evidence-based practices.


2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Caroline A. Bonham ◽  
David Sommerfeld ◽  
Cathleen Willging ◽  
Gregory A. Aarons

Objective. In recent years, New Mexico has prioritized integrated treatment for cooccurring mental health and substance use disorders within its public behavioral health system. This report describes factors likely to be important when implementing evidence-based practices (EBPs) in community agencies.Methods. Our mixed-method research design consisted of observations, semistructured interviews, and surveys undertaken with employees at 14 agencies at baseline and after 18 months. We developed four-agency typologies based on iterative coding and analysis of observations and interviews. We then examined survey data from employees at the four exemplar agencies to validate qualitative findings.Results. Financial resources and strong leadership impacted agency capacity to train providers and implement EBPs. Quantitative analysis of service provider survey responses from these agencies (N= 38) supported qualitative findings and demonstrated significant mean score differences in leadership, organizational climate, and attitudes toward EBPs in anticipated directions.Conclusion. The availability of strong leadership and financial resources were key components to initial implementation success in this study of community agencies in New Mexico. Reliance only on external funding poses risks for sustainment when demoralizing work climates precipitate employee turnover. Strong agency leadership does not always compensate for deficient financial resources in vulnerable communities.


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