Welcome, Agenda,Challenges and Potential Solutions

Implementing Evidence-Based Practices and Performance Measures

for Massachusetts Mental Health Services:An Educational Forum

Donald S. Shepard, Ph.D.Sept. 28, 2005

Shepard@Brandeis.edu

Tel 781-736-3975

Brandeis University, Waltham MA 02454

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Welcome

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Key questions

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1 What are EBPs? To inform key stakeholders about the key concepts and status of evidence-based practices (EBPs) and performance measures in mental health. 

2 How can they be implemented? To understand what is needed for successful implementation and the barriers to success. 

3 How can we work together to deliver more evidence-based practices? To bring together key behavioral health stakeholders to discuss how to support implementation of these practices in Massachusetts. 

Participants

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About 175 Registrants

7 States Represented:

MA, CT, MD, ME, NH, NY, VA

Sponsors

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Massachusetts Department of Mental Health

Massachusetts Department of Public Health, Bureau of Substance Abuse Services

Center for Behavioral Health, Schneider Institute for Health Policy, Brandeis University

Suffolk University Department of Public Management

Center for Mental Health Services, SAMHSA

Agenda

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Framework

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Context and Evidence-Based Practices Nationally

Performance Measurement (Process and Outcome)

Towards Implementation in Massachusetts• Participation by providers, interest groups, government• Training• Incentives• Etc.

Speakers

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Performance Measurement

(Horgan)

Towards Implementation in Massachusetts(Childs, Stelk, Lynch, Funk, Delman, Beinecke)

Context and Evidence-Based Practices Nationally

(Shepard, Keane, Botticelli, Mandersheid, Leff, Lynde, Ganju, Hermann)

Challenges and Potential Solutions

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A Suggestion: Incentives

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First Illustration: Setting

Goal: Improve retention in substance abuse treatment.“Eighty percent of success in life is showing up.”

Woody Allen (1935-, writer, director actor)

Setting: Randomized trial of outpatient aftercare based on relapse-prevention at Spectrum Addiction Services in MA

Enrolled 123 subjects in experimental arm (after excluding one death)

At midpoint: only 32% of clients completed minimal dose of at least 5 sessions

Authors: Donald Shepard Jeanne Calabro, James McKay, Craig Love, Jill Tetreault, Hyong Yeom

Support: NIDA DA 08739

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First Illustration:Counselor Incentive

• Bonus of $100 for each client who completed at least 5 relapse prevention sessions

• Additional bonus of $50 for each client who completed 12 relapse prevention sessions

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Illustration: Results

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64%

33%

19%

87%

59%

22%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 or more 5 or more 12 or more

Sessions attended (milestones)

% o

f cl

ien

ts m

eeti

ng

mil

esto

ne

Little or no incentives

Offered incentives

Odds Ratio 4.2

Odds Ratio 4.1

Odds Ratio 1.5

Ongoing project plans: Profiling and incentives in behavioral health care

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•Randomized trial (facilities randomized)

•Profiling according to “Connect to care” and other measures

•Case mix adjustment planned

•Coaching in evidence based practices

•Recognition and monetary incentives for top performing agencies planned

•Notes: Collaboration with Connecticut Department of Mental Health and Addiction Services (DMHAS)

•Part of Brandeis/Harvard NIDA Research Center on Managed Care in Drug Abuse Treatment.