The role of the outer setting in implementation: associations between state demographic, fiscal, and policy factors and use of evidence-based treatments in mental healthcare

Bruns, Eric J.; Parker, Elizabeth M.; Hensley, Spencer; Pullmann, Michael D.; Benjamin, Philip H.; Lyon, Aaron R.; Hoagwood, Kimberly E.

doi:10.1186/s13012-019-0944-9

Implementation Science

Table 2 Associations between state characteristics and state EBT fiscal and policy supports and EBT availability

From: The role of the outer setting in implementation: associations between state demographic, fiscal, and policy factors and use of evidence-based treatments in mental healthcare

	Outcome 1: Fiscal supports to promote EBT adoption		Outcome 2: Policy supports to promote EBT adoption		Outcome 3: EBT availability
Parameter	Unstandardized coef ^a	SE	Unstandardized coef ^a	SE	Unstandardized coef^b	SE
Political party in control	0.260^	0.141	0.248	0.177	− 0.148	0.191
Budget surplus (z score)	− 0.088	0.096	0.123	0.146	− 0.750***	0.204
Per capita income (z score)	0.433^	0.253	0.307	0.225	− 0.036	0.236
Region
South	− 0.00039	0.271	0.211	0.288	0.501	0.449
West	− 0.594	0.336	− 0.513	0.343	0.355	0.560
Midwest	− 0.126	0.334	− 0.140	0.370	− 0.937*	0.340
Northeast	0.721	0.357	0.443	0.433	0.081	0.601
2013 Medicaid expansion	0.950*	0.372	− 0.109	0.432	0.445	0.655
SMHA funds county (single or multicounty) or city mental health authorities which, in turn, fund local provider agencies or directly provide mental health services
Directly operates community-based programs	− 0.241	0.507	0.049	0.666	1.037*	0.526
Funds county or city MH authorities	− 0.039	0.434	0.047	0.421	0.139	0.465
Directly funds, but does not operate community-based agencies	Ref		Ref		Ref
SMHA is located within another state agency (ref = SMHA is an independent department/agency)	− 0.511	0.427	− 0.743^	0.434	− 0.060	0.690
SMHA Director sits as a member of the Governor’s cabinet (ref = no)	0.025	0.355	0.177	0.408	− 0.474	0.426
Research located within the SMHA (ref = no)	0.822*	0.372	0.870*	0.357	0.228	0.484
Research located outside the SMHA (ref = no)	0.906**	0.342	0.855*	0.389	0.338	0.619
SMHA promotes consumer/survivor participation in resource allocations at the SMHA level (ref = no)	0.185	0.392	0.095	0.470	0.151	0.099
SMHA has initiatives underway to work with other state government agencies to coordinate, reduce, or eliminate barriers between delivery systems and funding streams to the provision of appropriate mental health services (ref = no)	0.515*	0.246	2.836***	0.317	0.359	0.430
Representatives from other state government agencies participate as members of your SMHA’s mental health planning Council/Group (ref = no)	0.953	0.600	1.739**	0.532	0.112	0.466
Information management functions located within SMHA (ref = no)	− 0.168	0.299	− 0.187	0.421	No data available
Information management functions located outside SMHA (ref = no)	− 0.470	0.622	− 0.853	0.579	No data available
SMHA currently involved in activities to downsize, reconfigure, close and/or consolidate one or more state mental hospitals (ref = no)	− 0.033	0.228	0.416	0.301	− 0.028	0.387
Per capita expenditures (z score)	− 0.054	0.183	0.209	0.193	− 0.055	0.180
Controlled per capita expenditures for SMHA (z score)	0.038	0.325	0.256	0.258	− 0.071	0.215
Per capita mental health expenditures (z score)	0.274	0.196	0.277	0.259	0.097	0.271
Count of number of available child EBTs	0.238^	0.138	0.521**	0.185
Count of number of available adult EBTs	0.286*	0.115	0.103	0.181
Count of number of available EBTs (child and adult)	0.204*	0.081	0.242*	0.119

EBT evidence-based treatment
^aAdjusted for linear time centered at 2002
^bAdjusted for linear time centered at 2007
^p < 0.10, * p < 0.05, ** p < 0.01, *** p < 0.001

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ISSN: 1748-5908

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