BACKGROUND Despite consistent recognition of their influence, empirical study of how outer setting factors (e.g., policies, financing, stakeholder relationships) influence public systems' investment in and adoption of evidence-based treatment (EBT) is limited. This study examined associations among unmodifiable (e.g., demographic, economic, political, structural factors) and modifiable (e.g., allocation of resources, social processes, policies, and regulations) outer setting factors and adoption of behavioral health EBT by US states. METHODS Multilevel models examined relationships between state characteristics, an array of funding and policy variables, and state adoption of behavioral health EBTs for adults and children across years 2002-2012, using data from the National Association for State Mental Health Program Directors Research Institute and other sources. RESULTS Several unmodifiable state factors, including per capita income, controlling political party, and Medicaid expansion, predicted level of state fiscal investments in EBT. By contrast, modifiable factors, such as interagency collaboration and investment in research centers, were more predictive of state policies supportive of EBT. Interestingly, level of adult EBT adoption was associated with state fiscal supports for EBT, while child EBT adoption was predicted more by supportive policies. State per capita debt and direct state operation of services (versus contracting for services) predicted both child and adult EBT adoption. CONCLUSIONS State-level EBT adoption and associated implementation support is associated with an interpretable array of policy, financing, and oversight factors. Such information expands our knowledge base of the role of the outer setting in implementation and may provide insight into how best to focus efforts to promote EBT for behavioral health disorders.

中文翻译：

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外部环境在实施中的作用：州人口，财政和政策因素之间的关联以及在精神卫生保健中使用循证治疗。

背景技术尽管人们对其作用的认识一直得到认可，但是关于外部环境因素（例如，政策，融资，利益相关方关系）如何影响公共系统对基于证据的治疗（EBT）的投资和采用的实证研究仍然有限。这项研究考察了不可修改的（例如人口，经济，政治，结构因素）和可修改的（例如资源分配，社会过程，政策和法规）外部环境因素与美国各州对行为健康EBT的采用之间的联系。方法多级模型研究了2002-2012年间成人和儿童的州特征，一系列资金和政策变量以及州对行为健康EBT的采用之间的关系，使用来自美国国家心理健康协会计划主任研究所和其他来源的数据。结果几个不可修改的州因素，包括人均收入，控制政党和医疗补助扩张，预测了州财政对EBT的投资水平。相比之下，机构间合作和对研究中心的投资等可修改因素更能预测支持EBT的国家政策。有趣的是，成年EBT的收养水平与州对EBT的财政支持有关，而儿童EBT的收养更受支持性政策的预测。州人均债务和州直接服务运营（相对于服务承包）预测了儿童和成人EBT的收养情况。结论国家级EBT的采用和相关的实施支持与一系列可解释的政策，融资和监督因素相关。此类信息扩展了我们对外部环境在实施中的作用的知识库，并可能提供有关如何最佳地集中努力促进行为健康障碍EBT的见识。