Telesage Outcomes Measurement System (TOMS ) Tracking and Improving Behavioral Health Care

1. Telesage Outcomes Measurement System (TOMS) Tracking and Improving Behavioral Health Care Throughout Louisiana

2. What is TOMS? • The Telesage Outcomes Measurement System is a state-of-the art means for collecting and reporting client self-reportoutcomes and obtaining regular client treatment progress reports. • TOMS is sponsored by the state of Louisiana Office of Mental Health (OMH), and has been developed jointly with TeleSage, Inc., based on experience in several other states implementing the system

3. What is TOMS? • Specifically designed for public behavioral health populations • Developed and used statewide in states of Tennessee, Iowa, Pennsylvania, & Washington • Uses short items stated in simple language and at 5th grade reading level • Easy to understand 5-point response scale: Never, Rarely, Sometimes…

4. What are Consumer Outcomes? • Consumer outcomes are indicators of quality of lifethat measure domains, such as symptom severity and social functioning, as well as recovery. • Outcomes must by definition measure change over time, so taking the survey at regular intervals is necessary.

5. Who Benefits from Outcomes Tracking? • Client • Clinician • Regions & LGE’s • Office of Behavioral Health

6. What are the Benefits of Outcomes Tracking? • For the Client • Contributes to a client-centered, recovery-oriented approach to treatment • TOMS self-assessment is from the client’s viewpoint • Gives the client a “voice” and empowerment in recovery process • Benefits client involvement in treatment with the clinician, contributing to outcome-focused care

7. Who Benefits from Outcomes Tracking? • For the Clinician • Contributes to client-centered, outcome-focused treatment • Provides a comprehensive & concise view of clients functioning & needs at-a-glance • Provides standard measures of symptom severity, functional impairment, medication adherence and changes in these over time

8. What are the Benefits of Outcomes Tracking? • For Regions/ LGE’s • Contributes to service quality improvement • Demonstrates accountability for resources • Helps to meet requirements for certification, accreditation and/or payor organizations • For Office of Behavioral Health/ DHH • Contributes to program quality improvement • Demonstrate accountability for resources • Helps identify best practices

9. Guiding Principles of TOMS Development • Minimal burden on clients and providers • Actionable outcome reports for clinicians and agencies • User-friendly and flexible administration technologies • Web-based: Minimal hardware requirements or additional software needed onsite • Telesage incorporates feedback from users contributing to ongoing system improvements

10. The TOMS Outcome Instruments 1-Adult (age 18+) Self-assessment • Total: 44 items 2-Youth (age 13-17) Self-assessment • Total: 53 items 3-Parent/Guardian (age 6-12) assessment • Total: 52 items Estimated Client Completion Time: 6-12 minutes

11. Depression Anxiety Anger Psychoticism Physical Impairment Social Functioning (Peer) Recovery Daily Functioning Medication Adherence Medication Side Effects Substance Use Emergency/Hospital Use Work Safety Legal Living Situation Transportation Self-assessment Domains- Adult -

12. Depression Anxiety Anger Attention Deficit Hyperactivity Conduct Social Functioning (Peer) Social Functioning (Family) Empathy Daily Functioning Resiliency Medication Adherence Medication Side Effects Participation in Physical and Group Activities School Substance Use Emergency/Hospital Use Work Legal Living Situation Self-assessment Domains-Youth and Parent/Guardian-

13. Self-assessment Intervals New Clients • Intake Self-assessment (within 30 days of admission) • Every 3 months thereafter Existing Clients*(phase in at client review) • Intake Self-assessment (next treatment plan update) • Every 3 months thereafter *Existing clients are those who have been receiving services at your clinic for at least one month.

14. Technology Options for Self-assessment Administration Immediate Reports TOUCHSCREEN ON-LINE (mouse) PC PHONE (planned) ODBCDatabase PAPER* Export in any format *Rapid Data Entry

15. Touchscreen/ Online Survey Administration Consumer completes online self-assessment 1

16. Touchscreen/ Online TOMS Administration- w/ OMH-IIS Users 2 Provider receives instant results

17. Touchscreen/Online TOMS Administration- No OMH-IIS 2 Provider can receive instant results

18. Paper Survey Administration

19. Louisiana TOMS Home Page

20. TOMS Secure Clinic Site

21. TOMS Clinician Report • TOMS Clinician Reports are an informative and easy-to-read summary of a client’s self-assessment(s). • They contain graphs and summary sentences of important questions, as well as the client’s actual self-assessment responses. • They compare the client’s self-assessment responses over time, displaying responses at four time points (intake plus the three most recent assessments). • Graphs display the client’s domain scores. *Intake = Initial/First self-assessment completed

22. Sample Adult Clinician Report

23. Sample Adult Clinician Report

24. Sample Adult Self-assessment

25. Other Telesage Instruments Client Quality-of-Care Surveys (C’est Bon and La Fete programs) Adult Survey (MHSIP-based) • Total: 42 items Parent/Guardian Survey (YSS-F) • Total: 32 items

26. Client Quality of Care Domains • Access to Care • Appropriateness/Quality of Care • Outcomes of Care • Treatment Involvement

27. TOMS Administration Process • TOMS is completed at the point-of-service prior to a regular treatment session at the clinic • TOMS is introduced by reception staff using the Client Information Sheet, which also accomplishes client informed consent • The client is instructed on how to log-on and use the Touchscreen/On-line self-assessment via the TOMS Instruction Sheet • When the client completes the self-assessment, TOMS automatically prepares the outcome report • The TOMS is then ready for the next client

28. TOMS Implementation-Where we are now… • TOMS Initial Implementation • Started March, 2010 • 6 Initial Implementation Sites • Lafourche MHC • Terrebonne MHC • Lake Charles MHC • Shreveport MHC • Ruston MHC • Jonesboro MHC

29. TOMS Implementation-Where are we now • As of 06/04/10: Number of self-assessments administered: 900+ • Positive Feedback from Clients & Clinicians • Clients think it’s FUN!! • Clinician’s have instant useful information • Initial Implementation Report

30. TOMS Implementation-Some Lessons Learned • Importance of staff who will introduce & administer the TOMS • Have someone nearby should client need assistance • Make TOMS a routine part of everyday practice • Administer prior to Service Session • Offer option of Touchscreen or Mouse • Begin with New Admissions- establish baseline

31. TOMS Help • Ongoing Support • Thru weekly implementation GoToMeetings • TOMS Website • Technical Issues with the Site or Self-assessment • Contact TeleSage at LAhelp@telesage.com

32. TOMS Help continued • Other • Contact Annette Giroir at (225) 342-8641 or annette.giroir@la.gov Or Randall Lemoine at (225) 342-8605 or randall.lemoine@la.gov

33. In conclusion… TOMS provides a state-of-the-art, easy-to-administer client outcome measurement system for monitoring and improving service outcomes at both the level of the individual client-clinician and the local/state administrative levels Q&A

34. Our TOMS is up! Thank You!