From NRI's State Mental Health Agency Services Research, Program Evaluation and Policy in DC two presentations on the implementation of evidence based practices.
Linking Outcomes to Services: Using Montana's Recovery Markers for Program Development and System Change, Alison Hwong & Bobbi Renner.
Fourth largest state but a rural frontier population with 12 Native American tribes and seven reservations. They have developed a web based system to measure their outcomes.
Four recovery markers are used
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Employment status,
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housing,
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level of symptom interference, and
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substance use.
which are collected every 3 months. The Information system also links to pharmacy data, demographic, diagnosis, functioning, living status, and service provides. Will be able to link to the medicare/medicaid data.
[The nice thing about the markers is that they are typically single items with a few categories. This will be simple for users to enter and conceptualize, though psychometrically weak. Their simplicity may also lead to system gaming.]
Problems with implementation
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Lack of computer experienced (one user called reporting a strange moving line on their screen. After a bit of description it turned out to be the cursor.)
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Communication problems between users and computer professionals
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Art vs. science [practitioners think about treatment as a holistic interpersonal enterprise while computer folks are interested in the change in recovery markers]
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providers say they were required to enter to much information without additional compensation (advocacy groups wanted more information)
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maintenance level
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providers felt that the information collected "will never be useful to us"
[The implementation issues discussed in this presentation are exactly the same as those addressed during the early days of computer applications in mental health. Why is it we keep rediscovering the same facts over and over? Why have the folks who develop these systems not been taught the lessons we have learned?]
Ohio's Wellness Management and Recovery Program: Working Collaboratively to Develop, Implement and Evaluate a Statewide Recovery Initiative, Marion Becker, Airia Sasser, Timothy Boaz, Amber Gum, Wesley Bullock, Kelly Wesp, Deborah Wilcox, & Stephanie Rich. www.wmrohio,org
Participants develop a wellness plan using a psycho educational (social learning model) curriculum with role plays, video, lots of interactive content. Trainers are pairs one consumer and one staff. Doing a rigorous evaluation because they want it to be an evidence based practice.
Session topics (10 2-hour sessions)
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Mental Health recovery
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Wellness
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Understanding of Mental health
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role of Medication in recovery and wellness
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Learning to manage symptoms and side effects
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Effective communication
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communicating with your providers
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Coordinating your care
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Building social supports and involving others
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Planning for wellness.
Lots of focus on learning new skills.
Have moved from systems data to individualized data. Asking each consumer what they want to achieve. Steve will provide these on request.
[This is a really nice idea and one that I have been advocating for a number of years. If an individual's services are being directed to areas A, D, and E why would we bother assessing changes in areas B, and F? While this makes sense to evaluators this does not seem to be clinically reasonable. With our advanced statistical and data management techniques we should be able to define specific outcomes for specific individuals rather than assuming everyone is the same.]