Investigating the Payer Role in the Implementation of EBP in the Public Sector

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DESCRIPTION (provided by applicant): The goal of this Ruth L. Kirschstein National Research Service Award is to support the applicant in developing the critical skills necessary for an independent research program in promoting the implementation of evidence- based practices (EBPs) in community mental health through payer policy and financing. This F32 application proposes research to address Objective 4 of the NIMH Strategic Plan: Strengthen the Public Health Impact of NIMH-Supported Research, specifically improving the uptake and implementation of effective research-based interventions by various stakeholders and improving access to effective mental health interventions. Specific training goals to be achieved under the mentorship of David S. Mandell, ScD, an expert in implementation science are to: 1) develop expertise in implementation science and payer incentives in community mental health and broader fields, 2) gain relevant experience in the design, methods, and analyses appropriate for the proposed project and future research in implementation science and community mental health, and 3) establish a network of collaborative and cross-disciplinary relationships to assist in current and future research endeavors. The research component of this F32 will investigate the important question of the payer's role in the implementation of EBP. Despite the critical role payers can play in incentivizing the use of EBP through various strategies, there is remarkably little research examining which incentives are used in public mental health systems. The goal of the proposed study is to examine the extent to which payers for publicly-funded community mental health care use different incentives, how they implement them, and the facilitators and barriers to their use. Specifically, the applicant proposes to build on preliminary results by developing and fielding a national survey of county and state-level payers to: 1) systematically identify, document, and describe incentives employed by payers in the public mental health system to increase the use of evidence- based practices among community mental health providers and 2) examine potential barriers and facilitators to the implementation of incentives proposed in the literature. The applicant will also use qualitative methods and conduct semi-structured interviews with payers, stratified by the extent to which they implement different incentives to increase use of EBP, to determine barriers and facilitators to the use of different strategies. Over the course of this project the applicant will develop expertise in the role of governmental entities and payers in the implementation and sustainment of EBP, and will gain critical knowledge and skills in implementation science, payer and incentive financing, and survey design and development with the expertise of an experienced and established team of mentors.