Agency responses to a system-driven implementation of multiple evidence-based practices in children\u2019s mental health services

Jennifer Regan,Keri Pesanti,Lauren Brookman-Frazee,Miya Barnett,Anna S Lau,Lillian Bando,Alison Hamilton,Nicole Stadnick

doi:10.1186/s12913-017-2613-5

Abstract

BackgroundLarge mental health systems are increasingly using fiscal policies to encourage the implementation of multiple evidence-based practices (EBPs). Although many implementation strategies have been identified, little is known about the types and impacts of strategies that are used by organizations within implementation as usual. This study examined organizational-level responses to a fiscally-driven, rapid, and large scale EBP implementation in children’s mental health within the Los Angeles County Department of Mental Health.MethodsQualitative methods using the principles of grounded theory were used to characterize the responses of 83 community-based agencies to the implementation effort using documentation from site visits conducted 2 years post reform.ResultsFindings indicated that agencies perceived the rapid system-driven implementation to have both positive and negative organizational impacts. Identified challenges were primarily related to system implementation requirements rather than to characteristics of specific EBPs. Agencies employed a variety of implementation strategies in response to the system-driven implementation, with agency size associated with implementation strategies used. Moderate- and large-sized agencies were more likely than small agencies to have employed systematic strategies at multiple levels (i.e., organization, therapist, client) to support implementation.ConclusionsThese findings are among the first to characterize organizational variability in response to system-driven implementation and suggest ways that implementation interventions might be tailored by organizational characteristics.

Highlights

Large mental health systems are increasingly using fiscal policies to encourage the implementation of multiple evidence-based practices (EBPs)
The EBP implementation was linked with two other major shifts in service provision: (1) expansion to a new target population and (2) requirement for the collection of clinical outcome measures linked to individual EBPs
Themes that emerged from both data sources were grouped into the following three categories: 1) Perceptions of System Implementation Strategies, 2) Perceptions of Prevention and Early Intervention (PEI) Practice Implementation, and 3) Types of Agency Implementation Strategies

Summary

Introduction

Large mental health systems are increasingly using fiscal policies to encourage the implementation of multiple evidence-based practices (EBPs). This study examined organizational-level responses to a fiscally-driven, rapid, and large scale EBP implementation in children’s mental health within the Los Angeles County Department of Mental Health. System-driven implementation of multiple EBPs Efforts to implement evidence-based practices (EBPs) in community mental health systems have increased considerably [1, 2], with several public mental health systems instituting fiscal policies to support EBP delivery [3]. In Los Angeles County, the Department of Mental Health (LACDMH) enacted a plan to utilize a state revenue stream from a voter-approved ballot initiative, the Mental Health Services Act (MHSA), to promote the use of EBPs through new contracts for Prevention and Early Intervention (PEI) services [5, 6]. In the context of this urgent financial crisis and to prevent the imminent closure of communitybased agencies and substantial reduction in the number of clients served, LACDMH transformed and accelerated the PEI implementation to allow agencies to leverage MHSA funds

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