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The Organizational Financial Context of Publicly-Funded Mental Health Clinics: Development and Preliminary Psychometric Evaluation of the Agency Financial Status Scales

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Abstract

Funding is a major barrier to implementation of evidence-based practices (EBPs) in publicly-funded community mental health clinics (CMHCs). Understanding how best to deploy implementation strategies that address this barrier requires greater clarity on the financial context within agencies. We developed the Agency Financial Status Scales (AFSS) to assess employee perceptions of the level of three hypothesized and theoretical funding related constructs in organizations: (a) perceptions of financial health, (b) financial attitudes toward EBPs, and (c) strategic financial climate. This investigation serves as a preliminary evaluation of this measure. Participants were 239 therapists and 40 supervisors from 25 publicly-funded CMHCs providing outpatient mental health services for young people. Confirmatory factor analysis was used to investigate the latent trait structure of the items. Internal consistency, interrater agreement, concordance between therapists and supervisors, and convergent validity were also examined. A two-factor model measuring perceptions of financial health and strategic financial climate best fit the data. For both of these scales, alpha reliability was acceptable and agreement statistics provided moderate support for aggregation at the organizational level. Analyses supported the convergent validity of the scales. The development and preliminary evaluation of the AFSS is an important first step in understanding the financial context of publicly-funded CMHCs. Though findings from this investigation are promising, additional development and testing are needed to develop a more thorough understanding of the constructs and to improve the validity and reliability of this measure.

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Funding

Funding for this research project was supported by the following grants from NIMH: (K23MH099179, Beidas; P50MH113840, Beidas, Buttenheim, Mandell). Additionally, TMM is supported by NIMH grant MH117014 and the Lifespan Brain Institute (LiBI) of the Children’s Hospital of Philadelphia. Rinad Beidas receives royalties from Oxford University Press. Rinad Beidas has served as a consultant for the Camden Coalition of Healthcare Providers and currently serves as a consultant to United Behavioral Health. She also serves on the Clinical and Scientific Advisory Committee for Optum Behavioral Health.

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Authors and Affiliations

  1. Department of Psychology, Temple University, Philadelphia, USA

    Colleen A. Maxwell & Philip C. Kendall

  2. Department of Psychology, University of Central Florida, Orlando, USA

    Mark G. Ehrhart

  3. School of Social Work, Boise State University, Boise, USA

    Nathaniel J. Williams

  4. Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, 3015, Philadelphia, PA, 19104, USA

    Tyler M. Moore & Rinad S. Beidas

  5. Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA

    Rinad S. Beidas

  6. Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA

    Rinad S. Beidas

  7. Penn Implementation Science Center At the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, USA

    Rinad S. Beidas

  8. Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania Perelman School of Medicine, Philadelphia, USA

    Rinad S. Beidas

Authors
  1. Colleen A. Maxwell
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  2. Mark G. Ehrhart
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  3. Nathaniel J. Williams
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  4. Tyler M. Moore
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  5. Philip C. Kendall
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  6. Rinad S. Beidas
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Corresponding author

Correspondence to Rinad S. Beidas.

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Appendices

Appendix

Agency Financial Status Scale

Instructions: Please indicate the extent to which you agree with each statement.

 

Not at all

Slight extent

Moderate extent

Great extent

Very great extent

1. Overall, this agency is in a state of financial distress

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2. The financial status of this agency has improved in recent years

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3. The ongoing financial viability of this agency is a major concern

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4. This agency is in a strong financial position

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5. One of this agency’s main goals is to manage its finances effectively

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6. People in this agency think that the organization's financial health is important

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7. Being financially viable is a top priority in this agency

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8. Evidence-based practices are expensive

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9. Evidence-based practices offer many financial advantages to this agency

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10. Our agency has done a good job of finding adequate funding for evidence-based practices

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11. This agency would not implement evidence-based practices if they were not externally funded

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Maxwell, C.A., Ehrhart, M.G., Williams, N.J. et al. The Organizational Financial Context of Publicly-Funded Mental Health Clinics: Development and Preliminary Psychometric Evaluation of the Agency Financial Status Scales. Adm Policy Ment Health 48, 780–792 (2021). https://doi.org/10.1007/s10488-021-01128-4

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