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 at the New York University School of Global Public Health and also 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, suicide prevention, and novel financing models for mental health services—such as earmarked taxes and fees.
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 a NIMH-funded project focused on financing policies related to the 988 Suicide & Crisis Lifeline (R01MH131649), a NIDA-funded study (through the CHERISH Center, P30DA040500) that is analyzing social media data to identify audience segments of state legislators who conceptualize substance use issues in different ways and experimentally testing different ways of communicating evidence these legislators, and co-leading a NCI-funded study focused on cancer policy implementation strategies (R21ACA293319). He is also a co-investigator on projects focused on mental health and health care system resilience following disasters is Puerto Rico (R01MD016426) and Hawaiʻi (R61MD019939).
He has published over 170 peer-reviewed journal articles, is an Associate Editor at Implementation Science, Co-Chairs the Policy Advisory Board at Psychiatric Services, is on the Scientific Advisory Committee of the American Foundation for Suicide Prevention, and is Core Faculty of the NIMH-funded Implementation Research Institute.
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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
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., 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 911 Financing Data as a Model for 988
AbstractPurtle, J., Mauri, A. I., Cantor, J. H., & McBain, R. K. (n.d.).Publication year
2024Journal title
Psychiatric ServicesVolume
75Issue
7Page(s)
613Abstract~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.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. R., 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.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.Correction : Tailoring dissemination strategies to increase evidence-informed policymaking for opioid use disorder treatment: study protocol (Implementation Science Communications, (2023), 4, 1, (16), 10.1186/s43058-023-00396-5)
AbstractCrable, E. L., Grogan, C. M., Purtle, J., Roesch, S. C., & Aarons, G. A. (n.d.).Publication year
2023Journal title
Implementation science communicationsVolume
4Issue
1AbstractFollowing publication of the original article [1], the authors identified an error in Fig. 1. The correct figure is given below. (Figure presented.)Correction to : Scaling Interventions to Manage Chronic Disease: Innovative Methods at the Intersection of Health Policy Research and Implementation Science (Prevention Science, (2022), 10.1007/s11121-022-01427-8)
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
2023Journal title
Prevention ScienceAbstractThe article “Scaling Interventions to Manage Chronic Disease: Innovative Methods at the Intersection of Health Policy Research and Implementation Science”, written by McGinty, 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., and Stuart, E.A., was originally published electronically on the publisher’s internet portal on 01 September 2022 without open access.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. R., Crane, M. E., & Stadnick, N. A. (n.d.).Publication year
2023Journal title
Milbank QuarterlyAbstractPolicy 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.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.Interpreting Between-State Variation in 988 Suicide and Crisis Lifeline Call Volume Rates
AbstractPurtle, J., Goldman, M. L., & Stuart, E. A. (n.d.).Publication year
2023Journal title
Psychiatric ServicesVolume
74Issue
9Page(s)
901Abstract~National Suicide Prevention Lifeline 2020 In-State Answer Rates, Stratified by Call Volume Rates and Geographic Region
AbstractPurtle, J., Lindsey, M. A., Raghavan, R., & Stuart, E. A. (n.d.).Publication year
2023Journal title
Hospital and Community PsychiatryVolume
74Issue
2Page(s)
204-205Abstract~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.State and Federal Legislators’ Responses on Social Media to the Mental Health and Burnout of Health Care Workers Throughout the COVID-19 Pandemic : Natural Language Processing and Sentiment Analysis
AbstractAbrams, M. P., Pelullo, A. P., Meisel, Z. F., Merchant, R. M., Purtle, J., & Agarwal, A. K. (n.d.).Publication year
2023Journal title
JMIR InfodemiologyVolume
3AbstractBackground: Burnout and the mental health burden of the COVID-19 pandemic have disproportionately impacted health care workers. The links between state policies, federal regulations, COVID-19 case counts, strains on health care systems, and the mental health of health care workers continue to evolve. The language used by state and federal legislators in public-facing venues such as social media is important, as it impacts public opinion and behavior, and it also reflects current policy-leader opinions and planned legislation. Objective: The objective of this study was to examine legislators’ social media content on Twitter and Facebook throughout the COVID-19 pandemic to thematically characterize policy makers’ attitudes and perspectives related to mental health and burnout in the health care workforce. Methods: Legislators’ social media posts about mental health and burnout in the health care workforce were collected from January 2020 to November 2021 using Quorum, a digital database of policy-related documents. The total number of relevant social media posts per state legislator per calendar month was calculated and compared with COVID-19 case volume. Differences between themes expressed in Democratic and Republican posts were estimated using the Pearson chi-square test. Words within social media posts most associated with each political party were determined. Machine-learning was used to evaluate naturally occurring themes in the burnout- and mental health–related social media posts. Results: A total of 4165 social media posts (1400 tweets and 2765 Facebook posts) were generated by 2047 unique state and federal legislators and 38 government entities. The majority of posts (n=2319, 55.68%) were generated by Democrats, followed by Republicans (n=1600, 40.34%). Among both parties, the volume of burnout-related posts was greatest during the initial COVID-19 surge. However, there was significant variation in the themes expressed by the 2 major political parties. Themes most correlated with Democratic posts were (1) frontline care and burnout, (2) vaccines, (3) COVID-19 outbreaks, and (4) mental health services. Themes most correlated with Republican social media posts were (1) legislation, (2) call for local action, (3) government support, and (4) health care worker testing and mental health. Conclusions: State and federal legislators use social media to share opinions and thoughts on key topics, including burnout and mental health strain among health care workers. Variations in the volume of posts indicated that a focus on burnout and the mental health of the health care workforce existed early in the pandemic but has waned. Significant differences emerged in the content posted by the 2 major US political parties, underscoring how each prioritized different aspects of the crisis.State Legislator Social Media Posts about the 988 Suicide and Crisis Lifeline
AbstractPurtle, J., Soltero, M., Crane, M. E., McSorley, A. M., Knapp, M., & Drapeau, C. W. (n.d.).Publication year
2023Journal title
JAMA network openVolume
6Issue
10Abstract~Tailoring dissemination strategies to increase evidence-informed policymaking for opioid use disorder treatment : study protocol
AbstractCrable, E. L., Grogan, C. M., Purtle, J., Roesch, S. C., & Aarons, G. A. (n.d.).Publication year
2023Journal title
Implementation science communicationsVolume
4Issue
1AbstractBackground: Policy is a powerful tool for systematically altering healthcare access and quality, but the research to policy gap impedes translating evidence-based practices into public policy and limits widespread improvements in service and population health outcomes. The US opioid epidemic disproportionately impacts Medicaid members who rely on publicly funded benefits to access evidence-based treatment including medications for opioid use disorder (MOUD). A myriad of misaligned policies and evidence-use behaviors by policymakers across federal agencies, state Medicaid agencies, and managed care organizations limit coverage of and access to MOUD for Medicaid members. Dissemination strategies that improve policymakers’ use of current evidence are critical to improving MOUD benefits and reducing health disparities. However, no research describes key determinants of Medicaid policymakers’ evidence use behaviors or preferences, and few studies have examined data-driven approaches to developing dissemination strategies to enhance evidence-informed policymaking. This study aims to identify determinants and intermediaries that influence policymakers’ evidence use behaviors, then develop and test data-driven tailored dissemination strategies that promote MOUD coverage in benefit arrays. Methods: Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we will conduct a national survey of state Medicaid agency and managed care organization policymakers to identify determinants and intermediaries that influence how they seek, receive, and use research in their decision-making processes. We will use latent class methods to empirically identify subgroups of agencies with distinct evidence use behaviors. A 10-step dissemination strategy development and specification process will be used to tailor strategies to significant predictors identified for each latent class. Tailored dissemination strategies will be deployed to each class of policymakers and assessed for their acceptability, appropriateness, and feasibility for delivering evidence about MOUD benefit design. Discussion: This study will illuminate key determinants and intermediaries that influence policymakers’ evidence use behaviors when designing benefits for MOUD. This study will produce a critically needed set of data-driven, tailored policy dissemination strategies. Study results will inform a subsequent multi-site trial measuring the effectiveness of tailored dissemination strategies on MOUD benefit design and implementation. Lessons from dissemination strategy development will inform future research about policymakers’ evidence use preferences and offer a replicable process for tailoring dissemination strategies.Unintended consequences of disseminating behavioral health evidence to policymakers : Results from a survey-based experiment
AbstractPurtle, J., Nelson, K. L., Lê-Scherban, F., & Gollust, S. E. (n.d.).Publication year
2023Journal title
Implementation Research and PracticeVolume
4AbstractBackground: Communication research demonstrates that messages often have unintended consequences, but this work has received limited attention in implementation science. This dissemination experiment sought to determine whether state-tailored policy briefs about the behavioral health consequences of adverse childhood experiences (ACEs), compared to national policy briefs on the topic, increased state legislators’/staffers’ perceptions of the policy brief relevance and parental blame for the consequences of ACEs, and whether effects differed between Democrats and Republicans. Method: A preregistered, web-based survey experiment with U.S. state legislators/staffers was conducted in 2021 (n = 133). Respondents were randomized to view a policy brief about the behavioral health consequences of ACEs that included state-tailored data (intervention condition) or national data (control condition) and then answered survey questions. Dependent variables were perceived policy brief relevance and parental blame for the consequences of ACEs. Results: The mean policy brief relevance score was 4.1% higher in the intervention than in the control condition (p =.24), but the mean parental blame score was 16.5% higher (p =.02). When outcomes were dichotomized, 61.2% of respondents in the intervention condition rated parents as “very much to blame” for the consequences of ACEs compared to 37.1% in the control condition (p =.01). When the sample was stratified by political affiliation, the effect of the state-tailored policy brief on parental blame was larger in magnitude among Democrats and not significant among Republicans. The intervention policy brief increased the mean parental blame score by 22.8% among Democrats relative to the control policy brief (p =.007) and doubled the proportion rating parents as “very much to blame” (52.2% vs. 26.1%, p =.03). Conclusions: Despite limited statistical power, state-tailored policy briefs significantly increased state legislators’/staffers’ perceptions of parental blame for the behavioral health consequences of ACEs, relative to a policy brief with national data. Unintended messaging effects warrant greater attention in dissemination research and practice.Use of qualitative systems mapping and causal loop diagrams to understand food environments, diet and obesity : a scoping review protocol
AbstractStankov, I., Henson, R. M., Headen, I., Purtle, J., & Langellier, B. A. (n.d.).Publication year
2023Journal title
BMJ openVolume
13Issue
3AbstractIntroduction Food systems can shape dietary behaviour and obesity outcomes in complex ways. Qualitative systems mapping using causal loop diagrams (CLDs) can depict how people understand the complex dynamics, inter-relationships and feedback characteristic of food systems in ways that can support policy planning and action. To date, there has been no attempt to review this literature. The objectives of this review are to scope the extent and nature of studies using qualitative systems mapping to facilitate the development of CLDs by stakeholders to understand food environments, including settings and populations represented, key findings and the methodological processes employed. It also seeks to identify gaps in knowledge and implications for policy and practice. Methods and analysis This protocol describes a scoping review guided by the Joanna Briggs Institute manual, the framework by Khalil and colleagues and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist reporting guidelines. A search strategy was iteratively developed with two academic librarians and the research team. This strategy will be used to search six databases, including Ovid MEDLINE, Embase, EmCare, Web of Science, Scopus and ProQuest Central. Identified citations will be screened by two independent reviewers; first, by title and abstract, and then full-text articles to identify papers eligible for inclusion. The reference lists of included studies and relevant systematic reviews will be searched to identify other papers eligible for inclusion. Two reviewers will extract information from all included studies and summarise the findings descriptively and numerically. Ethics and dissemination The scoping review will provide an overview of how CLDs developed by stakeholders have been elicited to understand food environments, diet and obesity, the insights gained and how the CLDs have been used. It will also highlight gaps in knowledge and implications for policy and practice. The review will be disseminated through publication in an academic journal and conference presentations.Use, Potential Use, and Awareness of the 988 Suicide and Crisis Lifeline by Level of Psychological Distress
AbstractPurtle, J., McSorley, A. M., Adera, A. L., & Lindsey, M. A. (n.d.).Publication year
2023Journal title
JAMA network openVolume
6Issue
10Page(s)
e2341383Abstract~Use, Potential Use, and Awareness of the 988 Suicide and Crisis Lifeline by Level of Psychological Distress
AbstractPurtle, J., McSorley, A.-M. M., Adera, A. L., & Lindsey, M. A. (n.d.). In JAMA network open.Publication year
2023Volume
6Issue
10AbstractIntroductionThe 988 Suicide and Crisis Lifeline was launched nationally on July 16, 2022. Increases in call volume following the launch of 988 hotline1 and public awareness2 and policy maker communication3 about the 988 Lifeline have been documented. However, little is known about how use or awareness of the 988 Lifeline varies across populations with different levels of psychological distress. This represents an important area of study.4 To address this, we assessed variations in use, potential use, and awareness of the 988 Lifeline among people with varying levels of psychological distress.