Table 1 Summary of shifts in policy strategies since the publication of the original PEF in 2008

Organizational context

• Clinical settings within which EBPs are delivered

• Original PEF refers to as a service delivery organization, i.e., community mental health center

• Affordable Care Act changed the organizational landscape:

 ◦ Fourteen states have adopted Medicaid ACOs or ACO-like entities

 ◦ Sixteen states are considering adoption of Episodes of care programs

 ◦ Value-based purchasing implemented in 48 jurisdictions

• Prior authorization is largely extinct

• Rise of novel marketplaces (Children’s Service Funds)

Agency context

• Local or state bodies that oversee or influence this organizational activity

• Changed environment for contracting and bidding towards outcomes-based purchasing

• Increased consumer involvement

• Expanded loan forgiveness programs (largely due to ACA) expanded workforce

Political context

• All legislative and advocacy efforts that support the implementation of EBPs

• Both the Mental Health Parity and Addiction Equity Act and the ACA were passed after the publication of PEF

• Increased emphasis on racial justice, structural stigma, and institutional racism in regulation

• Increase in legislation directed at specific evidence-based practices (e.g., Family First Prevention Services Act)

Social context

• Cultural and structural factors that shape access to EBPs

• Increasing awareness of structural stigma (not just self-stigma), and institutionalized racism

• Increasing efforts to meaningfully include individuals with lived experience in the research and dissemination process to ensure that outputs and activities involve coproduction