Race and Equity in Statewide Implementation Programs: An Application of the Policy Ecology of Implementation Framework
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ORIGINAL ARTICLE
Race and Equity in Statewide Implementation Programs: An Application of the Policy Ecology of Implementation Framework Martha J. Aby1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Although the literature is growing regarding large-scale, system-wide implementation programs, the broader political and social contexts, including race and ethnicity, are frequently ignored. Using the Policy Ecology of Implementation framework (Raghavan et al., Implement Sci 3:26, 2008), Minnesota’s CEMIG is examined to investigate the role of social and political contexts in the implementation process and the barriers they create. Data from 22 interview transcripts from DHS administrators, agency grant managers, university educators, advocacy group representatives, and mental health board members, along with more than 1000 grant documents were qualitatively analyzed using content analysis to reveal three themes concerning how the participants experienced program implementation: invisibility, isolation, and inequity. Findings demonstrate the participants perceived that the grant program perpetuated inequities by neglecting to promote the program, advocate for clinicians of color, and coordinate isolated policy ecology systems. Strategies for future large-scale, system-wide mental health program implementation are provided. Keywords Case study · Policy ecology · Race and ethnicity
Introduction In the last few years, several large-scale, system-wide implementation initiatives in community mental health have been the subject of research inquiry. Often these studies focus on the individual clinician (Olin et al. 2016; Powell et al. 2017) or organizational characteristics that support adoption of EBPs (Skriner et al. 2017) within a large-scale, system-wide program. Recent literature has expanded the focus of inquiry to include social and policy levers within system-wide initiatives that can augment or hinder implementation (Stone et al. 2019; Walker et al. 2019). One potential analytic tool that helps uncover social and political factors, the Policy Ecology of Implementation (PEI) framework, was created to emphasize the role of the broader ecology in the implementation process (Raghavan et al. 2008). Using an ecological model, PEI views implementation in context with all of the systems that interact with an initiative (Raghavan et al. 2008; Walker et al. 2019) such as: the individual clinical * Martha J. Aby [email protected] 1
University of Washington, 4101 15th Avenue NE, Seattle, WA 98105, USA
encounter, provider agency, government regulatory agency, graduate training programs, political institutions (e.g., mental health boards and legislation), and social issues (e.g., stigma and cultural factors). As large-scale, system-wide implementation efforts occur within racially and ethnically diverse jurisdictions across the country, such Los Angeles County (BrookmannFrazee et al. 2016; Southam-Gerow et al. 2014); Philadelphia, Pennsylvania (Beidas et al. 2016; Powell et al. 2017; Skriner et
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