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Symposia

Dissemination & Implementation Science

Session: Fiscal, Organizational, and End-User Considerations for Improving Use of Evidence in Large Scale Healthcare Systems

1 - (SYM 150) Youth Mental Health System Perspectives on Financing Strategies for Evidence-based Treatment Implementation: Surveys of Service Agency, Funding Agency, and Intermediary Representatives

Sunday, November 19, 2023
10:30 AM – 12:00 PM PST
Location: Sol Duc (708), Level 7

Background: Evidence-based treatments (EBTs) are critical to effectively address mental health problems among children and adolescents, but costly for mental health service agencies to implement and sustain. Financing strategies help agencies overcome cost-related barriers by obtaining financial resources to support EBT implementation and/or sustainment. This study aimed to better understand use of financing strategies within youth mental health services by (1) investigating how system decision-makers view key features (e.g., relevance, feasibility) that inform EBT financing strategy selection and (2) comparing the perspectives of three key system roles: service agency, funding agency, and intermediary (i.e., EBT training and implementation support) representatives.

Method: Two surveys were disseminated to 48 representatives across U.S. youth mental health service agencies, funding agencies, and intermediaries who were participating in a larger study of financing strategies. Quantitative and qualitative data were gathered on 23 financing strategies through quantitative ratings and open-ended responses. Data were analyzed using descriptive statistics and rapid content analysis.

Results: The financing strategies rated as most relevant include braided funding streams, contracts for EBTs, credentialing/rostering providers, fee-for-service reimbursement (regular and increased), and grant funding. All other strategies were unfamiliar to 1/3 to 1/2 of participants. The six strategies were rated between somewhat and quite available, feasible, and effective for EBT sustainment. For sustaining different EBT components (e.g., delivery, materials), the mix of available financing strategies was rated as somewhat adequate. Qualitative analysis revealed challenges with strategies being non-recurring or unavailable in representatives’ regions. Ratings were largely similar across participant roles, though funding agency representatives were the most familiar with financing strategies.

Discussion: Despite the breadth of innovative financing strategies, expert representatives within the youth mental health services ecosystem had limited knowledge of most options. Experts relied on strategies that were familiar but often did not adequately support the implementation or sustainment of EBTs. These findings underscore more fundamental issues with under-resourced mental health systems in the U.S.; financing strategies can help agencies navigate EBT use but must be accompanied by larger-scale system reforms.