Barriers to Translating Evidence-Based Practices Into Policy: A Case Study in Texas

Background

Screening and brief intervention (SBI) in medical settings is an evidence-based practice for substance misuse (Bernstein, et al. 2005; Nilsen, et al., 2008) and injury prevention (Gentilello, et al., 1999). However, the Uniform Accident and Sickness Policy Provision Law (UPPL) discourages providers from carrying out SBI, as it allows insurers in 26 states (Baker, 2009) to deny claims for persons injured while under the influence of substances (Chezem, 2004). Denied claims can leave providers uncompensated (Gentilello, et al., 2005) and patients in financial peril (Himmelstein et al., 2005). If not screened, patients could face hazardous health consequences from interactions between medications and substances (Singh, et al., 1994; Vagts et al., 2003) and/or miss out on potentially beneficial interventions (ACS, 2006).

Due to UPPL repercussions, many states endeavor to overturn this law. UPPL repeals have been attempted in three recent Texas legislative sessions, but have failed in each. This project seeks to understand what communication issues may have impeded the success of UPPL repeal in Texas.

Methods

This project used case study methodology (Creswell, 2007; Stake, 1995) to describe the potential communication failures of these bills. First, the researchers examined records from the 2005 and 2007 legislative sessions pertaining to the UPPL repeal amendments to organize the order of events related to each bill. The researchers then examined both the transcriptions and audio files of committee hearings. Researchers developed a coding framework based on research of effective communication (Gordon, & Brodsky, 2005; Spitfire Strategies, n.d.) that contained two categories of communication factors: message factors (such as speaking to audience perspective) and responses factors (such as providing clear responses). This framework was reviewed by two social policy/advocacy experts. Transcripts were coded by two researchers using NVivo8. Codes were tallied (Miles & Huberman, 1994; Stake, 1995) and differences between codes reconciled.

Results

In 2005, the UPPL amendment successfully passed the house but failed in the senate. Communication in the house by advocates' included effective communication statements that spoke to the needs and perspectives of legislators more frequently (n=11) than opponents (n=1). Likewise, advocates more frequently responded to legislators with strength (n=10) compared to opponents who only responded weakly (n=4). However, after passing the house, opposition testimony in the senate included effective communication statements twice as frequently (n=6) as bill advocates (n=3). When the amendment was reintroduced in 2007, progress was halted during its first committee hearing. Despite strong messages for the bill, advocates' responses to legislators' questions were generally less effective. Advocates more frequently responded weakly to legislators (n=21) compared to opponents (n=7) by demonstrating such behaviors as repeated defensiveness and a lack of preparation.

Conclusion/Implications

As policymakers have become increasingly interested in supporting human service legislation grounded in evidence (Teater, 2008), researchers and advocates must ascertain why some legislation supported by evidence does not become law. Findings from this study suggest that the quality of communication may influence the success of evidence-based legislation. However, future research should replicate these analyses to further examine their utility in additional human service policymaking attempts.