The Perfect Storm: Collision of the Business of Mental Health and the Implementation of Evidence-Based Practices

Abstract

Financing has been hypothesized as an important driver of the implementation of evidence based practices (EBPs), yet there is little systematic investigation. This article presents a qualitative study of the effects of financial factors on the implementation of EBPs in a large urban publicly-funded mental health system. Our interviews with agency and system leaders identified financial distress in community mental health agencies, leading to concern about implementing complex and expensive EBPs. Stakeholders agreed that the cost of implementation of EBP should be shared between the agencies and the system, but disagreed on the solution.

A Multi-Level Examination of Stakeholder Perspectives of Implementation of Evidence-Based Practices in a Large Urban Publicly-Funded Mental Health System

“…Furthermore, providing support to organizations around better business practices; marketing and financing of EBPs; and leadership and strategic climate (Aarons, Ehrhart, Farahnak, & Hurlburt, 2015; Stewart et al, in press) are other potential future directions that merits careful consideration.…”

“…Identified barriers and facilitators were consistent across stakeholder group, lending confidence to the results. We noted relatively few points of divergence across the stakeholder groups; not surprisingly stakeholders were most likely to endorse barriers and facilitators in their sphere (e.g., treatment developers are more likely to endorse intervention characteristics) and while all stakeholders agreed finance was a major facilitator and barrier, they did not always agree on the cause or solution (Stewart et al, in press). Perhaps the most interesting omission, rather than point of divergence, was the lack of discussion of system-level facilitators, endorsed by the majority of system leaders and treatment developers, but not identified from the perspective of agency administrators.…”

Independent Contractors in Public Mental Health Clinics: Implications for Use of Evidence-Based Practices

“…Participants discussed the rationale for using independent contractors and their perceptions of the impact of such a model on their organization and staff. Overwhelmingly, participants discussed the dire financial environment in community mental health (26, 35, 36), and the reality that they could not provide salary and benefits to their therapists. There may be alternatives to improve organizational fiscal health such as teaching organizations better business practices (37) or changing federal and state policies to support these organizations.…”

Applying the Policy Ecology Framework to Philadelphia’s Behavioral Health Transformation Efforts

“…There are a number of barriers to implementing EBPs at the organizational-level, including (but certainly not limited to) variable organizational cultures and climates (Beidas et al, 2014; Glisson et al, 2008), implementation climates (Weiner, Belden, Bergmire, & Johnston, 2011), and leadership (Aarons, Ehrhart, & Farahnak, 2014a); lack of access to ongoing training, supervision, and consultation (Ganju, 2003; Manuel, Mullen, Fang, Bellamy, & Bledsoe, 2009; Powell, Hausmann-Stabile, & McMillen, 2013; Shapiro, Prinz, & Sanders, 2012); turnover of staff and leadership (Beidas, Marcus, Benjamin Wolk, et al, 2015), and inadequate financial supports (Hoagwood, 2003; Isett et al, 2007; Stewart et al, 2016). DBHIDS has used a number of strategies to support provider organizations and assist in covering the marginal costs of implementation (Raghavan, 2012; Raghavan et al, 2008), allowing organizations to invest more fully in the adoption, implementation, and sustainment of EBPs.…”