The Role of State Mental Health Authorities in Managing Change for the Implementation of Evidence-Based Practices

Abstract

The evidence-based practice demonstration for services to adults with serious mental illness has ended its pilot stage. This paper presents the approaches states employed to combine traditional policy levers with more strategic/institutional efforts (e.g., leadership) to facilitate implementation of these practices. Two rounds of site visits were completed and extensive interview data collected. The data were analyzed to find trends that were consistent across states and across practices. Two themes emerged for understanding implementation of evidence-based practices: the support and influence of the state mental health authority matters and so does the structure of the mental health systems.

The State Health Authority Yardstick (SHAY)

“…For one thing, implementation monitors were primarily focused on the activities at the site level, not on state activities. Thus, even though the dimension of Leadership Skills was rarely coded for the state level, other analyses of the National Implementing EBPs Project have clearly suggested the criticality of state leadership (Isett et al 2007(Isett et al , 2008. In addition, there is considerable evidence that efforts at the state-level were important in the areas of fidelity monitoring ) and outcome monitoring (Marty et al 2008), even though neither of these dimensions emerged as important from analysis of the NIEBPP data.…”

“…The initial source for these categories was the work of the MacArthur Mental Health Policy Research Network, as described elsewhere (Isett et al 2007(Isett et al , 2008. Briefly, this research group used state-level key informant interviews as the primary source of data for understanding the role of the SMHAs in the eight states participating in the National Implementing EBPs Project.…”

“…Nevertheless, there continues to be keen interest in systematically assessing state-level influences on implementation. A qualitative study of the role of the SMHA in implementing EBP's conducted for the National Implementing Evidence-Based Practices Project by the MacArthur Foundation found that financing and regulations, leadership, and training were important to successful implementation (Isett et al 2007(Isett et al , 2008. McFarlane et al (2001) concluded that a strong positive relationship between the SMHA and the provider community was a key ingredient in the success of statewide implementation of family psychoeducation.…”

“…Five EBPs in eight states were studied, providing data on the effectiveness of an EBP implementation model involving state oversight and site level implementation support, and creating a rich qualitative database on the program level barriers, strategies and facilitators of EBP implementation over time (Torrey et al 2005;McHugo et al 2007). The MacArthur Mental Health Policy Research Network used the opportunity created by the National Implementing EBPs Project to examine statelevel EBP activities and innovations (Isett et al 2007(Isett et al , 2008. The scale described in this paper evolved from an interest in linking these two studies to explore the relationship between state conditions and the success of EBP implementation in the community.…”

Implementation of Evidence-Based Practices for Treatment of Alcohol and Drug Disorders: The Role of the State Authority

“…Leaders have multiple means to communicate the commitment to EBPs, including a commitment of resources, mission statements, and internal and external collaborations. 19,51,52 Various methods SSA policymakers can use to promulgate their expectations include state-provider contracts, design of RFPs and grant funding decisions, licensing regulations, quality improvement plans, and media dissemination (e.g., newsletters, reports, press releases, and presentations). 15,52 Of course, these efforts are dependent on appropriate financial support.…”