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Applying the Policy Ecology Framework to Philadelphia’s Behavioral Health Transformation Efforts

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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.

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Notes

  1. 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.

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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).

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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

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