Partnering with stakeholders to develop behavioral economics based implementation strategies that target organizations to implement evidence-based practices

University Of Pennsylvania, Philadelphia PA

Investigators

Linked publications & trials

Abstract

PROJECT SUMMARY  This project uses a behavioral economic approach to target implementation of evidence-based practice at the organizational level and harnesses collaboration between our group and the City of Philadelphia Department of Behavioral Health. We will partner with stakeholders to develop organizational-level implementation strategies that leverage established principles from behavioral economics to improve evidence-based practice (EBP) implementation in public mental health. In our work investigating the implementation of EBP over the past five years, clinic leaders and policy makers have repeatedly stated that the most significant barrier to the implementation of EBP is the low organizational financial investment, a function of an under-resourced mental health system.3,4 Our findings corroborate hypotheses drawn from implementation science frameworks that acknowledge the importance of outer context factors like funding for implementation. Our work leverages this information and the fact that health care payers are increasingly instituting pay-for-performance schemes. Our goal is to engage in formative work to design incentive-based implementation strategies that target organizations. While the literature on pay-for-performance strongly supports paying individuals to change their behavior, most systems are paying organizations to change individual behavior. The experimental evidence about the effectiveness of organizational pay-for-performance is mixed. This may be due to design of organizational pay-for-performance programs. They have not used principles of behavioral economics to change behavior, nor have they been developed with stakeholder input. Thus, this exploratory project will take the first steps toward applying behavioral economics principles to the development of organizational-level incentive-oriented implementation strategies in collaboration with stakeholders. Our objective in this exploratory project is to collaboratively develop implementation strategies in partnership with community mental health agency leadership, payers and policy-makers to increase the use of EBP with fidelity in community mental health using discrete choice experiment, a method hailing out of the participatory design approach. The results of this study will inform the next proposal in which we plan to evaluate the effectiveness of implementation strategies that we develop based upon principles of behavioral economics and target the behavior of leaders of organizations. The next studies include an R01 comparative effectiveness trial testing the developed implementation strategies versus active comparators therapist fidelity and client outcomes; with an emphasis on mechanisms, consistent with the NIMH experimental therapeutics approach.