Advisor(s)

Nancy Borkowski

Committee Member(s)

Allyson Hall
Heather Nelson-Brantley
Monica Aswani
Reena Kelly

Document Type

Dissertation

Date of Award

1-27-2026

Degree Name

Doctor of Science in Administration Health Services (DSc)

School

School of Health Professions

Department

Health Professions

Abstract

The need for accessible, quality behavioral healthcare (BH) has increased dramatically over recent decades. The availability of BH services for patients has long been complicated by high cost, lack of insurance coverage, and location accessibility. BH organizations face ongoing challenges to meet the demand for services including costs of operation, worker shortages, and navigating the payer landscape. The history of BH in the U.S. provides the foundation to conceptualize federal regulations and attempts at parity. Literature regarding federal legislation, such as the Mental Health Parity Addiction and Equity Act (MHPAEA), the Affordable Care Act, and Medicaid expansion; BH facilities and organizational characteristics; workforce availability including Health Professional Shortage Areas and scope of practice regulations for nurse practitioners; and market factors such as crisis measures, income, and population age, informed the conceptual framework for examining the research question. Understanding the application of Strategic Adaptation Theory (SAT) across industries provides a theoretical framework for examining the research question. The study design for this research is a two-part, mixed-methods, non-experimental design using data from each of the 50 U.S. states to examine the influence of the MHPAEA through the difference in the number of residential behavioral healthcare (RBH) facilities per state and additional market variables to conduct a quantitative statistical analysis. A qualitative analysis was conducted through interviews with BH executive leaders. The total sample population consists of 50 states for quantitative statistical analysis and six BH leaders for qualitative analysis. The impact of the implementation of the MHPAEA including the Final Rule in 2014 was measured against the difference in the number of RBH facilities in each state two years prior to implementation (2012) and two years following implementation (2016). This study aimed to fill the gap in the research literature regarding the influence of the MHPAEA on treatment centers that provide residential-level care. Residential treatment is the highest level of care outside of a hospital setting and provides vital behavior-blocking and therapeutic engagement, which are correlated with long-term recovery efforts. SAT guided this research and informed the application of leadership decision-making related to growth and expansion in the BH space.

Keywords

Affordable Care Act;federal policy;insurance;Mental Health Parity Addiction and Equity Act;Residential Behavioral Healthcare;Strategic Adaptation Theory

ProQuest Publication Number

32281287

ISBN

9798273381070

Download

Share

COinS