Table 1.

Summary of shifts in policy strategies since the publication of the original PEF in 2008

Level in the policy ecology	Context description	Key changes
Organizational context	• Clinical settings within which EBPs are delivered	• Original PEF refers to as a service delivery organization, i.e., community mental health center • Affordable Care Act changed the organizational landscape:  ◦ Fourteen states have adopted Medicaid ACOs or ACO-like entities  ◦ Sixteen states are considering adoption of Episodes of care programs  ◦ Value-based purchasing implemented in 48 jurisdictions • Prior authorization is largely extinct • Rise of novel marketplaces (Children’s Service Funds)
Agency context	• Local or state bodies that oversee or influence this organizational activity	• Changed environment for contracting and bidding towards outcomes-based purchasing
		• Increased consumer involvement
		• Expanded loan forgiveness programs (largely due to ACA) expanded workforce
Political context	• All legislative and advocacy efforts that support the implementation of EBPs	• Both the Mental Health Parity and Addiction Equity Act and the ACA were passed after the publication of PEF
		• Increased emphasis on racial justice, structural stigma, and institutional racism in regulation
		• Increase in legislation directed at specific evidence-based practices (e.g., Family First Prevention Services Act)
Social context	• Cultural and structural factors that shape access to EBPs	• Increasing awareness of structural stigma (not just self-stigma), and institutionalized racism • Increasing efforts to meaningfully include individuals with lived experience in the research and dissemination process to ensure that outputs and activities involve coproduction