Association for Public Policy Analysis & Management

In 2011, the Child and Family Services Improvement and Innovation Act required Title IV-E funded child welfare programs to submit a plan for the identification and treatment of the trauma experienced by children in foster care. This requirement affected the approximately 427,910 children placed in the United States foster care system. Of these children, approximately 90% have been exposed to trauma. While the evidence-base available to identify and treat this trauma expanded drastically over the past decade, limited studies exist examining whether and how this evidence is incorporated into systems-level policy responses. In response, we examine how decision-makers incorporate various types of information (including but not limited to evidence) in unique ways across the stages of developing, implementing, and evaluating a systems-level policy or programmatic response.

Methods

Semi-structured interviews were conducted with mid-level managers in child welfare, mental health, and Medicaid agencies (n=33); all respondents were involved in systems-level decisions to identify and treat the trauma experienced by children in foster care. Drawing on a decision-making ecology framework, we developed an interview guide in which respondents identified a recent and important decision in how the system seeks to identify or treat the trauma experienced by children in foster care. Respondents answered questions in four domains about the index decision: types of information used; influential values and other factors; focus, formality, frequency, and function of relevant collaborations; and trade-offs considered and thresholds for the decision made. Transcripts were analyzed using a five-stage modified framework analysis to systematically characterize data across respondents and the types and ways in which information was used.

Results

Policymakers reported using eight different types of information ranging from research evidence to testimony. The information type most often used was testimony and expert opinion. Decision-makers indicated that these types of information were dynamically used across policy stages to facilitate decisions that would optimize well-being of youth and service providers, assure implementation feasibility, and facilitate responsiveness to stakeholder perspectives. Using Research Utilization Models proposed by Weiss, decision-makers in the adoption stage were most likely to use the interactive model to gain a wide range of information on options that exist. While at the implementation and evaluation stage policymakers employed the problem-solving model to inform specific policy actions. At the implementation and evaluation stage, policymakers also used the conceptual model with greater frequency employing principles derived from available evidence to accommodate the under-specification of protocols for evidence-based practices.

Discussion and Policy Implications

Our taxonomy suggests that while policymakers used various types of information specific to this discrete policy arena, participants most often employed information gathered from the testimony of affected stakeholders. The model for research evidence use also varied across the policy development process. Accordingly, technical assistance efforts to promote use of evidence in mental health policy should assist decision-makers in how to elicit and accomodate stakeholder perspectives in selecting, implementing, and evaluating mental health policies across adoption, implementation, and evaluation.