Massachusetts Department of Mental Health

1. Massachusetts Department of Mental Health Implications and Next Steps for Massachusetts: Department of Mental Health Strategic Plan Elizabeth Childs, MD Commissioner

2. Vision Statement Mental health is an essential part of health care. The Massachusetts Department of Mental Health, as the State Mental Health Authority, promotes mental health through early intervention, treatment, education, policy and regulation so that all residents of the Commonwealth may live full and productive lives.

3. Mission Statement The Department of Mental Health, as the State Mental Health Authority, assures and provides access to services and supports to meet the mental health needs of individuals of all ages, enabling them to live, work and participate in their communities. The Department establishes standards to ensure effective and culturally competent care to promote recovery. The Department sets policy, promotes self-determination, protects human rights, and supports mental health training and research. This critical mission is accomplished by working in partnership with other state agencies, individuals, families, providers and communities.

4. Principles Excellence • Excellence: Pursuing quality, adopting evidence based treatment practices and operating in a continuous quality improvement framework to produce accountable outcomes • Innovation/Creativity: Adopting promising treatment practices that promote recovery and implementing best of breed administrative practices to support system operations • Efficiency:Ensuring cost effective, local services and supports that maximize outcomes. • Value: Promoting effective care that has high value to consumers, citizens and our communities. Value is the product of excellence, efficiency and innovation. Value Innovation/Creativity Efficiency The SMHA Value Proposition Ensure high value treatment and supports to people with mental illnesses to empower personal growth and to promote an optimal and productive life in the community.

5. National Context: New Freedom Commission In a Transformed Mental Health System: • Americans understand that mental health is essential to overall health • Mental health care is consumer and family driven and recovery oriented • Disparities in mental health services are eliminated • Early mental health screening, assessment, and referral to services are common practice • Excellent mental health care is delivered and research is accelerated • Technology is used to access mental health care and information Citation: President’s New Freedom Commission

6. National Context: Institute of Medicine Crossing the Quality Chasm Six specific aims for improvement. Health care must become: • Safe • Effective • Patient centered • Timely • Efficient • Equitable Tensimple rules that provide a basis for all improvement activities: • Care is based on continuous healing relationships • Care is customized according to patient needs and values • The patient is the source of control • Knowledge is shared and information flows freely • Decision making is evidence based • Safety is a system property • Transparency is necessary • Needs are anticipated • Waste is continuously decreased • Cooperation among clinicians is a priority

7. Evidence Based Practice "Evidence-based practice (EBP) is an approach to health care wherein health professionals use the best evidence possible, i.e. the most appropriate information available, to make clinical decisions for individual patients. EBP values, enhances and builds on clinical expertise, knowledge of disease mechanisms, and pathophysiology.  It involves complex and conscientious decision-making based not only on the available evidence but also on patient characteristics, situations, and preferences.  It recognizes that health care is individualized and ever changing and involves uncertainties and probabilities.  Ultimately EBP is the formalization of the care process that the best clinicians have practiced for generations.”  Source: McKibbon KA (1998). Evidence based practice. Bulletin of the Medical Library Association 86 (3): 396-401.

8. Evidence Based Practice • The time has come has come for Evidence Based Practice in Massachusetts. • We must seize the opportunity created by a Unified Behavioral Health System and an overarching quality structure that will highlight performance through transparent data, critical indicators and established benchmarks and targets. • The implementation of Evidence Based Practice is a critical component of these combined initiatives.

9. Safe: Avoiding injuries to patients from care that is intended to help them. Effective: Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit. Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs and values and ensuring that patient values guide all clinical decisions. Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care. Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and energy. Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location and socio-economics status. Evidence Based Practice The Department’s model for this effort will follow the “dashboard” aims identified by the Institute of Medicine’s goals set forth in its seminal article “Crossing the Quality Chasm.”

10. The DMH “Dashboard” Model: Comprehensive Quality Improvement System SAFETY PATIENT CENTERED TIMELY EFFICIENT EQUITABLE EFFECTIVE • Facility Review • Critical Incidents • Substance Abuse • EBPs • Restraint/ seclusion • Drop-Out Rate • Client Satisfaction • Access • LOS • Overtime • Data Integrity • ADC • Eligibility

11. EBP is embedded in DMH CQI initiative • Goal • Develop a customer-informed, data-driven infrastructure to continuously improve behavioral health services in the Commonwealth • Strategies • Use reliable, transparent and accessible data • Quality will be defined by the needs of individuals, families and communities • Commitment to evidence based practices and the sharing of best practices • Commitment to innovation and creativity Quality

12. Emerging Opportunities for Evidence Based Practice • Redesign of the system of services within DMH and the MHBH unit is a significant opportunity to repair inconsistencies in the overall system, eliminate duplication and cover gaps in care, restructure clinical and administrative accountability, develop information technology and reinforce the adoption of Evidence Based Practices. • National efforts such as the New Freedom Commission and Institute of Medicine provide a framework that articulates the goals of the Department’s priority projects.

13. Challenges for a culture change The Department of Mental Health, through its priority projects, uses its leadership role to address the challenges of how we can implement evidence based practice in the delivery of behavioral health services.

14. Challenges We Face Training: • What are our priority needs in determining which evidence based practice to implement? • What standardized trainings can we develop and how should they be sustained among our provider partners?

15. Challenges We Face, con’t. Funding • Can we develop and agree to a rate structure that rewards evidence based practice in the public sector? • How will funding be used as a culture change agent?

16. Challenges We Face, con’t. Quality monitoring • How can we demonstrate to the consumer, payers, and the public of the value of evidence based practice? • What transparent mechanisms can we develop to ensure that evidence based practice maintains fidelity to the established model? • How can we account for and encourage regional variations in practice?