Innovations in mental health services implementation: a report on state-level data from the U.S. Evidence-Based Practices Project

Abstract

Background: The Evidence-Based Practice (EBP) Project has been investigating the implementation of evidence-based mental health practices (Assertive Community Treatment, Family Psychoeducation, Integrated Dual Diagnosis Treatment, Illness Management and Recovery, and Supported Employment) in state public mental health systems in the United States since 2001. To date, Project findings have yielded valuable insights into implementation strategy characteristics and effectiveness. This paper reports results of an effort to identify and classify state-level implementation activities and strategies employed across the eight states participating in the Project.

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

“…Other states have undertaken broad Medicaid reform to address financing issues. 20,21,30 Several SSA representatives noted that there is a need for a greater number of best practices for specific populations such as pregnant women, women with children, and diverse populations. Generally, issues related to the lack of evidence for diverse populations are concerning, and some SSA representatives noted conflicting ideas about how to address the lack of EBPs for specific populations.…”

“…20 However, implementation of substance abuse EBPs has received less attention than mental health EBPs. 2,4,13,15,21 Barriers include disparities in insurance coverage, such that clients may have Medicaid or private insurance coverage that provides mental health services but excludes substance abuse services. 22,23 Additionally, providers may not share a common philosophical ground to support integrated treatment.…”

“…22,23 Additionally, providers may not share a common philosophical ground to support integrated treatment. 21 This fragmentation reflects conflicting treatment approaches and perspectives; one result is that mental health is often treated as a chronic disorder and substance abuse as an acute disorder. 24,25 It is important to recognize that both can be chronic disorders that may benefit from evidence-based treatment.…”

“…Additionally, an examination of effective strategies for implementation of mental health EBPs, including IDDT, from the EvidenceBased Practice Project identified 106 specific implementation strategies in eight states and classified them into five categories: (1) state infrastructure building and commitment, (2) stakeholder relationship building and communications, (3) financing, (4) continuous quality management, and (5) service delivery practices and training. 21,32,34 In Magnabosco's analysis, 21 states' emphasis on particular groups of strategies shifted for differing phases of the overall implementation process. For example, during the pre-implementation phase, states emphasized stakeholder relationship building and communication activities, whereas during initial implementation and sustainability planning phases, states emphasized financing 21 .…”

“…21,32,34 In Magnabosco's analysis, 21 states' emphasis on particular groups of strategies shifted for differing phases of the overall implementation process. For example, during the pre-implementation phase, states emphasized stakeholder relationship building and communication activities, whereas during initial implementation and sustainability planning phases, states emphasized financing 21 . Accordingly, organizational research suggests that evidence-based innovation requires the support of administration and management, sufficient financial and human resources, and an organizational culture that values scientifically based practice, problemsolving and creativity, and systems change.…”