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Published in: Prevention Science 8/2019

Open Access 01-11-2019

Scaling up Evidence-Based Interventions in US Public Systems to Prevent Behavioral Health Problems: Challenges and Opportunities

Authors: Abigail A. Fagan, Brian K. Bumbarger, Richard P. Barth, Catherine P. Bradshaw, Brittany Rhoades Cooper, Lauren H. Supplee, Deborah Klein Walker

Published in: Prevention Science | Issue 8/2019

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Abstract

A number of programs, policies, and practices have been tested using rigorous scientific methods and shown to prevent behavioral health problems (Catalano et al., Lancet 379:1653–1664, 2012; National Research Council and Institute of Medicine, 2009). Yet these evidence-based interventions (EBIs) are not widely used in public systems, and they have limited reach (Glasgow et al., American Journal of Public Health 102:1274–1281, 2012; National Research Council and Institute of Medicine 2009; Prinz and Sanders, Clinical Psychology Review 27:739–749, 2007). To address this challenge and improve public health and well-being at a population level, the Society for Prevention Research (SPR) formed the Mapping Advances in Prevention Science (MAPS) IV Translation Research Task Force, which considered ways to scale up EBIs in five public systems: behavioral health, child welfare, education, juvenile justice, and public health. After reviewing other efforts to scale up EBIs in public systems, a common set of factors were identified as affecting scale-up in all five systems. The most important factor was the degree to which these systems enacted public policies (i.e., statutes, regulations, and guidance) requiring or recommending EBIs and provided public funds for EBIs. Across systems, other facilitators of scale-up were creating EBIs that are ready for scale-up, public awareness of and support for EBIs, community engagement and capacity to implement EBIs, leadership support for EBIs, a skilled workforce capable of delivering EBIs, and data monitoring and evaluation capacity. It was concluded that the following actions are needed to significantly increase EBI scale-up in public systems: (1) provide more public policies and funding to support the creation, testing, and scaling up of EBIs; (2) develop and evaluate specific frameworks that address systems level barriers impeding EBI scale-up; and (3) promote public support for EBIs, community capacity to implement EBIs at scale, and partnerships between community stakeholders, policy makers, practitioners, and scientists within and across systems.
Footnotes
1
This paper conceptualizes behavioral health problems broadly to include social, physical, mental health, and academic problems. These problems may manifest, for example, as delinquency, violence, teen pregnancy, high-risk sexual behaviors, obesity, substance use/abuse, depression, anxiety, poor academic performance, and school drop-out.
 
2
The MAPS IV Task Force considered adding “community” as a system to recognize the important role that community-based non-profit agencies and networks play in financing, promoting, and delivering EBIs. However, we decided that communities are not a system per se, but rather are embedded in local, state and federal public systems. Furthermore, community agencies are too diverse in their scope, functions, and outcomes of interest to be neatly categorized as one system. Similarly, we debated whether or not “early childhood” should be an additional public system but decided not to designate it as such because early childhood EBIs are delivered in multiple public systems (e.g., child welfare, education, and public health).
 
3
As stated in Footnote 1, behavioral health problems are defined broadly in this paper and are not the sole purview of the behavioral health system. Although the behavioral health system is concerned with reducing an array of mental, emotional, and behavioral disorders (see Table 1), its efforts focus on mental health and substance use/abuse.
 
4
The federal government also provides categorical funds that are similar to block grants, but these are usually allocated for a more narrowly prescribed set of services. For example, Medicaid is a categorical grant that can be used for EBIs and is being used in Washington State to support the Triple P program with parents in primary care settings (Steverman and Shern 2014).
 
5
For comprehensive descriptions of evidence-based registries and discussion of their differences and limitations, see Burkhardt et al. (2015), Means et al. (2015), and Neuhoff et al. (2015).
 
6
Given that systems differ in their organizational structures, flexibility, and funding and statutory contexts, the specific ways in which systems can facilitate scale-up are likely to differ. As part of the MAPS IV initiative, the behavioral health, education, and public health workgroups drafted policy briefs that identify system-specific challenges to EBI scale-up and recommendations for addressing these factors. Links to these three briefs are available on the SPR website (https://​www.​preventionresear​ch.​org/​). We encourage readers of this manuscript to share the briefs with their colleagues, particularly those working within these public systems.
 
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Metadata
Title
Scaling up Evidence-Based Interventions in US Public Systems to Prevent Behavioral Health Problems: Challenges and Opportunities
Authors
Abigail A. Fagan
Brian K. Bumbarger
Richard P. Barth
Catherine P. Bradshaw
Brittany Rhoades Cooper
Lauren H. Supplee
Deborah Klein Walker
Publication date
01-11-2019
Publisher
Springer US
Published in
Prevention Science / Issue 8/2019
Print ISSN: 1389-4986
Electronic ISSN: 1573-6695
DOI
https://doi.org/10.1007/s11121-019-01048-8

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