Policy actors' perspectives on improving federal grants to promote the implementation success of evidence-based behavioral health practices.

BACKGROUND: To promote high-quality behavioral health service delivery, federal agencies often invest in evidence-informed and evidence-based practice (EBP) implementation through discretionary (i.e., competitive) grants. However, gaps remain in understanding how federal grant mechanisms can lead to large-scale reach (i.e., the extent of EBP integration into service systems). To understand EBP reach through federal grant mechanisms and provide actionable data, we conducted a series of focus groups with relevant federal and state policy actors to gather their perspectives on how to improve federal grants to support EBP implementation.

METHODS: This study was informed by ongoing research examining implementation outcomes (i.e., provider-level reach) from federal grants supporting the delivery of the Adolescent Community Reinforcement Approach (A-CRA), an EBP to address youth substance use. We conducted four focus groups, two with staff from state agencies who received federal A-CRA grants (n = 12) and two with U.S. federal agency officials responsible for behavioral health grant making (n = 12). We used the policy-adapted EPIS (Exploration, Preparation, Implementation, Sustainment) framework, conceptualizing grants as bridging factors between the outer policy context and inner service provision context. We used directed content analysis to characterize participant perspectives on contextual influences of EBP reach, and thematic analyses to identify how to improve federal grants for EBP implementation success (e.g., high levels of reach). We codified themes by EPIS domains and phases, and by policy actors.

RESULTS: We identified three contextual influences in Bridging Factors, six in the Inner Contexts, nine in the Outer Contexts, and three in Innovation characteristics. We found seven themes about grant improvements spanning all EPIS phases; examples include strengthening collaboration between multilevel actors in the implementation process (specifically federal and state agencies and treatment organizations), and integrating EBPs into insurance billing practices (which also included insurance leadership as a key actor group).

CONCLUSIONS: To support large-scale EBP reach, federal funders may consider using implementation strategies that foster greater collaboration between policy actors from multiple sectors and organization levels. This work also demonstrates how implementation science frameworks can be used to study the influence of federal financing initiatives for EBPs in the area of youth behavioral health.