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Background:
Empirical research demonstrates that recipients of mental
health services achieve greater success if certain services
are available and provided appropriately. The same studies
indicate that the quality of implementation strongly influences
outcomes. Success appears to depend upon: (1) fidelity to
proven program models; (2) education and training of providers;
(3) informing consumers about best practices; (4) ongoing
"hands-on" consultation by experienced clinical
experts; (5) environmental support of effort to adopt best
practices; (6) creation of financial incentives to encourage
implementation of best practices; (7) monitoring outcomes,
and sharing of data with participating organizations.
Objectives:
Evidence-based best practices will be included as part
of the Western New York Care Coordination Program. Our objectives
are as follows:
1. Ensure that service planning is based on preferences
and needs of individual recipients, as reflected in the
Individual Services Plan.
2. Learn from experience of others about proven "best
practices" of service to persons diagnosed with serious
and persistent mental illness.
3. Stage implementation of evidence-based best practices
over the life of the program to allow adequate preparation
and lasting results.
4. Educate provider organizations, clinical staff, and
service recipients about evidence based best practices.
5. Create a performance improvement process by linking
evidence based practices, outcomes measurement, and the
quality monitoring system - treat best practices as a process
that leads to enhanced outcomes.
6. Select "best practices" to be applied throughout
the WNY region to enhance service to people who participate
in the Care Coordination Program. (This might include the
DBT program, other illness self-management training, supported
employment, etc.)
7. Establish training programs and clinical consulting
capability to encourage fidelity to proven techniques and
successful introduction of evidence-based practices.
8. Allow providers flexibility in implementation of evidence-based
practices.
9. Encourage development of centers of excellence in particular
treatment or service modalities.
10. Establish outcomes measures to evaluate the success
of this effort. Measure provider performance against outcomes.
11. Create capability to capture outcomes information without
undue burden on providers, recipients, and others.
Levels of Implementation:
Evidence based best practices can be implemented at several
levels.
| "Care Coordination" level
practices (can be implemented by Care Coordination
Organizations in concert with Peer Support Programs): |
| • |
Wellness self-management |
| • |
Peer Support
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| "Provider" level practices
(can be implemented by providers): |
| • |
Integrated Treatment of Substance Abuse & Mental
Illness |
| • |
Family Mental Health Education |
| • |
Supported Employment
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| Systems level practices (beyond
the scope of Care Coordination Project): |
| • |
Assertive Community Treatment (ACT) |
| • |
Medications |
Care Coordination Program Approach to Implementing
Evidence Based Practices:
The Care Coordination Program will strive to implement
the following five evidence-based practices at two levels:
| • |
Wellness self-management and peer support principles
and practices are essential to successful engagement
between the enrollee and the care coordinator and are
therefore necessary components of care coordination.
These practices dovetail with the values of intentional
care, person centered planning and individualized service
planning. Therefore, Wellness Self-management &
Peer Support will be implemented simultaneously at the
Care Coordinator level by Care Coordination organizations
in concert with peer support programs. In effect, these
two practices will be implemented as an extension of
the initial care coordinator training through the use
of self-assessments and other fidelity measures, toolkits
and other materials, and trainers and consultants available
to the Program.
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| • |
Integrated Treatment of Mental Health and Chemical
Dependency; Family Mental Health Education; and Supported
Employment will be implemented at the participating
provider level. Focusing on participating providers
who currently offer these services and assessing and
improving the fidelity of their practices will facilitate
simultaneous implementation of the three practices.
In phase 2, providers not currently offering these
services will be trained to and supported in including
them in their practice repertoire.
The New York State Office of Mental Health (OMH)
will provide toolkits for each of these areas in the
near future to the Care Coordination Program. Each
toolkit will include videotape introducing the practice,
informational materials for different stakeholders,
a PowerPoint presentation or research handouts, and
videotapes demonstrating the practice.
OMH is also working with the University of Rochester
to establish a center of excellence for Family Mental
Health Education.
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| • |
ACT and medication (psychopharmacology) practices
are beyond the scope of the Care Coordination Program
at this time, and will be considered for implementation
in subsequent phases of the Program.
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