Adapting the Fiscal Mapping Process to improve the financial sustainability of implementation support and mental health delivery organizations: protocol for a mixed methods study.

BACKGROUND

Sustainability of evidence-based mental health intervention (EBI) implementation is a challenge to increasing access to mental health services. Funding is a common barrier to sustainment. EBIs, while cost effective, are expensive to implement. The Fiscal Mapping Process is a strategic planning tool designed for behavioral health agencies to plan the financial sustainment of specific EBIs. Financial planning at an organizational level is also required to enable implementation support organizations (ISOs) and mental health delivery organizations (MHDOs) to sustainably operate. Project FISCAL (Financing Implementation for Sustainable Care, Access, and Localization) will adapt the Fiscal Mapping Process for ISOs/MHDOs to plan for financial sustainability while balancing access and high-quality mental health care.

METHODS

The study will be guided by the Discover, Design/Build, and Test human-centered design framework. ISOs will include intermediary and purveyor organizations, and MHDOs will include provider and digital mental health organizations. In the Discover Phase (Aim 1), we will identify ISOs'/MHDOs' needs for a strategic financial planning tool through process mapping and a semi-structured qualitative interview. Process mapping also will identify how ISOs/MHDOs selected financing strategies for their organization. In the Design/Build Phase (Aim 2), we will refine the Fiscal Mapping Process using Design Charrettes. In the Test Phase (Aim 3), we will assess the preliminary impact and usability of the Fiscal Mapping Process for ISOs'/MHDOs' financial sustainability using a comparative case study design. Participants in Aims 1-3 will include individuals working in ISOs/MHDOs (n = 20 ISOs/MHDOs per aim) and in Aims 1-2 also will include 5 ISO/MHDO advisors. Data will be analyzed using a convergent mixed methods approach integrating qualitative and quantitative data.

DISCUSSION: The adapted Fiscal Mapping Process created in this project will help organizations with strategic financial planning to broadly sustain and scale access to effective mental health treatments. The study addresses two understudied areas of implementation science: sustainability and organizational-level financing strategies. Without careful consideration, ISOs'/MHDOs' business models could unintentionally decrease access to care for some individuals if funding is prioritized or if only certain patient populations are reached.