October 2002

Grant Results

SUMMARY

From 1998 to 2000, a partnership between the American College of Mental Health Administration and five major U.S. accrediting organizations produced a consensus set of indicators for behavioral health services.

Indicators are particular aspects of health care that can be quantified and measured to assess whether a process or outcome occurs.

The college, founded in 1979, is an interdisciplinary leadership group composed of a range of stakeholders in behavioral health, including public and private providers, purchasers, consumers, advocates, individual practitioners, researchers/academics and managed care companies.

The Problem
Historically, the behavioral health field has had no "gold standard" for measuring performance and outcomes. In 1997, the American College of Mental Health Administration initiated a national dialog on achieving consensus in quality measurement with a series of annual meetings known as the Santa Fe Summits.

The American College of Mental Health Administration and five national accrediting organizations — jointly known as the Accreditation Organization Workgroup — began a process of reaching agreement on what is important to measure and how to measure it. The five accrediting organizations included:

Along with the Robert Wood Johnson Foundation (RWJF), a number of other organizations supported the efforts of the Accreditation Organization Workgroup, including the MacArthur Foundation, Eli Lilly, the Substance Abuse and Mental Health Services Administration, and the Health Care Financing Administration (now known as the Centers for Medicare and Medicaid Services).

Key Results

  • The Accreditation Organization Workgroup met six times, resulting in the development and dissemination of a proposed consensus set of indicators.
  • An important byproduct of this project has been the development of a new level of collaboration among the accrediting organizations.

Communications
The workgroup has disseminated more than 700 copies of their 2001 Interim Report: A Proposed Consensus Set of Indicators for Behavioral Health to American College of Mental Health Administration members, conference attendees and accrediting organizations. The report also is available online.

After the Grant
While agreement on what is important to measure has been reached, the problems of data collection, measurement, implementation and reporting — or, how to measure it — have yet to be addressed. In addition, more work is needed to apply these general behavioral health indicators to children's and substance abuse services. The workgroup believes that this next step will require a national dialogue within the field.

Concurrent with the release of the workgroup's report, the Substance Abuse and Mental Health Services Administration organized a Carter Center Forum to develop "common" indicators for behavioral health. The forum adopted the workgroup's proposed indicators with some modifications and will continue the dialog at a meeting in 2003.

Funding
RWJF supported this project through a grant of $45,000.

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GRANT DETAILS & CONTACT INFORMATION

Project

Development of a Core Set of Indicators for Behavioral Health

Grantee

American College of Health Administration (Columbia,  SC)

  • Amount: $ 45,000
    Dates: December 1998 to December 2000
    ID#:  035462

Contact

Neal Adams
(916) 651-6742
nadamsmd@pacbell.net

Web Site

http://www.acmha.org

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Proposed Consensus Indicators

ACCESS — Getting into services
Topic Concept or Concern Things to Count
Services are available Persons served perceive and experience that services are available a. The rate of persons served reporting that they receive the services they need
b. The rates of utilization of services as compared to the identified needs of the community
Services are convenient Persons served perceive and experience services as convenient (i.e., available services are well located, offered at convenient hours, etc.) a. The rate of persons served reporting that transportation is not a barrier to recovery
b. Geographic analysis of population-to-provider rates and travel times for behavioral health professionals
Services are timely Persons served perceive and experience services as timely a. The rate of persons served reporting timely response from first request for service to first face-to-face meeting with a mental health professional
b. The rate of persons reporting timeliness from a first appointment to a second appointment
c. The average number of days from first request for service to first face-to-face meeting with a behavioral health professional
d. The average number of days from a first appointment to a second appointment
Services are provided Services are available and provided to people who need them a. The rate of utilization of services at each available level of care described by meaningful groupings of persons served
PROCESS — What happens during services
Topic Concept or Concern Things to Count
Treatment Decisions Persons served (and families of children and adolescents) participate meaningfully in treatment decisions a. The rate at which persons served report they receive useful information to make informed choices about their treatment
b. The rate of participation in decisions regarding treatment by persons served
c. The rate of participation in decisions regarding treatment by families of children and adolescents when indicated
Responsiveness Services are responsive to the clinical status of the person served a. The rates of persons served who receive timely face-to-face follow-up care after leaving a 24-hour care setting
b. The rate of persons served who receive a timely course of treatment following diagnosis of a behavioral health disorder
Non-coercive Treatment Whenever possible, treatment should be voluntary and non-coercive a. The rate of persons served who report experiencing treatment as non-coercive
b. The rate of involuntary treatments
c. The rate of seclusion and restraint
Experience of Care Persons served should perceive and experience service providers as responsive and sensitive a. The rate at which persons served report they were treated with politeness, respect and dignity by staff
b. The rate at which persons served report feeling hopeful about their recovery
c. The rate at which persons served report they were treated with sensitivity to their gender, age, sexual orientation, culture, religious, ethnic and linguistic background
Safe Treatment Persons served are safe in treatment a. The rate at which persons served report that they feel safe in treatment
b. The rate at which persons served report they feel safe in the community
c. The rate of suicide, homicide and unexpected deaths
OUTCOME — Results of services
Topic Concept or Concern Things to Count
Well-Being Persons served experience an improvement in health and psychological well-being as a result of treatment a. The rate of persons served who are better, worse or unchanged at the termination of treatment compared to the initiation of treatment
b. The rate of persons served who are better, worse or unchanged at a standard interval following the termination of treatment compared to the initiation of treatment
Work and School Persons served are productively involved in work and school a. For adults: the rate of employed/unemployed adults counted at the termination of treatment and at a standard interval following the termination of treatment
b. For employed adults: the average number of days not worked counted at a standard interval following the termination of treatment
c. For children: the average number of missed class days counted at a standard interval following the termination of treatment
Safety Treatment improves the safety of persons served a. The rate of episodes of victimization reported at a standard interval following the termination of treatment
b. For persons served who identify victimization or vulnerability as a concern at the initiation of treatment: the rate of perceived vulnerability reported at the termination of treatment and at a standard interval following the termination of treatment
Legal Involvement Persons served should be out of trouble with the law a. For persons served who identify problems with the law as a concern at the initiation of treatment: the rate of arrests, detentions and/or incarcerations counted at a standard interval following the termination of treatment
Housing Housing needs are resolved b. The rate of domiciled/homeless persons at the termination of treatment and at a standard interval following the termination of treatment
c. For adults who identify housing as a concern at the initiation of treatment: the rate who report improvement, worsening or no change in their satisfaction with housing at the termination of treatment and at a standard interval following the termination of treatment
d. For children: the rate of children at home at the termination of treatment and at a standard interval following the termination of treatment

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Reports

Adams N (ed.). 2001 Interim Report: A Proposed Consensus Set of Indicators for Behavioral Health. Pittsburgh Pa.: The American College of Mental Health Administration Accreditation Organization Workgroup, 2001. Available online.

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Report prepared by: Matthew Calhoun
Reviewed by: Karin Gillespie
Reviewed by: Molly McKaughan
Program Officer: Constance Pechura