Jonathan Purtle
Jonathan Purtle
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Associate Professor of Public Health Policy & Management
Director of Policy Research at NYU’s Global Center for Implementation Science
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Professional overview
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Jonathan Purtle is Associate Professor of Public Health Policy & Management and Director of Policy Research at NYU’s Global Center for Implementation Science.
Dr. Purtle is a mental health policy researcher and implementation scientist. His work examines questions such as how the implementation of policies “on the books” can be improved in practice, how research evidence can be most effectively communicated to policymakers and is used in policymaking processes, and how social and political contexts affect mental health policymaking and policy implementation. He is also studies population-based approaches to mental health and suicide prevention.
Dr. Purtle’s work has been consistently funded by the National Institute of Mental Health (NIMH) and Robert Wood Johnson Foundation (RWJF). He is currently leading/recently led NIMH-funded projects focused on the implementation of financing policies related to the 988 Suicide & Crisis Lifeline (R01MH131649) and policies that earmark taxes for mental health services (R21MH125261) and understanding the dynamics of research evidence in mental health policymaking (P50MH113662). He also recently completed a RWJF-funded project that experimentally tested different ways of communicating evidence about child maltreatment to the public and policymakers.
He has published over 150 peer-reviewed journal articles, is an Associate Editor at Implementation Science, and Co-Chairs the Policy Advisory Board at Psychiatric Services. He is Core Faculty of the NIMH-funded Implementation Research Institute, was Chair of the Policy Section of the AcademyHeath/NIH Dissemination and Implementation in Heath Conference from 2017 to 2022, was awarded the 2018 Champion of Evidence-Based Interventions Award from the Association for Behavioral and Cognitive Therapies for his work on evidence use in mental health policymaking.
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Education
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BA, Psychology, Roger Williams UniversityMSc, Sociology, Universiteit van AmsterdamMPH, Drexel UniversityDrPH, Drexel University
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Publications
Publications
A regional analysis of healthcare utilization trends during consecutive disasters in puerto rico using private claims data
AbstractStimpson, J. P., Mercado, D. L., Rivera-González, A. C., Purtle, J., & Ortega, A. N. (n.d.).Publication year
2025Journal title
Scientific reportsVolume
15Issue
1AbstractPuerto Rico has endured multiple natural disasters in recent years, including Hurricanes Irma and Maria (2017), earthquakes (2019), and the COVID-19 pandemic (2020), which placed significant strain on its healthcare system. This study examined trends in health care utilization for injuries, infectious diseases, and mental health services across Puerto Rico’s health regions from 2016 to 2022. Using private claims data from four major insurers, we analyzed trends in health care utilization rates per 1,000 beneficiaries across seven health regions. Infectious disease claims rose significantly following each disaster, with the sharpest increases observed post-2020, particularly in the Caguas region. Mental health and substance use claims exhibited a consistent upward trend across all health regions, with Caguas and Ponce reporting the largest increases. Injury claims declined in 2020 but rebounded in most regions by 2021, with Caguas consistently reporting the highest rates. These findings highlight the substantial and varied impacts of consecutive disasters on health care utilization in Puerto Rico, particularly for infectious diseases and mental health services. Notable regional disparities, such as higher utilization rates in Caguas, underscore the need for interventions to strengthen health system resilience and ensure equitable healthcare access in preparation for future disasters.Changes in Specialty Crisis Services Offered Before and After the Launch of the 988 Suicide and Crisis Lifeline
AbstractCantor, J., Schuler, M. S., Kerber, R., Purtle, J., & McBain, R. K. (n.d.).Publication year
2025Journal title
JAMA PsychiatryAbstractImportance: The launch of the 988 Suicide and Crisis Lifeline (988) in July 2022 aimed to enhance access to crisis mental health services by replacing the National Suicide Prevention Lifeline with a more memorable number and expanding the Lifeline scope beyond suicide. However, 988's success relies on the availability of community crisis services. Objective: To examine whether the launch of 988 was associated with the availability of crisis services. Design, Setting, and Participants: This cohort study characterized trends in crisis services offered by US mental health treatment facilities (MHTFs) from November 1, 2021, through June 30, 2023. Longitudinal data were from the Mental Health and Addiction Treatment Tracking Repository, which contains daily instances from the Substance Abuse and Mental Health Services Administration's Behavioral Health Treatment Locator. The analysis includes licensed MHTFs that completed the National Substance Use and Mental Health Services Survey. Proportions of facilities offering 4 specific crisis services were calculated nationally and at the state level. Mixed-effects logistic regression was used to assess changes in availability of each crisis service after the launch of 988, controlling for MHTF characteristics. Exposure: Launch of 988 in July 2022. Main Outcomes and Measures: Outcomes were the availability of mobile crisis response services, psychiatric emergency walk-in services, suicide prevention services, or peer support services. Results: Across 15623 MHTFs (184769 observations; 79268 before and 105501 after the 988 launch), the largest changes were observed for availability of peer support services, which increased from 39% (n = 31170) before to 42% (n = 44630) after the 988 launch (P <.001), and emergency psychiatric walk-in services, which decreased from 32% (n = 25684) before to 29% (n = 30300) after the 988 launch (P <.001). When controlling for MHTF characteristics, after the 988 launch, the odds of peer support availability increased 1.3% per month (odds ratio, 1.013; 95% CI, 1.009-1.018), and the odds of emergency psychiatric walk-in service availability decreased by 0.6% per month (odds ratio, 0.994; 95% CI, 0.989-0.999). Availability of other service types also decreased at the national level, with mobile crisis response decreasing from 22% (n = 17071) before to 21% (n = 22023) after the 988 launch and suicide prevention decreasing from 69% (n = 54933) before to 68% (n = 71905) after the 988 launch. Significant variation across states was observed in service availability trends before and after the 988 launch. Conclusions and Relevance: This study found that the launch of 988 did not coincide with significant and equitable growth in the availability of most crisis services except for a small increase in peer support services. These findings suggest that strategies are needed to boost the financing and availability of crisis services to reduce disparities and increase 988's likelihood of success.Court-mandated redistricting and disparities in infant mortality and deaths of despair
AbstractSchnake-Mahl, A., Anfuso, G., Bilal, U., Goldstein, N. D., Purtle, J., Hernandez, S. M., & Eberth, J. M. (n.d.).Publication year
2025Journal title
BMC public healthVolume
25Issue
1AbstractBackground: Health and health disparities vary substantially by geography, including geopolitical boundaries such as United States congressional districts. Every ten years congressional districts for the House of Representatives are redistricted, but occasionally the Courts step in and force states to redistrict gerrymandered congressional maps. Analyses of court mandated redistricting decisions often focus on the distribution of voters by political party and race, but less is known about how health and health disparities are distributed across congressional districts before and after redistricting. In this analysis, we examine how the magnitude of disparities varied between and within congressional districts in Pennsylvania, before and after the state Supreme Court of Pennsylvania’s decision ordering a redistricting in 2018 that produced less politically gerrymandered districts. Methods: Using georeferenced vital statistics data from 2013–2015 (before the redistricting), we explore levels of and disparities in infant mortality rates (IMR) and deaths of despair (DoD) using boundaries from before (Congresses 113–115) and after (Congress 116) this redistricting. Results: Using consistent mortality data (2013–2015) and boundaries from before and after the 2018 redistricting, we find that after redistricting disparities in infant mortality and deaths of despair between congressional districts were slightly wider for all educational groups except for those with less than a high school degree, and slightly narrower for all racial-ethnic groups other than for Hispanic and non-Hispanic White populations, compared with before redistricting. Conclusions: Understanding how disparities vary between and within districts after redistricting can inform our understanding of the relationships between geopolitical boundaries, election processes, and health disparities.State Parental Consent Law and Treatment Use among Adolescents with Depression
Schleider, J. L., Smock, A., Ahuvia, I. L., Walubita, T., Rapoport, A. S., Hill, S., & Purtle, J. (n.d.). In JAMA Pediatrics (1–).Publication year
2025Volume
179Issue
2Page(s)
209-212The 988 Suicide and Crisis Lifeline in the US: status of evidence on implementation
Purtle, J., & Lindsey, M. (n.d.).Publication year
2025Journal title
World PsychiatryVolume
24Issue
1Page(s)
135-136The effect of caregiver opinion leaders to increase demand for evidence-based practices for youth anxiety: A cluster randomized controlled trial
AbstractCrane, M. E., Atkins, M. S., Becker, S. J., Purtle, J., Dysart, G. C., Keller, S., Brauer, O., Tiwari, S. E., Olino, T. M., Baez, L., Lestino, J., & Kendall, P. C. (n.d.).Publication year
2025Journal title
Implementation Research and PracticeVolume
6AbstractBackground: Dissemination initiatives have the potential to increase consumer knowledge of and engagement with evidence-based treatments (e.g., cognitive behavioral therapy [CBT]). Opinion leaders (OLs) have been used in public health campaigns, but have not been examined for the dissemination of mental health treatments. This study uses the Theory of Planned Behavior to test the dissemination strategy of involving an OL in an educational presentation to increase caregiver demand for CBT for youth anxiety. Method: Participants (N = 262; 92% female; 69% White, 82% non-Hispanic) were caregivers who registered for a virtual presentation on youth anxiety treatment through their child's school. Schools within 1.5-hr drive of Philadelphia, PA were cluster-randomized (k = 25; two-arm prospective randomization) to the OL condition (presented by a clinical researcher and local caregiver OL; n = 119 participants) or the researcher-only condition (n = 143 participants). Presentations occurred from May 2021 to May 2022. Measures were completed pre- and post-presentation and at 3-month follow-up. Results: Relative to the researcher co-presenter, participants rated the OL as significantly more relatable, familiar, similar, and understanding of their community, but less credible than the researcher co-presenter. In both conditions, there was a significant pre-post increase in participants’ knowledge of, attitudes about, subjective norms related to, and intention of seeking CBT for youth anxiety, but not stigma. Presentation conditions did not differ in change on these measures, or on rates of seeking youth anxiety CBT at follow-up. Conclusions: Although involvement of a caregiver OL did not increase caregiver demand for evidence-based treatment for youth anxiety, the outreach presentation was associated with increases in knowledge of, attitudes about, subjective norms related to, and intention to seek CBT for youth anxiety. Involving OLs in researcher-delivered dissemination efforts may not be necessary for all consumer audiences, but may be beneficial for engendering a sense of relatability, similarity, and connection with disseminators.A Mixed-Methods Exploration of the Implementation of Policies That Earmarked Taxes for Behavioral Health
AbstractStadnick, N. A., Geremia, C., Mauri, A. I., Swanson, K., Wynecoop, M., & Purtle, J. (n.d.).Publication year
2024Journal title
Milbank QuarterlyVolume
102Issue
4Page(s)
913-943AbstractPolicy Points Earmarked tax policies for behavioral health are perceived as having positive impacts related to increasing flexible funding, suggesting benefits to expand this financing approach. Implementation challenges related to these earmarked taxes included tax base volatility that impedes long-term service delivery planning and inequities in the distribution of tax revenue. Recommendations for designing or revising earmarked tax policies include developing clear guidelines and support systems to manage the administrative aspects of earmarked tax programs, cocreating reporting and oversight structures with system and service delivery agents, and selecting revenue streams that are relatively stable across years. Context: Over 200 cities and counties in the United States have implemented policies earmarking tax revenue for behavioral health services. This mixed-methods study was conducted with the aim of characterizing perceptions of the impacts of these earmarked tax policies, strengths and weaknesses of tax policy designs, and factors that influence decision making about how tax revenue is allocated for services. Methods: Study data came from surveys completed by 274 officials involved in behavioral health earmarked tax policy implementation and 37 interviews with officials in a sample of jurisdictions with these taxes—California (n = 16), Washington (n = 12), Colorado (n = 6), and Iowa (n = 3). Interviews primarily explored perceptions of the advantages and drawbacks of the earmarked tax, perceptions of tax policy design, and factors influencing decisions about revenue allocation. Findings: A total of 83% of respondents strongly agreed that it was better to have the tax than not, 73.2% strongly agreed that the tax increased flexibility to address complex behavioral health needs, and 65.1% strongly agreed that the tax increased the number of people served by evidence-based practices. Only 43.3%, however, strongly agreed that it was easy to satisfy tax-reporting requirements. Interviews revealed that the taxes enabled funding for services and implementation supports, such as training in the delivery of evidence-based practices, and supplemented mainstream funding sources (e.g., Medicaid). However, some interviewees also reported challenges related to volatility of funding, inequities in the distribution of tax revenue, and, in some cases, administratively burdensome tax reporting. Decisions about tax revenue allocation were influenced by goals such as reducing behavioral health care inequities, being responsive to community needs, addressing constraints of mainstream funding sources, and, to a lesser degree, supporting services considered to be evidence based. Conclusions: Earmarked taxes are a promising financing strategy to improve access to, and quality of, behavioral health services by supplementing mainstream state and federal financing.A Tale of Two Taxes: Implementation of Earmarked Taxes for Behavioral Health Services in California and Washington State
AbstractPurtle, J., Stadnick, N. A., Wynecoop, M., Walker, S. C., Bruns, E. J., & Aarons, G. A. (n.d.).Publication year
2024Journal title
Psychiatric ServicesVolume
75Issue
5Page(s)
410-418AbstractObjective: The authors sought to characterize perceptions of the impacts, attributes, and support for taxes earmarked for behavioral health services and to compare perceptions of the taxes among professionals in California and Washington, two states differing in earmarked tax designs. Methods: Surveys were completed by 155 public agency and community organization professionals involved in tax implementation in California (N=87) and Washington State (N=68) during 2022–2023 (29% response rate). Respondents indicated their perceptions of the taxes’ impacts, attributes, and support. Responses were summed as aggregate scores and were also analyzed as individual items. Bivariate analyses were used to compare responses of professionals in California versus Washington State. Results: Earmarked taxes were generally regarded positively. Of the respondents, >80% strongly agreed that the taxes increased funding for services and were helpful, and only 10% strongly agreed that the taxes decreased behavioral health funding from other sources. Substantially more respondents in California than in Washington State strongly agreed that taxes’ reporting requirements were complicated (45% vs. 5%, p<0.001) and that the taxes increased unjustified scrutiny of services or systems (33% vs. 2%, p<0.001). However, more respondents in California than in Washington State also strongly agreed that the taxes increased public awareness about behavioral health (56% vs. 15%, p<0.001) and decreased behavioral health stigma (47% vs. 14%, p<0.001). Conclusions: Perceptions of the strengths and weaknesses of taxes earmarked for behavioral health services may vary by design features of the tax. Such features include stigma-reduction initiatives and tax spending and reporting requirements.Acceptability and feasibility of policy implementation strategies for taxes earmarked for behavioral health services
AbstractPurtle, J., Stadnick, N. A., Wynecoop, M., Walker, S. C., Bruns, E. J., & Aarons, G. A. (n.d.).Publication year
2024Journal title
Frontiers in Health ServicesVolume
4AbstractBackground: This study's aims are to: (1) Compare the acceptability and feasibility of five types of implementation strategies that could be deployed to increase the reach of evidence-based practices (EBPs) with revenue from policies that earmark taxes for behavioral health services, and (2) Illustrate how definitions of implementation strategies and measures of acceptability and feasibility can be used in policy-focused implementation science research. Methods: Web-based surveys of public agency and community organization professionals involved with earmarked tax policy implementation were completed in 2022–2023 (N = 211, response rate = 24.9%). Respondents rated the acceptability and feasibility of five types of implementation strategies (dissemination, implementation process, integration, capacity-building, and scale-up). Aggregate acceptability and feasibility scores were calculated for each type of strategy (scoring range 4–20). Analyses of variance compared scores across strategies and between organizational actor types. Findings: For acceptability, capacity-building strategies had the highest rating (M = 16.3, SD = 3.0), significantly higher than each of the four other strategies, p ≤. 004), and scale-up strategies had the lowest rating (M = 15.6). For feasibility, dissemination strategies had the highest rating (M = 15.3, significantly higher than three of the other strategies, p ≤.002) and scale-up strategies had the lowest rating (M = 14.4). Conclusions: Capacity-building and dissemination strategies may be well-received and readily deployed by policy implementers to support EBPs implementation with revenue from taxes earmarked for behavioral health services. Adapting definitions of implementation strategies for policy-focused topics, and applying established measures of acceptability and feasibility to these strategies, demonstrates utility as an approach to advance research on policy-focused implementation strategies.Demographic variation in preferred sources for suicide prevention and mental health crisis services among U.S. adults
AbstractPurtle, J., Mauri, A. I., McSorley, A. M. M., Adera, A. L., Goldman, M. L., & Lindsey, M. A. (n.d.).Publication year
2024Journal title
Preventive Medicine ReportsVolume
47AbstractIntroduction: Recent federal policy initiatives (e.g., 988 Lifeline, Certified Community Behavioral Health Clinics) aim to increase access to mental health crisis services. The objective of this study was to determine the prevalence and correlates of U.S. adults reporting being “very likely” to reach out to different sources if they/a loved one were experiencing suicidality or a mental health crisis. Methods: A nationally representative Ipsos KnowledgePanel survey of 5,058 U.S. adults (response rate = 55.0 %) in English and Spanish was conducted in June 2023. Multivariable logistic regression models assessed the reported likelihood of reaching out to five different sources of support in a crisis, controlling for past 30-day psychological distress and demographic characteristics. Results: One-in-four respondents (27.8 %; 95 % CI = 26.5 %, 29.0 %) were very likely to reach out to a crisis line and 33.6 % (95 % CI = 32.3 %, 34.9 %) were very likely to reach out to a mental health professional. A friend/family member was the most frequently identified source of support (44.7 %; 95 % CI = 43.4 %, 46.1 %). After adjustment, people of younger ages, male gender, and identifying as Republican had significantly lower odds of reporting being very likely to reach out to a crisis line and mental health professional. Black and Hispanic respondents had significantly higher odds of reporting being very likely to reach out to a crisis line and someone in their religious network than non-Hispanic Whites. Conclusions: Most U.S. adults report not being very likely to reach out to a crisis line or mental health professional if experiencing suicidality/crisis, although variation across demographic groups exists.Design considerations for developing measures of policy implementation in quantitative evaluations of public health policy
AbstractSmith, N. R., Levy, D. E., Falbe, J., Purtle, J., & Chriqui, J. F. (n.d.).Publication year
2024Journal title
Frontiers in Health ServicesVolume
4AbstractTypical quantitative evaluations of public policies treat policies as a binary condition, without further attention to how policies are implemented. However, policy implementation plays an important role in how the policy impacts behavioral and health outcomes. The field of policy-focused implementation science is beginning to consider how policy implementation may be conceptualized in quantitative analyses (e.g., as a mediator or moderator), but less work has considered how to measure policy implementation for inclusion in quantitative work. To help address this gap, we discuss four design considerations for researchers interested in developing or identifying measures of policy implementation using three independent NIH-funded research projects studying e-cigarette, food, and mental health policies. Mini case studies of these considerations were developed via group discussions; we used the implementation research logic model to structure our discussions. Design considerations include (1) clearly specifying the implementation logic of the policy under study, (2) developing an interdisciplinary team consisting of policy practitioners and researchers with expertise in quantitative methods, public policy and law, implementation science, and subject matter knowledge, (3) using mixed methods to identify, measure, and analyze relevant policy implementation determinants and processes, and (4) building flexibility into project timelines to manage delays and challenges due to the real-world nature of policy. By applying these considerations in their own work, researchers can better identify or develop measures of policy implementation that fit their needs. The experiences of the three projects highlighted in this paper reinforce the need for high-quality and transferrable measures of policy implementation, an area where collaboration between implementation scientists and policy experts could be particularly fruitful. These measurement practices provide a foundation for the field to build on as attention to incorporating measures of policy implementation into quantitative evaluations grows and will help ensure that researchers are developing a more complete understanding of how policies impact health outcomes.Impact of U.S. Federal Loan Repayment Programs on the Behavioral Health Workforce: Scoping Review
AbstractLast, B. S., Crable, E. L., Khazanov, G. K., Scheinfeld, L. P., McGinty, E. E., & Purtle, J. (n.d.).Publication year
2024Journal title
Hospital and Community PsychiatryVolume
75Issue
7Page(s)
652-666AbstractOBJECTIVE: Federal loan repayment programs (LRPs) are one strategy to address the shortage of behavioral health providers. This scoping review aimed to identify and characterize the federal LRPs' impact on the U.S. behavioral health workforce. METHODS: A scoping review was conducted in accordance with JBI (formerly known as the Joanna Briggs Institute) methodology for scoping reviews. The authors searched the Ovid MEDLINE, Web of Science, APA PsycInfo, EconLit, PAIS Index, and Embase databases, and gray literature was also reviewed. Two coders screened each article's abstract and full text and extracted study data. Findings were narratively synthesized and conceptually organized. RESULTS: The full-text screening identified 17 articles that met eligibility criteria. Of these, eight were peer-reviewed studies, and all but one evaluated the National Health Service Corps (NHSC) LRP. Findings were conceptually organized into five categories: descriptive studies of NHSC behavioral health needs and the NHSC workforce (k=4); providers' perceptions of, and experiences with, the NHSC (k=2); associations between NHSC funding and the number of NHSC behavioral health providers (k=4); NHSC behavioral health workforce productivity and capacity (k=3); and federal LRP recruitment and retention (k=4). CONCLUSIONS: The literature on federal LRPs and their impact on the behavioral health workforce is relatively limited. Although federal LRPs are an important and effective tool to address the behavioral health workforce shortage, additional federal policy strategies are needed to attract and retain behavioral health providers and to diversify the behavioral health workforce.Maui Wildfire and 988 Suicide and Crisis Lifeline Call Volume and Capacity
Rivera-González, A. C., Purtle, J., Kaholokula, J. K. A., Stimpson, J. P., & Ortega, A. N. (n.d.).Publication year
2024Journal title
JAMA network openVolume
7Issue
11Measuring variation in infant mortality and deaths of despair by US congressional district in Pennsylvania: a methodological case study
AbstractSchnake-Mahl, A., Anfuso, G., Goldstein, N. D., Purtle, J., Eberth, J. M., Ortigoza, A., & Bilal, U. (n.d.).Publication year
2024Journal title
American Journal of EpidemiologyVolume
193Issue
7Page(s)
1040-1049AbstractMany ecological studies examine health outcomes and disparities using administrative boundaries such as census tracts, counties, or states. These boundaries help us to understand the patterning of health by place, along with impacts of policies implemented at these levels. However, additional geopolitical units (units with both geographic and political meaning), such as congressional districts (CDs), present further opportunities to connect research with public policy. Here we provide a step-by-step guide on how to conduct disparities-focused analysis at the CD level. As an applied case study, we use geocoded vital statistics data from 2010-2015 to examine levels of and disparities in infant mortality and deaths of despair in the 19 US CDs of Pennsylvania for the 111th-112th (2009-2012) Congresses and 18 CDs for the 113th-114th (2013-2016) Congresses. We also provide recommendations for extending CD-level analysis to other outcomes, states, and geopolitical boundaries, such as state legislative districts. Increased surveillance of health outcomes at the CD level can help prompt policy action and advocacy and, hopefully, reduce rates of and disparities in adverse health outcomes.Methods and measures to evaluate the impact of participatory model building on public policymakers: a scoping review protocol
AbstractHenson, R. M., Purtle, J., Headen, I., Stankov, I., & Langellier, B. A. (n.d.).Publication year
2024Journal title
BMJ openVolume
14Issue
1AbstractIntroduction Public policymakers are increasingly engaged in participatory model building processes, such as group model building. Understanding the impacts of policymaker participation in these processes on policymakers is important given that their decisions often have significant influence on the dynamics of complex systems that affect health. Little is known about the extent to which the impacts of participatory model building on public policymakers have been evaluated or the methods and measures used to evaluate these impacts. Methods and analysis A scoping review protocol was developed with the objectives of: (1) scoping studies that have evaluated the impacts of facilitated participatory model building processes on public policymakers who participated in these processes; and (2) describing methods and measures used to evaluate impacts and the main findings of these evaluations. The Joanna Briggs Institute's Population, Concept, Context framework was used to formulate the article identification process. Seven electronic databases - MEDLINE (Ovid), ProQuest Health and Medical, Scopus, Web of Science, Embase (Ovid), CINAHL Complete and PsycInfo - will be searched. Identified articles will be screened according to inclusion and exclusion criteria and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist for scoping reviews will be used and reported. A data extraction tool will collect information across three domains: study characteristics, methods and measures, and findings. The review will be conducted using Covidence, a systematic review data management platform. Ethics and dissemination The scoping review produced will generate an overview of how public policymaker engagement in participatory model building processes has been evaluated. Findings will be disseminated through peer-reviewed publications and to communities of practice that convene policymakers in participatory model building processes. This review will not require ethics approval because it is not human subject research.Multi-level alignment processes in the sustainment of a youth substance use treatment model following a federal implementation initiative: A mixed method study
AbstractWright, B., González, I., Chen, M., Aarons, G. A., Hunter, S. B., Godley, M. D., Purtle, J., & Dopp, A. R. (n.d.).Publication year
2024Journal title
Journal of Substance Use and Addiction TreatmentVolume
166AbstractIntroduction: Government agencies have identified evidence-based practice (EBP) dissemination as a pathway to high-quality behavioral health care for youth. However, gaps remain about how to best sustain EBPs in treatment organizations in the U.S., especially in resource-constrained settings like publicly-funded youth substance use services. One important, but understudied, determinant of EBP sustainment is alignment: the extent to which multi-level factors that influence sustainment processes and outcomes are congruent, consistent, and/or coordinated. This study examined the role of alignment in U.S. states' efforts to sustain the Adolescent Community Reinforcement Approach (A-CRA), an EBP for youth substance use disorders, during the COVID-19 pandemic. Methods: In this mixed methods study, the qualitative investigation preceded and informed the quantitative investigation. We interviewed state administrators and providers (i.e., supervisors and clinicians) from 15 states that had completed a federal A-CRA implementation grant; providers also completed surveys. The sample included 50 providers from 35 treatment organizations that reported sustaining A-CRA when the COVID-19 pandemic began, and 20 state administrators. In qualitative thematic analyses, we applied the EPIS (Exploration, Preparation, Implementation, Sustainment) framework to characterize alignment processes that interviewees described as influential on sustainment. We then used survey items to quantitatively explore the associations described in qualitative themes, using bivariate linear regressions. Results: At the time of interview, staff from 80 % of the treatment organizations (n = 28), reported sustaining A-CRA. Providers from both sustainer and non-sustainer organizations, as well as state administrators, described major sources of misalignment when state agencies ceased technical assistance post-grant, and because limited staff capacity conflicted with A-CRA's training model, which was perceived as time-intensive. Participants described the pandemic as exacerbating preexisting challenges, including capacity issues. Sustainer organizations reported seeking new funding to help sustain A-CRA. Quantitative associations between self-rated extent of sustainment and other survey items mostly followed the pattern predicted from the qualitative findings. Conclusions: The COVID-19 pandemic amplified longstanding A-CRA sustainment challenges, but treatment organizations already successfully sustaining A-CRA pre-pandemic largely continued. There are missed opportunities for state-level actors to coordinate with providers on the shared goal of EBP sustainment. A greater focus on alignment processes in research and practice could help states and providers strengthen sustainability planning.Operational and organizational variation in determinants of policy implementation success: the case of policies that earmark taxes for behavioral health services
AbstractPurtle, J., Stadnick, N. A., Mauri, A. I., Walker, S. C., Bruns, E. J., & Aarons, G. A. (n.d.).Publication year
2024Journal title
Implementation ScienceVolume
19Issue
1AbstractBackground: Research on determinants of health policy implementation is limited, and conceptualizations of evidence and implementation success are evolving in the field. This study aimed to identify determinants of perceived policy implementation success and assess whether these determinants vary according to: (1) how policy implementation success is operationally defined [i.e., broadly vs. narrowly related to evidence-based practice (EBP) reach] and (2) the role of a person’s organization in policy implementation. The study focuses on policies that earmark taxes for behavioral health services. Methods: Web-based surveys of professionals involved with earmarked tax policy implementation were conducted between 2022 and 2023 (N = 272). The primary dependent variable was a 9-item score that broadly assessed perceptions of the tax policy positively impacting multiple dimensions of outcomes. The secondary dependent variable was a single item that narrowly assessed perceptions of the tax policy increasing EBP reach. Independent variables were scores mapped to determinants in the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Multiple linear regression estimated associations between measures of determinants and policy implementation success. Results: Perceptions of tax attributes (innovation determinant), tax EBP implementation climate (inner-context determinant), and inter-agency collaboration in tax policy implementation (outer-context and bridging factor determinant) were significantly associated with perceptions of policy implementation success. However, the magnitude of associations varied according to how success was operationalized and by respondent organization type. For example, the magnitude of the association between tax attributes and implementation success was 42% smaller among respondents at direct service organizations than non-direct service organizations when implementation success was operationalized broadly in terms of generating positive impacts (β = 0.37 vs. β = 0.64), and 61% smaller when success was operationalized narrowly in terms of EBP reach (β = 0.23 vs. β = 0.59). Conversely, when success was operationalized narrowly as EBP reach, the magnitude of the association between EBP implementation climate and implementation success was large and significant among respondents at direct service organizations while it was not significant among respondents from non-direct service organizations (β = 0.48 vs. β=-0.06). Conclusion: Determinants of perceived policy implementation success may vary according to how policy implementation success is defined and the role of a person’s organization in policy implementation. This has implications for implementation science and selecting policy implementation strategies.Policy dissemination and implementation research
Purtle, J., Crable, E. L., Cruden, G., Lee, M., Lengnick-Hall, R., Silver, D., & Raghavan, R. (n.d.). In Dissemination and Implementation Research in Health (1–).Publication year
2024Page(s)
511-533Proportion of US Counties and Population Served by Certified Community Behavioral Health Clinics
Mauri, A. I., Xiang, N., Adams, D. R., & Purtle, J. (n.d.).Publication year
2024Journal title
JAMA Health ForumVolume
5Issue
10Scaling Interventions to Manage Chronic Disease: Innovative Methods at the Intersection of Health Policy Research and Implementation Science
AbstractMcGinty, E. E., Seewald, N. J., Bandara, S., Cerdá, M., Daumit, G. L., Eisenberg, M. D., Griffin, B. A., Igusa, T., Jackson, J. W., Kennedy-Hendricks, A., Marsteller, J., Miech, E. J., Purtle, J., Schmid, I., Schuler, M. S., Yuan, C. T., & Stuart, E. A. (n.d.).Publication year
2024Journal title
Prevention ScienceVolume
25Page(s)
96-108AbstractPolicy implementation is a key component of scaling effective chronic disease prevention and management interventions. Policy can support scale-up by mandating or incentivizing intervention adoption, but enacting a policy is only the first step. Fully implementing a policy designed to facilitate implementation of health interventions often requires a range of accompanying implementation structures, like health IT systems, and implementation strategies, like training. Decision makers need to know what policies can support intervention adoption and how to implement those policies, but to date research on policy implementation is limited and innovative methodological approaches are needed. In December 2021, the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness and the Johns Hopkins Center for Mental Health and Addiction Policy convened a forum of research experts to discuss approaches for studying policy implementation. In this report, we summarize the ideas that came out of the forum. First, we describe a motivating example focused on an Affordable Care Act Medicaid health home waiver policy used by some US states to support scale-up of an evidence-based integrated care model shown in clinical trials to improve cardiovascular care for people with serious mental illness. Second, we define key policy implementation components including structures, strategies, and outcomes. Third, we provide an overview of descriptive, predictive and associational, and causal approaches that can be used to study policy implementation. We conclude with discussion of priorities for methodological innovations in policy implementation research, with three key areas identified by forum experts: effect modification methods for making causal inferences about how policies’ effects on outcomes vary based on implementation structures/strategies; causal mediation approaches for studying policy implementation mechanisms; and characterizing uncertainty in systems science models. We conclude with discussion of overarching methods considerations for studying policy implementation, including measurement of policy implementation, strategies for studying the role of context in policy implementation, and the importance of considering when establishing causality is the goal of policy implementation research.The Translational Science Benefits Model, a new training tool for demonstrating implementation science impact: A pilot study
AbstractAndersen, S., Wilson, A., Combs, T., Brossart, L., Heidbreder, J., McCrary, S., Beidas, R. S., Cabassa, L. J., Finley, E. P., McGinty, E. E., Purtle, J., Saldana, L., Proctor, E., & Luke, D. (n.d.).Publication year
2024Journal title
Journal of Clinical and Translational ScienceVolume
8Issue
1AbstractIntroduction: Demonstrating the impact of implementation science presents a new frontier for the field, and operationalizing downstream impact is challenging. The Translational Science Benefits Model (TSBM) offers a new approach for assessing and demonstrating research impact. Here we describe integration of the TSBM into a mentored training network. Methods: Washington University’s Clinical and Translational Science Awards TSBM team collaborated with a National Institute of Mental Health-supported training program, the Implementation Research Institute (IRI), a 2-year training institute in mental health implementation science. This partnership included three phases: (1) introductory workshop on research impact, (2) workshop on demonstrating impact, and (3) sessions to guide dissemination, including interactive tools and consultation with the TSBM research team. Fifteen IRI alumni were invited to participate in the pilot; six responded agreeing to participate in the training, develop TSBM case studies, and provide feedback about their experiences. Participants applied the tools and gave feedback on design, usability, and content. We present their case studies and describe how the IRI used the results to incorporate TSBM into future trainings. Results: The case studies identified 40 benefits spanning all four TSBM domains, including 21 community, 11 policy, five economic, and three clinical benefits. Participants reported that TSBM training helped them develop a framework for talking about impact. Selecting benefits was challenging for early-stage projects, suggesting the importance of early training. Conclusions: The case studies showcased the institute’s impact and the fellows’ work and informed refinement of tools and methods for incorporating TSBM into future IRI training.Trends in hospital capacity and utilization in Puerto Rico by health regions, 2010–2020
AbstractStimpson, J. P., Rivera-González, A. C., Mercado, D. L., Purtle, J., Canino, G., & Ortega, A. N. (n.d.).Publication year
2024Journal title
Scientific reportsVolume
14Issue
1AbstractLike many under resourced, island communities, most of the municipalities in Puerto Rico are medically underserved. However, there is limited information about changes in hospital capacity and any regional disparities in availability of hospital services in Puerto Rico, especially given the multiple public health emergencies the island has faced in recent years (e.g. hurricanes, earthquakes, and COVID-19). This study described the trends in hospital capacity and utilization for the Island of Puerto Rico and by health regions from 2010 to 2020. We analyzed the 2021–22 Area Health Resource File (AHRF) and aggregated the data by seven health regions, which are groupings of municipalities defined by the Puerto Rico Department of Health. Ten-year estimates for hospital utilization were adjusted for population size by health region. During the more recent five-year period, there were decreases in hospitals, hospital beds, and surgeries, which represent a shift from the earlier five-year period. Over the 10 years of the study period, there was an overall decrease in population-adjusted measures of hospital utilization on the island of Puerto Rico—despite multiple disasters that would, theoretically, increase need for health care services. We also found variation in hospital capacity and utilization by health regions indicating the rate of change was not uniform across Puerto Rico. The capacity of Puerto Rico’s hospital system has shrunk over the past decade which may pose a challenge when responding to recurrent major public health emergencies, especially within specific health regions.United States Federal Policies Contributing to Health and Health Care Inequities in Puerto Rico
AbstractMcSorley, A. M. M., Rivera-González, A. C., Lopez Mercado, D., Pagán, J. A., Purtle, J., & Ortega, A. N. (n.d.).Publication year
2024Journal title
American journal of public healthVolume
114Page(s)
S478-S484AbstractPuerto Rico, a territory of the United States since 1898, has recently experienced an increasing frequency and intensity of natural disasters and public health emergencies. In 2022, Hurricane Fiona became the latest storm to attract media attention and cast a light on Puerto Rico's deteriorating conditions, including infrastructural failings, health care provider shortages, and high levels of chronic illness. Although recent events have been uniquely devastating, decades of inequitable US federal policy practices have fueled the persistence of health inequities in the territory. Here we demonstrate how existing health and health care inequities in Puerto Rico have been exacerbated by compounding disasters but are rooted in the differential treatment of the territory under US federal policies. Specifically, we focus on the unequal US Federal Emergency Management Agency response to disasters in the territory, the lack of parity in federal Medicaid funding for Puerto Rico, and Puerto Rico's limited political power as a territory of the United States. We also provide empirically supported policy recommendations aimed at reducing health and health care inequities in the often-forgotten US territory of Puerto Rico.Using policy codesign to achieve multi-sector alignment in adolescent behavioral health: a study protocol
AbstractWalker, S. C., Ahrens, K. R., Owens, M. D., Parnes, M., Langley, J., Ackerley, C., Purtle, J., Saldana, L., Aarons, G. A., Hogue, A., & Palinkas, L. A. (n.d.).Publication year
2024Journal title
Implementation Science CommunicationsVolume
5Issue
1AbstractBackground: Policymaking is quickly gaining focus in the field of implementation science as a potential opportunity for aligning cross-sector systems and introducing incentives to promote population health, including substance use disorders (SUD) and their prevention in adolescents. Policymakers are seen as holding the necessary levers for realigning service infrastructure to more rapidly and effectively address adolescent behavioral health across the continuum of need (prevention through crisis care, mental health, and SUD) and in multiple locations (schools, primary care, community settings). The difficulty of aligning policy intent, policy design, and successful policy implementation is a well-known challenge in the broader public policy and public administration literature that also affects local behavioral health policymaking. This study will examine a blended approach of coproduction and codesign (i.e., Policy Codesign), iteratively developed over multiple years to address problems in policy formation that often lead to poor implementation outcomes. The current study evaluates this scalable approach using reproducible measures to grow the knowledge base in this field of study. Methods: This is a single-arm, longitudinal, staggered implementation study to examine the acceptability and short-term impacts of Policy Codesign in resolving critical challenges in behavioral health policy formation. The aims are to (1) examine the acceptability, feasibility, and reach of Policy Codesign within two geographically distinct counties in Washington state, USA; (2) examine the impact of Policy Codesign on multisector policy development within these counties using social network analysis; and (3) assess the perceived replicability of Policy Codesign among leaders and other staff of policy-oriented state behavioral health intermediary organizations across the USA. Discussion: This study will assess the feasibility of a specific approach to collaborative policy development, Policy Codesign, in two diverse regions. Results will inform a subsequent multi-state study measuring the impact and effectiveness of this approach for achieving multi-sector and evidence informed policy development in adolescent SUD prevention and treatment.What social norms are associated with parenting programs?
AbstractSrivastav, A., Nelson, K. L., McRell, A. S., Wilson, A., & Purtle, J. (n.d.).Publication year
2024Journal title
Child and Adolescent Social Work JournalVolume
41Issue
3Page(s)
349-355AbstractPurpose: Positive parenting and parental skill building are associated with child well-being and can be enhanced through community-based parenting interventions. Although parenting intervention access and participation are influenced by individual and community-level factors, little is known about how social norms around parenting predict support for parenting interventions and parenting programs. To better understand the association between personal beliefs, help seeking social norms and support for parenting interventions, we examined survey data collected through phone interviews of adults living in South Carolina, United States (n = 1,143). Methods: One-way ANOVAs assessed the relationship between personal beliefs and perceived social norms (what participants think are norms in their community) about seeking help for parenting and support for parenting interventions. Results: The extent to which personal beliefs and social norms related to parenting support were associated with parenting support was estimated using ordinary least squares regression models. After adjustment for demographic characteristics, awareness of where to go to get parenting knowledge and skills, believing that the government and other organizations should help parents who do not have support from family and friends, and believing that parents need support from family and friends “when parenting gets hard” all predicted support for believing that “all first-time parents should have the option of no cost in-home parenting support.” Believing that parents need support from family and friends when parenting gets hard predicted support for state government tax credits for attending positive parenting classes. Discussion: Activating these specific norms can help home visiting and positive parenting program investment and use and can encourage positive parenting practices.