Closing the Research to Practice Gap in Children’s Mental Health: Structures, Solutions, and Strategies

Abstract

Failure to apply research on effective interventions spans all areas of medicine, including children's mental health services. This article examines the policy, structural, and economic problems in which this gap originates. We identify four steps to close this gap. First, the field should develop scientific measures of the research-practice gap. Second, payors should link incentives to outcomes-based performance measures. Third, providers and others should develop improved understanding and application of effective dissemination and business models. Fourth, efforts to link EBP to clinical practice should span patient/consumers, providers, practices, plans, and purchasers. The paper discusses each of these in turn and relates them to fundamental problems of service delivery.

Improving Community-Based Mental Health Care for Children: Translating Knowledge into Action

“…Not surprisingly, organizations are likely to implement an EB intervention if there are economic and/or other incentives to do so (Mendel et al 2008). Economic incentives such as pay-for-performance contracts may facilitate delivery of EB practices (Jensen and Foster 2010). Alternatively, funding limitations and inflexible reimbursement systems are the most commonly reported reasons for “de-adoption” (i.e., lack of sustainment) of innovative practices (Massatti et al 2008).…”

“…Administrative datasets that allow sophisticated assessment of practice delivery, outcomes, and costs can facilitate needed cost-benefit studies which can ultimately drive policy and practice change (Foster and Holden 2002). The challenges of improving the delivery of EB practice may be more effectively addressed by adopting a business marketing perspective providing evidence of cost-benefit to consumers, providers, and the government (Jensen and Foster 2010). …”

Outcome Domains in Child Mental Health Research Since 1996: Have They Changed and Why Does It Matter?

“…The introduction of the dissemination-implementation research agenda within NIH also enabled a number of services researchers to re-engineer their scientific work so that it would be relevant to the new agenda on implementation of effective treatments or service practices, including fidelity, supervision and training. 11,22,274 …”

Implementing Evidence-Based Practices for Youth in an HMO: The Roles of External Ratings and Market Share

“…(1) a follow-up medication visit for ADHD youth within 30 days of starting a medication; (2) two or more visits within 270 days after the initial diagnosis and treatment initiation period (Jensen and Foster 2010); (3) the proportion of hospitalized youth seen within 30 days of discharge (National Committee for Quality Assurance 2010). HEDIS and other measures ironically impede implementation of measures proven to improve outcome via their singular focus in CAP on access as though access alone is sufficient.…”

“…Resulting gains in improved treatment results will likely be substantial. Jensen and Foster (2010) noted that currently there is no incentive to apply efficient, evidence-based procedures, and that what is needed are ''…fundamental changes that tie incentives to outcomes-based feedback and performance'' (p. 113). Grading agencies switching to use outcomes-based feedback in CAP would be exactly such an incentive because the feedback would now be linked to market share.…”