Perspectives on Financing Strategies for Evidence-Based Treatment Implementation in Youth Mental Health Systems

Background: Evidence-based treatments (EBTs) are critical to ef-fectively address mental health problems among children and adoles-cents, but costly for mental health service agencies to implement and sustain. Financing strategies help agencies overcome cost-related barriers by obtaining financial resources to support EBT implemen-tation and/or sustainment. Aims: We sought to (i) understand how youth mental health system decision-makers involved with EBT implementation and sustain-ment view key features (e.g., relevance, feasibility) that inform fi-nancing strategy selection and (ii) compare service agency, funding agency, and intermediary representative perspectives. Method: Two surveys were disseminated to 48 representatives across U.S. youth mental health service agencies, funding agencies, and intermediaries who were participating in a larger study of financ-ing strategies. Quantitative and qualitative data were gathered on 23 financing strategies through quantitative ratings and open-ended responses. Data were analyzed using descriptive statistics and rapid content analysis. Results: The financing strategies rated as most relevant include braided funding streams, contracts for EBTs, credentialing/rostering providers, fee-for-service reimbursement (regular and increased), and grant funding. All other strategies were unfamiliar to 1/3 to 1/2 of participants. The six strategies were rated between somewhat and quite available, feasible, and effective for EBT sustainment. For sus-taining different EBT components (e.g., delivery, materials), the mix of financing strategies was rated as somewhat adequate. Qualitative analysis revealed challenges with strategies being non-recurring or unavailable in representatives' regions. Ratings were largely similar across participant roles, though funding agency representatives were the most familiar with financing strategies.