Policy Implementation Research of Earmarked Taxes for Mental Health Services

项目总结 资金不足经常被认为是最大限度地扩大循证实践的障碍 (EBPS)。因此，增加获得新资金的机会被认为是一项执行战略。已指定用途 税收--被定义为收入只能用于特定活动的税收--越来越受欢迎 可以改善EBPS覆盖范围的融资战略。美国约有5100万人(16% 人口)目前居住在已对卫生保健服务征收专项税的司法管辖区。 随着公众对提高MH的需求日益增长，这些税收可能会变得越来越普遍 服务体系。然而，人们对指定用途税的设计和推出情况知之甚少。 优化以确保将收入分配给基于证据的服务。很少有经验指导 为专项税的设计或执行战略的选择提供信息，以确保 提高EBPS的覆盖面。缺乏关于税收执行的证据反映了这样一个事实，即政策是 在D&I研究中未完成学业。该项目的具体目标是：1)确定美国所有符合以下条件的司法管辖区 已对精神卫生服务实行专项税收和税收设计目录信息；2) 描述县精神卫生机构领导实施专项税的经验，了解 使用EPIS框架对税收资助服务做出决定的决定因素，并评估 不同类型执行战略的可接受性和可行性；以及3)制定概念性政策 改进专用税设计的执行框架，告知选择执行战略 扩大EBPS的税收覆盖范围，并将框架传播给相关的政策受众。这些目标 将通过一项法律测绘研究来实现，对大约300名县精神卫生机构负责人进行调查 已实施指定精神健康税的90个县，在4个月中进行了50次半结构化访谈 有目的地选择县，并通过系统地整合和量化和定性数据 框架开发流程。该项目具有创新性，因为它研究了一个尚未探索的D&I主题，并 意义重大并将产生影响，因为它将为选择实施战略提供经验基础 用于征收专项税，以扩大EBP的覆盖范围。这项研究将为混合动力2型R01奠定基础 制定了政策执行框架，以测试这些战略对执行和 临床结果。该项目团队由具有心理健康专业知识的早期/中期研发人员组成 公共资助精神卫生服务中的政策研发研究和法律测绘(Purtle，PI)和研发 (Stadnick，Co-I)和参与加州税收实施的高级调查人员(Aarons)和 华盛顿(布伦斯和沃克)。

PROJECT SUMMARY Insufficient funding is frequently identified as a barrier to maximizing the reach of evidence-based practices (EBPs). As such, increasing access to new funding is recognized as an implementation strategy. Earmarked taxes—defined as taxes for which revenue can only be spent on specific activities—are an increasingly popular financing strategy that could improve the reach of EBPs. Approximately 51 million people in the U.S. (16% of the population) currently resides in a jurisdiction that has implemented an earmarked tax for MH services. These taxes are likely to become increasingly common amidst growing public demand for enhancement of MH service systems. However, little is known about how the design and rollout of earmarked taxes might be optimized to ensure that revenue is allocated for services that are evidence-based. Little empirical guidance exists to inform the design of earmarked taxes or selection of implementation strategies to ensure that they improve the reach of EBPs. The dearth of evidence about tax implementation reflects the fact that policy is understudied in D&I research. The project's specific aims are to: 1) Identify all jurisdictions in the U.S. that have implemented earmarked taxes for mental health services and catalogue information about tax design; 2) Characterize county mental health agency leaders' experiences implementing earmarked taxes, understand the determinants of decisions about tax-funded services using the EPIS framework, and assess the acceptability and feasibility of different types of implementation strategies; and 3) Develop a conceptual policy implementation framework to improve earmarked tax design, inform the selection of implementation strategies to increase the taxes' reach of EBPs, and disseminate the framework to relevant policy audiences. These aims will be achieved by a legal mapping study, survey of 300 county mental health agency leaders in approximately 90 counties that have implemented earmarked mental health taxes, 50 semi-structured interviews in four purposively selected counties, and integration and quantitative and qualitative data through a systematic framework development process. The project is innovative because it studies an unexplored D&I topic and is significant and will have impact because it will provide an empirical basis to select implementation strategies for earmarked taxes to enhance EBP reach. This study will set the stage for a hybrid Type 2 R01 that will apply the developed policy implementation framework to test the effects of these strategies on implementation and clinical outcomes. The project team consists of early/mid-career D&I scientists with expertise in mental health policy D&I research and legal mapping (Purtle, PI) and D&I in publicly-funded mental health services (Stadnick, Co-I) and senior investigators involved with tax implementation in California (Aarons) and Washington (Bruns and Walker).