Project FISCAL: Adapting a Financial Planning Tool to Help Implementation and Mental Health Organizations Sustainably Scale their Impact

Summary

Organizations often struggle to maintain evidence-based mental health interventions after the initial training ends. Interventions can be expensive, and many organizations face the common problem of not having steady funding. This makes it hard to keep using the interventions and to use them on a larger scale.^1,2  Further, implementation organizations (e.g., intermediary and purveyor organizations which train mental health organizations in evidence-based treatments) and mental health organizations (e.g., provider organizations and digital mental health companies) often have trouble identifying financing strategies that will provide funding sustainability.^3,4  Without strategic financial planning, leaders in mental health organizations may de-prioritize offering evidence-based interventions or may stop serving low-income patients. This can result in organizations offering lower quality mental health services or only providing services to individuals with financial means.

Project FISCAL (Financing Implementation for Sustainable Care, Access, and Localization) will adapt a strategic financial planning tool (the fiscal mapping process) for implementation and mental health organizations. It uses human-centered design methods, which involves repeatedly refining a tool based on user feedback. The project will (1) identify key decisions leaders made when determining their organization’s financial model, (2) improve the fiscal mapping process with feedback from users, and (3) test whether the fiscal mapping process actually helps implementation and mental health organizations create sustainable financial plans.

Our team at Brown University is collaborating with experts in mental health financing, human-centered design, qualitative methods, and sustainable implementation. The study team also includes individuals with practical experience in digital mental health, implementation practice, and entrepreneurship to ensure the tool is practical.

Significance

Organizations in this study will learn funding strategies to help them deliver evidence-based mental health interventions sustainably and equitably. Especially given recent changes in federal policy, implementation and mental health organizations can struggle to identify sustainable sources of revenue. Without the help of clear business models, organizations can end up laying off staff or struggling to serve lower-income patients. As part of the fiscal mapping process, organizations will consider how their financial model impacts who has access to their services. Through improved financial planning, implementation and mental health organizations will be better able to improve the mental health of the populations they serve.

Benefits

Demonstrated benefits are those that have been observed and are verifiable.

Potential benefits are those logically expected with moderate to high confidence.

Community & public health benefits

Enable novel clinical treatments to reach broader populations at scale. potential.

Resource access

Primary beneficiary:

Patients

Enable digital mental health programs to be accessed by patients at scale. potential.

Consumer software

Primary beneficiary:

Patients

Economic benefits

Lower cost of mental health services paid by patients. potential.

Cost savings

Primary beneficiary:

Patients

Help individuals create implementation and mental health organizations through strategic financial planning. potential.

Non-profit or commercial entities

Primary beneficiary:

Service providers

This research has community and economic implications. The framework for these implications was derived from the Translational Science Benefits Model created by the Institute of Clinical & Translational Sciences at Washington University in St. Louis.⁵ 

Community

Implementation and mental health organizations must be financially stable to offer the community evidence-based mental health services at scale. Innovative, high-quality treatments can only benefit the community if companies have a financial model to disseminate the treatments to patients. 

Economic

This study will support implementation and mental health organizations in achieving financial stability through strategic financial planning. Participating organizations will receive direct coaching to build their financial plans and explore strategies that can reduce patients’ costs for care. Study findings will help other organizations with their financial planning, whether they are starting a new business or adapting their financial plan to fit the current economy. Industry consultants, university technology transfer offices, and investors can use study findings and the fiscal mapping process in their work. 

Lessons Learned

We anticipate that our transdisciplinary team will help the study be successful. The study team includes research experts in implementation science, human centered design, mental health financing, and qualitative methods, as well as experts with practice-based expertise in digital mental health, implementation, and entrepreneurship. Additionally, the adapted fiscal mapping process is likely to be more useable given we will seek iterative feedback from end users.