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Implementation Science
Published in: Implementation Science 1/2019

Open Access 01-12-2019 | Research

The role of the outer setting in implementation: associations between state demographic, fiscal, and policy factors and use of evidence-based treatments in mental healthcare

Authors: Eric J. Bruns, Elizabeth M. Parker, Spencer Hensley, Michael D. Pullmann, Philip H. Benjamin, Aaron R. Lyon, Kimberly E. Hoagwood

Published in: Implementation Science | Issue 1/2019

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Abstract

Background

Despite consistent recognition of their influence, empirical study of how outer setting factors (e.g., policies, financing, stakeholder relationships) influence public systems’ investment in and adoption of evidence-based treatment (EBT) is limited. This study examined associations among unmodifiable (e.g., demographic, economic, political, structural factors) and modifiable (e.g., allocation of resources, social processes, policies, and regulations) outer setting factors and adoption of behavioral health EBT by US states.

Methods

Multilevel models examined relationships between state characteristics, an array of funding and policy variables, and state adoption of behavioral health EBTs for adults and children across years 2002–2012, using data from the National Association for State Mental Health Program Directors Research Institute and other sources.

Results

Several unmodifiable state factors, including per capita income, controlling political party, and Medicaid expansion, predicted level of state fiscal investments in EBT. By contrast, modifiable factors, such as interagency collaboration and investment in research centers, were more predictive of state policies supportive of EBT. Interestingly, level of adult EBT adoption was associated with state fiscal supports for EBT, while child EBT adoption was predicted more by supportive policies. State per capita debt and direct state operation of services (versus contracting for services) predicted both child and adult EBT adoption.

Conclusions

State-level EBT adoption and associated implementation support is associated with an interpretable array of policy, financing, and oversight factors. Such information expands our knowledge base of the role of the outer setting in implementation and may provide insight into how best to focus efforts to promote EBT for behavioral health disorders.
Literature
1.
Bond GR, Campbell K. Evidence-based practices for individuals with severe mental illness. J Rehabil. 2008;74(2):33–44.
2.
Chorpita BF, Daleiden EL. Structuring the collaboration of science and service in pursuit of a shared vision. J Clin Child Adolesc Psychol. 2014;43(2):323–38.PubMedCrossRef
3.
Daleiden EL, Chorpita BF. From data to wisdom: quality improvement strategies supporting large-scale implementation of evidence-based services. Child Adolesc Psychiatr Clin N Am. 2005;14(2):329–49.PubMedCrossRef
4.
Nakamura BJ, Chorpita BF, Hirsch M, Daleiden E, Slavin L, Amundson MJ, et al. Large-scale implementation of evidence-based treatments for children 10 years later: Hawaii’s evidence-based services initiative in children’s mental health. Clin Psychol Sci Pract. 2011 Mar;18(1):24–35.CrossRef
5.
Prinz RJ, Sanders MR, Shapiro CJ, Whitaker DJ, Lutzker JR. Population-based prevention of child maltreatment: the US triple P system population trial. Prev Sci. 2009;10(1):1–12.PubMedPubMedCentralCrossRef
6.
Hoagwood K, Atkins M, Ialongo N. Unpacking the black box of implementation: the next generation for policy, research and practice. Adm Policy Ment Health Ment Health Serv Res. 2013 Nov;40(6):451–5.CrossRef
7.
Purtle J, Dodson EA, Nelson K, Meisel ZF, Brownson RC. Legislators’ sources of behavioral health research and preferences for dissemination: variations by political party. Psychiatr Serv. 2018 Jul 9;69(10):1105–8.PubMedPubMedCentralCrossRef
8.
Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Admin Pol Ment Health. 2011;38:4–23.CrossRef
9.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.PubMedPubMedCentralCrossRef
10.
11.
Nilsen P, Ståhl C, Roback K, Cairney P. Never the twain shall meet? - a comparison of implementation science and policy implementation research. Implement Sci. 2013;8:63.PubMedPubMedCentralCrossRef
12.
Powell BJ, Beidas RS, Rubin RM, Stewart RE, Wolk CB, Matlin SL, et al. Applying the policy ecology framework to Philadelphia’s behavioral health transformation efforts. Admin Pol Ment Health. 2016;43(6):909–26.CrossRef
13.
Fisher WH, Rivard JC. The research potential of administrative data from state mental health agencies. Psychiatr Serv. 2010 Jun 1;61(6):546–8.PubMedCrossRef
14.
U.S. Department of Health and Human Services. Achieving the promise: transforming mental health care in America. (DHHS Publication No. SMA-03-3832). Rockville: New Freedom Initiative on Mental Health; 2003.
15.
U.S. Department of Health and Human Services. 2011 medicaid managed care enrollment report. Baltimore: Center for Medicare and Medicaid Services; 2012.
16.
Purtle J, Peters R, Brownson RC. A review of policy dissemination and implementation research funded by the National Institutes of Health, 2007–2014. Implement Sci. 2016 Jan;11:1.PubMedPubMedCentralCrossRef
17.
18.
Moullin JC, Dickson KS, Stadnick NA, Rabin B, Aarons GA. Systematic review of the exploration, preparation, implementation, sustainment (EPIS) framework. Implement Sci. 2019;14:1.PubMedPubMedCentralCrossRef
19.
Bruns EJ, Kerns SEU, Pullmann MD, Hensley SW, Lutterman T, Hoagwood KE. Research, data, and evidence-based treatment use in state behavioral health systems, 2001–2012. Psychiatr Serv. 2015;67(5):496–503.PubMedPubMedCentralCrossRef
20.
Proctor EK, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health Ment Health Serv Res. 2009 Jan;36(1):24–34.CrossRef
21.
Lewis CC, Stanick CF, Martinez RG, Weiner BJ, Kim M, Barwick M, et al. The society for implementation research collaboration instrument review project: a methodology to promote rigorous evaluation. Implement Sci. 2015;10:2.PubMedPubMedCentralCrossRef
22.
Harris JR, Cheadle A, Hannon PA, Lichiello P, Forehand M, Mahoney E, et al. A framework for disseminating evidence-based health promotion practices. Prev Chronic Dis. 2011;15:9(22).
23.
Magnabosco JL. Innovations in mental health services implementation: a report on state-level data from the U.S. evidence-based practices project. Implement Sci. 2006;1:13.PubMedPubMedCentralCrossRef
24.
Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. A refined compilation of implementation strategies: results from the expert recommendations for implementing change (ERIC) project. Implement Sci. 2015 Feb 12;10:21.PubMedPubMedCentralCrossRef
25.
26.
27.
28.
29.
Farmer EMZ, Burns BJ, Dubs MS, Thompson S. Assessing conformity to standards for therapeutic foster care. J Emot Behav Disord. 2002;10(4):213–22.CrossRef
30.
Osei GK, Gorey KM, Jozefowicz DMH. Delinquency and crime prevention: overview of research comparing therapeutic foster care and group care. Child Youth Care Forum. 2015;45(1):33–46.CrossRef
31.
Henggeler SW. Efficacy studies to large-scale transport: the development and validation of multisystemic therapy programs. Annu Rev Clin Psychol. 2011;7(1):351–81.PubMedCrossRef
32.
Henggeler SW, Schoenwald SK, Borduin CM, Rowland MD, Cunningham PB. Multisystemic therapy for antisocial behavior in children and adolescents. 2nd ed. New York: Guilford Press; 2009.
33.
Sexton TL, Alexander JF. Functional family therapy: a mature clinical model for working with at-risk adolescents and their families. In: Handbook of family therapy: the science and practice of working with families and couples. New York: Brunner-Routledge; 2003. p. 323–48.
34.
Tabol C, Drebing C, Rosenheck R. Studies of “supported” and “supportive” housing: a comprehensive review of model descriptions and measurement. Eval Program Plann. 2010;33(4):446–56.PubMedCrossRef
35.
Cook JA, Leff HS, Blyler CR, Gold PB, Goldberg RW, Mueser KT, et al. Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness. Arch Gen Psychiatry. 2005;62(5):505–12.PubMedCrossRef
36.
Drake RE, McHugo GJ, Clark RE, Teague GB, Xie H, Miles K, et al. Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder. Am J Orthop. 1998;68(2):201–15.CrossRef
37.
38.
Corp S. Stata statistical software (release 13) [computer software]. College Station: StataCorp LP; 2013.
39.
Raudenbush SW, Bryk AS, Cheong YF, Congdon RT, du Toit M. Hierarchical linear modeling (version 7.0) [computer software]. Chicago: Scientific Software International; 2011.
40.
Raudenbush SW, Bryk AS. Hierarchical linear models: applications and data analysis methods. 2nd ed. Thousand Oaks: Sage Publications, Inc.; 2002.
41.
Davies E, Dube S, Farver M, Silloway T, Sutherland K, White D. How states engage in evidence-based policymaking: a national assessment. Chicago: Pew-MacArthur Results First Initiative; 2017.
42.
Chernick H. Redistribution at the state and local level: consequences for economic growth. Public Finance Rev. 2010;38(4):409–49.CrossRef
43.
Bae S, Moon S, Jung C. Economic effects of state-level tax and expenditure limitations. Public Adm Rev. 2012;72(5):649–58.CrossRef
44.
Alms J, Rogers J. Do state fiscal policies affect state economic growth? Public Finance Rev. 2011;39(4):483–526.CrossRef
45.
Chang C-P, Kim Y, Ying Y. Economics and politics in the United States: a state-level investigation. J Econ Policy Reform. 2009;12(4):343–54.CrossRef
46.
47.
Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health Ment Health Serv Res. 2011;38(1):4–23.CrossRef
48.
Palinkas LA, Fuentes D, Finno M, Garcia AR, Holloway IW, Chamberlain P. Inter-organizational collaboration in the implementation of evidence-based practices among public agencies serving abused and neglected youth. Adm Policy Ment Health Ment Health Serv Res. 2014;41(1):74–85.CrossRef
49.
Hawkins JD, Catalano RF, Arthur MW. Promoting science-based prevention in communities. Addict Behav. 2002;27(6):951–76.PubMedCrossRef
50.
Bruns EJ, Hoagwood KE, Hamilton JD. State implementation of evidence-based practice for youths, part I: responses to the state of the evidence. J Am Acad Child Adolesc Psychiatry. 2008;47(4):369–73.PubMedCrossRef
51.
Bruns EJ, Hoagwood KE, Rivard JC, Wotring J, Marsenich L, Carter B, et al. State implementation of evidence-based practice for youths, part II: recommendations for research and policy. J Am Acad Child Adolesc Psychiatry. 2008;47(5):499–504.PubMedCrossRef
52.
Proctor E, Hooley C, Morse A, McCrary S, Kim H, Kohl P. Intermediary/purveyor organizations for evidence-based interventions in the US child mental health: characteristics and implementation strategies. Impliment Sci. 2019;14:3.CrossRef
53.
Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F. Implementation research: a synthesis of the literature. Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231); 2005.
54.
Franks RP, Bory CT. Who supports the successful implementation and sustainability of evidence-based practices? Defining and understanding the roles of intermediary and purveyor organizations. New Dir Child Adolesc Dev. 2015;2015(149):41–56.PubMedCrossRef
55.
Bruns EJ, Walker JS, Bernstein A, Daleiden E, Pullmann MD, Chorpita BF. Family voice with informed choice: coordinating wraparound with research-based treatment for children and adolescents. J Clin Child Adolesc Psychol. 2014;43(2):256–69.PubMedCrossRef
56.
Friedman RM, Drews DA. Evidence-based practices, systems of care, & individualized care. Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute, Department of Child & Family Studies. The Research and Training Center for Children’s Mental Health; 2005.
57.
Walker JS, Sanders B. The community supports for wraparound inventory: an assessment of the implementation context for wraparound. J Child Fam Stud. 2011 Dec;20(6):747–57.CrossRef
58.
Metadata
Title
The role of the outer setting in implementation: associations between state demographic, fiscal, and policy factors and use of evidence-based treatments in mental healthcare
Authors
Eric J. Bruns
Elizabeth M. Parker
Spencer Hensley
Michael D. Pullmann
Philip H. Benjamin
Aaron R. Lyon
Kimberly E. Hoagwood
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2019
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-019-0944-9

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