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Peer-reviewedCC BYImplementation science communications

Adapting the Fiscal Mapping Process to improve the financial sustainability of implementation support and mental health delivery organizations: protocol for a mixed methods study.

  • Margaret E Crane1
  • Alex R Dopp2
  • Aaron R Lyon3
  • Bo Kim4,5
  • David C Mohr6
  • William A Aldridge Ii7
  • Joshua J Kemp8,9
  • A Rani Elwy8,10
10 affiliations
  1. 1Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA. [email protected].
  2. 2RAND, 1776 Main Street, Santa Monica, CA, 90401, USA.
  3. 3Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA.
  4. 4Center for Health Optimization and Implementation Research (CHOIR), Boston Healthcare System, 150 S. Huntington Ave, Boston, VA, MA, 02130, USA.
  5. 5Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
  6. 6Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 06111, USA.
  7. 7The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Campus Box 8180, Chapel Hill, NC, 27599-8180, USA.
  8. 8Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA.
  9. 9Pediatric Anxiety Research Center (PARC) at Bradley Hospital, Brown University Health, 1011 Veterans Memorial Pkwy., RI, 02915, Riverside, USA.
  10. 10Center for Health Optimization and Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, 01730, USA.
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Abstract

Background

Sustainability of evidence-based mental health intervention (EBI) implementation is a challenge to increasing access to mental health services. Funding is a common barrier to sustainment. EBIs, while cost effective, are expensive to implement. The Fiscal Mapping Process is a strategic planning tool designed for behavioral health agencies to plan the financial sustainment of specific EBIs. Financial planning at an organizational level is also required to enable implementation support organizations (ISOs) and mental health delivery organizations (MHDOs) to sustainably operate. Project FISCAL (Financing Implementation for Sustainable Care, Access, and Localization) will adapt the Fiscal Mapping Process for ISOs/MHDOs to plan for financial sustainability while balancing access and high-quality mental health care.Methods

The study will be guided by the Discover, Design/Build, and Test human-centered design framework. ISOs will include intermediary and purveyor organizations, and MHDOs will include provider and digital mental health organizations. In the Discover Phase (Aim 1), we will identify ISOs'/MHDOs' needs for a strategic financial planning tool through process mapping and a semi-structured qualitative interview. Process mapping also will identify how ISOs/MHDOs selected financing strategies for their organization. In the Design/Build Phase (Aim 2), we will refine the Fiscal Mapping Process using Design Charrettes. In the Test Phase (Aim 3), we will assess the preliminary impact and usability of the Fiscal Mapping Process for ISOs'/MHDOs' financial sustainability using a comparative case study design. Participants in Aims 1-3 will include individuals working in ISOs/MHDOs (n = 20 ISOs/MHDOs per aim) and in Aims 1-2 also will include 5 ISO/MHDO advisors. Data will be analyzed using a convergent mixed methods approach integrating qualitative and quantitative data.Discussion

The adapted Fiscal Mapping Process created in this project will help organizations with strategic financial planning to broadly sustain and scale access to effective mental health treatments. The study addresses two understudied areas of implementation science: sustainability and organizational-level financing strategies. Without careful consideration, ISOs'/MHDOs' business models could unintentionally decrease access to care for some individuals if funding is prioritized or if only certain patient populations are reached.

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Cite

BibTeXRIS
BibTeX
@article{crane2026adapting,
  title = {{Adapting the Fiscal Mapping Process to improve the financial sustainability of implementation support and mental health delivery organizations: protocol for a mixed methods study.}},
  author = {Margaret E Crane and Alex R Dopp and Aaron R Lyon and Bo Kim and David C Mohr and William A Aldridge Ii and Joshua J Kemp and A Rani Elwy},
  journal = {Implementation science communications},
  year = {2026},
  month = jul,
  doi = {10.1186/s43058-026-01050-6},
  url = {https://europepmc.org/article/MED/42919361},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Adapting the Fiscal Mapping Process to improve the financial sustainability of implementation support and mental health delivery organizations: protocol for a mixed methods study.
AU  - Margaret E Crane
AU  - Alex R Dopp
AU  - Aaron R Lyon
AU  - Bo Kim
AU  - David C Mohr
AU  - William A Aldridge Ii
AU  - Joshua J Kemp
AU  - A Rani Elwy
PY  - 2026
DA  - 2026/07/01
JO  - Implementation science communications
DO  - 10.1186/s43058-026-01050-6
UR  - https://europepmc.org/article/MED/42919361
AB  - Background  Sustainability of evidence-based mental health intervention (EBI) implementation is a challenge to increasing access to mental health services. Funding is a common barrier to sustainment. EBIs, while cost effective, are expensive to implement. The Fiscal Mapping Process is a strategic planning tool designed for behavioral health agencies to plan the financial sustainment of specific EBIs. Financial planning at an organizational level is also required to enable implementation support organizations (ISOs) and mental health delivery organizations (MHDOs) to sustainably operate. Project FISCAL (Financing Implementation for Sustainable Care, Access, and Localization) will adapt the Fiscal Mapping Process for ISOs/MHDOs to plan for financial sustainability while balancing access and high-quality mental health care.Methods  The study will be guided by the Discover, Design/Build, and Test human-centered design framework. ISOs will include intermediary and purveyor organizations, and MHDOs will include provider and digital mental health organizations. In the Discover Phase (Aim 1), we will identify ISOs'/MHDOs' needs for a strategic financial planning tool through process mapping and a semi-structured qualitative interview. Process mapping also will identify how ISOs/MHDOs selected financing strategies for their organization. In the Design/Build Phase (Aim 2), we will refine the Fiscal Mapping Process using Design Charrettes. In the Test Phase (Aim 3), we will assess the preliminary impact and usability of the Fiscal Mapping Process for ISOs'/MHDOs' financial sustainability using a comparative case study design. Participants in Aims 1-3 will include individuals working in ISOs/MHDOs (n = 20 ISOs/MHDOs per aim) and in Aims 1-2 also will include 5 ISO/MHDO advisors. Data will be analyzed using a convergent mixed methods approach integrating qualitative and quantitative data.Discussion  The adapted Fiscal Mapping Process created in this project will help organizations with strategic financial planning to broadly sustain and scale access to effective mental health treatments. The study addresses two understudied areas of implementation science: sustainability and organizational-level financing strategies. Without careful consideration, ISOs'/MHDOs' business models could unintentionally decrease access to care for some individuals if funding is prioritized or if only certain patient populations are reached.
SN  - 2662-2211
ER  -