Exploring County-Level Resources Influencing Evidence-Based Practices and Treatment Uptake in Behavioral Health...

Evidence-Based Practices and Treatments (EBPTs) are recommended to improve outcomes for individuals with behavioral health disorders and the service delivery system. However, costs associated with EBPTs are frequently cited as a barrier to implementation and sustainability. This study examines the relationship between existing and new resources and the availability of different types of EBPTs for individuals involved with criminal-legal systems (police, court, probation, and jail) in 519 U.S. counties. Significant predictors of EBPs in criminal justice programs (CJ-EBPs) and evidence-based treatments (EBTs) were identified using Poisson count regression models. Similar models were used to predict outcomes related to the availability of higher-, medium-, low-, and minimal-cost programs. More EBPs occur in counties with populations over 750,000, fewer individuals receiving behavioral health service, increased funding for intensive programs, more grants received, more skilled staff, in a Medicaid expansion state, and counties that participate in the Stepping-Up initiative. Specifically, Stepping-Up participation and Medicaid expansion were the only significant predictors for medium and minimal-cost CJ-EBPs. Existing staff resources coupled with a history of prior grants largely influence the availability of CJ-EBPs and EBTs. Improving county staffing patterns, particularly through peer support and resources may increase the availability of EBP and EBTs in a county.