6 - (IOP 1) Implementation Considerations and Benefits of a Financing Strategy to Increase Evidence-based Practice Use Within a Public Mental Health System

Background: Evidence-based practice (EBP) implementation throughout a public mental health system requires a significant financial investment and coordination. To incentivize organizations to integrate EBP training into their practice, Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) and Community Behavioral Health (CBH; the Medicaid payer in this system) offered an enhanced reimbursement rate to agencies who demonstrated integration and sustainment of one or more EBPs in their routine services. Sustainment of EBP implementation is especially important in public mental health systems as it increases the likelihood that underserved and marginalized communities receive high-quality, evidence-based care, reducing health disparities. Financial strategies may facilitate sustainment by providing incentives and resources to under-resourced public organizations striving to implement EBPs. However, little work has focused on frontline workers who vary in exposure to financial strategies. This study explored the perspectives of mental health workers from Philadelphia public mental health agencies regarding the effectiveness of an enhanced reimbursement rate financing strategy.

Methods: Semi-structured qualitative interviews (N = 45) were conducted with mental health workers (22 therapists, 16 supervisors, 7 leaders) from June 2022 to October 2024. Participants on average were 39.9 years old and racially/ethnically diverse (37.8% White, 24.4% Black/African American, 13.3% Hispanic/Latine, 8.9% Other, 6.7% Asian, 2.2% American Indian/Alaska Native). An initial set of interviews (n = 26) have been coded with a timeline set to finish coding the remaining interviews by June 2025. We used thematic analysis to capture widespread patterns in the data.

Results: Preliminary results suggest that agency leaders indicated familiarity with enhanced reimbursement while therapists and supervisors frequently reported little to no familiarity with the financing strategy. Perceived benefits of access to enhanced reimbursement included (1) the ability to obtain additional resources, (2) increased budgets, and (3) positive attitudes towards the potential for increased EBP knowledge and expertise. Confusion was noted as a barrier to accessing enhanced reimbursement due to a lack of information at the agency and system level. Accordingly, across leadership levels, workers expressed a desire to learn more about enhanced reimbursement. Nuances in agency financial structures emerged as an important contextual theme as agencies vastly differed in the structure and amount their workers were paid. Final analyses will indicate differences in impressions of the effectiveness of enhanced reimbursement across leadership levels and recommendations for improving implementation.

Conclusion: Financing strategies represent a path toward incentivizing EBP adoption and implementation across public mental health systems. This study is pivotal in better understanding perceptions of advantages and disadvantages of a financing strategy among those directly involved in EBP implementation. Findings provide key information to inform mental health policy.