Toward a policy ecology of implementation of evidence-based practices in public mental health settings

Ramesh Raghavan, Charlotte Lyn Bright, Amy L. Shadoin

    Research output: Contribution to journalArticle

    Abstract

    Background: Mental health policymaking to support the implementation of evidence-based practices (EBPs) largely has been directed toward clinicians. However, implementation is known to be dependent upon a broader ecology of service delivery. Hence, focusing exclusively on individual clinicians as targets of implementation is unlikely to result in sustainable and widespread implementation of EBPs. Discussion: Policymaking that is informed by the implementation literature requires that policymakers deploy strategies across multiple levels of the ecology of implementation. At the organizational level, policies are needed to resource the added marginal costs of EBPs, and to assist organizational learning by re-engineering continuing education units. At the payor and regulatory levels, policies are needed to creatively utilize contractual mechanisms, develop disease management programs and similar comprehensive care management approaches, carefully utilize provider and organizational profiling, and develop outcomes assessment. At the political level, legislation is required to promote mental health parity, reduce discrimination, and support loan forgiveness programs. Regulations are also needed to enhance consumer and family engagement in an EBP agenda. And at the social level, approaches to combat stigma are needed to ensure that individuals with mental health need access services. Summary: The implementation literature suggests that a single policy decision, such as mandating a specific EBP, is unlikely to result in sustainable implementation. Policymaking that addresses in an integrated way the ecology of implementation at the levels of provider organizations, governmental regulatory agencies, and their surrounding political and societal milieu is required to successfully and sustainably implement EBPs over the long term.

    Original languageEnglish (US)
    Article number26
    JournalImplementation Science
    Volume3
    Issue number1
    DOIs
    StatePublished - Jun 5 2008

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    Evidence-Based Practice
    Ecology
    Mental Health
    Public Health
    Forgiveness
    Continuing Education
    Disease Management
    Parity
    Legislation
    Outcome Assessment (Health Care)
    Learning
    Organizations
    Costs and Cost Analysis

    ASJC Scopus subject areas

    • Health Policy
    • Health Informatics
    • Public Health, Environmental and Occupational Health

    Cite this

    Toward a policy ecology of implementation of evidence-based practices in public mental health settings. / Raghavan, Ramesh; Bright, Charlotte Lyn; Shadoin, Amy L.

    In: Implementation Science, Vol. 3, No. 1, 26, 05.06.2008.

    Research output: Contribution to journalArticle

    Raghavan, Ramesh ; Bright, Charlotte Lyn ; Shadoin, Amy L. / Toward a policy ecology of implementation of evidence-based practices in public mental health settings. In: Implementation Science. 2008 ; Vol. 3, No. 1.
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