Evidence-based practices and comparative effectiveness research are salient topics in public policy. Empirical validation of agency operating processes provides agencies and policy-makers the opportunity to address uncertainty surrounding effectiveness. While this is an increasingly accepted rational approach to public policy, the exact mechanism for how this operates is less known. In order to evaluate several theoretical assumptions and normative rational expectations inherent in this approach, the implementation of a state legislative mandate stating policy expectations for behavioral health evidence-based practices is assessed. This study sought to assess whether implementation patterns and associated outcomes reflect "rational mechanism" policy expectations. While the premise of this research surrounds a state behavioral health legal mandate, results inform broader health policy efforts. Study results identify some evidence that the policy yielded "rational mechanism" processes and outcomes, but also indicated that other mechanisms may have influenced implementation patterns. In addition, evidence of a link between policy and outcomes is at best inconsistent. Further research on evidence-based policies using definitional and measurement frameworks applied in this study is clearly warranted.

Youth substance abuse in Oregon reached epidemic proportions in the early 1980s. A response to this social issue from the Governor's Office, the state legislature, and the Office of Alcohol and Drug Programs during 1983-1985 is the foundation of this case study. Oregon, a small state of three million, was faced with a growing problem of youth and adult substance abuse. Legislative leaders, agency staff, and Governor Atiyeh recognized an opportunity to create public policy to solve problems of substance abuse including crime. The focus on substance abuse included streamlining several budgets with substance abuse monies in various state agencies. The intent of this study was to recreate the development of public policy specifically in the area of youth substance abuse during the years 1983-1985. The final policy, Oregon House Bill 2124 (1985), represented the work budgets with alcohol and drug monies in various state agencies. The intent of this study is to recreate the development of public policy specifically in the area of youth substance abuse during the years 1983-1985. The final policy, Oregon House Bill 2124 (1985), represented the work of several political entities, and presented recommendations for substance abuse treatment, budget alignments among several agencies with alcohol and drug monies, and finally, prevention of youth substance abuse. This dissertation established that leadership and politics affected policy development more than the variables of economics, special interest groups, or research which were chosen from the literature in policy development. Research was the variable studied in depth to determine if policy developers utilized what was known about youth substance abuse to develop policy goals. Several barriers to the use of research and rational methods for policy development were uncovered. The study found that the use of research was regarded as important among policy developers, but their practice was not at all congruent with that belief. There were many studies on youth prevention and social competency training available to policy planners which may have supported more specific policy recommendations. No collaborations between researchers and policy developers occurred in this case study. The barriers to collaborative efforts with researchers and the use of policy analysis methods were uncovered in this study. The final policy document presented to the legislature lacked specific recommendations for well researched programs which appeared to be the result of political considerations rather than rational policy development. Finally, this case of policy development revealed a process that was inconsistent, politically driven, disregarded available research, and resulted in broad policy goals which have not been exceptionally successful in limiting or even addressing youth substance abuse over the nine years of implementation by the same administrator who significantly helped to develop them.

Since 1988 when the first HIV positive drug user was identified in Poland, for close to two decades, the predominant route of HIV transmission has been through injecting drug use. In mid 2000s, Polish officials reported that injecting drug use no longer contributed to incrasing HIV incidence. The consequences of such a statement are that many of the structural and personal risks associated with HIV infection go unaddressed, that drug users are neglected by HIV prevention efforts, that HIV treatment is not made available to drug users and that the policy environment does not adequately support effective public health initiatives. This case study is based on documentation, archival records, interviews, participant observation, and physical artifacts shows that these assertions were made, and continue to be repeated, in a highly political context. Poland is a post-socialist state with strong neoliberal leanings, and it is highly invested in successful integration with the European Union. Powerful Catholic Church serves as an important backdrop. While people considered "at risk" now have more freedom to conduct their lives, they also have a set of neoliberal expectations and religious pressures placed on them. Country's geographic location adds to this complexity - situated between "Old Europe" where HIV problem has been successfully contained and the former Soviet Union, where the HIV incidence among drug users is the highest in the world, Poland attempts to align itself with the success of the West. Furthermore, examination of the available data suggests that the assertions made by Polish officials omit numerous variables. My research shows that even though Polish leadership in the area of HIV and drug policy wishes to resemble Western Europe, Poland does not meet international standards for the prevention of HIV transmission. The interviews I conducted, as well as the review of the literature on drug and HIV policies and programs suggest that these services are scattered, often unavailable, and that their number is stagnating, at best, and in some cases, even decreasing. This maybe a direct result of lack of engagement of drug users in their design. Excluded from the discussion of risk, drug users are thus not the focus of prevention efforts. Based on gathered data, there are seven crucial issues that require immediate action if Poland is to manage HIV prevention and care for people who use drugs in a manner consistent with the international standards. The areas requiring action are: a change in the drug policy from the current very punitive approach, expansion of needle and syringe programs and other harm reduction services, improved data collection and an increase in the availability of HIV testing, scaled-up substitution treatment, improved quality of other forms of drug treatment, greater investment in civil society organizations, improved access to HIV treatment, and educational and training efforts that encourage greater attention to HIV related matters across disciplines.