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

Dopp, Alex R.; Narcisse, Marie‐Rachelle; Mundey, Peter; Silovsky, Jane F.; Smith, Allison; Mandell, David S.; Funderburk, Beverly W.; Powell, Byron J.; Schmidt, Susan R.; Edwards, Daniel; Luke, Douglas A.; Mendel, Peter

doi:10.1177/2633489520939980

Cited by 36 publications

(52 citation statements)

References 78 publications

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“…A major challenge to implementing and sustaining EBPs is covering associated costs with the limited, fragmented funding available [ 5 , 23 , 24 ]. Our case examples show how financing strategies may overcome cost-related barriers for EBPs by organizing stakeholders around complex interventions (case #1), optimize the clinical and economic benefits of an intervention package (case #2), and link available funds to financing needs (case #3).…”

Section: Discussionmentioning

confidence: 99%

“…Examples of currently used financing strategies included enhanced fee-for-service reimbursement rates (with the additional reimbursement covering implementation costs) and the use of grants, contracts, and budget line-items to fund EBP adoption. The review focused on behavioral health services, but also documented usage in health and social services more broadly [ 24 ], and its findings and recommendations were consistent with those from a systematic review of alternative payment models for cancer care [ 25 ]. The authors noted a lack of rigorous research on the role of financing strategies within EBP implementation and recommended that implementation scientists begin investigating these strategies.…”

Section: Introductionmentioning

confidence: 91%

“…Research on financing public and non-profit private organizations more broadly is also helpful to consider for these decisions; for example, studies demonstrate the benefits of having diverse revenue streams [ 28 ]. If the funding system cannot offer adequate financing strategies, then the service delivery system may never successfully execute its EBP implementation decisions [ 24 ], even when economic evaluations suggest considerable benefits would result.…”

Section: Overview Of Ebp Implementation Financingmentioning

confidence: 99%

“…Family treatments for substance use disorders have low uptake in service systems, due to financing barriers for interventions that focus on people other than the identified patient [ 56 ] and the limited economic evaluations of such treatments [ 57 ]. To address these cost- and financing-related barriers, the INSPIRE pragmatic trial deploys a recently developed fiscal mapping process to identify key intervention components and link them to sustainable financing strategies (see [ 24 ]). Fiscal mapping is a five-step process adapted from Intervention Mapping, a well-established method recommended for tailored selection of implementation strategies [ 58 ].…”

Section: Case Examplesmentioning

confidence: 99%

“…Maximizing the public health impact of EBPs requires strategies that align service delivery and financing to effectively support and sustain implementation [ 23 ]. Such strategies remain under-researched, but a recent scoping review compiled the first dedicated list of “financing strategies” that support EBP implementation and sustainment [ 24 ]. The authors defined 23 potential financing strategies and characterized their frequency of use in health services research.…”

Section: Introductionmentioning

confidence: 99%

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Translating economic evaluations into financing strategies for implementing evidence-based practices

et al. 2021

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Background Implementation researchers are increasingly using economic evaluation to explore the benefits produced by implementing evidence-based practices (EBPs) in healthcare settings. However, the findings of typical economic evaluations (e.g., based on clinical trials) are rarely sufficient to inform decisions about how health service organizations and policymakers should finance investments in EBPs. This paper describes how economic evaluations can be translated into policy and practice through complementary research on financing strategies that support EBP implementation and sustainment. Main body We provide an overview of EBP implementation financing, which outlines key financing and health service delivery system stakeholders and their points of decision-making. We then illustrate how economic evaluations have informed decisions about EBP implementation and sustainment with three case examples: (1) use of Pay-for-Success financing to implement multisystemic therapy in underserved areas of Colorado, USA, based in part on the strength of evidence from economic evaluations; (2) an alternative payment model to sustain evidence-based oncology care, developed by the US Centers for Medicare and Medicaid Services through simulations of economic impact; and (3) use of a recently developed fiscal mapping process to collaboratively match financing strategies and needs during a pragmatic clinical trial for a newly adapted family support intervention for opioid use disorder. Conclusions EBP financing strategies can help overcome cost-related barriers to implementing and sustaining EBPs by translating economic evaluation results into policy and practice. We present a research agenda to advance understanding of financing strategies in five key areas raised by our case examples: (1) maximize the relevance of economic evaluations for real-world EBP implementation; (2) study ongoing changes in financing systems as part of economic evaluations; (3) identify the conditions under which a given financing strategy is most beneficial; (4) explore the use and impacts of financing strategies across pre-implementation, active implementation, and sustainment phases; and (5) advance research efforts through strong partnerships with stakeholder groups while attending to issues of power imbalance and transparency. Attention to these research areas will develop a robust body of scholarship around EBP financing strategies and, ultimately, enable greater public health impacts of EBPs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

Section: Overview Of Ebp Implementation Financingmentioning

confidence: 99%

Section: Case Examplesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Translating economic evaluations into financing strategies for implementing evidence-based practices

et al. 2021

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Programmatic Costs of Project ImPACT for Children with Autism: A Time-Driven Activity Based Costing Study

Cidav

Mandell

Ingersoll

et al. 2023

Adm Policy Ment Health

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Programmatic cost assessment of clinical interventions can inform future dissemination and implementation efforts. We conducted a randomized trial of Project ImPACT (Improving Parents As Communication Teachers) in which community early intervention (EI) providers coached caregivers in techniques to improve young children’s social communication skills. We estimated implementation and intervention costs while demonstrating an application of Time-Driven Activity-Based Costing (TDABC). We defined Project ImPACT implementation and intervention as processes that can be broken down successively into a set of procedures. We created process maps for both implementation and intervention delivery. We determined resource use and costs, per unit procedure in the first year of the program, from a payer perspective. We estimated total implementation cost per clinician and per site, intervention cost per child, and provided estimates of total hours spent and associated costs for implementation strategies, intervention activities and their detailed procedures. Total implementation cost was $43,509 per clinic and $14,503 per clinician. Clinician time (60%) and coach time (12%) were the most expensive personnel resources. Implementation coordination and monitoring (47%), ongoing consultation (26%) and clinician training (19%) comprised most of the implementation cost, followed by fidelity assessment (7%), and stakeholder engagement (1%). Per-child intervention costs were $2619 and $9650, respectively, at a dose of one hour per week and four hours per week Project ImPACT. Clinician and clinic leader time accounted for 98% of per child intervention costs. Highest cost intervention activity was ImPACT delivery to parents (89%) followed by assessment for child’s ImPACT eligibility (10%). The findings can be used to inform funding and policy decision-making to enhance early intervention options for young children with autism. Uncompensated time costs of clinicians are large which raises practical and ethical concerns and should be considered in planning of implementation initiatives. In program budgeting, decisionmakers should anticipate resource needs for coordination and monitoring activities. TDABC may encourage researchers to assess costs more systematically, relying on process mapping and gathering prospective data on resource use and costs concurrently with their collection of other trial data. Supplementary Information The online version contains supplementary material available at 10.1007/s10488-022-01247-6.

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Conceptualizing Implementation Practice Capacity in Community-Based Organizations Delivering Evidence-Based Behavioral Health Services

Vroom

Massey

Tyson

et al. 2021

Glob Implement Res Appl

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Due to the significant prevalence of mental and substance use disorders in the United States, the push for the development and implementation of evidence-based practices (EBPs) in behavioral health has risen exponentially in the last 30 years. Community-based organizations (CBOs) (i.e., self-governing and/or not-for-profit) have been recognized as important providers of behavioral health services. However, there are gaps in the literature surrounding CBO implementation capacity-ability to adopt, implement, and sustain an EBP-and capacity training initiatives (e.g., training in data-based decision-making) that specifically target CBOs and implementation practice. The purpose of this exploratory study was to assess how individuals working within Florida CBOs conceptualize implementation practice capacity and what is needed to reach adequate capacity to utilize an EBP. This qualitative study consisted of semi-structured interviews with eight administrators and nine practitioners currently employed by CBOs who deliver evidence-based behavioral health services (N = 17). Results showed certain implementation practice characteristics such as leadership, culture/climate, collaboration/communication, data-based decision-making and evaluation, and funding were all important areas of implementation practice capacity. Implications for future research focused on conceptualizing and building implementation practice capacity within the context of community behavioral health settings will be discussed.

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

Cited by 36 publications

References 78 publications

Translating economic evaluations into financing strategies for implementing evidence-based practices

Translating economic evaluations into financing strategies for implementing evidence-based practices

Programmatic Costs of Project ImPACT for Children with Autism: A Time-Driven Activity Based Costing Study

Conceptualizing Implementation Practice Capacity in Community-Based Organizations Delivering Evidence-Based Behavioral Health Services

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