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
Purtle and roman respond
AbstractPurtle, J., & Roman, L. A. (n.d.).Publication year
2015Journal title
American journal of public healthVolume
105Issue
10Page(s)
e9-e10Abstract~Purtle responds
AbstractPurtle, J. (n.d.).Publication year
2013Journal title
American journal of public healthVolume
103Issue
11Page(s)
e6-e8Abstract~Quantifying the Restrictiveness of Local Housing Authority Policies Toward People with Criminal Justice Histories : United States, 2009-2018
AbstractPurtle, J., Gebrekristos, L. T., Keene, D., Schlesinger, P., Niccolai, L., & Blankenship, K. M. (n.d.).Publication year
2020Journal title
American journal of public healthVolume
110Issue
S1Page(s)
S137-S144AbstractObjectives. To quantify variation in the restrictiveness of local public housing authority policies related to the admission and eviction of people with criminal justice histories. Methods. We conducted content analysis of housing authority policy documents for US cities with a population of 100 000 or more (n = 152). Factor analysis identified policy provisions to create a restrictiveness score (range = 0-8). We explored associations between restrictiveness scores and city-level measures of racial/ethnic diversity, racial/ethnic neighborhood segregation, ideology, and public housing scarcity. Results. Eight policy provisions, 6 relating to consideration of mitigating circumstances, explained 71.0% of the variance in housing authority policy provisions related to criminal justice histories. We observed small but significant positive associations between restrictiveness scores and racial/ethnic diversity (r = 0.22) and neighborhood segregation (r = 0.18). There was no correlation between restrictiveness scores of housing authorities within the same state (intraclass correlation = 0.0002). Conclusions. Housing authority policies vary substantially regarding the circumstances under which people with criminal justice histories can obtain and retain public housing. Exposure to constellations of policy provisions that might institutionalize health inequities and increase health risk among people with criminal justice histories can be quantified through a systematic process. (Am J Public Health. 2020;110:S137-S144. doi: 10.2105/AJPH.2019.305437).Quantitative measures of health policy implementation determinants and outcomes : A systematic review
AbstractAllen, P., Pilar, M., Walsh-Bailey, C., Hooley, C., Mazzucca, S., Lewis, C. C., Mettert, K. D., Dorsey, C. N., Purtle, J., Kepper, M. M., Baumann, A. A., & Brownson, R. C. (n.d.).Publication year
2020Journal title
Implementation ScienceVolume
15Issue
1AbstractBackground: Public policy has tremendous impacts on population health. While policy development has been extensively studied, policy implementation research is newer and relies largely on qualitative methods. Quantitative measures are needed to disentangle differential impacts of policy implementation determinants (i.e., barriers and facilitators) and outcomes to ensure intended benefits are realized. Implementation outcomes include acceptability, adoption, appropriateness, compliance/fidelity, feasibility, penetration, sustainability, and costs. This systematic review identified quantitative measures that are used to assess health policy implementation determinants and outcomes and evaluated the quality of these measures. Methods: Three frameworks guided the review: Implementation Outcomes Framework (Proctor et al.), Consolidated Framework for Implementation Research (Damschroder et al.), and Policy Implementation Determinants Framework (Bullock et al.). Six databases were searched: Medline, CINAHL Plus, PsycInfo, PAIS, ERIC, and Worldwide Political. Searches were limited to English language, peer-reviewed journal articles published January 1995 to April 2019. Search terms addressed four levels: health, public policy, implementation, and measurement. Empirical studies of public policies addressing physical or behavioral health with quantitative self-report or archival measures of policy implementation with at least two items assessing implementation outcomes or determinants were included. Consensus scoring of the Psychometric and Pragmatic Evidence Rating Scale assessed the quality of measures. Results: Database searches yielded 8417 non-duplicate studies, with 870 (10.3%) undergoing full-text screening, yielding 66 studies. From the included studies, 70 unique measures were identified to quantitatively assess implementation outcomes and/or determinants. Acceptability, feasibility, appropriateness, and compliance were the most commonly measured implementation outcomes. Common determinants in the identified measures were organizational culture, implementation climate, and readiness for implementation, each aspects of the internal setting. Pragmatic quality ranged from adequate to good, with most measures freely available, brief, and at high school reading level. Few psychometric properties were reported. Conclusions: Well-tested quantitative measures of implementation internal settings were under-utilized in policy studies. Further development and testing of external context measures are warranted. This review is intended to stimulate measure development and high-quality assessment of health policy implementation outcomes and determinants to help practitioners and researchers spread evidence-informed policies to improve population health.Review of Emergent Financing Models for Mental Health Crisis Systems
AbstractPurtle, J., Mauri, A. I., & Frederick, D. (n.d.).Publication year
2025Journal title
Milbank QuarterlyAbstractPolicy Points The sources and adequacy of funding for crisis systems currently varies significantly among the US states and across services in the crisis continuum. Crisis services are funded by a wide range of sources, including 988 telecom fees and other state appropriations, community mental health services block grants and other federal funding sources, Medicaid, and commercial insurance. Priority areas for research related to financing crisis systems include evaluating the effects of 988 telecom fees, value-based payment models, and non-Medicaid payors.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.Scaling 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
2022Journal title
Prevention ScienceAbstractPolicy 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.Scared safe? Abandoning the use of fear in urban violence prevention programmes
AbstractPurtle, J., Jonathan, J. P., Cheney, R., Wiebe, D. J., & Dicker, R. (n.d.).Publication year
2015Journal title
Injury PreventionVolume
21Issue
2Page(s)
140-141Abstract~Selecting evidence to frame the consequences of adverse childhood experiences : testing effects on public support for policy action, multi-sector responsibility, and stigma
AbstractGollust, S. E., Nelson, K. L., & Purtle, J. (n.d.).Publication year
2022Journal title
Preventive MedicineVolume
154AbstractWhile clinical and public health researchers have produced a high volume of research evidence about the consequences of ACEs, there is limited research on public understanding of ACEs or how to most effectively communicate about this body of science. The objective of this study was to determine which messages describing evidence about the consequences of adverse childhood experiences (ACEs) affect public perceptions. We conducted an online experiment with a nationally-representative sample of U.S. adults in July–August 2020. Participants were randomized to control groups receiving messages describing ACE prevalence or resilience, or treatment groups receiving messages describing consequences of ACEs on mental health and substance use, economics, racial equity, or biology. We compared respondents' perceptions of prevention policies and likelihood of policy engagement, attributions of multi-sector responsibility, and blame and stigma across experimental groups. Messages about economic consequences increased respondents' support for policy and attributions of multi-sector responsibility relative to control groups, while also increasing parental blame. The message describing racial equity lowered respondents' perceptions of importance of state policy action and attributions of responsibility to health care. None of the messages affected stigmatizing attitudes. Describing the economic consequences of ACEs on public systems boosts public support for policy action. More research is needed on how the public responds to messaging connecting systemic racism with childhood adversity and health.Simulating the role of knowledge brokers in policy making in state agencies : An agent-based model
AbstractCombs, T., Nelson, K. L., Luke, D., McGuire, F. H., Cruden, G., Henson, R. M., Adams, D. R., Hoagwood, K. E., & Purtle, J. (n.d.).Publication year
2022Journal title
Health Services ResearchVolume
57 Suppl 1Issue
S1Page(s)
122-136AbstractObjective: To model children's mental health policy making dynamics and simulate the impacts of knowledge broker interventions. Data sources: Primary data from surveys (n = 221) and interviews (n = 64) conducted in 2019–2021 with mental health agency (MHA) officials in state agencies. Study design: A prototype agent-based model (ABM) was developed using the PARTE (Properties, Actions, Rules, Time, Environment) framework and informed through primary data collection. In each simulation, a policy is randomly generated (salience weights: cost, contextual alignment, and strength of evidence) and discussed among agents. Agents are MHA officials and heterogenous in their properties (policy making power and network influence) and policy preferences (based on salience weights). Knowledge broker interventions add agents to the MHA social network who primarily focus on the policy's research evidence. Data collection/extraction methods: A sequential explanatory mixed method approach was used. Descriptive and regression analyses were used for the survey data and directed content analysis was used to code interview data. Triangulated results informed ABM development. In the ABM, policy makers with various degrees of decision influence interact in a scale-free network before and after knowledge broker interventions. Over time, each decides to support or oppose a policy proposal based on policy salience weights and their own properties and interactions. The main outcome is an agency-level decision based on policy maker support. Each intervention and baseline simulation runs 250 times across 50 timesteps. Principal findings: Surveys and interviews revealed that barriers to research use could be addressed by knowledge brokers. Simulations indicated that policy decision outcomes varied by policy making context within agencies. Conclusions: This is the first application of ABM to evidence-informed mental health policy making. Results suggest that the presence of knowledge brokers can: (1) influence consensus formation in MHAs, (2) accelerate policy decisions, and (3) increase the likelihood of evidence-informed policy adoption.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 and Local Government Expenditures and Infant Mortality in the United States
AbstractGoldstein, N. D., Palumbo, A. J., Bellamy, S. L., Purtle, J., & Locke, R. (n.d.).Publication year
2020Journal title
PediatricsVolume
146Issue
5AbstractBACKGROUND AND OBJECTIVES: Evidence suggests that government expenditures on non–health care services can reduce infant mortality, but it is unclear what types of spending have the greatest impact among groups at highest risk. Thus, we sought to quantify how US state government spending on various services impacted infant mortality rates (IMRs) over time and whether spending differentially reduced mortality in some subpopulations. METHODS: A longitudinal, repeated-measures study of US state-level infant mortality and state and local government spending for the years 2000–2016, the most recent data available. Expenditures included spending on education, social services, and environment and housing. Using generalized linear regression models, we assessed how changes in spending impacted infant mortality over time, overall and stratified by race and ethnicity and maternal age group. RESULTS: State and local governments spend, on average, $9 per person. A $0.30 per-person increase in environmental spending was associated with a decrease of 0.03 deaths per 1000 live births, and a $0.73 per-person increase in social services spending was associated with a decrease of 0.02 deaths per 1000 live births. Infants born to mothers aged,20 years had the single greatest benefit from an increase in expenditures compared with all other groups. Increased expenditures in public health, housing, parks and recreation, and solid waste management were associated with the greatest reduction in overall IMR. CONCLUSIONS: Investment in non–health care services was associated with lower IMRs among certain high-risk populations. Continued investments into improved social and environmental services hold promise for further reducing IMR disparities.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~State legislators' opinions about adverse childhood experiences as risk factors for adult behavioral health conditions
AbstractPurtle, J., Lê-Scherban, F., Wang, X., Brown, E., & Chilton, M. (n.d.).Publication year
2019Journal title
Psychiatric ServicesVolume
70Issue
10Page(s)
894-900AbstractObjectives: Adverse childhood experiences (ACEs) increase risk of adult behavioral health conditions. State legislators are an important audience to target with evidence about ACEs because they make policy decisions that can prevent ACE exposure and enhance resilience. This study sought to describe state legislators' opinions about ACEs as risk factors for adult behavioral health conditions and identify how opinions vary between legislators with different characteristics. Methods: A multimodal survey was conducted in 2017 (response rate, 16.4%; N=475). Dependent variables were the extent to which legislators thought that four ACEs-sexual abuse, physical abuse, witnessing domestic violence, and childhood neglect-increase risk of adult behavioral health conditions. Independent variables were legislator characteristics (e.g., ideology and gender). Rao-Scott chi-square tests and multivariable logistic regression were conducted. Results: Childhood sexual abuse was identified as a major risk factor by the largest proportion of respondents (77%), followed by childhood physical abuse (59%), witnessing domestic violence (39%), and childhood neglect (38%). The proportion identifying each ACE as a major risk factor was significantly higher among Democrats than among Republicans, liberals than among conservatives, and women than among men. For example, 56% of liberals identified witnessing domestic violence as a major risk factor, compared with 29% of conservatives (p,.001). Conclusions: Opinions about ACEs as risk factors for adult behavioral health conditions varied between legislators with different characteristics, especially liberals and conservatives. To enhance the policy impact of evidence about ACEs, advocates might consider developing multiple versions of ACE evidence summaries that are tailored on the basis of these characteristics.State Legislators’ Divergent Social Media Response to the Opioid Epidemic from 2014 to 2019 : Longitudinal Topic Modeling Analysis
AbstractStokes, D. C., Purtle, J., Meisel, Z. F., & Agarwal, A. K. (n.d.).Publication year
2021Journal title
Journal of general internal medicineVolume
36Issue
11Page(s)
3373-3382AbstractBackground: The opioid epidemic is widely recognized as a legislative priority, but there is substantial variation in state adoption of evidence-based policy. State legislators’ use of social media to disseminate information and to indicate support for specific initiatives continues to grow and may reflect legislators’ openness to opioid-related policy change. Objective: We sought to identify changes in the national dialogue regarding the opioid epidemic among Democratic and Republican state legislators and to estimate changing partisanship around understanding and addressing the epidemic over time. Design: Longitudinal natural language processing analysis. Participants: A total of 4083 US state legislators in office between 2014 and 2019 with any opioid-related social media posts. Main Measures: Association between opioid-related post volume and state overdose mortality, as measured by Kendall’s rank correlation coefficient. Latent Dirichlet allocation analysis of all social media posts to identify key opioid-related topics. Longitudinal analysis of differences in the prevalence of key topics among Democrats and Republicans over time. Key Results: In total, 43,558 social media posts met inclusion criteria, with the vast majority to Twitter (n=28,564; 65.6%) or Facebook (n=14,283; 32.8%). Posts were more likely to mention fentanyl and less likely to mention heroin over time. The volume of opioid-related content was positively associated with state-level unintentional overdose mortality among both Democrats (tau=0.42, PState Legislators’ Support for Behavioral Health Parity Laws : The Influence of Mutable and Fixed Factors at Multiple Levels
AbstractPurtle, J., Lê-Scherban, F., Wang, X., Shattuck, P. T., Proctor, E. K., & Brownson, R. C. (n.d.).Publication year
2019Journal title
Milbank QuarterlyVolume
97Issue
4Page(s)
1200-1232AbstractPolicy Points When communicating with state legislators, advocates for state behavioral health parity laws should emphasize that the laws do not increase insurance premiums. Legislators’ opinions about the impacts of state behavioral health parity laws and the effectiveness of behavioral health treatment have more influence on support for the laws than do their political party affiliation or state-level contextual factors. Reducing legislators’ stigma toward people with mental illness could increase their support for state behavioral health parity laws. Context: Comprehensive state behavioral health parity legislation (C-SBHPL) is an evidence-based policy that improves access and adherence to behavioral health treatments. However, adoption of C-SBHPL by state legislators is low. Little is known about how C-SBHPL evidence might be most effectively disseminated to legislators or how legislators’ fixed characteristics (eg, ideology), mutable characteristics (eg, beliefs about the policy's impact), and state-level contextual factors might influence their support for behavioral health policies. The purpose of our study is (1) to describe the associations between legislators’ fixed and mutable characteristics, state-level contextual factors, and support for C-SBHPL; and (2) to identify the mutable characteristics of legislators independently associated with C-SBHPL support. Methods: We conducted a multimodal (post mail, email, telephone) survey of US state legislators in 2017 (N = 475). The dependent variable was strong support for C-SBHPL, and the independent variables included legislators’ fixed and mutable characteristics and state-level contextual factors. We conducted multivariable, multilevel (legislator, state) logistic regression. Findings: Thirty-nine percent of the legislators strongly supported C-SBHPL. After adjustment, the strongest predictors of C-SBHPL support were beliefs that C-SBHPL increases access to behavioral health treatments (aOR = 5.85; 95% CI = 2.41, 14.20) and does not increase insurance premiums (aOR = 2.70; 95% CI = 1.24, 5.90). Stigma toward people with mental illness was inversely associated with support (aOR = 0.86; 95% CI = 0.78, 0.95). After adjustment, ideology was the only fixed characteristic significantly associated with support for C-SBHPL. State-level contextual factors did not moderate associations between mutable characteristics and support for C-SBHPL. Conclusions: Legislators’ mutable characteristics are stronger predictors of C-SBHPL support than are most of their fixed characteristics and all state-level contextual factors, and thus should be targeted by dissemination efforts.State Mental Health Agency Officials' Preferences for and Sources of Behavioral Health Research
AbstractPurtle, J., Lê-Scherban, F., Nelson, K. L., Shattuck, P. T., Proctor, E. K., & Brownson, R. C. (n.d.).Publication year
2019Journal title
Psychological ServicesAbstractState mental health agencies (SMHAs) are integral to public behavioral health service systems. As such, senior-level officials within SMHAs are important targets for advocacy and dissemination of behavioral health research findings. Evidence-informed decision making in SMHAs can potentially be enhanced by developing summaries of behavioral health research (e.g., policy briefs) that reflect SMHA officials' information preferences, but knowledge about these preferences is lacking. An exploratory study was conducted with the aims of characterizing senior-level SMHA officials' preferences for behavioral health research and describing where they turn for this research when making policy decisions. A crosssectional, web-based survey of senior-level SMHA officials (1 per state) was conducted in March±May 2017 (n = 43, response rate = 84%). The features of behavioral health research that SMHA officials identified as "very important" most frequently were research being relevant to state residents (93.0%), providing data on cost-effectiveness (86.0%) and budget impact (81.4%), and being presented concisely (81.0%). The primary sources that SMHA officials turned to for behavioral research when making policy decisions were professional organizations (79.1%), SMHA agency staff (60.5%), and university researchers (55.8%). Compared with state legislators' responses to the same survey questions, results suggest that senior-level SMHA officials and legislators have similar preferences for behavioral health research but turn to different sources for this research. Advocates and researchers who seek to promote evidenceinformed decision making in SMHAs should consider developing policy briefs that are concise, provide state-level prevalence data about behavioral conditions, and contain economic evaluation data, and they should disseminate these materials to multiple sources.State Parental Consent Law and Treatment Use Among Adolescents With Depression
AbstractSchleider, J. L., Smock, A., Ahuvia, I. L., Walubita, T., Rapoport, A. S., Hill, S., & Purtle, J. (n.d.).Publication year
2025Journal title
JAMA PediatricsVolume
179Issue
2Page(s)
209-212Abstract~State Policies that Impact the Design of Children’s Mental Health Services : A Modified Delphi Study
AbstractNelson, K. L., Powell, B. J., Langellier, B., Lê-Scherban, F., Shattuck, P., Hoagwood, K., & Purtle, J. (n.d.).Publication year
2022Journal title
Administration and Policy in Mental Health and Mental Health Services ResearchVolume
49Issue
5Page(s)
834-847AbstractTo identify the state-level policies and policy domains that state policymakers and advocates perceive as most important for positively impacting the use of children’s mental health services (CMHS). We used a modified Delphi technique (i.e., two rounds of questionnaires and an interview) during Spring 2021 to elicit perceptions among state mental health agency officials and advocates (n = 28) from twelve states on state policies that impact the use of CMHS. Participants rated a list of pre-specified policies on a 7-point Likert scale (1 = not important, 7 = extremely important) in the following policy domains: insurance coverage and limits, mental health services, school and social. Participants added nine policies to the initial list of 24 policies. The “school” policy domain was perceived as the most important, while the “social” policy domain was perceived as the least important after the first questionnaire and the second most important policy domain after the second questionnaire. The individual policies perceived as most important were school-based mental health services, state mental health parity, and Medicaid reimbursement rates. Key stakeholders in CMHS should leverage this group of policies to understand the current policy landscape in their state and to identify gaps in policy domains and potential policy opportunities to create a more comprehensive system to address children’s mental health from a holistic, evidence-based policymaking perspective.State-Level Social and Economic Policies and Their Association With Perinatal and Infant Outcomes
AbstractWebster, J. L., Paul, D., Purtle, J., Locke, R., & Goldstein, N. D. (n.d.).Publication year
2022Journal title
Milbank QuarterlyVolume
100Issue
1Page(s)
218-260AbstractPolicy Points State-level social and economic policies that expand tax credits, increase paid parental leave, raise the minimum wage, and increase tobacco taxes have been demonstrated to reduce adverse perinatal and infant health outcomes. These findings can help prioritize evidence-based legislated policies to improve perinatal and infant outcomes in the United States. Context: Rates of preterm birth and infant mortality are alarmingly high in the United States. Legislated efforts may directly or indirectly reduce adverse perinatal and infant outcomes through the enactment of certain economic and social policies. Methods: We conducted a narrative review to summarize the associations between perinatal and infant outcomes and four state-level US policies. We then used a latent profile analysis to create a social and economic policy profile for each state based on the observed policy indicators. Findings: Of 27 articles identified, nine focused on tax credits, eight on paid parental leave, four on minimum wages, and six on tobacco taxes. In all but three studies, these policies were associated with improved perinatal or infant outcomes. Thirty-three states had tax credit laws, most commonly the earned income tax credit (n = 28, 56%). Eighteen states had parental leave laws. Two states had minimum wage laws lower than the federal minimum; 14 were equal to the federal minimum; 29 were above the federal minimum; and 5 did not have a state law. The average state tobacco tax was $1.76 (standard deviation = $1.08). The latent profile analysis revealed three policy profiles, with the most expansive policies in Western and Northeastern US states, and the least expansive policies in the US South. Conclusions: State-level social and economic policies have the potential to reduce adverse perinatal and infant health outcomes in the United States. Those states with the least expansive policies should therefore consider enacting these evidence-based policies, as they have shown a demonstratable benefit in other states.Strengthening partnerships between substance use researchers and policy makers to take advantage of a window of opportunity
AbstractMeisel, Z. F., Mitchell, J., Polsky, D., Boualam, N., McGeoch, E., Weiner, J., Miclette, M., Purtle, J., Schackman, B., & Cannuscio, C. C. (n.d.).Publication year
2019Journal title
Substance Abuse: Treatment, Prevention, and PolicyVolume
14Issue
1AbstractBackground: The National Institute on Drug Abuse has identified a persistent research-to-practice gap in the implementation of evidence-based prevention and treatment programs for substance use disorder. To identify mechanisms to close this gap, we sought to obtain and characterize the range of policy makers' perspectives on the use of research in substance use disorder treatment and coverage decisions. Methods: We conducted open-ended, semi-structured interviews with a purposive sample of eighteen policy makers involved in the delivery of health services. The aim was to identify barriers and facilitators, attitudes, beliefs, and experiences surrounding the use of research related to the treatment and economics of substance use disorder. Results: The analysis generated four themes: 1) policy maker engagement with evidence and researchers; 2) strategic use and usefulness of research; 3) scientific rigor versus relevance; and 4) communication of evidence. Within each theme, the participants identified barriers, facilitators, current practice, and gave their perspectives on "ideal conditions" for research design, conduct and communication. Conclusions: Recommendations for investigators are the following actionable steps: 1) partner with policy makers early in the research process, 2) formulate and use research designs to meet the strategic goals of end-users; 3) systematically test alternative phrasing of scientific terminology - particularly in the realm of cost effectiveness research - that allow end users to better understand and repurpose the data; 4) incorporate qualitative research methods to uncover the narratives that explain the context and relevance of evidence; 5) incorporate study designs that prioritize timeliness of results; and 6) promote and reward researcher involvement in policy discussions.Systematic Review of Evaluations of Trauma-Informed Organizational Interventions That Include Staff Trainings
AbstractPurtle, J. (n.d.).Publication year
2020Journal title
Trauma, Violence, and AbuseVolume
21Issue
4Page(s)
725-740AbstractEnthusiasm for trauma-informed practice has increased dramatically. Organizational interventions that train staff about trauma-informed practice are frequently used to promote trauma-informed systems change, but evidence about these interventions’ effects has not been integrated. A systematic review was conducted of studies that evaluated the effects of organizational interventions that included a “trauma-informed” staff training component. A search was conducted in July 2017 and studies were identified in PubMed, PsycINFO, and the Published International Literature on Traumatic Stress database, limited to articles published in English after 2000. Six hundred and thirty-two articles were screened and 23 met inclusion criteria. Seventeen studies used a single group pretest/posttest design, five used a randomized controlled design, and one used a quasi-experimental design with a nonrandomized control group. The duration of trauma-informed trainings ranged from 1 hr to multiple days. Staff knowledge, attitudes, and behaviors related to trauma-informed practice improved significantly pre-/posttraining in 12 studies and 7 studies found that these improvements were retained at ≥1month follow-up. Eight studies assessed the effects of a trauma-informed organizational intervention on client outcomes, five of which found statistically significantly improvements. The strength of evidence about trauma-informed organization intervention effects is limited by an abundance of single group, pretest/posttest designs with short follow-up periods, unsophisticated analytic approaches, and inconsistent use of assessment instruments. In addition to addressing these methodological limitations, priorities for future research include understanding intervention effects on clients’ perceptions of care and the mechanisms through which changes in staff knowledge and attitudes about trauma-informed practice influence client outcomes.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.The 988 Suicide and Crisis Lifeline in the US : status of evidence on implementation
AbstractPurtle, J., & Lindsey, M. A. (n.d.).Publication year
2025Journal title
World PsychiatryVolume
24Issue
1Page(s)
135-136Abstract~The Affordable Care Act’s Medicaid expansion creates incentive for state Medicaid agencies to provide reimbursement for hospital-based violence intervention programmes
AbstractFischer, K., Purtle, J., & Corbin, T. (n.d.).Publication year
2014Journal title
Injury PreventionVolume
20Issue
6Page(s)
427-430Abstract~