Spotlight on Scholarship

NYU Silver Associate Professor Dr. Victoria Stanhope and colleagues, including PhD Candidate Mimi Choy Brown and Assistant Professors Dr. Stacey Barrenger and Dr. Jennifer Manuel, recently co-authored an article in the journal Implementation Science that evaluated New York State behavioral health organizations' use of training and technical assistance provided by the state Department of Health-funded Clinic Technical Assistance Center (CTAC) to facilitate implementation of clinical and business practices required by the state’s Medicaid redesign plan.

The article, entitled “A comparison of how behavioral health organizations utilize training to prepare for health care reform,” noted that the federal Patient Protection and Affordable Care Act incentivizes states to restructure their Medicaid systems to improve patient outcomes and reduce costs. As Stanhope and colleagues explained, “A key part of implementing these large-scale state initiatives has been preparing individual organizations to adapt and thrive in this rapidly changing health care landscape…CTAC has provided a valuable opportunity to better understand the uptake of evidence-based trainings and associated factors among behavioral health organizations.”

Stanhope and colleagues examined organizational characteristics (drawn from SAMHSA's 2008 National Mental Health Services Survey) and training participation (drawn from CTAC’s database) of 196 of the 292 behavioral health organizations that were eligible to receive the trainings CTAC offered, free of charge, between November 2011 and March 2014. During that period, CTAC offered 187 trainings in clinical practices, business practices, and both practices, and delivered them via low-intensity, hour-long webinars; moderate-intensity, day-long in-person trainings; and high-intensity, 6- to 18-month learning collaboratives. Organizational characteristics indicated were organizational size, population served, service quality, and infrastructure.

Among the key findings were that 72% of organizations participated in some form of training, with large organizations more likely than their smaller counterparts to participate. Organizations that pursued training were also more likely to serve both children and adults, provide child evidence-based practices and use computerized scheduling than those that did not pursue training. Among those organizations that received training, 95% participated in webinars, 64% in learning collaboratives and 35% in in-person trainings. Both business and clinical trainings were pursued by a majority of organizations with 63.8% participating in business training and 59.2% in clinical training.

In their discussion, Stanhope and colleagues looked more closely at the findings and explained factors that may have influenced them. A particular concern they highlighted in their conclusion is that “This study confirms size may be a key predictor of who seeks out training to help them succeed in this new environment. The potential for loss of smaller community-based behavioral health organizations presents a critical implication for the future of the behavioral health field.”

The authors noted the study’s contributions to understanding organizations’ uptake of training to prepare for healthcare reform and called for more research “to understand how organizations respond to broad policy changes and whether up-front investment in training leads to improved service quality and better fiscal outcomes,” as well as to determine “the most effective and efficient types of training.” They cited the research-provider partnership they employed in their study as a model “to further this type of research and build the evidence base in the complex area of large-scale implementation efforts.”