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

Powell, Byron J.; Beidas, Rinad S.; Rubin, Ronnie M.; Stewart, Rebecca E.; Wolk, Courtney Benjamin; Matlin, Samantha L.; Weaver, Shawna; Hurford, Matthew O.; Evans, Arthur C.; Hadley, Trevor R.; Mandell, David S.

doi:10.1007/s10488-016-0733-6

Cited by 66 publications

(74 citation statements)

References 86 publications

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“…In 2012, CBH implemented an enhanced financial rate for therapists to incentivize use of TF-CBT during implementation. These implementation strategies are consistent with the broader approach that DBHIDS has taken to the implementation of EBPs (Powell et al, 2016). …”

Section: Case Study: Creating a Trauma-informed Behavioral Health Syssupporting

confidence: 75%

Lessons learned while building a trauma-informed public behavioral health system in the City of Philadelphia

Beidas

Adams

Kratz

et al. 2016

Evaluation and Program Planning

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Exposure to traumatic experiences among youth is a serious public health concern. A trauma-informed public behavioral health system that emphasizes core principles such as understanding trauma, promoting safety, supporting consumer autonomy, sharing power, and ensuring cultural competence, is needed to support traumatized youth and the providers who work with them. This article describes a case study of the creation and evaluation of a trauma-informed publicly funded behavioral health system for children and adolescents in the City of Philadelphia (the Philadelphia Alliance for Child Trauma Services; PACTS) using the Exploration, Preparation, Implementation, and Sustainment (EPIS) as a guiding framework. We describe our evaluation of this effort with an emphasis on implementation determinants and outcomes. Implementation determinants include inner context factors, specifically therapist knowledge and attitudes (N = 114) towards evidence-based practices. Implementation outcomes include information on rate of PTSD diagnoses in agencies over time, number of youth receiving TF-CBT over time, and penetration (i.e., number of youth receiving TF-CBT divided by the number of youth screening positive on trauma screening). We describe lessons learned from our experiences building a trauma-informed public behavioral health system in the hopes that this case study can guide other similar efforts.

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Section: Case Study: Creating a Trauma-informed Behavioral Health Syssupporting

confidence: 75%

Lessons learned while building a trauma-informed public behavioral health system in the City of Philadelphia

Beidas

Adams

Kratz

et al. 2016

Evaluation and Program Planning

Self Cite

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show abstract

“…Second, predictors of therapy strategy use were largely only significant when clinician participated in EBP training efforts. In large systems, even when an organization is implementing an EBP, the practice seldom reaches all staff (Powell et al, 2016). This suggests that it is important to conceptualize these two groups of clinicians as heterogeneous with different factors driving their behavior (and potentially different targets for strategies to change behavior).…”

Section: Discussionmentioning

confidence: 99%

“…Many systems are moving towards implementation of EBP (Bruns et al, 2008; Bruns et al, 2016; Ganju, 2003; Lau & Brookman-Frazee, 2016; Powell et al, 2016). Understanding how to increase implementation, and sustainment in these systems is critical to the success of these efforts.…”

Section: Discussionmentioning

confidence: 99%

“…The department began widespread implementation of CBT in 2007 (Stirman et al, 2010; Stirman et al, 2012; Creed et al, 2016), prolonged exposure in 2011, trauma-focused CBT in 2011 (Beidas, Adams, et al, 2016), and dialectical behavior therapy in 2012. These four initiatives have supported and financed training, expert consultation, and ongoing technical assistance in more than 60 organizations and in over 500 clinicians (Powell et al, 2016). Two of the initiatives, CBT and trauma-focused CBT, were implemented in child outpatient settings.…”

Section: Methodsmentioning

confidence: 99%

“…While there are many evidence-based practices (EBP; Butler, Chapman, Forman, & Beck, 2006; Chorpita et al, 2011), efforts to translate efficacious treatments from research to practice have been slow (Stewart & Chambless, 2007; Weissman et al, 2006). In the past decade, large behavioral health systems have invested substantial resources in support of implementation of EBP (Bruns et al, 2008; Bruns et al, 2016; Ganju, 2003; Lau & Brookman-Frazee, 2016; Powell et al, 2016). These resources have primarily supported training the existing workforce in EBP.…”

Section: Introductionmentioning

confidence: 99%

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The relationship between consumer, clinician, and organizational characteristics and use of evidence-based and non-evidence-based therapy strategies in a public mental health system

Beidas

Skriner

Adams

et al. 2017

Behaviour Research and Therapy

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We investigated the relationship between consumer, clinician, and organizational factors and clinician use of therapy strategies within a system-wide effort to increase the use of cognitive-behavioral therapy. Data from 247 clinicians in 28 child-serving organizations were collected. Clinicians participating in evidence-based practice training initiatives were more likely to report using cognitive-behavioral therapy when they endorsed more clinical experience, being salaried clinicians, and more openness to evidence-based practice. Clinicians participating in evidence-based practice initiatives were more likely to use psychodynamic techniques when they had older clients, less knowledge about evidence-based practice, more divergent attitudes toward EBP, higher financial strain, and worked in larger organizations. In clinicians not participating in evidence-based training initiatives; depersonalization was associated with higher use of cognitive-behavioral; whereas clinicians with less knowledge of evidence-based practices were more likely to use psychodynamic techniques. This study suggests that clinician characteristics are important when implementing evidence-based practices; and that consumer, clinician, and organizational characteristics are important when de-implementing non evidence-based practices. This work posits potential characteristics at multiple levels to target with implementation and deimplementation strategies.

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The Implementation of Integrated Behavioral Health Models

Zerden¹,

Cruden²,

Lombardi³

et al. 2019

Handbook of Health Social Work

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

Cited by 66 publications

References 86 publications

Lessons learned while building a trauma-informed public behavioral health system in the City of Philadelphia

Lessons learned while building a trauma-informed public behavioral health system in the City of Philadelphia

The relationship between consumer, clinician, and organizational characteristics and use of evidence-based and non-evidence-based therapy strategies in a public mental health system

The Implementation of Integrated Behavioral Health Models

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