We are pleased to bring you this expanded issue of networks focused on the critical topic of performance measures in public behavioral healthcare. In exploring the needs of consumers, purchasers and providers, it is apparent that the level of interest and energy being devoted to holding the behavioral healthcare system accountable for the expenditure of public dollars makes this an exciting time, but also a confusing one.
Reviewing a number of performance measurement systems developed at the county,state and national levels makes it clear that we don t yet speak the same language. For example, are we really sure of the difference between a domain, a measure, an indicator and an outcome? A comprehensive set of performance measures has not been compiled in one place, so we are not yet sure what the universe is. Beyond that, the process of analyzing these measures to determine how well they strike the necessary balance between cost control and quality of care is just beginning. There is a good deal of work to do.
NTAC is pleased to be a part of that work. We have facilitated and/or participated in a number of activities central to the national performance measurement dialogue, including providing logistical and program support for a series of five regional and national Performance Partnership conferences sponsored by the Center for Mental Health Services and the Office of the Assistant Secretary for Health. The discussions generated at these meetings helped to inform the seventy-five representatives of state, county and national organizations who joined us for a one day institute held on July 16, "Managed Care and Performance Measures in Public Mental Health Systems" (co-sponsored by NTAC and the NASMHPD Research Institute).
As states move further into managed care, NTAC will continue to assist those with county-based systems in considering the critical issues of accountability and authority through the State/County Managed Care Project. Working with a number of partners, NTAC will also help to facilitate and convene a Performance Measures Work Group designed to advise future state mental health agency efforts in developing and applying performance measures to behavioral healthcare systems.
We look forward to learning about your experiences with performance measures and other important issues and invite you to share your comments and suggestions on how NTAC can better meet your technical assistance needs.
-Bruce D. Emery, M.S.W.
Efforts are well underway by State Mental Health Agencies (SMHAs), national organizations and county mental health authorities to measure mental health system performance and thereby ensure accountability for the expenditure of public behavioral healthcare dollars.
While cost containment for Medicaid beneficiaries was arguably the primary consideration in the first wave of restructuring and refinancing driven by managed care, outcome evaluation has rapidly become an important tool to ensure that quality of care is also considered as a key criteria in making service-related decisions. The sheer number of initiatives and increasing discussions at national, state and local levels demonstrates the intensity of interest in performance measures of system and client-level outcomes.
Nationally, the Center for Mental Health Services is now field-testing the Mental Health Statistics Improvement Project (MHSIP) Report Card, a consumer-centered managed care report card covering the general "domains" of access, quality and appropriateness, promotion/prevention and outcomes. The MHSIP Report Card measures systems performance such as: speed and access to a full range of services; affordability; parity of coverage; consumer access to information; and absence of cultural barriers. Focusing on client strengths, the Report Card also proposes to measure consumer health and quality of life, reduction in psychological stress, and consumer productivity and independence.
The American Managed Behavioral Healthcare Association, representing 18 of the nation's private managed behavioral healthcare providers, is currently field-testing PERMS 1.0 (Performance Measures for Managed Behavioral Healthcare Programs). Utilizing data collected from medical records, administrative data and client surveys, PERMS organizes performance measures into access, consumer satisfaction and quality of care domains and includes measures of service utilization, cost, penetration rates, call abandonment rates, and consumer satisfaction with access to clinical care, efficiency, and effectiveness.
The National Association of County Behavioral Healthcare Directors (NACBHD) recently contracted with the Evaluation Center @ HSRI to develop Candidate Indicators for County Performance Outcomes. Due for completion shortly, NACBHD s proposed system addresses five separate domains: access, consumer satisfaction, consumer outcomes, intersystem outcomes and utilization.
Individual indicators and measures of service include: level of staff cultural competence; location; speed, ease and timeliness; consumer satisfaction with comprehensiveness; integration of services with social supports; symptom management and level of wellness; level of independence; self-reliance and self esteem; level of consumer involvement in work, school, social and family relationships; contacts with other community providers; use of hospital care; and cost of services.
The Health Plan Employer Data and Information Set (HEDIS 3.0) developed by the National Committee for Quality Assurance includes performance measures of effectiveness, access, availability, consumer choice/satisfaction and cost. HEDIS 3.0 relies primarily on process measures (e.g., utilization) to assist corporate purchasers interested in standardizing evaluation of general health care plan performance for multiple populations, such as Medicaid and Medicare recipients. The system is currently under review by the field. Comments must be submitted by September 3, to NCQA (contact Carolyn Cocotas, 800-839-6487).
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) intends to integrate a group of acceptable existing measures into its accreditation process under a single performance measurement umbrella. JCAHO is currently surveying the field to identify performance measures that cover the full range of behavioral healthcare services: (1) clinical; (2) patient care; (3) health/functional status; (4) satisfaction; and (5) administration and organization.
At the state level, performance measures are being developed in both states that have, as well as those that have not, introduced managed care reforms. In states with Medicaid waivers approved or pending, the State Medicaid Agency has tended to be the driving force behind the development of performance measures. In those cases, SMHAs have had to struggle for a voice in the discussion, with varying degrees of success. With or without the pressures of managed care initiatives, however, serious efforts by states have been underway for a number of years to develop performance and client measures that pertain to both hospital and community systems. Using them both to monitor contracts, and to ensure continuous quality improvement, about half of the states in the U.S. have developed or are developing report cards or performance outcome measurement systems.
At a recent national meeting convened by the NASMHPD Research Institute, Inc., a series of themes emerged from states' experiences in developing performance measures. First, performance measurement systems must have a clear purpose. Without a clear purpose, or by trying to serve too many purposes, performance measurement systems usually fail to meet any purpose at all. Secondly, the specificity of an indicator or measure varies as a function of its audience and purpose. More specific information is needed at the lowest system level while the least specific information is needed at the top. Third, all constituencies should be involved in developing performance measures from the beginning. States that do not include all relevant parties at the outset were generally forced to backtrack and build consensus. Last, while states can and should readily learn from one another, each state will have to develop its own unique set of performance measures. Any specific group of consumers, families, providers and state government leaders will produce a unique mix of needs and resulting measures. A detailed analysis and summary of states' efforts is planned for later this summer.
While many similarities exist among the domains and specific measures identified by various performance measurement systems at county, state and national levels, significant concerns exist within the consumer, family and provider communities regarding the connection between service costs and service outcomes in all systems. Such a linkage is seen as essential to monitoring the impact of cost-cutting on service delivery, as well as to prevent cost-shifting in an increasingly privatized public mental health system. Several national projects are now underway to examine current and proposed performance measurement systems and to explore the balance between measures of cost and adequacy of service.
The Research Infrastructure Support Program (RISP) of the NASMHPD Research Institute is initiating work around performance and outcome measures by collecting and documenting the measures utilized by SMHAs under managed care purchase of service contracts. Those measures will be synthesized, refined and made available to states and others later this year.
The National Alliance for the Mentally Ill (NAMI) is developing a report on "The Impact of Managed Care on People with Severe Mental Illnesses: A National Report Card." Working under the aegis of the NAMI "Outcomes Roundtable," the project is developing a set of principles to serve as a foundation for outcomes assessment and management systems, to evaluate existing delivery systems and to advocate for clinical and administrative outcome measures.
In conjunction with the University of Cincinnati Department of Psychiatry, the Institute for Behavioral Healthcare (IBH) conducted a survey of behavioral healthcare organizations throughout the country to collect and analyze performance measures most commonly in use. The study evaluates these measures and accompanying indicators for both broad and specific utility. Available directly from IBH, the report includes a comprehensive list of measures and indicators used by a broad range of behavioral healthcare organizations.
Whether generated by states, counties or national organizations, evolving performance measurement technologies are contributing significantly to the dialogue regarding the need to balance cost and quality of care. As key participants continue to make their presence and perspectives felt, the challenge will be to construct performance measurement systems that integrate the needs of purchaser, provider and recipients without overwhelming an already heavily burdened behavioral healthcare system.
American Managed Behavioral Healthcare Association. (1995). Performance Measures for Managed Behavioral Healthcare Programs. (Contact AMBHA at 202/434-4565).
Center for Mental Health Services. (1996). Consumer-Oriented Mental Health Report Card. The Final Report of the Mental Health Statistics Improvement Program (MHSIP) Task Force on a Consumer-Oriented Mental Health Report Card. (Contact MHKEN at 800/789-2647).
Center for Mental Health Services and the National Association of County Behavioral Health Directors. Candidate Indicators for County Performance Outcomes Project. (Contact the Evaluation Center at HSRI at 617/876-0426, ext. 323).
Cross, Theodore P. and McDonals, Elizabeth. Evaluating the Outcome of Children's Mental Health Services: A Guide for the Use of Available Child and Family Outcome Measures. The Technical Assistance Center for the Evaluation of Children's Mental Health Systems. $15.00. (Contact Judge Baker Children's Center at 617/232-8390 x 2139).
Institute for Behavioral Healthcare. (1996). Performance Indicators in Behavioral Healthcare: Measures of Access, Appropriateness, Quality, Outcomes and Prevention. (Contact Rebecca Theriot at 415/851-6469).
Kamis-Gould, Edna. (1996). Toolkit for the Assessment of Mental Health Plans and Systems Performance. A Model of Indicators & Report Card. (Contact The Evaluation Center at HSRI at 617/876-0426).
McGuirk, Frank D., Sanchez, A. Marie, and Evants, Deborah D. (editors). (1994). Outcomes Issues in a Managed Care Environment. Western Interstate Commission for Higher Education. (Contact WICHE at 303/541-0250).
New York State Office of Mental Health. (1996). Quality of Care: Performance Measurement. (Second Draft Report) Mental Health Task Force Subcommittee of the New York State Medicaid Managed Care Advisory Committee. (Contact New York State Office of Mental Health at 518/474-4403).
Nicholson, Joanne and Robinson, Gail. A Guide for Evaluating Consumer Satisfaction with Child and Adolescent Mental Health Services. The Technical Assistance Center for the Evaluation of Children s Mental Health Systems, Judge Baker Children's Center. $10.00. (Contact Judge Baker Children's Center at 617/232-8390, x 2139).
Technical Assistance Center for the Evaluation of Children's Mental Health Systems, Judge Baker Children s Center. (1996) Culturally Competent Evaluation of Outcomes in Systems of Care for Children's Mental Health. TABrief, Volume 2, Number 2. (Contact Judge Baker Children's Center at 617/232-8390 x 2139).
Department of Health and Human Services (DHHS) Performance Measurement Web Site: http://www.os.dhhs.gov/progorg/io
Outcome related sites are listed at: http://utsph.sph.uth.tmc.edu/www/utsph/cs/other.htm
National Committee for Quality Assurance (NCQA): http://www.ncqa.org/
Windows for Healthcare: http://www.mednet.ucla.edu/
e-mail: mshug@msn.com
In this era of public and private health care system reform, the development of performance measures has gained increased attention and involvement of all stakeholders, including consumers, the primary population served by mental health systems across the country.
Developed to provide information and tools for evaluating mental health systems and service delivery, performance measures are often described as "report cards" for consumers and others to evaluate the quality and effectiveness of mental health services.
NTAC spoke with four nationally-known mental health consumers to discover how they believe mental health performance measures have impacted or will impact consumers; to understand consumers level of involvement in the development of performance measures; and to learn what these particular consumers view as the more successful measures or models being employed in the mental health field.
According to these leaders, it is essential to differentiate between the direct, personal consequences of applying mental health performance measures to consumers and their use by other stakeholders (e.g., mental health authorities, managed care organizations, and clinicians). After all, they say, these report cards are measuring and evaluating human lives--an individual's response to mental health treatment, the ability to function in the community, and the ability to maintain a significant job, or avoid homelessness. That means that consumers have a special stake in what and how performance measures are developed and used.
Recently published by the Center for Mental Health Services, the Mental Health Statistics Improvement Program (MHSIP) Report Card is cited by its authors as being unique for its design and orientation in measuring what matters most to mental health consumers. While consumers support MHSIP in concept and as "a useful first step," leaders within the consumer movement do not universally endorse the MHSIP Report Card as a performance measurement model.
Daniel Fisher, M.D., Ph.D., Director of the National Empowerment Center, both a consumer and a provider of mental health services, praised MHSIP for having meaningful consumer involvement in its development and for including good measures. However, he believes that further work needs to be done in the measurement area, particularly for measuring self-determination and suggests that future efforts include measures for "hope." According to Dr. Fisher, "consumers who achieve significant recovery say that a central ingredient is that those around them fostered a sense of hope."
Darby Penny, Director of Recipient Affairs in the New York State Office of Mental Health, echoed Dr. Fisher s conditional support for the MHSIP Report Card. "It's certainly a step in the right direction," she said, "but many of us felt that the consumer/survivor perspective was no adequately represented in the final document." Ms. Penny, who is also President of the National Association of Consumer/Survivor Mental Health Administrators, called on MHSIP to include more significant consumer/survivor input in future iterations of the report card.
Earlier this year, the New York State Office of Mental Health convened a number of task forces and committees to provide recommendations on New York s managed care efforts. As a member of the performance measurement subcommittee, Darby Penny assisted in developing indicators to measure system performance. Subcommittee members surveyed thousands of service recipients, families, and providers in New York to identify the most important mental health outcomes. According to Ms. Penny, "survey results point to major differences between what recipients think is important to measure and what other stakeholders (family members and providers) think is most important." For example, while recipients rate self-esteem as their most important outcome measure, clinicians and family members regard the elimination of symptoms as the most important goal.
At the National Mental Health Consumers Self-Help Clearinghouse in Philadelphia, Joseph Rogers, Executive Director, and Thomas Leibfried, Program Manager, described consumer involvement in a process which monitors consumer satisfaction of mental health service programs. Using a consumer satisfaction team (CST) comprised of consumers and family members, this approach uses one-on-one interviews with mental health staff and consumers to determine consumer satisfaction. Following the visit, a report is submitted either to the County Office of Mental Health, the Quality Control Administrator, or to the Commissioner of Mental Health, depending on the visit s outcome. According to Rogers, the CST model being replicated in other states is being used "more as a tool for fostering continuous program improvement and quality of life rather than evaluating mental health systems." Rogers and Liebfried report that the CST model has been so successful that it has been included in the state's managed care proposal.
One consumer-based effort identified by leaders in the movement as being "ahead of its time" was the 1993 convening of consumer/survivors to participate in a pilot project using "concept mapping." The pilot, conducted by two recipient/researchers, Jeanne Dumont, Ph.D. and Jean Campbell, Ph.D., was the first of its kind to provide a structured setting that enabled consumers to identify what mental health service measurements were most important to them. Organized by the NASMHPD Research Institute to provide input into the State Mental Health Profiling System, the results of the concept mapping project revealed that inner healing, citizenship, freedom from coercion, and hope were the most important outcomes of mental health services to consumers. Concept mapping has also been used in some states for mental health planning and evaluation and is regarded as a useful tool for developing performance measures.
According to the consumers interviewed by NTAC, information gleaned from using and developing performance measures can make a significant contribution to the quality of life for recipients of mental health services. To achieve the greatest quality, however, system managers will need to actively seek and incorporate meaningful consumer representation in all aspects of health care reform.
NTAC has just released, Housing for Persons with Psychiatric Disabilities: Best Practices in a Changing Environment, a technical assistance tool kit containing effective strategies for meeting the housing and related support needs of people with psychiatric disabilities. The report contains a synthesis of models and best practices presented in the context of the rapidly changing federal and state environment in housing finance and development.
The tool kit was produced to address the information and technical assistance needs of state mental health agencies, state housing finance agencies, and public and private housing developers. A broad audience of clinicians, consumers, family members, advocates, and technical assistance providers will also find the contents of the report useful in designing, financing and advocating for housing and supports for people with psychiatric disabilities.
One copy of the kit will be sent to each state mental health agency free of charge. Additional copies are available for $20 by calling NTAC at (703) 739-9333, ext. 30.
Funded through a cooperative agreement between the Center for Mental Health Services (CMHS), and the National Association of State Mental Health Program Directors NASMHPD), the National Technical Assistance Center (NTAC) for State Mental Health Planning provides on-site technical assistance to individual states and regions; convenes national work groups to examine current issues of importance to state mental health authorities, consumers, family members and state mental health planning and advisory councils; offers a comprehensive library of mental health-related materials; maintains a consultant database; and communicates electronically with the mental health community nationwide. The following provides a brief overview of NTAC activities since the last issue of networks.
Technical Assistance to States.
On-Site Technical Assistance. To date, NTAC has awarded three states on-site technical assistance (TA), and is reviewing requests from six additional states. The scope of these requests represents a wide range of TA needs. Virginia received on-site consultation to develop pilot managed care service delivery projects (see story on pg. 8). NTAC also supported on-site technical assistance to Vermont to assess the role of the state mental health authority as purchaser, provider, and regulator in a managed care environment. Finally, Kentucky was recently awarded funding to develop and implement a state-wide supported housing training effort.
Pending TA applications from states include requests to support a state-wide conference to promote consumer and family member participation in mental health service planning, delivery and evaluation; on-site consultation by a psychiatric hospital systems expert to assist with planning to unify ten independent hospitals into one facility system; and, assistance to develop a consensus of best practice models in mental health services as part of a quality assurance program. TA award decisions will be finalized over the next two months.
Performance Partnership Grants. NASMHPD and NTAC recently forwarded a draft report to the National Academy of Sciences providing recommendations for the development and use of performance measures in public health Performance Partnership Grants (PPGs). Sponsored by the CMHS, NTAC provided logistical support for more than 100 consumers, family members, and mental health providers to participate in regional PPG meetings held in Portland, OR, San Francisco, Chicago, and Philadelphia. On May 17, NTAC convened a 12-member national work group to examine indicators produced in the regional PPG meetings. The draft report and recommendations for future policy and technical assistance activities resulted from the deliberations of the national work group. A summary of the Preferred Performance Measures Survey is available from NTAC upon request.
National Education and Training Events.
Disaster/Crisis Counseling. NTAC staff have drafted a report to the Emergency Services and Disaster Relief Branch of CMHS reflecting recommendations of the national workshop (sponsored by CMHS and convened by NTAC) held on June 6-7. The work group focused on states' experiences in providing crisis counseling services after presidentially-declared disasters, such as fires, floods and hurricanes.
Managed Care and Performance Measures. On July 17, NTAC co-sponsored a training institute with the NASMHPD Research Institute, "A National Dialogue on Managed Care and Performance Measures in Public Mental Health Systems" in Chicago. The Institute, attended by approximately 75 state and county mental health agency representatives, consumers and family members, focused on identifying lessons learned and examining key issues in managed care and performance measures. Participants made recommendations on topics for future institutes and for NTAC training and technical assistance activities.
State/County Managed Care. At the request of several state mental health commissioners, NTAC convened a focus group via teleconference on July 3rd, comprised of representatives from states with county-based mental health systems to examine their unique issues and concerns as they enter into managed care arrangements. The focus group has begun to identify key issues and training and technical assistance needs, and will continue to meet via teleconference to determine ways that states and counties can be helped to clarify their respective roles and responsibilities.
Housing. NTAC coordinated a panel on housing for persons with psychiatric disabilities at the National Association of State Mental Health Program Directors' Summer Commissioners' Meeting held in Chicago on July 17-20. The plenary session informed state mental health commissioners of important changes in federal funding of affordable housing and the impact of managed care on housing; identified best practices and strategies to promote partnerships among state mental health agencies and state housing finance agencies; and notified participants of NTAC activities designed to meet the housing-related technical assistance needs of state mental health agencies (see page 4 for information on the NTAC Housing Tool Kit).
For information on how to obtain technical assistance, call Bruce D. Emery, M.S.W., Director, at 703/739-9333, ext. 28, or e-mail bruce.emery@nasmhpd.org.
The New Hampshire Charitable Trust and the National Institute of Mental Health have awarded the New Hampshire-Dartmouth Psychiatric Research Center a two-year grant to develop, test, and implement outcome measures that can be used to assess the delivery of behavioral health care for elderly persons with mental health and behavioral problems.
A recent study conducted by the Center demonstrates that one-quarter of all elderly residents in New Hampshire will develop a behavioral or mental health problem: Alzheimer s disease or other brain disorder, late life mental illness, alcohol and medication abuse, or emotional problems associated with neglect or abuse. The study also suggests that the number of elderly residents seeking care for behavioral and mental disorders may more than triple over the next several decades.
As is true in a number of states, community services in New Hampshire are fragmented across multiple agencies and lack uniform measures of client outcomes and system performance necessary to ensure high quality care at a competitive cost. Existing medical and mental health outcome measures do not adequately address the special needs of elderly clients. Informed decisions regarding public policy and the allocation of limited health care resources require that common outcome measures be developed that can evaluate different service models and providers.
One major emphasis of the project will be to develop measures that evaluate the effectiveness of alternative models of home and community-based care in a capitated funding environment. First year efforts will include a collaborative effort to identify practical and valid performance and outcome measures that can be easily applied across service systems. Second year activities will entail the refinement, field testing, and implementation of the measures. Methods will be developed for linking utilization and cost data with outcomes to support cost-effectiveness analyses.
Consumers, family members, advocacy groups and providers from New Hampshire s community mental health centers, home health agencies, area agencies on aging, residential and long-term care providers, and the U.S. Department of Health and Human Services will provide project oversight and participate in project activities.
The project's task force is currently seeking information from states and provider organizations that have developed or are currently developing client and system outcome measures for behavioral health care services for elderly clients. Contact Stephen Bartels, M.D., Principal Investigator at the New Hampshire-Dartmouth Psychiatric Research Center at 603/271-5747, or e-mail: stephen.j.bartel@dartmouth.edu,or contact Keith Miles, Project Director at 603/448-0126.
Frequently Asked Questions
of the National Technical Assistance Center (NTAC)
for State Mental Health Planning
I am a program manager in a state department of mental health looking for information on the impact of managed care on the elderly population. Does NTAC have or know of any recent research on this issue?
Representatives of State Mental Health Programs for Older Persons, a division of the National Association of State Mental Health Program Directors, prepared a report in November, 1995, titled, "Critical Issues in Mental Health and Managed Care for Older Adults." The report highlights the issues important to the delivery of mental health services for older adults within the context of state level initiatives, Medicaid re-structuring, and the introduction and/or expansion of managed behavioral health care technologies in the public sector. Requests for this report can be directed to Christine Diaz at 703/739-9333 ext. 30, or e-mail christine.diaz@nasmhpd.org. [Please include your name and return mailing address, email address and/or telephone number in the body of your message so we may respond to your inquiry].
I recently attended one of the regional Performance Partnership Grant meetings sponsored by the U.S. Department of Health and Human Services (DHHS) and the Center for Mental Health Services. What are the next steps following these meetings?
A draft report has been submitted by NASMHPD/NTAC to the National Academy of Sciences which will deliver its report to DHHS later this fall. Refer to page 5 of this newsletter for further details.
As we look at the future role of state psychiatric facilities, it would be useful to have information on physician staffing patterns in state mental health hospitals to aid us in managing the privatization of our mental health system. Does NTAC maintain this type of information, or can you refer me to someone who does?
The NASMHPD Research Institute, Inc. (NRI) has surveyed state mental health agencies for this data and has prepared tables reflecting information regarding staff ratios and salaries at State Mental Health Hospitals. Contact the NRI at 703/739-9333 for a copy of the report.
The National Technical Assistance Center for State Mental Health Planning (NTAC) recently provided facilitation and mediation support services to Virginia s Technical Work Group on Mental Health System Reform, culminating in a plan for constituents to work together in an unprecedented way.
The Technical Work Group was initiated by Timothy A. Kelly, Ph.D., Commissioner of the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services, to address issues relating to the changing environment of publicly funded mental health services. The Work Group included technical experts on populations, services, funding, performance and outcomes issues, and consisted of representatives from consumer organizations, families, advocates, community service boards, local government, central office and state hospital staff.
As a consultant to NTAC, Noel Mazade, Ph.D., Executive Director of the NASMHPD Research Institute, Inc. worked with the group as a "third party" facilitator and mediator. According to Kelly, members were able to move from guarded skepticism to genuine mutual respect and collaboration, capitalizing on each others diversity of interests and expertise. The consultation helped members deal with differences in values; delineate each party's unique interests; develop a working definition for consensus; explore perceived power differences; stimulate creative thinking, and form new working alliances culminating in the formulation of pilot proposals in previously uncharted areas. Kelly says the two pilot proposals developed by the Work Group, "constitute the first steps of genuine system reform in Virginia."
The Priority Populations and Case Rate Funding Pilot Proposal and the Performance and Outcome Measurement System Pilot Proposal reflect significant changes that the Department and system constituents hope to achieve by identifying priority populations and services, creating new fiscal incentives, and focusing on performance and outcomes.
The two pilots begin to create a new management information system through modeling and analyzing proposed changes in populations, services, and funding. Actual changes in service delivery will follow the modeling and analysis phase, thereby ensuring a careful, gradual movement into system reform guided by pilot data. If successful, the pilots will begin the process of moving the service system toward a more organized and managed health care environment.
The Priority Populations and Funding Pilot Project links priority populations with the distribution of state-controlled public funds. The project defines new funding, administrative and clinical responsibilities, and tests the impact of shifting from the current grant program funding mechanism to individual case-rate funding. It also explores how universal screening, emergency and post-crisis services, and prevention services can be funded outside the proposed case rate mechanism.
The Performance and Outcome Measurement System Project explores ways to redesign Virginia's management information system to: 1) enhance the State s ability to assess provider performance and consumer outcomes; 2) ensure accountability to consumers; and 3) utilize standardized consumer clinical outcomes to enable line managers to improve effectiveness and efficiency of services. Measures will include: access; quality and appropriateness of care; consumer satisfaction; and clinical outcomes.
Kelly says there are several important lessons to learn from the State s recent system reform effort. "The best plans for system reform will go nowhere without adequate consensus," says Kelly, "and perfect consensus means little if it is only for the sake of protecting the status quo." Work Group members suggest that perhaps the most important lesson learned by Virginia is that all constituents must be invited into a process based on trust and collaboration. As Virginia has discovered, doing so can create a powerful group that is marked by productivity, mutual respect, and satisfaction, becoming a tremendous resource for ongoing efforts to reform the public mental health service delivery system.
NTAC announces the debut of it's World Wide Web site dedicated to the exchange of information and ideas around the planning, delivery and evaluation of state mental health services. NTAC s web site offers information about its full range of technical assistance activities, including:
Our goal is to utilize this new mode of communication to its fullest potential. Please e-mail your comments and suggestions to: ntac@nasmhpd.org. [Please include your name and return mailing address, email address and/or telephone number in the body of your message so we may respond to your inquiry].
August 21-23, Second Annual Measuring Outcomes Across Integrated Delivery Systems, Washington, D.C. Call 800/210-7158.
September 9-12, National Coalition of Hispanic Health and Human Service Organization Annual Conference, Santa Fe, NM. Call Jonathon Bergman at 202/387-5000.
September 22-25, Southern Regional Conference on Mental Health Statistics, Values-Based Outcomes for Mental Health Services. Call Gary Olsen at 801/263-7165.
November 6-9, National Association for Rights, Protection and Advocacy (NARPA) Annual Conference, Tacoma, WA. Call Judy Levine at 401/434-2120.
November 15-17, The Federation of Families for Children s Mental Health Conference, Arlington, VA. Call 703/684-7710.
November 17-21, American Public Health Association 124th Annual Meeting and Exposition, New York, NY. Call Anna Keller at 202/789-5600.
December 8-10, National Association of State Mental Health Program Directors (NASMHPD) Winter 1996 Commissioners Meeting, Arlington, VA. Call Roy Praschil at 703/739-9333, ext. 20, or e-mail roy.praschil @nasmhpd.org.
The Substance Abuse and Mental Health Services Administration (SAMHSA), through the Center for Mental Health Services and the Health Care Financing Administration(HCFA), have recently funded a 6-month collaborative project that will explore the use of performance measures and outcome indicators by state mental health agencies, state substance abuse agencies, and state medicaid agencies to purchase services under managed care.
In the first collaboration of its kind, the national associations that will join together to represent these state agencies include the National Association of State Mental Health Program Directors (NASMHPD), in cooperation with the NASMHPD Research Institute, Inc., the National Association of State Alcohol and Drug Abuse Directors, and the National Association of State Medicaid Directors housed at the American Public Welfare Association.
The primary activities associated with this project include:
This project results directly from the September 1995 SAMSHA Partnerships for Change conference initiated by Tipper Gore which highlighted the necessity for collaborative efforts to plan, monitor and regulate public managed behavioral health care. For more information, contact Noel Mazade, Ph.D. at the NASMHPD Research Institute, 703/739-9333.
Center for Psychiatric Rehabilitation
Boston University Psychiatric Rehabilitation Center
Dedicated to improving the effectiveness of people, programs and
service system through training and research.
WHAT'S ONLINE - Research, training and service activities/ Collaborating organizations/Related
sites
WWW: http://www.bu.edu/SARPSYCH/
Research and Training Center for Children s Mental Health
Department of Child and Family Studies
Florida Mental Health Institute, University of South Florida
Conducting research and training on the systems of care, policy
and issues affecting children and families.
WHAT'S ONLINE - Research and training project descriptions/Publications
WWW: http://www.fmhi.usf.edu/cfsstatement.html
ResourceNet - the Child and Family Studies Electronic Bulletin
Board
WHAT'S ONLINE - Current research and information/Forums, reports and
announcements/Florida statistical and demographic data/Special
interest forums
EBB - 813/974-6137
Richard Bast
Center for Mental Health Services
Rockville, MD
Paolo DelVecchio
Center for Mental Health Services
Rockville, MD
Don A. Gilbert, M.B.A.
Department of Mental Health and Mental Retardation
Austin, TX
David Granger
Cuyahoga County Mental Health Board
Cleveland, OH
Ronald Manderscheid, Ph.D.
Center for Mental Health Services
Rockville, MD
Pamela Marshall, J.D.
Consultant
Little Rock, AR
Sinikka McCabe
Bureau of Community Mental Health
Madison, WI
A. Kathryn Power
Department of Mental Health,
Mental Retardation and Hospitals
Cranston, RI
Teri J. Sanders
MIKID
Flagstaff, AZ
David Shern, Ph.D.
Florida Mental Health Institute
Tampa, FL
Garrett Smith, M.P.A.
Mental Health and Developmental Disabilities Division
Salem, OR
Bruce D. Emery, M.S.W.
Director
"networks" is supported under a Cooperative Agreement between the Center for Mental Health Services, Substance Abuse and Mental Health Services Adm. and the National Assoc. of State Mental Health Program rectors. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CMHS/SAMHSA.
Summer 1996 Issue -
Bruce D. Emery, M.S.W., director
Gail P. Hutchings, M.P.A., assistant director
Lynnette A. Banning, technical assistance associate/editor/layout
Rebecca Crocker, technical assistance support specialist/layout
Christine Diaz, administrative assistant
Cited reproductions, comments, and suggestions are encouraged. You may also be added to the mailing list for networks. Contact Christine Diaz at 703/739-9333, ext. 30, or send e-mail to: christine.diaz@nasmhpd.org. [Please include your name and return mailing address, email address and/or telephone number in the body of your message so we may respond to your inquiry].
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