Abstract
Raghavan et al. (Implement Sci 3(26):1–9, 2008) proposed that effective implementation of evidence-based practices requires implementation strategies deployed at multiple levels of the “policy ecology,” including the organizational, regulatory or purchaser agency, political, and social levels. However, much of implementation research and practice targets providers without accounting for contextual factors that may influence provider behavior. This paper examines Philadelphia’s efforts to work toward an evidence-based and recovery-oriented behavioral health system, and uses the policy ecology framework to illustrate how multifaceted, multilevel implementation strategies can facilitate the widespread implementation of evidence-based practices. Ongoing challenges and implications for research and practice are discussed.
Similar content being viewed by others
Notes
Philadelphia’s decision making process and ultimate decision to create its own managed care organization rather than allow a private sector health maintenance organization to manage the behavioral health care of Medicaid recipients is documented elsewhere (Guckenberger 2002). What is pertinent to this article is that by taking on the risk of managing Medicaid dollars at the city level, DBHIDS also benefits from any savings that they incur through the provision of more efficient and effective care. They are able to use these saving to reinvest in the system in ways that will improve the quality of behavioral health care for Medicaid recipients. Many of the efforts described in this article are funded in part through these reinvestment dollars.
References
Aarons, G. A., Ehrhart, M. G., & Farahnak, L. R. (2014a). Aligning leadership across systems and organizations to develop a strategic climate for evidence-based practice implementation. Annual Review of Public Health, 35, 255–274. doi:10.1146/annurev-publhealth-032013-182447.
Aarons, G. A., Ehrhart, M. G., & Farahnak, L. R. (2014b). Aligning leadership across systems and organizations to develop a strategic climate for evidence-based practice implementation. Annual Review of Public Health, 35, 255–274. doi:10.1146/annurev-publhealth-032013-182447.
Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38, 4–23. doi:10.1007/s10488-010-0327-7.
Abrahams, I. A., Ali, O., Davidson, L., Evans, A. C., King, J. K., Poplawski, P., … Philadelphia Department of Behavioral Health and Intellectual disAbility Services. (2013). Philadelphia behavioral health services transformation: Practice guidelines for recovery and resilience oriented treatment (I.I.). Bloomington, Indiana: AuthorHouse Publishers. Retrieved from http://www.dbhids.org/assets/Forms–Documents/transformation/PracticeGuidelines2013.pdf
Albrecht, L., Archibald, M., Arseneau, D., & Scott, S. D. (2013). Development of a checklist to assess the quality of reporting of knowledge translation interventions using the workgroup for intervention development and evaluation research (WIDER) recommendations. Implementation Science, 8(52), 1–5. doi:10.1186/1748-5908-8-52.
Austin, M. J. (2008). Strategies for transforming human service organizations into learning organizations: Knowledge management and the transfer of learning. Journal of Evidence-Based Social Work, 5(3–4), 569–596. doi:10.1080/15433710802084326.
Beidas, R. S., Aarons, G. A., Barg, F., Evans, A., Hadley, T., Hoagwood, K., & Mandell, D. S. (2013a). Policy to implementation: Evidence-based practice in community mental health—study protocol. Implementation Science, 8(38), 1–9. doi:10.1186/1748-5908-8-38.
Beidas, R. S., Cross, W., & Dorsey, S. (2013b). Show me, don’t tell me: Behavioral rehearsal as a training and analogue fidelity tool. Cognitive and Behavioral Practice,. doi:10.1016/j.cbpra.2013.04.002.
Beidas, R. S., Edmunds, J. M., Marcus, S. C., & Kendall, P. C. (2012). Training and consultation to promote implementation of an empirically supported treatment: A randomized trial. Psychiatric Services, 63(7), 660–665. doi:10.1176/appi.ps.201100401.
Beidas, R. S., Marcus, S., Aarons, G. A., Hoagwood, K. E., Schoenwald, S., Evans, A. C., & Mandell, D. S. (2015a). Predictors of community therapists’ use of therapy techniques in a large public mental health system. JAMA Pediatrics, 169(4), 374–382. doi:10.1001/jamapediatrics.2014.3736.
Beidas, R. S., Marcus, S., Benjamin Wolk, C., Powell, B. J., Aarons, G. A., Evans, A. C., & Mandell, D. S. (2015b). A prospective examination of clinician and supervisor turnover within the context of implementation of evidence-based practices in a publicly-funded mental health system. Administration and Policy in Mental Health and Mental Health Services Research,. doi:10.1007/s10488-015-0673-6.
Beidas, R. S., Stewart, R. E., Adams, D. R., Fernandez, T., Lustbader, S., Powell, B. J., & Barg, F. K. (2015c). A multi-level examination of stakeholder perspectives of implementation of evidence-based practices in a large urban publicly-funded mental health system. Administration and Policy in Mental Health and Mental Health Services Research,. doi:10.1007/s10488-015-0705-2.
Beidas, R. S., Wolk, C. B., Walsh, L. M., Evans, A. C., Hurford, M. O., & Barg, F. K. (2014). A complementary marriage of perspectives: Understanding organizational social context using mixed methods. Implementation Science, 9(175), 1–15. doi:10.1186/s13012-014-0175-z.
Birkel, R. C., Hall, L. L., Lane, T., Cohan, K., & Miller, J. (2003). Consumers and families as partners in implementing evidence-based practice. Psychiatric Clinics of North America, 26, 867–881.
Birken, S. A., Lee, S.-Y. D., Weiner, B. J., Chin, M. H., & Schaefer, C. T. (2013). Improving the effectiveness of health care innovation implementation: Middle managers as change agents. Medical Care Research and Review, 70(1), 29–45. doi:10.1177/1077558712457427.
Bunger, A. C., Collins-Camargo, C., McBeath, B., Chuang, E., Perez-Jolles, M., & Wells, R. (2014). Collaboration, competition, and co-opetition: Interorganizational dynamics between private child welfare agencies and child serving sectors. Children and Youth Services Review, 38, 113–122. doi:10.1016/j.childyouth.2014.01.017.
Chambers, D. A. (2012). Forward. In R. C. Brownson, G. A. Colditz, & E. K. Proctor (Eds.), Dissemination and implementation research in health: Translating science to practice (pp. 7–10). New York: Oxford University Press.
Chambers, D. A., & Azrin, S. T. (2013). Partnership: A fundamental component of dissemination and implementation research. Psychiatric Services, 64(16), 509–511. doi:10.1176/appi.ps.201300032.
CHESS/NIATx. (2015). NIATx: Removing barriers to treatment and recovery. Retrieved August 17, 2015, from http://www.niatx.net/
Chinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift, A., & Delphin-Rittmon, M. E. (2014). Peer support services for individuals with serious mental illnesses: Assessing the evidence. Psychiatric Services, 65(4), 429–441. doi:10.1176/appi.ps.201300244.
Chinman, M., Imm, P., & Wandersman, A. (2004). Getting to outcomes 2004: Promoting accountability through methods and tools for planning, implementation, and evaluation. Santa Monica, CA: Rand Health.
Chorpita, B. F., & Daleiden, E. L. (2009). Mapping evidence-based treatments for children and adolescents: Application of the distillation and matching model to 615 treatments from 322 randomized trials. Journal of Consulting and Clinical Psychology, 77(3), 566–579. doi:10.1037/a0014565.
Chorpita, B. F., Daleiden, E. L., & Weisz, J. R. (2005). Identifying and selecting the common elements of evidence based interventions: A distillation and matching model. Mental Health Services Research, 7(1), 5–20. doi:10.1007/s11020-005-1962-6.
City of Philadelphia Department of Behavioral Health and Intellectual disAbility Services. (2014). Healthy Minds Philly. Retrieved from http://healthymindsphilly.org
City of Philadelphia Mural Arts Program. (2015). Porch Light. Retrieved August 18, 2015, from http://muralarts.org/programs/porch-light
Community Behavioral Health. (2015). Request for proposals for substance use adult partial hospitalization services. Retrieved from http://www.dbhids.us/assets/Forms–Documents/CBH/RFP-Substance-Use-Adult-Partial-Hospitalization.pdf
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(50), 1–15.
DBHIDS & PRO-ACT. (2015). Philadelphia Recovery Idol 2015. Retrieved August 20, 2015, from phillyrecoveryidol.weebly.com
Department of Behavioral Health and Intellectual disAbility Services. (2015a). Community Behavioral Health. Retrieved August 13, 2015, from http://dbhids.us/community-behavioral-health/
Department of Behavioral Health and Intellectual disAbility Services. (2015b). Peer Specialist Initiative. Retrieved September 22, 2015, from http://dbhids.us/certified-peer-specialist
Department of Behavioral Health and Intellectual disAbility Services. (2015c). The Community Coalition Initiative. Retrieved September 23, 2015, from http://www.dbhids.us/the-community-coalition-initiative
Dorsey, S., Pullman, M. D., Deblinger, E., Berliner, L., Kerns, S. E., Thompson, K., & Garland, A. F. (2013). Improving practice in community-based settings: A randomized trial of supervision—study protocol. Implementation Science, 8(89), 1–11. doi:10.1186/1748-5908-8-89.
Forsetlund, L., Bjørndal, A., Rashidian, A., Jamtvedt, G., O’Brien, M. A., Wolf, F., & Oxman, A. D. (2009). Continuing education meetings and workshops: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews,. doi:10.1002/14651858.CD003030.pub2.
Ganju, V. (2003). Implementation of evidence-based practices in state mental health systems: Implications for research and effectiveness studies. Schizophrenia Bulletin, 29(1), 125–131.
Garner, B. R., Godley, S. H., & Bair, C. M. L. (2011). The impact of pay-for-performance on therapists’ intentions to deliver high quality treatment. Journal of Substance Abuse Treatment, 41(1), 97–103. doi:10.1016/j.jsat.2011.01.012.
Garner, B. R., Godley, S. H., Dennis, M. L., Hunter, B. D., Bair, C. M. L., & Godley, M. D. (2012). Using pay for performance to improve treatment implementation for adolescent substance use disorders. Archives of Pediatric and Adolescent Medicine, 166(10), 938–944. doi:10.1001/archpediatrics.2012.802.
Gawande, A. (2008). Better: A surgeon’s notes on performance. New York: Picador.
Glisson, C., Landsverk, J., Schoenwald, S., Kelleher, K., Hoagwood, K. E., Mayberg, S., & Green, P. (2008). Assessing the organizational social context (OSC) of mental health services: Implications for research and practice. Administration and Policy in Mental Health and Mental Health Services Research, 35(1–2), 98–113. doi:10.1007/s10488-007-0148-5.
Glisson, C., Schoenwald, S., Hemmelgarn, A., Green, P., Dukes, D., Armstrong, K. S., & Chapman, J. E. (2010). Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy. Journal of Consulting and Clinical Psychology, 78(4), 537–550. doi:10.1037/a0019160.
Glisson, C., & Williams, N. J. (2015). Assessing and changing organizational social contexts for effective mental health services. Annual Review of Public Health, 36, 507–523. doi:10.1146/annurev-publhealth-031914-122435.
Goeschel, C. A., Weiss, W. M., & Pronovost, P. J. (2012). Using a logic model to design and evaluate quality and patient safety improvement programs. International Journal for Quality in Health Care, 24(4), 330–337. doi:10.1093/intqhc/mzs029.
Goffman, I. (1963). Stigma: Notes on the management of spoiled identity. New York: Simon & Schuster Inc.
Guckenberger, K. (2002). Public takes on private: The Philadelphia behavioral health system (No. C16-02-1649.0) (pp. 1–20). Kennedy School of Government Case Program.
Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry,. doi:10.1186/1471-244X-10-113.
Herschell, A. D., Kolko, D. J., Baumann, B. L., & Davis, A. C. (2010). The role of therapist training in the implementation of psychosocial treatments: A review and critique with recommendations. Clinical Psychology Review, 30, 448–466. doi:10.1016/j.cpr.2010.02.005.
Hoagwood, K. E. (2003). The policy context for child and adolescent mental health services: Implications for systems reform and basic science development. Annals of the New York Academy of Sciences, 1008, 140–148. doi:10.1196/annals.1301.015.
Hoagwood, K. E., Olin, S. S., Horwitz, S., McKay, M., Cleek, A., Gleacher, A., & Hogan, M. (2014). Scaling up evidence-based practices for children and families in New York state: Toward evidence-based policies on implementation for state mental health systems. Journal of Clinical Child & Adolescent Psychology, 43(2), 145–157. doi:10.1080/15374416.2013.869749.
Hovmand, P. S. (2014). Community based system dynamics. New York: Springer.
Institute for Healthcare Improvement. (2003). The breakthrough series: IHI’s colaborative model for achieving breakthrough improvement. Cambridge, MA: Institute for Healthcare Improvement.
Isett, K. R., Burnam, M. A., Coleman-Beattie, B., Hyde, P. S., Morrissey, J. P., Magnabosco, J., & Goldman, H. H. (2007). The state policy context of implementation issues for evidence-based practices in mental health. Psychiatric Services, 58(7), 914–921. doi:10.1176/appi.ps.58.7.914.
Jennett, P., & Affleck, L. (1998). Chart audit and chart stimulated recall as methods of needs assessment in continuing professional education. Journal of Continuing Education in the Health Professions, 18(3), 163–171. doi:10.1002/chp.1340180306.
Kauth, M. R., Sullivan, G., Cully, J., & Blevins, D. (2011). Facilitating practice changes in mental health clinics: A guide for implementation development in health care systems. Psychological Services, 8(1), 36–47. doi:10.1037/a0022250.
Kellogg Foundation, W. K. (2004). Logic model development guide: Using logic models to bring together planning, evaluation, and action. Battle Creek, Michigan: W. K. Kellogg Foundation.
Kirchner, J. E., Kearney, L. K., Ritchie, M. J., Dollar, K. M., Swensen, A. B., & Schohn, M. (2014). Lesson’s learned through a national partnership between clinical leaders and researchers. Psychiatric Services,. doi:10.1176/appi.ps.201400054.
Kitchener, B. A., & Jorm, A. F. (2006). Mental health first aid training: Review of evaluation studies. Australian and New Zealand Journal of Psychiatry, 40, 6–8.
Klein, K. J., & Sorra, J. S. (1996). The challenge of innovation implementation. Academy of Management Review, 21(4), 1055–1080. doi:10.5465/AMR.1996.9704071863.
Korczykowski, J. (2014). Transformation in Philadelphia. Retrieved August 11, 2015, from http://www.behavioral.net/article/transformation-philadelphia
Lewis, C. C., Weiner, B. J., Stanick, C., & Fischer, S. M. (2015). Advancing implementation science through measure development and evaluation: A study protocol. Implementation Science, 10(102), 1–10. doi:10.1186/s13012-015-0287-0.
Lipsky, M. (1980). Street-level bureaucracy: Dilemmas of the individual in public services. New York: Russell Sage Foundation.
Lyon, A. R., & Lewis, C. C. (2015). Designing health information technologies for uptake: Development and implementation of measurement feedback systems in mental health service delivery. Administration and Policy in Mental Health and Mental Health Services Research,. doi:10.1007/s10488-015-0704-3.
Lyon, A. R., Maras, M. A., Pate, C. M., Igusa, T., & Vander Stoep, A. (2015). Modeling the impact of school-based universal depression screening on additional service capacity needs: A system dynamics approach. Administration and Policy in Mental Health and Mental Health Services Research,. doi:10.1007/s10488-015-0628-y.
Magnabosco, J. L. (2006). Innovations in mental health services implementation: A report on state-level data from the US evidence-based practices project. Implementation Science, 1(13), 1–11. doi:10.1186/1748-5908-1-13.
Manuel, J. I., Mullen, E. J., Fang, L., Bellamy, J. L., & Bledsoe, S. E. (2009). Preparing social work practitioners to use evidence-based practice: A comparison of experiences from an implementation project. Research on Social Work Practice, 19(5), 613–627. doi:10.1177/1049731509335547.
McHugh, R. K., & Barlow, D. H. (2010). The dissemination and implementation of evidence-based psychological treatments. American Psychologist, 65(2), 73–84.
Mental Health QUERI. (2014). Implementation facilitation training manual: Using external and internal facilitation to improve care in the veterans health administration (pp. 1–95). Washington, D. C.: U.S. Department of Veterans Affairs. Retrieved from http://www.queri.research.va.gov/tools/implementation/Facilitation-Manual.pdf
Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., & Wood, C. E. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46(1), 81–95. doi:10.1007/s12160-013-9486-6.
Mohatt, N., Singer, J. B., Evans, A. C., Matlin, S. L., Golden, J., Harris, C., & Tebes, J. K. (2013). A community’s response to suicide through public art: Stakeholder perspectives from the finding the light within project. American Journal of Community Psychology, 52, 197–209. doi:10.1007/s10464-013-9581-7.
Nilsen, P., Stahl, C., Roback, K., & Cairney, P. (2013). Never the twain shall meet?: A comparison of implementation science and policy implementation research. Implementation Science, 8(63), 1–12. doi:10.1186/1748-5908-8-63.
Novins, D. K., Green, A. E., Legha, R. K., & Aarons, G. A. (2013). Dissemination and implementation of evidence-based practices for child and adolescent mental health: A systematic review. Journal of the American Academy of Child & Adolescent Psychiatry, 52(10), 1009–1025. doi:10.1016/j.jaac.2013.07.012.
Palinkas, L. A., Short, C., & Wong, M. (2015). Research-practice-policy partnerships for implementation of evidence-based practices in child welfare and child mental health. William T. Grant Foundation.
Pipkin, S., Sterrett, E. M., Antle, B., & Christensen, D. N. (2013). Washington state′s adoption of a child welfare practice model: An illustration of the getting-to-outcomes implementation framework. Children and Youth Services Review, 35(12), 1923–1932. doi:10.1016/j.childyouth.2013.09.017.
Powell, B. J., Beidas, R. S., Lewis, C. C., Aarons, G. A., McMillen, J. C., Proctor, E. K., & Mandell, D. S. (2015a). Methods to improve the selection and tailoring of implementation strategies. Journal of Behavioral Health Services & Research,. doi:10.1007/s11414-015-9475-6.
Powell, B. J., Hausmann-Stabile, C., & McMillen, J. C. (2013a). Mental health clinicians’ experiences of implementing evidence-based treatments. Journal of Evidence-Based Social Work, 10(5), 396–409. doi:10.1080/15433714.2012.664062.
Powell, B. J., McMillen, J. C., Hawley, K. M., & Proctor, E. K. (2013b). Mental health clinicians’ motivation to invest in training: Results from a practice-based research network survey. Psychiatric Services, 64(8), 816–818. doi:10.1176/appi.ps.003602012.
Powell, B. J., McMillen, J. C., Proctor, E. K., Carpenter, C. R., Griffey, R. T., Bunger, A. C., & York, J. L. (2012). A compilation of strategies for implementing clinical innovations in health and mental health. Medical Care Research and Review, 69(2), 123–157. doi:10.1177/1077558711430690.
Powell, B. J., Proctor, E. K., & Glass, J. E. (2014). A systematic review of strategies for implementing empirically supported mental health interventions. Research on Social Work Practice, 24(2), 192–212. doi:10.1177/1049731513505778.
Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., & Kirchner, J. E. (2015b). A refined compilation of implementation strategies: Results from the expert recommendations for implementing change (ERIC) project. Implementation Science, 10(21), 1–14. doi:10.1186/s13012-015-0209-1.
PRO-ACT. (2015). PRO-ACT Recover Walks! Retrieved August 19, 2015, from www.recoverywalks.org
Proctor, E. K., Powell, B. J., & Feely, M. (2014). Measurement in dissemination and implementation science. In R. S. Beidas & P. C. Kendall (Eds.), Dissemination and implementation of evidence-based practices in child and adolescent mental health (pp. 22–43). New York: Oxford University Press.
Proctor, E. K., Powell, B. J., & McMillen, J. C. (2013). Implementation strategies: Recommendations for specifying and reporting. Implementation Science, 8(139), 1–11. doi:10.1186/1748-5908-8-139.
Proudfoot, J. G. (2004). Computer-based treatment for anxiety and depression: Is it feasible? Is it effective? Neuroscience & Beiobehavioral Reviews, 28(3), 353–363. doi:10.1016/j.neubiorev.2004.03.008.
Raghavan, R. (2012). The role of economic evaluation in dissemination and implementation research. In R. C. Brownson, G. A. Colditz, & E. K. Proctor (Eds.), Dissemination and implementation research in health: Translating science to practice (pp. 94–113). New York: Oxford University Press.
Raghavan, R., Bright, C. L., & Shadoin, A. L. (2008). Toward a policy ecology of implementation of evidence-based practices in public mental health settings. Implementation Science, 3(26), 1–9. doi:10.1186/1748-5908-3-26.
Schoenwald, S. K. (2011). It’s a bird, it’s a plane, it’s…fidelity measurement in the real world. Clinical Psychology Science and Practice, 18, 142–147.
Schoenwald, S. K., Garland, A. F., Chapman, J. E., Frazier, S. L., Sheidow, A. J., & Southam-Gerow, M. A. (2011). Toward the effective and efficient measurement of implementation fidelity. Administration and Policy in Mental Health and Mental Health Services Research, 38, 32–43. doi:10.1007/s10488-010-0321-0.
Shapiro, C. J., Prinz, R. J., & Sanders, M. R. (2012). Facilitators and barriers to implementation of an evidence-based parenting intervention to prevent child maltreatment: The triple p-positive parenting program. Child Maltreatment, 17(1), 86–95. doi:10.1177/1077559511424774.
Stewart, R. E., Adams, D., Mandell, D., Hadley, T., Evans, A., Rubin, R., & Beidas, R. (2016). The perfect storm: Collision of the business of mental health and the implementation of evidence-based practices. Psychiatric Services, 67(2), 159–161. doi:10.1176/appi.ps.201500392.
Stewart, R. E., & Chambless, D. L. (2010). Interesting practitioners in training in empirically supported treatments: Research reviews versus case studies. Journal of Clinical Psychology, 66(1), 73–95.
Stirman, S. W., Matza, A., Gamarra, J., Toder, K., Xhezo, R., Evans, A. C., & Creed, T. (2015). System-level influences on the sustainability of a cognitive therapy program in a community behavioral health network. Psychiatric Services,. doi:10.1176/appi.ps.201400147.
Tabak, R. G., Khoong, E. C., Chambers, D. A., & Brownson, R. C. (2012). Bridging research and practice: Models for dissemination and implementation research. American Journal of Preventive Medicine, 43(3), 337–350. doi:10.1016/j.amepre.2012.05.024.
Tebes, J. K., Matlin, S. L., Hunter, B., Thompson, A. B., Prince, D. M., & Mohatt, N. (2015). Porch light program: Final evaluation report (pp. 1–36). New Haven, CT: Yale School of Medicine.
Trupin, E., & Kerns, S. (2015). Introduction to the special issue: Legislation related to children’s evidence-based practice. Administration and policy in mental health and mental health services research,. doi:10.1007/s10488-015-0666-5.
Waltz, T. J., Powell, B. J., Matthieu, M. M., Damschroder, L. J., Chinman, M. J., Smith, J. L., & Kirchner, J. E. (2015). Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: Results from the expert recommendations for implementing change (ERIC) study. Implementation Science, 10(109), 1–8. doi:10.1186/s13012-015-0295-0.
Weiner, B. J. (2009). A theory of organizational readiness for change. Implementation Science, 4(67), 1–9. doi:10.1186/1748-5908-4-67.
Weiner, B. J. (2015). The overlooked elements in the implementation infrastructure. Presented at the Global Implementation Conference, Dublin, Ireland.
Weiner, B. J., Belden, C. M., Bergmire, D. M., & Johnston, M. (2011). The meaning and measurement of implementation climate. Implementation Science, 6(78), 1–12. doi:10.1186/1748-5908-6-78.
Weiner, B. J., Lewis, M. A., Clauser, S. B., & Stitzenberg, K. B. (2012). In search of synergy: Strategies for combining interventions at multiple levels. JNCI Monographs, 44, 34–41. doi:10.1093/jncimonographs/lgs001.
Weisz, J. R., Chorpita, B. F., Palinkas, L. A., Schoenwald, S. K., Miranda, J., & Bearman, S. K. (2012). Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: A randomized effectiveness trial. Archives of General Psychiatry, 69(3), 274–282. doi:10.1001/archgenpsychiatry.2011.147.
Wells, K. B., Jones, L., Chung, B., Dixon, E. L., Tang, L., Gilmore, J., & Miranda, J. (2013). Community-partnered cluster-randomized comparative effectiveness trial of community engagement and planning of resources for services to address depression disparities. Journal of General Internal Medicine, 28(10), 1268–1278. doi:10.1007/s11606-013-2484-3.
Williams, V., Deane, F. P., Oades, L. G., Crowe, T. P., Ciarrochi, J., & Andresen, R. (2016). A cluster-randomised controlled trial of values-based training to promote autonomously held recovery values in mental health workers. Implementation Science, 11(13), 1–11. doi:10.1186/s13012-015-0363-5.
Wiltsey Stirman, S., Buchhofer, R., McLaulin, J. B., Evans, A. C., & Beck, A. T. (2009). The beck initiative: A partnership to implement cognitive therapy in a community behavioral health system. Psychiatric Services, 60(10), 1302–1304. doi:10.1176/appi.ps.60.10.1302.
Young, J., & Beck, A. T. (1980). Cognitive therapy scale rating manual (pp. 1–16). Bala Cynwyd, Pennsylvania: Beck Institute for Cognitive Behavior Therapy. Retrieved from http://www.beckinstitute.org/SiteData/docs/CTRScurren/813940638db8cdb0/CTRS-current-10-2011.pdf
Acknowledgments
This work was supported in part by Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services through a fellowship to BJP, and by the National Institutes of Mental Health through a contract to BJP through the Clinical Research Loan Repayment Program, and grants to RSB (K23MH099179); RES (F32MH103960); CBW (F32MH103955); and DSM (R01MH106175).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Powell, B.J., Beidas, R.S., Rubin, R.M. et al. Applying the Policy Ecology Framework to Philadelphia’s Behavioral Health Transformation Efforts. Adm Policy Ment Health 43, 909–926 (2016). https://doi.org/10.1007/s10488-016-0733-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-016-0733-6