Implementing National Strategies at the Local Level
Success in implementing national health policies at the local level requires that resources and people are committed toward a common goal. This is an interactive process with several distinct phases and with opportunities to be influenced by decision makers at each stage. Specifically, a policy goes through the phases of formulation, implementation, evaluation, and modification (Abood, 2007). At each point, there are risks to the project’s implementation; risk of losing funding, failure to define the scope of the project adequately, lack of clear objectives and deliverables or failure of infrastructure and support systems. Perhaps most crucial in implementing national healthcare policies at the local level is enlisting the support, buy-in and ongoing commitment of providers of care who are familiar with regional issues.
In the case study, “Introducing Evidence-Based Practice in Mental Health in North Carolina” (McLaughlin & McLaughlin, 2008), the state of North Carolina attempts to induce changes to its mental health delivery system by introducing evidence-based practices into its clinics. Their success, however, is limited in part because of lack of ownership at the local level as well as absence of understanding at the national level to support implementation of the policies. An analysis of this case study also reveals that differences exist between clinical knowledge and practice in the field of mental health versus the concept of more formal evidence-based practices as dictated by outside agents at the national level. Gaps between the evidence-based claims of a national mental health policy and how those services are implemented at the local level also become apparent.
The Impetus for Change and Its Significance
The push for change in healthcare processes can come from a variety of sources. In the case study, “Introducing Evidence-Based Practice in Mental Health in North Carolina” (McLaughlin & McLaughlin, 2008), the driving stimulus behind the changes are twofold; one, the Surgeon General’s 1999 Report on Mental Health and later, the Presidents New Freedom Commission on Mental Health 2003’ Achieving the Promise: Transforming Mental Health in America. These evaluative reports identified current mental health services as being “fragmented, disconnected, and often inadequate” (McLaughlin & McLaughlin, 2008, p. 366) and challenged the mental health community with translating proven community-based mental health services into community settings. In addition, one of the initiatives that resulted from these reports was a national project aimed at reducing the time it takes for implementing evidence-based practices (EBPs) into the field of mental health. Part of that national initiative identified six EBPs and developed implementation resources to aid in their universal adoption. Follow-up to this initiative resulted in a grant program and North Carolina subsequently applied for and received a...