The state policy context of implementation issues for evidence-based practices in mental health.
OBJECTIVE
This study analyzed implementation issues related to several evidence-based practices for adults with serious mental illness that were included in a national demonstration project. The five evidence-based practices included in this investigation are assertive community treatment, family psychoeducation, illness management and recovery, integrated dual diagnosis treatment, and supported employment. The objective of the study was to assess the role of state mental health authorities as agents of change.


METHODS
Two-person teams conducted interviews with state mental health authorities, consumers, families, representatives of local mental health authorities, and representatives of other relevant state agencies--more than 30 individuals at each of the eight sites. Interviews took place at two time points at least one year apart and probed the facilitators and barriers to implementation at the state level. Data were assessed qualitatively to identify common trends and issues across states related to leadership, training, and regulatory issues for each evidence-based practice.


RESULTS
Each of the five practices has different critical contingencies for statewide implementation and requires unique assets to address those contingencies by the state mental health authorities. The contingencies are related to these critical areas: financing and regulations, leadership, and training and quality.


CONCLUSIONS
States are key to implementing evidence-based practices, but state mental health authorities should note that each of the practices requires different skill sets and involves different stakeholders. Thus implementing many evidence-based practices at once may not yield economies of scale.
Isett
Kimberley R
KR
Department of Health Policy and Management, Columbia University, 600 W. 168th St., 6th Floor, New York, NY 10032, USA. ki2129@colum
Burnam
M Audrey
MA
Coleman-Beattie
Brenda
B
Hyde
Pamela S
PS
Morrissey
Joseph P
JP
Magnabosco
Jennifer
J
Rapp
Charles A
CA
Ganju
Vijay
V
Goldman
Howard H
HH
D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D007407:Interviews as Topic; D008605:Mental Health Services; D011050:Policy Making; D013219:State Government