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 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.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.Measuring 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.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)
511-533Scaling 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.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.A landscape assessment of the activities and capacities of evidence-to-policy intermediaries (EPI) in behavioral health
AbstractAlmquist, L., Walker, S. C., & Purtle, J. (n.d.).Publication year
2023Journal title
Implementation Science CommunicationsVolume
4Issue
1AbstractBackground: A significant gap exists between the production of research evidence and its use in behavioral health policymaking. Organizations providing consulting and support activities for improving policy represent a promising source for strengthening the infrastructure to address this gap. Understanding the characteristics and activities of these evidence-to-policy intermediary (EPI) organizations can inform the development of capacity-building activities, leading to strengthened evidence-to-policy infrastructure and more widespread evidence-based policymaking. Methods: Online surveys were sent to 51 organizations from English-speaking countries involved in evidence-to-policy activities in behavioral health. The survey was grounded in a rapid evidence review of the academic literature regarding strategies used to influence research use in policymaking. The review identified 17 strategies, which were classified into four activity categories. We administered the surveys via Qualtrics and calculated the descriptive statistics, scales, and internal consistency statistics using R. Results: A total of 31 individuals completed the surveys from 27 organizations (53% response rate) in four English-speaking countries. EPIs were evenly split between university (49%) and non-university (51%) settings. Nearly all EPIs conducted direct program support (mean = 4.19/5 [sd = 1.25]) and knowledge-building (4.03 [1.17]) activities. However, engagement with traditionally marginalized and non-traditional partners (2.84 [1.39]) and development of evidence reviews using formal critical appraisal methods (2.81 [1.70]) were uncommon. EPIs tend to be specialized, focusing on a group of highly related strategies rather than incorporating multiple evidence-to-policy strategies in their portfolios. Inter-item consistency was moderate to high, with scale α’s ranging from 0.67 to 0.85. Ratings of respondents’ willingness to pay for training in one of three evidence dissemination strategies revealed high interest in program and policy design. Conclusions: Our results suggest that evidence-to-policy strategies are frequently used by existing EPIs; however, organizations tend to specialize rather than engage in a breadth of strategies. Furthermore, few organizations reported consistently engaging with non-traditional or community partners. Focusing on building capacity for a network of new and existing EPIs could be a promising strategy for growing the infrastructure needed for evidence-informed behavioral health policymaking.A policy implementation study of earmarked taxes for mental health services: study protocol
AbstractPurtle, J., Stadnick, N. A., Wynecoop, M., Bruns, E. J., Crane, M. E., & Aarons, G. (n.d.).Publication year
2023Journal title
Implementation Science CommunicationsVolume
4Issue
1AbstractBackground: Insufficient funding is frequently identified as a critical barrier to the implementation and sustainment of evidence-based practices (EBPs). Thus, increasing access to funding is recognized as an implementation strategy. Policies that create earmarked taxes—defined as taxes for which revenue can only be spent on specific activities—are an increasingly common mental health financing strategy that could improve the reach of EBPs. This project’s specific aims are to (1) identify all jurisdictions in the USA that have implemented earmarked taxes for mental health and catalogue information about tax design; (2) characterize experiences implementing earmarked taxes among local (e.g., county, city) mental health agency leaders and other government and community organization officials and assess their perceptions of the acceptability and feasibility of different types of policy implementation strategies; and (3) develop a framework to guide effect earmarked tax designs, inform the selection of implementation strategies, and disseminate the framework to policy audiences. Methods: The project uses the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to inform data collection about the determinants and processes of tax implementation and Leeman’s typology of implementation strategies to examine the acceptability and feasibility strategies which could support earmarked tax policy implementation. A legal mapping will be conducted to achieve aim 1. To achieve aim 2, a survey will be conducted of 300 local mental health agency leaders and other government and community organization officials involved with the implementation of earmarked taxes for mental health. The survey will be followed by approximately 50 interviews with these officials. To achieve aim 3, quantitative and qualitative data will be integrated through a systematic framework development and dissemination process. Discussion: This exploratory policy implementation process study will build the evidence base for outer-context implementation determinants and strategies by focusing on policies that earmarked taxes for mental health services.Amplifying consumers as partners in dissemination and implementation science and practice
AbstractCrane, M. E., Purtle, J., & Becker, S. J. (n.d.).Publication year
2023Journal title
Implementation Research and PracticeVolume
4AbstractBackground: This Viewpoint argues for consumers (people with lived experience and their families) to be amplified as key partners in dissemination and implementation science and practice. Method: We contend that consumer opinion and consumer demand can be harnessed to influence practitioners and policymakers. Results: Amplifying consumers’ voices can improve the fit of evidence-based interventions to the intended end user. We offer recommendations of frameworks to engage consumers in the dissemination and implementation of health interventions. We discuss the primary types of evidence consumers may rely upon, including testimonials and lived experience. Conclusions: Our intention is for this Viewpoint to continue the momentum in dissemination and implementation science and practice of engaging consumers in our work.An Examination of Factors Affecting State Legislators’ Support for Parity Laws for Different Mental Illnesses
AbstractPilar, M., Purtle, J., Powell, B. J., Mazzucca, S., Eyler, A. A., & Brownson, R. C. (n.d.).Publication year
2023Journal title
Community mental health journalVolume
59Issue
1Page(s)
122-131AbstractMental health parity legislation can improve mental health outcomes. U.S. state legislators determine whether state parity laws are adopted, making it critical to assess factors affecting policy support. This study examines the prevalence and demographic correlates of legislators’ support for state parity laws for four mental illnesses— major depression disorder, post-traumatic stress disorder (PTSD), schizophrenia, and anorexia/bulimia. Using a 2017 cross-sectional survey of 475 U.S. legislators, we conducted bivariate analyses and multivariate logistic regression. Support for parity was highest for schizophrenia (57%), PTSD (55%), and major depression (53%) and lowest for anorexia/bulimia (40%). Support for parity was generally higher among females, more liberal legislators, legislators in the Northeast region of the country, and those who had previously sought treatment for mental illness. These findings highlight the importance of better disseminating evidence about anorexia/bulimia and can inform dissemination efforts about mental health parity laws to state legislators.Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study
AbstractDopp, A. R., Hunter, S. B., Godley, M. D., González, I., Bongard, M., Han, B., Cantor, J., Hindmarch, G., Lindquist, K., Wright, B., Schlang, D., Passetti, L. L., Wright, K. L., Kilmer, B., Aarons, G. A., & Purtle, J. (n.d.).Publication year
2023Journal title
Implementation ScienceVolume
18Issue
1AbstractBackground: Financial barriers in substance use disorder service systems have limited the widespread adoption—i.e., provider-level reach—of evidence-based practices (EBPs) for youth substance use disorders. Reach is essential to maximizing the population-level impact of EBPs. One promising, but rarely studied, type of implementation strategy for overcoming barriers to EBP reach is financing strategies, which direct financial resources in various ways to support implementation. We evaluated financing strategies for the Adolescent Community Reinforcement Approach (A-CRA) EBP by comparing two US federal grant mechanisms, organization-focused and state-focused grants, on organization-level A-CRA reach outcomes. Method: A-CRA implementation took place through organization-focused and state-focused grantee cohorts from 2006 to 2021. We used a quasi-experimental, mixed-method design to compare reach between treatment organizations funded by organization-focused versus state-focused grants (164 organizations, 35 states). Using administrative training records, we calculated reach as the per-organization proportion of trained individuals who received certification in A-CRA clinical delivery and/or supervision by the end of grant funding. We tested differences in certification rate by grant type using multivariable linear regression models that controlled for key covariates (e.g., time), and tested threats to internal validity from our quasi-experimental design through a series of sensitivity analyses. We also drew on interviews and surveys collected from the treatment organizations and (when relevant) interviews with state administrators to identify factors that influenced reach. Results: The overall certification rates were 27 percentage points lower in state-focused versus organization-focused grants (p =.01). Sensitivity analyses suggested these findings were not explained by confounding temporal trends nor by organizational or state characteristics. We did not identify significant quantitative moderators of reach outcomes, but qualitative findings suggested certain facilitating factors were more influential for organization-focused grants (e.g., strategic planning) and certain barrier factors were more impactful for state-focused grants (e.g., states finding it difficult to execute grant activities). Discussion: As the first published comparison of EBP reach outcomes between financing strategies, our findings can help guide state and federal policy related to financing strategies for implementing EBPs that reduce youth substance use. Future work should explore contextual conditions under which different financing strategies can support the widespread implementation of EBPs for substance use disorder treatment.County- and state-level immigration policies are associated with Supplemental Nutrition Assistance Program (SNAP) participation among Latino households
AbstractChaparro, M. P., Auchincloss, A. H., Argibay, S., Ruggiero, D. A., Purtle, J., & Langellier, B. A. (n.d.).Publication year
2023Journal title
Social Science and MedicineVolume
333AbstractThe purpose of this study was to investigate the association between county- and state-level immigrant criminalizing and integrating policies and Latino household participation in the largest safety net program against food insecurity in the U.S., the Supplemental Nutrition Assistance Program (SNAP). Our outcome, county-level proportion of SNAP-participating Latino households, and county-level covariates were obtained from the American Community Survey 1-year county files (N = 675 counties) for 13 years (2007–2019). Our exposures were county-level presence of sanctuary policies and a state-level immigrant friendliness score, created based on 19 immigrant criminalizing and integrating state-level policies obtained from the Urban Institute's State Immigration Policies Resource. We classified every county in the sample as 1) sanctuary policy + immigrant friendly state, 2) sanctuary policy + immigrant unfriendly state, 3) no sanctuary policy + immigrant friendly state, and 4) no sanctuary policy + immigrant unfriendly state. Using multivariable generalized linear models that adjusted for poverty levels and other social composition characteristics of counties, we found that county-level SNAP participation among Latino households was 1.1 percentage-point higher in counties with sanctuary policies (B = 1.12, 95%CI = 0.26–1.98), compared to counties with no sanctuary policies, and 1.6 percentage-point higher in counties with sanctuary policies in immigrant friendly states (B = 1.59, 95%CI = 0.33–2.84), compared to counties with no sanctuary policy in immigrant unfriendly states. Local and state immigration policy, even when unrelated to SNAP eligibility, may influence SNAP participation among Latino households. Jurisdictions which lack sanctuary policies or have more criminalizing and less integrating policies should consider adopting targeted outreach strategies to increase SNAP enrollment among Latino households.Earmarked Taxes for Mental Health Services in the United States: A Local and State Legal Mapping Study
AbstractPurtle, J., Wynecoop, M., Crane, M. E., & Stadnick, N. A. (n.d.).Publication year
2023Journal title
Milbank QuarterlyVolume
101Issue
2Page(s)
457-485AbstractPolicy Points Local governments are increasingly adopting policies that earmark taxes for mental health services, and approximately 30% of the US population lives in a jurisdiction with such a policy. Policies earmarking taxes for mental health services are heterogenous in their design, spending requirements, and oversight. In many jurisdictions, the annual per capita revenue generated by these taxes exceeds that of some major federal funding sources for mental health. Context: State and local governments have been adopting taxes that earmark (i.e., dedicate) revenue for mental health. However, this emergent financing model has not been systematically assessed. We sought to identify all jurisdictions in the United States with policies earmarking taxes for mental health services and characterize attributes of these taxes. Methods: A legal mapping study was conducted. Literature reviews and 11 key informant interviews informed search strings. We then searched legal databases (HeinOnline, Cheetah tax repository) and municipal data sources. We collected information on the year the tax went into effect, passage by ballot initiative (yes/no), tax base, tax rate, and revenue generated annually (gross and per capita). Findings: We identified 207 policies earmarking taxes for mental health services (95.7% local, 4.3% state, 95.7% passed via ballot initiative). Property taxes (73.9%) and sales taxes/fees (25.1%) were most common. There was substantial heterogeneity in tax design, spending requirements, and oversight. Approximately 30% of the US population lives in a jurisdiction with a tax earmarked for mental health, and these taxes generate over $3.57 billion annually. The median per capita annual revenue generated by these taxes was $18.59 (range = $0.04-$197.09). Per capita annual revenue exceeded $25.00 in 63 jurisdictions (about five times annual per capita spending for mental health provided by the US Substance Abuse and Mental Health Services Administration). Conclusions: Policies earmarking taxes for mental health services are diverse in design and are an increasingly common local financing strategy. The revenue generated by these taxes is substantial in many jurisdictions.Four very basic ways to think about policy in implementation science
AbstractPurtle, J., Moucheraud, C., Yang, L. H., & Shelley, D. (n.d.).Publication year
2023Journal title
Implementation Science CommunicationsVolume
4Issue
1AbstractBackground: Policy is receiving increasing attention in the field of implementation science. However, there remains a lack of clear, concise guidance about how policy can be conceptualized in implementation science research. Building on Curran’s article “Implementation science made too simple”—which defines “the thing” as the intervention, practice, or innovation in need of implementation support—we offer a typology of four very basic ways to conceptualize policy in implementation science research. We provide examples of studies that have conceptualized policy in these different ways and connect aspects of the typology to established frameworks in the field. The typology simplifies and refines related typologies in the field. Four very basic ways to think about policy in implementation science research. 1) Policy as something to adopt: an evidence-supported policy proposal is conceptualized as “the thing” and the goal of research is to understand how policymaking processes can be modified to increase adoption, and thus reach, of the evidence-supported policy. Policy-focused dissemination research is well-suited to achieve this goal. 2) Policy as something to implement: a policy, evidence-supported or not, is conceptualized as “the thing” and the goal of research is to generate knowledge about how policy rollout (or policy de-implementation) can be optimized to maximize benefits for population health and health equity. Policy-focused implementation research is well-suited to achieve this goal. 3) Policy as context to understand: an evidence-supported intervention is “the thing” and policies are conceptualized as a fixed determinant of implementation outcomes. The goal of research is to understand the mechanisms through which policies affect implementation of the evidence-supported intervention. 4) Policy as strategy to use: an evidence-supported intervention is “the thing” and policy is conceptualized as a strategy to affect implementation outcomes. The goal of research is to understand, and ideally test, how policy strategies affect implementation outcomes related to the evidence-supported intervention. Conclusion: Policy can be conceptualized in multiple, non-mutually exclusive ways in implementation science. Clear conceptualizations of these distinctions are important to advancing the field of policy-focused implementation science and promoting the integration of policy into the field more broadly.Growing inequities in mental health crisis services offered to indigent patients in Puerto Rico versus the US states before and after Hurricanes Maria and Irma
AbstractPurtle, J., Rivera-González, A. C., Mercado, D. L., Barajas, C. B., Chavez, L., Canino, G., & Ortega, A. N. (n.d.).Publication year
2023Journal title
Health Services ResearchVolume
58Issue
2Page(s)
325-331AbstractObjective: To assess changes in the availability of mental health crisis services in Puerto Rico relative to US states before and after Hurricanes Maria and Irma. Data Sources/Study Setting: National Mental Health Services Surveys conducted in 2016 and 2020. Study design: Repeated cross-sectional design. The independent variable was mental health facility location in Puerto Rico or a US state. Dependent variables were the availability of three mental health crisis services (psychiatric emergency walk-in services, suicide prevention services, and crisis intervention team services). Data Collection/Extraction Methods: The proportion and per 100,000 population rate of facilities offering crisis services were calculated. Principal Findings: The availability of crisis services at mental health facilities in Puerto Rico remained stable between 2016 and 2020. These services were offered less at indigent care facilities in Puerto Rico than US states (e.g., 38.2% vs. 49.5% for suicide prevention, p = 0.06) and the magnitude of difference increased following Hurricane Maria. Conclusions: There are disparities between Puerto Rico and US states in the availability of mental health crisis services for indigent patients.Implementation of the 988 Suicide & Crisis Lifeline: Estimating State-Level Increases in Call Demand Costs and Financing
AbstractPurtle, J., Chance Ortego, J., Bandara, S., Goldstein, A., Pantalone, J., & Goldman, M. L. (n.d.).Publication year
2023Journal title
Journal of Mental Health Policy and EconomicsVolume
26Issue
2Page(s)
85-95AbstractBackground: Per federal law, “988” became the new three-digit dialing code for the National Suicide & Crisis Lifeline on July 16, 2022 (previously reached by dialing “1-800-283-TALK”). Aims of the Study: This study aimed to produce state-level estimates of: (i) annual increases in 988 Lifeline call volume following 988 implementation, (ii) the cost of these increases, and (iii) the extent to which state and federal funding earmarked for increases in 988 Lifeline call volume are sufficient to meet call demand. Method: A 50 state pre-post policy implementation design was used. State-level Lifeline call volume data were obtained. For each state, we calculated the absolute difference in number of Lifeline calls in the four-month periods between August-November 2021 (pre-988 implementation) and August-November 2022 (post-988 implementation), and also expressed this difference as percent change and rate per 100,000 population. The difference call volume was multiplied by a published estimate of the cost of a single 988 Lifeline call ($82), and then by multiplied by three to produce annual, 12-month state-level cost increase estimates. These figures were then divided by each state's population size to generate cost estimates per state resident. State-level information on the amount of state (FY 2023) and federal SAMHSA (FY 2022) funding earmarked for 988 Lifeline centers in response to 988 implementation were obtained from legal databases and government websites and expressed as dollars per state resident. State-level differences between per state resident estimates of increased cost and funding were calculated to assess the extent to which state and federal funding earmarked for increases in 988 Lifeline call volume were sufficient to meet call demand. Results: 988 Lifeline call volume increased in all states post-988 implementation (within-state mean percent change = +32.8%, SD = +20.5%). The total estimated cost needed annually to accommodate increases in 988 Lifeline call volume nationally was approximately $46 million. The within-state mean estimate of additional cost per state resident was +$0.16 (SD = +$0.11). The additional annual cost per state resident exceeded $0.40 in three states, was between $0.40- $0.30 in three states, and between $0.30- $0.20 in seven states. Twenty-two states earmarked FY 2023 appropriations for 988 Lifeline centers in response to 988 (within-state mean per state resident = $1.51, SD = $1.52) and 49 states received SAMHSA 988 capacity building grants (within-state mean per state resident = $0.36, SD = $0.39). State funding increases exceeded the estimated cost increases in about half of states. Conclusions: The Lifeline's transition to 988 increased 988 Lifeline call volume in all states, but the magnitude of the increase and associated cost was heterogenous across states. State funding earmarked for increases in 988 Lifeline center costs is sufficient in about half of states. Sustained federal funding, and/or increases in state funding, earmarked for 988 Lifeline centers is likely important to ensuring that 988 Lifeline centers have the capacity to meet call demand in the post-988 implementation environment.National Suicide Prevention Lifeline 2020 In-State Answer Rates, Stratified by Call Volume Rates and Geographic Region
Purtle, J., Lindsey, M. A., Raghavan, R., & Stuart, E. A. (n.d.).Publication year
2023Journal title
Psychiatric ServicesVolume
74Issue
2Page(s)
204-205Newspaper Coverage of Adverse Childhood Experiences and Toxic Stress in the United States, 2014–2020: Consequences, Causes, and Solutions
AbstractPurtle, J., Bowler, S., Boughter-Dornfeld, M., Nelson, K. L., & Gollust, S. E. (n.d.).Publication year
2023Journal title
Trauma, Violence, and AbuseVolume
24Issue
1Page(s)
313-323AbstractNews media can shape public opinion about child adversity and influence the translation of research into public policy. Research about adverse childhood experiences (ACEs) and toxic stress has increased dramatically in recent years, but little is known about how these concepts are covered in news media. We reviewed how newspapers in the United States have portrayed the consequences of, causes of, and solutions to address ACEs and toxic stress, examined trends in newspaper coverage, and assessed differences in coverage of ACEs versus toxic stress. Quantitative content analysis was conducted of 746 newspaper articles mentioning “adverse childhood experience(s)” and/or “toxic stress” published in 25 U.S. newspapers between January 1, 2014, and May 30, 2020. κ statistics of interrater reliability were calculated, and variables with κ ≥.60 were retained for quantitative analysis. We found that newspaper coverage of ACEs and toxic stress increased dramatically between 2014 and 2018 and then sharply declined. Only 13.3% of articles mentioned both ACEs and toxic stress. There were many statistically significant (p <.05) differences in the causes, consequences, and solutions identified in articles focused on ACEs versus toxic stress. Coverage of both concepts predominantly focused on consequences for individuals, not society. However, 54.6% of articles identified a structural cause of ACEs and/or toxic stress. Increased volume in newspaper coverage about ACEs and toxic stress could increase public awareness about the relationship between childhood adversity and adult outcomes. There is a need to portray ACEs and toxic stress as complementary concepts more coherently in news media.Revisiting the policy ecology framework for implementation of evidence-based practices in mental health settings
AbstractWortham, W. K., Rodwin, A. H., Purtle, J., Munson, M. R., & Raghavan, R. (n.d.).Publication year
2023Journal title
Implementation ScienceVolume
18Issue
1AbstractBackground: Over the past three decades, policy actors and actions have been highly influential in supporting the implementation of evidence-based practices (EBPs) in mental health settings. An early examination of these actions resulted in the Policy Ecology Framework (PEF), which was originally developed as a tactical primer for state and local mental health regulators in the field of child mental health. However, the policy landscape for implementation has evolved significantly since the original PEF was published. An interrogation of the strategies originally proposed in the PEF is necessary to provide an updated menu of strategies to improve our understanding of the mechanisms of policy action and promote system improvement. Objectives: This paper builds upon the original PEF to address changes in the policy landscape for the implementation of mental health EBPs between 2009 and 2022. We review the current state of policy strategies that support the implementation of EBPs in mental health care and outline key areas for policy-oriented implementation research. Our review identifies policy strategies at federal, state, agency, and organizational levels, and highlights developments in the social context in which EBPs are implemented. Furthermore, our review is organized around some key changes that occurred across each PEF domain that span organizational, agency, political, and social contexts along with subdomains within each area. Discussion: We present an updated menu of policy strategies to support the implementation of EBPs in mental health settings. This updated menu of strategies considers the broad range of conceptual developments and changes in the policy landscape. These developments have occurred across the organizational, agency, political, and social contexts and are important for policymakers to consider in the context of supporting the implementation of EBPs. Summary: The updated PEF expands and enhances the specification of policy levers currently available, and identifies policy targets that are underdeveloped (e.g., de-implementation and sustainment) but are becoming visible opportunities for policy to support system improvement. The updated PEF clarifies current policy efforts within the field of implementation science in health to conceptualize and better operationalize the role of policy in the implementation of EBPs.