Dataset Information

Research, Data, and Evidence-Based Treatment Use in State Behavioral Health Systems, 2001-2012.

ABSTRACT: OBJECTIVE:Empirical study of public behavioral health systems' use of data and their investment in evidence-based treatments (EBTs) is limited. This study describes trends in state-level EBT investment and research supports from 2001 to 2012. METHODS:Data were from National Association for State Mental Health Program Directors Research Institute (NRI) surveys, which were completed by representatives of state mental health authorities (SMHAs). Multilevel models examined change over time related to state adoption of EBTs, numbers of clients served, and penetration rates for six behavioral health EBTs for adults and children: supported housing, supported employment, assertive community treatment, therapeutic foster care, multisystemic therapy, and functional family therapy. State supports related to research, evaluation, and information management were also examined. RESULTS:Increasing percentages of states reported funding an external research center, promoting the adoption of EBTs through provider contracts, and providing financial incentives for EBTs. Decreasing percentages of states reported promoting EBT adoption through stakeholder mobilization, monitoring fidelity, and specific budget requests. There was greater reported use of adult-focused EBTs (65%-80%) compared with youth-focused EBTs (25%-50%). Overall penetration rates of EBTs were low (1%-3%) and EBT adoption by states showed flat or declining trends. SMHAs' investment in data systems and use of research showed little change. CONCLUSIONS:SMHA investment in EBTs, implementation infrastructure, and use of research has declined. More systematic measurement and examination of these metrics may provide a useful approach for setting priorities, evaluating success of health reform efforts, and making future investments.

SUBMITTER: Bruns EJ

PROVIDER: S-EPMC5107263 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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Research, Data, and Evidence-Based Treatment Use in State Behavioral Health Systems, 2001-2012.

Bruns Eric J EJ Kerns Suzanne E U SE Pullmann Michael D MD Hensley Spencer W SW Lutterman Ted T Hoagwood Kimberly E KE

Psychiatric services (Washington, D.C.) 20151215 5

<h4>Objective</h4>Empirical study of public behavioral health systems' use of data and their investment in evidence-based treatments (EBTs) is limited. This study describes trends in state-level EBT investment and research supports from 2001 to 2012.<h4>Methods</h4>Data were from National Association for State Mental Health Program Directors Research Institute (NRI) surveys, which were completed by representatives of state mental health authorities (SMHAs). Multilevel models examined change over ...[more]

PMID: 26695495

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Project description:ObjectiveUse of research evidence in public health decision making can be affected by organizational supports. Study objectives are to identify patterns of organizational supports and explore associations with research evidence use for job tasks among public health practitioners.DesignIn this longitudinal study, we used latent class analysis to identify organizational support patterns, followed by mixed logistic regression analysis to quantify associations with research evidence use.SettingThe setting included 12 state public health department chronic disease prevention units and their external partnering organizations involved in chronic disease prevention.ParticipantsChronic disease prevention staff from 12 US state public health departments and partnering organizations completed self-report surveys at 2 time points, in 2014 and 2016 (N = 872).Main outcome measuresLatent class analysis was employed to identify subgroups of survey participants with distinct patterns of perceived organizational supports. Two classify-analyze approaches (maximum probability assignment and multiple pseudo-class draws) were used in 2017 to investigate the association between latent class membership and research evidence use.ResultsThe optimal model identified 4 latent classes, labeled as "unsupportive workplace," "low agency leadership support," "high agency leadership support," and "supportive workplace." With maximum probability assignment, participants in "high agency leadership support" (odds ratio = 2.08; 95% CI, 1.35-3.23) and "supportive workplace" (odds ratio = 1.74; 95% CI, 1.10-2.74) were more likely to use research evidence in job tasks than "unsupportive workplace." The multiple pseudo-class draws produced comparable results with odds ratio = 2.09 (95% CI, 1.31-3.30) for "high agency leadership support" and odds ratio = 1.74 (95% CI, 1.07-2.82) for "supportive workplace."ConclusionsFindings suggest that leadership support may be a crucial element of organizational supports to encourage research evidence use. Organizational supports such as supervisory expectations, access to evidence, and participatory decision making may need leadership support as well to improve research evidence use in public health job tasks.

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Project description:Because health systems are conceptualized as social systems, embedded in social contexts and shaped by human agency, values are a key factor in health system change. As such, health systems software-including values, norms, ideas and relationships-is considered a foundational focus of the field of health policy and systems research (HPSR). A substantive evidence-base exploring the influence of software factors on system functioning has developed but remains fragmented, with a lack of conceptual clarity and theoretical coherence. This is especially true for work on 'social values' within health systems-for which there is currently no substantive review available. This study reports on a systematic mixed-methods evidence mapping review on social values within HPSR. The study reaffirms the centrality of social values within HPSR and highlights significant evidence gaps. Research on social values in low- and middle-income country contexts is exceedingly rare (and mostly produced by authors in high-income countries), particularly within the limited body of empirical studies on the subject. In addition, few HPS researchers are drawing on available social science methodologies that would enable more in-depth empirical work on social values. This combination (over-representation of high-income country perspectives and little empirical work) suggests that the field of HPSR is at risk of developing theoretical foundations that are not supported by empirical evidence nor broadly generalizable. Strategies for future work on social values in HPSR are suggested, including: countering pervasive ideas about research hierarchies that prize positivist paradigms and systems hardware-focused studies as more rigorous and relevant to policy-makers; utilizing available social science theories and methodologies; conceptual development to build common framings of key concepts to guide future research, founded on quality empirical research from diverse contexts; and using empirical evidence to inform the development of operationalizable frameworks that will support rigorous future research on social values in health systems.

Dataset Information

Research, Data, and Evidence-Based Treatment Use in State Behavioral Health Systems, 2001-2012.

Publications

Research, Data, and Evidence-Based Treatment Use in State Behavioral Health Systems, 2001-2012.

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