Disseminating Mental Health Evidence to State Legislators

1. Disseminating Mental Health Evidence to State LegislatorsJonathan Purtle, DrPH, MScDrexel University Dornsife School of Public HealthMilitary Suicide Research ConsortiumDissemination Science Institute NIMH: R21MH111806 (Purtle), R25MH080916 (Proctor) RWJF:73960 (Purtle)

3. My Burning Research Question:How Do We Translate Mental HealthEvidence into Policy? ?

4. The Importance of State Legislators • The 7,383 state legislators in the U.S. shape the architecture of mental health service systems • Allocation of tax revenue for services • Regulation of insurance markets • Affect social determinants of mental health • Most Legislators… • Lack specialized knowledge about mental health • Rely heaving on heuristics to make decisions • Have misconceptions about mental health issues and stigma towards people with mental illness

5. Dissemination & Implementation Research in Health

6. What is Dissemination? • Dissemination Science: • “The scientific study of targeted distribution of information and intervention materials to a specific public health or clinical practice audience. The intent is to understand how best to spread and sustain knowledge and the associated evidence-based interventions.” (NIH PAR-18-007) • “Implementation is the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings.”

7. Emphasis in the Field of D&I Research (my subjective appraisal)

8. 12 funded projects, 8.2%

9. Very Little Policy Dissemination Research Has Focused on Mental Health Williamson, A., Makkar, S. R., McGrath, C., & Redman, S. (2015). How can the use of evidence in mental health policy be increased? A systematic review. Psychiatric Services, 66(8), 783-797.

10. A Research Approach for Evidence-Based Dissemination

11. A Research Approach for Evidence-Based Dissemination • Step 1: Conduct formative research to assess a target audience’s… • Preferences for evidence • Content? Source? Framing? • Knowledge and opinions about evidence • Awareness of evidence about the prevalence of, risk factors for, and consequences of issue? Opinions about evidence-based intervention strategies? • -

12. Formative Research to Inform Development of Dissemination Strategies

13. Methods • March-September 2017: • Multi-modal survey (post-mail, e-mail, phone) of a state-stratified random sample of state legislators • Excluding their staff • Post-mail invitation to complete the survey online, two paper versions of the survey, called up to 15 times, received ten e-mail invitations to complete the survey online (28 recruitment attempts) \ • N= 475 (response rate= 16.4%) • Calculated and applied non-response weights accounting for political party, gender, and region

14. Sources that Legislators Turn to for Behavioral Health Evidence When Making Policy Decisions Purtle, J., Dodson, E., Nelson, K.L., Meisel, Z. Brownson, R. Legislators’ Sources of Behavioral Health Research and Preferences for Dissemination: Variations by Political Party. Psychiatric Services. 2018 Jul.

15. Sources that Legislators Turn to for Behavioral Health Evidence When Making Policy Decisions p< .001 Purtle, J., Dodson, E., Nelson, K.L., Meisel, Z. Brownson, R. Legislators’ Sources of Behavioral Health Research and Preferences for Dissemination: Variations by Political Party. Psychiatric Services. 2018 Jul.

16. “Very Important” Features of Disseminated Evidence: Purtle, J., Dodson, E., Nelson, K.L., Meisel, Z. Brownson, R. Legislators’ Sources of Behavioral Health Research and Preferences for Dissemination: Variations by Political Party. Psychiatric Services. 2018 Jul.

17. “Very Important” Features of Disseminated Evidence:Political Party p< .001 p< .001 Purtle, J., Dodson, E., Nelson, K.L., Meisel, Z. Brownson, R. Legislators’ Sources of Behavioral Health Research and Preferences for Dissemination: Variations by Political Party. Psychiatric Services. 2018 Jul.

18. Sources that Legislators Turn to for Behavioral Health Evidence When Making Policy Decisions

19. Sources that Legislators Turn to for Behavioral Health Evidence When Making Policy Decisions Purtle, J., Lê-Scherban, F., Nelson, K.L., Shattuck, P., Proctor, E.K., Brownson, R.C. State Mental Health Agency Officials’ Preferences for and Sources of Behavioral Health Research. Psychological Services. In press.

20. “Very Important” Features of Disseminated Evidence: Purtle, J., Lê-Scherban, F., Nelson, K.L., Shattuck, P., Proctor, E.K., Brownson, R.C. State Mental Health Agency Officials’ Preferences for and Sources of Behavioral Health Research. Psychological Services. In press.

21. Legislator Opinions about Adverse Childhood Experiences as Major Risk Factors for Adult Behavioral Health Conditions Purtle, J., Lê-Scherban, F., Wang, X., Chilton, M. Legislators’ Opinions about Adverse Childhood Experiences as Risk Factors for Adult Behavioral Health Conditions. Psychiatric Services. In press.

22. Legislator Opinions about Adverse Childhood Experiences as Major Risk Factors for Adult Behavioral Health Conditions Purtle, J., Lê-Scherban, F., Wang, X., Chilton, M. Legislators’ Opinions about Adverse Childhood Experiences as Risk Factors for Adult Behavioral Health Conditions. Psychiatric Services. In press.

23. Purtle, J., Lê-Scherban, F., Wang, X., Shattuck, P., Proctor, EK., Brownson, RC. State Legislator Support for Behavioral Health Parity Laws: The Influence of Mutable and Fixed Factors at Multiple Levels. Under review.

24. Purtle, J., Lê-Scherban, F., Wang, X., Shattuck, P., Proctor, EK., Brownson, RC. State Legislator Support for Behavioral Health Parity Laws: The Influence of Mutable and Fixed Factors at Multiple Levels. Under review.

25. A Research Approach for Evidence-Based Dissemination

26. A Research Approach for Evidence-Based Dissemination • Step 1: Conduct formative research • Step 2: Conduct audience segmentation research • Standard practice in marketing, common in health communication • Premise: Members of a population are heterogeneous in their knowledge, attitudes, and behaviors related to an issue • Identify discrete sub-groups that have similar characteristics • Tailored communication efforts are more effective than “one-size-fits-all” efforts • Demographic separation and empirical clustering approaches

28. Inspiration

29. Aims • Identify behavioral health audience segments among state legislators; • Identify legislator characteristics that are predictive of segment membership; and • Determine whether segment membership is predictive of support for state behavioral health parity laws

30. Methods • Latent class analysis • Identify audience segments • Assigned each legislator to the segment that they had the highest probability of belonging • Multi-level logistic regression (legislator, state) • Identify predictors of segment membership • Assess associations between segment membership and “strong support” for state parity laws

31. Results:Three Audience Segments Emerged

36. Legislator Characteristics Predictive of Segment Membership • Budget-Oriented Skeptics with Stigma • Most male (83.8%), Republican (73.6%), socially conservative (66.1%), and fiscally conservative (78.3%) • Action-Oriented Supporters • Most ideologically diverse segment: Democrat (51.5%), modal social ideology moderate (41.9%), modal fiscal ideology conservative (51.8%) • Passive Supporters • Most gender diversity (34.2% female, 65.9% male)

37. Predictive Validity of Segment Membership on Support for State Parity Laws

38. Do Legislators in Different Audience Segments Seek Behavioral Health Research from Different Sources?

39. Sources that Legislators Turn to for Behavioral Health Evidence When Making Policy Decisions

40. Sources that Legislators Turn to for Behavioral Health Evidence When Making Policy Decisions

41. Discussion:Implications for Dissemination Practice

42. Discussion:Implications for Dissemination Research • Empirical clustering approaches to audience segmentation have potential utility in D&I research • Approach can be extending to different populations and contexts • E.g., Psychologists and clinical practice guidelines • Future research should test effects of dissemination materials that are tailored vs. not tailored for audience segments

43. A Research Approach for Evidence-Based Dissemination

44. A Research Approach for Evidence-Based Dissemination • Step 1: Conduct formative research • Step 2: Conduct audience segmentation research • Step 3: Conduct field experiments to determine effectiveness of different dissemination strategies • Outcomes: • Engagement with evidence (e-mail open and link clink rates) • Attitudes towards and intent to use evidence (surveys) • Behaviors (observations) • Are case examples of PTSD treatment success from patient perspective more effective than examples form clinician perspective? • Is engagement with evidence summaries about PTSD practice guidelines higher when sent from professional society or an individual clinicians who are leaders in the field?

46. Testing Strategies to Communicate Evidence about Childhood Trauma While Minimizing Stigma towards Children and Families

47. Testing Strategies to Communicate Evidence about Childhood Trauma While Minimizing Stigma towards Children and Families

48. Concluding Thoughts • Evidence-based dissemination probably isn’t going to transform practice or policy • But it can help • It can help without substantial infusion of new resources (it can be done at low cost) • If we have perfect evidence about how to disseminate effectively, who would do it and why?

49. Thank You! • JPP46@Drexel.edu