title: The Perfect Storm: Collision of the Business of Mental Health and the Implementation of Evidence-Based Practices.
abstract: Financing has been hypothesized to be an important driver of the implementation of evidence-based practices (EBPs), yet there has been little systematic investigation of financing as a factor in EBP implementation. This column presents findings from a qualitative study of the effects of financial factors on the implementation of EBPs in a large urban publicly funded mental health system. Interviews with 33 agency leaders and 16 policy makers identified financial distress in community mental health agencies, leading to concerns about complex and expensive implementation of EBPs. Stakeholders agreed that the cost of EBP implementation should be shared between the agencies and the system; however, the stakeholders did not agree on how EBPs should be financed.
authors.affiliation: Dr. Stewart, Ms. Adams, Dr. Mandell, Dr. Hadley, Dr. Evans, Dr. Hurford, and Dr. Beidas are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (e-mail: restewar@upenn.edu ). Dr. Evans is also with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services. Dr. Hurford is also with the Community Care Behavioral Health Organization, Pittsburgh. Dr. Rubin, Ms. Erney, and Dr. Neimark are with Community Behavioral Health, Philadelphia. Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Stewart
authors.affiliation: Dr. Stewart, Ms. Adams, Dr. Mandell, Dr. Hadley, Dr. Evans, Dr. Hurford, and Dr. Beidas are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (e-mail: restewar@upenn.edu ). Dr. Evans is also with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services. Dr. Hurford is also with the Community Care Behavioral Health Organization, Pittsburgh. Dr. Rubin, Ms. Erney, and Dr. Neimark are with Community Behavioral Health, Philadelphia. Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column.
authors.forename: Danielle R
authors.initials: DR
authors.lastname: Adams
authors.affiliation: Dr. Stewart, Ms. Adams, Dr. Mandell, Dr. Hadley, Dr. Evans, Dr. Hurford, and Dr. Beidas are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (e-mail: restewar@upenn.edu ). Dr. Evans is also with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services. Dr. Hurford is also with the Community Care Behavioral Health Organization, Pittsburgh. Dr. Rubin, Ms. Erney, and Dr. Neimark are with Community Behavioral Health, Philadelphia. Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column.
authors.forename: David S
authors.initials: DS
authors.lastname: Mandell
authors.affiliation: Dr. Stewart, Ms. Adams, Dr. Mandell, Dr. Hadley, Dr. Evans, Dr. Hurford, and Dr. Beidas are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (e-mail: restewar@upenn.edu ). Dr. Evans is also with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services. Dr. Hurford is also with the Community Care Behavioral Health Organization, Pittsburgh. Dr. Rubin, Ms. Erney, and Dr. Neimark are with Community Behavioral Health, Philadelphia. Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column.
authors.forename: Trevor R
authors.initials: TR
authors.lastname: Hadley
authors.affiliation: Dr. Stewart, Ms. Adams, Dr. Mandell, Dr. Hadley, Dr. Evans, Dr. Hurford, and Dr. Beidas are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (e-mail: restewar@upenn.edu ). Dr. Evans is also with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services. Dr. Hurford is also with the Community Care Behavioral Health Organization, Pittsburgh. Dr. Rubin, Ms. Erney, and Dr. Neimark are with Community Behavioral Health, Philadelphia. Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column.
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Evans
authors.affiliation: Dr. Stewart, Ms. Adams, Dr. Mandell, Dr. Hadley, Dr. Evans, Dr. Hurford, and Dr. Beidas are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (e-mail: restewar@upenn.edu ). Dr. Evans is also with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services. Dr. Hurford is also with the Community Care Behavioral Health Organization, Pittsburgh. Dr. Rubin, Ms. Erney, and Dr. Neimark are with Community Behavioral Health, Philadelphia. Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column.
authors.forename: Ronnie
authors.initials: R
authors.lastname: Rubin
authors.affiliation: Dr. Stewart, Ms. Adams, Dr. Mandell, Dr. Hadley, Dr. Evans, Dr. Hurford, and Dr. Beidas are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (e-mail: restewar@upenn.edu ). Dr. Evans is also with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services. Dr. Hurford is also with the Community Care Behavioral Health Organization, Pittsburgh. Dr. Rubin, Ms. Erney, and Dr. Neimark are with Community Behavioral Health, Philadelphia. Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column.
authors.forename: Joan
authors.initials: J
authors.lastname: Erney
authors.affiliation: Dr. Stewart, Ms. Adams, Dr. Mandell, Dr. Hadley, Dr. Evans, Dr. Hurford, and Dr. Beidas are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (e-mail: restewar@upenn.edu ). Dr. Evans is also with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services. Dr. Hurford is also with the Community Care Behavioral Health Organization, Pittsburgh. Dr. Rubin, Ms. Erney, and Dr. Neimark are with Community Behavioral Health, Philadelphia. Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Neimark
authors.affiliation: Dr. Stewart, Ms. Adams, Dr. Mandell, Dr. Hadley, Dr. Evans, Dr. Hurford, and Dr. Beidas are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (e-mail: restewar@upenn.edu ). Dr. Evans is also with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services. Dr. Hurford is also with the Community Care Behavioral Health Organization, Pittsburgh. Dr. Rubin, Ms. Erney, and Dr. Neimark are with Community Behavioral Health, Philadelphia. Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column.
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Hurford
authors.affiliation: Dr. Stewart, Ms. Adams, Dr. Mandell, Dr. Hadley, Dr. Evans, Dr. Hurford, and Dr. Beidas are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (e-mail: restewar@upenn.edu ). Dr. Evans is also with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services. Dr. Hurford is also with the Community Care Behavioral Health Organization, Pittsburgh. Dr. Rubin, Ms. Erney, and Dr. Neimark are with Community Behavioral Health, Philadelphia. Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column.
authors.forename: Rinad S
authors.initials: RS
authors.lastname: Beidas
mesh_terms: D055317:Evidence-Based Practice / Q000191:economics*; D019981:Health Care Sector / Q000191:economics*; D006801:Humans; D008605:Mental Health Services / Q000191:economics*; D015143:Philadelphia; D036301:Qualitative Research