Measuring Sustainment of Multiple Practices Fiscally Mandated in Children's Mental Health Services

Abstract

Examining sustainment of multiple evidence-based practices is crucial to understanding the processes and outcomes of system-driven implementation efforts that are increasingly common. This study used administrative claims data to characterize volume and penetration of six practices over 19 fiscal quarters following initial implementation within the context of a system-driven, fiscally mandated implementation effort in Los Angeles County Department of Mental Health's Prevention and Early Intervention services. Patterns of volume changes over time revealed an overall ramp up of practice claims over time, but variability in patterns of volume and penetration for each practice. Findings varied by the methods used to index and analyze volume and penetration. Furthermore, a number of client case-mix and therapist characteristics were associated with the volume of therapists' claims for each practice relative to their claims for the other practices.

Keywords: Children’s mental health services; Evidence-based practice; Implementation; Sustainment outcomes.

Figure 1

Practice Volume over Time at the Claim, Child, Therapist, and Agency Levels

Figure 2

Gross Penetration at the Claim, Child, Therapist, and Agency Levels

Figure 3

Practice-Specific Trajectories of Relative Claims Volume at the Therapist-Level Note. The dotted line for the first fiscal quarter of MAP indicates that it was adopted later than the other practices. CBITS did not have a statistically significant quadratic trajectory and is not reflected in this figure.