PHILADELPHIA—Researchers at the Perelman School of Medicine at the University of Pennsylvania will receive $6.4 million in funding from the National Institute of Mental Health (NIMH) to create a new center to improve mental health service delivery through behavioral economics and implementation science. Insights from behavioral economics are increasingly being applied in health care settings to identify and correct decision errors that contribute to health problems. Implementation science is the study of methods to promote the use of evidence-based practices in community care settings.
The Penn ALACRITY Center—one of two NIMH-funded Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness—will launch with three projects to enhance treatment for people served through publicly-funded mental health systems. ALACRITY Centers are designed to carry out transdisciplinary projects that would not be possible using standard research-project grant processes. Penn’s center comprises collaboration between the Center for Mental Health Policy and Services Research (CMHPSR) and the Center for Health Incentives and Behavioral Economics (CHIBE), both in the Perelman School of Medicine. For the past eight years, CHIBE has been one of two NIH-funded centers devoted to the study of behavioral economics and health.
Three principal investigators from the Perelman School of Medicine will lead the Penn center: Rinad Beidas, PhD, an assistant professor of Psychiatry and director of Implementation Research; David Mandell, ScD, a professor of Psychiatry and director of Penn's Center for Mental Health Policy and Services Research; and Kevin Volpp, MD, PhD, the Janet and John Haas President’s Distinguished professor of Medicine, Medical Ethics and Health Policy; Health Care management at Wharton; and director of the Penn Center for Health Incentives and Behavioral Economics.
“The foundation of this initiative is a three decade-long relationship between the City of Philadelphia’s Department of Behavioral Health and Penn’s Center for Mental Health Policy and Services Research, which is integral to the success of this work,” Beidas said. “We are grateful for this relationship and are committed to working with our partners to ensure that the findings of this work result in policies that improve care for people with mental illness.”
“One of the major challenges of delivering mental health services effectively and efficiently is to get those who are seeking such services into evidence-based treatment in the community settings where most care is provided,” Volpp said. “This funding will help us to do that and we are very grateful to the National Institute of Mental health for its support. This is especially important because studies show that many forms of treatment with good records of success in clinical trials and practices are seldom implemented successfully in community settings.”
The Penn ALACRITY Center will feature a “methods core” that provides expertise in behavioral economics and implementation science; participatory design (which involves patients, clinicians, and staff in decision-making processes of a study or treatment); and statistical applications for designing studies and treatments and measuring their effectiveness. Additionally, an administrative core will provide oversight and promote communication about best practices and collaboration among researchers and clinicians taking part in ALACRITY Center activities.
The first project, led by Steve Marcus, PhD, Mark Olfson, MD, and Volpp, will compare ways of increasing adherence to antidepressant medications in the first six weeks of treatment among adults newly diagnosed with depression. Only one-fourth of those newly diagnosed with depression take their medication for twelve weeks, often because antidepressants do not offer quick relief of symptoms. Penn experts will test two forms of financial incentives, and the use of daily feedback on medication adherence, to identify effective ways of encouraging patients to take their antidepressant medication.
Project two, led by Mandell and Melanie Pellecchia, PhD, will test the effectiveness of non-financial incentives -- such as positive feedback and tying performance to professional status -- to improve use of evidence-based practices among one-to-one aides assigned to work with school-age children with autism. (More than half of all children with autism have a one-to-one aide.) The need for this project stems from the fact that these aides work almost solely in the community, with little supervision or support.
Project three, directed by Beidas and Nate Williams, PhD, emerges from work conducted in the Philadelphia public mental health system over the past 5 years, which found that therapists do not feel recognized or rewarded for using evidence-based practices. In this project, investigators will use innovation tournaments to solicit clinician perspectives on the best ways for organizations to use financial and non-financial incentives to encourage therapists in community mental health centers to use evidence-based practices. Clinicians with winning ideas will partner with behavioral economists to refine their ideas; in future trials, these strategies will be tested against each other to determine their effects on increasing clinicians’ use of evidence-based practices.
In addition to carrying out specific research projects, center faculty and staff members will offer training opportunities to other Penn researchers in using behavioral economics and implementation science to improve delivery of mental health services. Pilot funding will be available on an annual basis. Center personnel will also develop new statistical methods and study-designs for increasing the quality of mental health care and improving outcomes through the use of evidence-based mental health treatments.
“We have decades worth of evidence regarding the best ways to treat people with psychiatric disorders, yet we find over and over again that care delivered in to most people with psychiatric disorders is not consistent with that evidence,” Mandell said. “Our center is designed to develop and rigorously test innovative, practical strategies to increase the use of evidence-based care. We’ve brought together internationally-renowned researchers from different disciplines to conduct work that will transform the way we think about the care system for people with these often-disabling disorders.”
Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $8.6 billion enterprise.
The Perelman School of Medicine has been ranked among the top medical schools in the United States for more than 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $494 million awarded in the 2019 fiscal year.
The University of Pennsylvania Health System’s patient care facilities include: the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center—which are recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report—Chester County Hospital; Lancaster General Health; Penn Medicine Princeton Health; and Pennsylvania Hospital, the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.
Penn Medicine is powered by a talented and dedicated workforce of more than 43,900 people. The organization also has alliances with top community health systems across both Southeastern Pennsylvania and Southern New Jersey, creating more options for patients no matter where they live.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2019, Penn Medicine provided more than $583 million to benefit our community.