A scoping review of strategies for financing the implementation of evidence-based practices in behavioral health systems: State of the literature and future directions

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.

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Clinician's Guide to Evidence-Based Practices

10.1093/med:psych/9780190621933.001.0001 ◽

2017 ◽

Cited By ~ 3

Author(s):

John C. Norcross ◽

Thomas P. Hogan ◽

Gerald P. Koocher ◽

Lauren A. Maggio

Keyword(s):

Behavioral Health ◽

Patient Characteristics ◽

Research Literature ◽

Successful Implementation ◽

Evidence Based ◽

Evidence Based Practices ◽

Addictive Disorders ◽

Hands On ◽

Health Practitioners ◽

The Right

The second edition of the Clinician’s Guide to Evidence-Based Practices: Behavioral Health and Addictions provides practitioners with the skills to retrieve and use research in order to benefit patients suffering from mental and addictive disorders. Practice must be informed and guided by research, yet so much of the research literature feels inaccessible and overwhelming, too removed and too large to guide what we do daily with our patients. This book overcomes these challenges to evidence-based practice (EBP) by serving as a practical, how-to guide for graduate students and behavioral health practitioners. Following three realistic patients throughout, the Clinician’s Guide canvases the entire EBP process: asking the right questions, accessing the best available research, appraising the research, translating that research into practice, integrating that research with clinician expertise and patient characteristics, evaluating the entire enterprise, attending to the ethical considerations, and, when done, moving the EBP process forward by teaching it to others. This revised and updated edition includes a separate chapter on filtered sources for accessing the best available research, a series of hands-on Skill Exercises in each chapter to provide practical use of the material, a new section on barriers to successful implementation, and a companion website with expanded content, interactive examples, and hyperlinked references.

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

Psychiatric Services ◽

10.1176/appi.ps.201700508 ◽

2018 ◽

Vol 69 (6) ◽

pp. 685-688 ◽

Cited By ~ 6

Author(s):

Rebecca E. Stewart ◽

Steven C. Marcus ◽

Trevor R. Hadley ◽

Brian M. Hepburn ◽

David S. Mandell

Keyword(s):

Behavioral Health ◽

Health Systems ◽

Evidence Based ◽

Evidence Based Practices ◽

State Adoption

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Systems Applications of Evidence Based Practices in Occupational Behavioral Health

PsycEXTRA Dataset ◽

10.1037/e533652013-086 ◽

2012 ◽

Author(s):

Richard Gist ◽

Patricia Watson

Keyword(s):

Behavioral Health ◽

Evidence Based ◽

Evidence Based Practices

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The Role of Organizational Processes in Dissemination and Implementation Research

10.1093/oso/9780190683214.003.0008 ◽

2017 ◽

Cited By ~ 2

Author(s):

Gregory A. Aarons ◽

Joanna C. Moullin ◽

Mark G. Ehrhart

Keyword(s):

Health Care ◽

Organizational Development ◽

Organizational Factors ◽

Dissemination And Implementation ◽

Evidence Based ◽

Organizational Strategies ◽

Evidence Based Practices ◽

Effective Dissemination ◽

Dissemination And Implementation Research ◽

Ebp Implementation

Both organizational characteristics and specific organizational strategies are important for the effective dissemination and implementation of evidence-based practices (EBPs) in health and allied health care settings, as well as mental health, alcohol/drug treatment, and social service settings. One of the primary goals of this chapter is to support implementers and leaders within organizations in attending to and shaping the context in which implementation takes place in order to increase the likelihood of implementation success and long-term sustainment. The chapter summarizes some of the most critical organizational factors and strategies likely to impact successful evidence-based practice implementation. There are myriad approaches to supporting organizational development and change—this chapter focuses on issues supported by relevant scientific literatures, particularly those germane to EBP implementation in health care and related settings.

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Measures of organizational culture, organizational climate, and implementation climate in behavioral health: A systematic review

Implementation Research and Practice ◽

10.1177/26334895211018862 ◽

2021 ◽

Vol 2 ◽

pp. 263348952110188

Author(s):

Byron J Powell ◽

Kayne D Mettert ◽

Caitlin N Dorsey ◽

Bryan J Weiner ◽

Cameo F Stanick ◽

...

Keyword(s):

Organizational Culture ◽

Organizational Climate ◽

Psychometric Properties ◽

Behavioral Health ◽

Implementation Research ◽

Learning Climate ◽

Evidence Based ◽

Implementation Climate ◽

Relative Priority ◽

Evidence Based Practices

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.

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