Abstract
BackgroundA large proportion of the US population has limited access to mental health treatments because insurance providers limit the utilization of mental health services in ways that are more restrictive than for physical health services. Comprehensive state mental health parity legislation (C-SMHPL) is an evidence-based policy intervention that enhances mental health insurance coverage and improves access to care. Implementation of C-SMHPL, however, is limited. State policymakers have the exclusive authority to implement C-SMHPL, but sparse guidance exists to inform the design of strategies to disseminate evidence about C-SMHPL, and more broadly, evidence-based treatments and mental illness, to this audience. The aims of this exploratory audience research study are to (1) characterize US State policymakers’ knowledge and attitudes about C-SMHPL and identify individual- and state-level attributes associated with support for C-SMHPL; and (2) integrate quantitative and qualitative data to develop a conceptual framework to disseminate evidence about C-SMHPL, evidence-based treatments, and mental illness to US State policymakers.MethodsThe study uses a multi-level (policymaker, state), mixed method (QUAN→qual) approach and is guided by Kingdon’s Multiple Streams Framework, adapted to incorporate constructs from Aarons’ Model of Evidence-Based Implementation in Public Sectors. A multi-modal survey (telephone, post-mail, e-mail) of 600 US State policymakers (500 legislative, 100 administrative) will be conducted and responses will be linked to state-level variables. The survey will span domains such as support for C-SMHPL, knowledge and attitudes about C-SMHPL and evidence-based treatments, mental illness stigma, and research dissemination preferences. State-level variables will measure factors associated with C-SMHPL implementation, such as economic climate and political environment. Multi-level regression will determine the relative strength of individual- and state-level variables on policymaker support for C-SMHPL. Informed by survey results, semi-structured interviews will be conducted with approximately 50 US State policymakers to elaborate upon quantitative findings. Then, using a systematic process, quantitative and qualitative data will be integrated and a US State policymaker-focused C-SMHPL dissemination framework will be developed.DiscussionStudy results will provide the foundation for hypothesis-driven, experimental studies testing the effects of different dissemination strategies on state policymakers’ support for, and implementation of, evidence-based mental health policy interventions.
Highlights
A large proportion of the US population has limited access to mental health treatments because insurance providers limit the utilization of mental health services in ways that are more restrictive than for physical health services
The current study aims to address these knowledge gaps through an exploratory audience research study that uses a multi-level, sequential mixed method (QUAN→ qual) design with the ultimate goal of developing an empirically grounded framework to guide the dissemination of evidence about Comprehensive state mental health parity legislation (C-SMHPL), evidence-based treatments (EBTs), and mental illness to US State policymakers (Fig. 1)
The partner organizations are the National Conference of State Legislatures (NCSL), a non-governmental organization that serves as an informational resource for US State legislators and their staff; the National Association of State Mental Health Program Directors, a member organization that represents the executives of state public mental health service systems; the National Association of Insurance Commissioners, an organization created and governed by states’ chief insurance regulators that provides guidance on best practices for the regulatory oversight of insurance markets; Mental Health America, a national advocacy organization focused on addressing the needs of people affected by mental illness; and Parity Track, an organization that works to monitor and elevate implementation of federal and state parity laws
Summary
Practice partners The current study was conceptualized in collaboration with five practice partner organizations that will serve in an advisory capacity throughout the project. For the purpose of the current study, a deficit of Multiple Streams is that it does not account for individual attributes of state policymakers (i.e., the adopters of C-SMHPL). These characteristics are important because they are mutable targets that can be altered by targeted dissemination strategies [28]. Multiple Streams was supplemented with the concepts of inner- and outer-contextual factors from Aarons’ Model of Evidence-Based Implementation in Public Sectors [71]. The current study is guided by Kingdon’s Multiple Streams Framework [75] and adapted to incorporate constructs from Aarons’ Model of Evidence-Based Implementation in Public Sectors [71] (Fig. 2). The primary independent variables are knowledge and attitudes (i.e., inner-contextual factors) that are postulated
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