Implementing Evidence-Based Practices and Quality Care in New York State
This page provides examples of program designs at OMH that integrate the concepts of EBPs, and also examples of ongoing initiatives at OMH that focus on implementing evidence-based practices and quality care.
Implementation Strategies by Phase of Implementation *
In August 2001 OMH held a series of four focus groups to introduce the concept of Evidence-Based Practice to local government leaders, service providers, advocates, and recipients of service. Based on these sessions, cultural and structural changes necessary for the implementation of Evidence-Based Practices were identified. They provided the basis for designing an implementation plan with strategies for change.
| Implementation Strategies | Phase
I Consensus Building |
Phase
II Enacting |
Phase
III Sustaining |
| Awareness: Encouragement and collaboration with our stakeholders | Identify and use a network of champions from local government, stakeholders, and advising groups | Using formal consensus-building projects to create a set of evidence-based demonstrations throughout the state (including Drake pilot sites) | Evaluate for widespread replication |
| Education: Introduction and development of new quality initiatives | Produce introductory materials, include national EBP implementation strategies and quality outcome measures | Develop several 'Centers for Excellence' for ongoing research and education | Secure permanent funding for 'Centers for Excellence' statewide |
|
Structural and Clinical Improvement: Incorporation of quality measures into both individual practitioner and provider performance |
Develop and test quality outcome measures using network of champions and demonstration sites | Develop fiscal and regulatory changes indicated during development and testing | Create a local level evaluative capacity to monitor performance against outcomes |
| Continual Improvement and Support: Monitoring of the quality measures and means for continuous upgrading | Use existing progress report structure to 'test' and initial series of performance reviews in selected EBP areas | Use performance data in selected EBP areas to make regulatory and funding decisions | Periodically revisit consensus building stages to identify and promote innovations |
* Carpinello, S. et al. (2002). New York State’s Campaign to Implement Evidence-Based Practices for People with Serious Mental Disorders. Psychiatric Services, (53) 2.
Examples of Program Designs
|
Assertive Community Treatment (ACT) Program: Assertive Community Treatment (ACT) Goal: The purpose of Assertive Community Treatment (ACT) is to deliver comprehensive and effective services to individuals who are diagnosed with a severe mental illness and whose needs have not been well met by more traditional service delivery approaches. Features: Assertive Community Treatment is an evidence-based practice. ACT provides an integrated set of other evidence-based treatment, rehabilitation, case management, and support services delivered by a mobile, multi-disciplinary mental health treatment team. ACT supports recovery through a highly individualized approach that provides recipients with the tools to obtain and maintain housing, employment, relationships and relief from symptoms and medication side effects. The nature and intensity of ACT services are adjusted through the process of daily team meetings. ACT integrates the principles of cultural competence, addressing the impact of discrimination/stigma, and inter-system collaboration into its service philosophy. ACT will provide services with consideration of linguistic preference. An essential aspect of ACT is recognizing the importance of family, community-based, and faith-based supports. Outcomes:
Biggest Challenge: In order to support ACT as an evidence-based practice the model must approximate closely to fidelity standards. These standards call for a multi-disciplinary team that provides services in-vivo. Garnering the support of Provider leadership and key stakeholders is of utmost importance to the implementation of the ACT model. How Other Organizations Can Adopt: In New York State agencies interested in providing ACT services should contact their local government unit to discuss if there is a need for ACT service capacity and if there is funding for ACT services in their county. Contact Point: Judith F. Cox, Director of ACT Services,
New York State Office of Mental Health |
|
Performance-Based Contracting (PBC) Program: Performance-Based Contracting (PBC) Demonstration Program Goal: The goal of the PBC Demonstration Program is to promote integrated, competitive employment for people with serious persistent mental health conditions by funding employment outcomes rather then process. Features: Key features of the Program include: 1) a milestone structure developed from evidence based supported employment technology, 2) incremental funding, weighted so that larger payments at later stages of employment provide the incentive to help consumers retain employment yet smaller payments at the beginning make service delivery viable, 3) a two tiered payment structure that reimburses at a higher rate services to those with more barriers to employment to avoid creaming, 4) built in quality assurance through individualized performance feedback and process consultation, 5) agency discretion over how services are offered and 6) consumer self-determination in selection of a career path and setting the pace through the employment process. Outcomes: At the mid-point of the two year demonstration, preliminary evaluation findings indicate that the Program effectively reaches the target population including those consumers who have historically been more difficult to support in employment, promotes rapid placement in permanent, competitive jobs for a significant proportion of participants, and encourages provider agencies to adopt evidence based practices to achieve employment outcomes. Biggest Challenge: The biggest challenges are to facilitate systems coordination to ensure seamless services for consumers securing and sustaining employment and to provide effective on-going support for long -term retention. How Other Organizations Can Adopt: To adopt this approach service provider agencies can implement evidence based supported employment technology and move towards making vocational goals for consumers an agency wide priority. Contact Point: Jan Kaelin-Kee at the New York State
Office of Mental Health |
|
Functional Family Therapy (FFT) Program: Functional Family Therapy (FFT) Goal: To improve mental health outcomes for at-risk/high-risk youth ages 11 to 18, involved in the juvenile justice and/or child welfare systems. Features: Provides short-term, family-based therapy in the home, clinic or school setting. A specially trained Functional Family Therapy therapist meets with the youth and family together, for an average of 12 sessions, applying the three phases of the FFT model in sequence to: (1) engage and motivate the youth and family, (2) promote behavior change, and (3) support generalization of learned skills and behaviors. Two years’ intensive training for an agency-based team of FFT therapists is delivered by national consultants and funded by the NYS Office of Mental Health. Outcomes: Improvements in mental health outcomes and family functioning; reduced clinic dropout; and other systems changes such as reduced recidivism, out-of-home placement and school dropout. To date, outcomes for this NYS program have not been systematically measured as it is still in the start-up phase, therapists are still in training and clients are in the early stages of the model. However, therapists report promising preliminary results and excitement about the model. In other programs across the U.S., FFT has yielded 80% completion rates, 50% reduction in recidivism and documented reductions in system costs. Biggest Challenge: Building FFT into the organization culture so it is understood as a change in practice and long-term investment, and is accommodated by staff, other stakeholders (both internal and external), structures and systems. How Other Organizations Can Adopt: Submit an application for 3-to-8 staff to be trained and certified as an FFT team. Upon FFT Inc.’s approval of the application, the team receives two years’ rigorous training, consultation and support by national FFT trainers, prior to certification. Therapists maintain FFT caseloads of 5-to-15 families each. Certification is maintained by practicing FFT in the team environment and entering data on a web-based tracking system. Contact Point: Deborah L. Greene, Consulting Manager
for FFT Implementation Project, NYS Office of Mental Health |
|
School-Based Mental Health Program: School-Based Mental Health collaboration (NYS Office of Mental Health, NYS Education Department, NYS Department of Health, Families Together of New York, Inc., Columbia University Center for the Advancement of Children’s Mental Health) Goal: To assist children and adolescents in primarily low-income communities to succeed in school through the integration of school-based services and supports, including mental health, education, health and family support services. Features: Integrated services at seven high-needs schools in New York City. Includes participation by mental health professionals in the school’s regular assessment and planning processes for students with emotional/behavioral issues, collaboration between on-site licensed mental health clinics and school-based health centers, development of school-based family support mechanisms, as well as training and ongoing supervision of mental health professionals in use of evidence-based clinical protocols. Development of practical skills (e.g., positive behavioral interventions and supports and self-advocacy) is emphasized in training for school staff and families. Family involvement, strengths-based planning, and frequent consultations with teachers (1:1 and small group) are important components. Serves primarily minority students (African-American, Hispanic, Asian). Outcomes: Program evaluation is underway. Anticipated outcomes include better attendance, fewer disciplinary referrals and suspensions, improved academic performance, ability to maintain students in general education settings, when appropriate, and reduced symptomatology. Biggest challenges: Effective family engagement strategies; crisis-management (as opposed to planned services); maintaining balance between collaborative supports, strengths-based planning and billable services. How Other Organizations Can Adopt: Identify mutual goals of education system and other agencies and organizations serving children and families with emotional/behavioral issues. Match goals to funding streams and other resources. Contact Point: Eileen Myers, NYS Office
of Mental Health |
|
Project Liberty Program: Project Liberty Goal: Alleviate the psychological distress that large numbers of New Yorkers have experienced as a result of the World Trade Center disaster, by providing them with effective, community-based disaster mental health services that help them to recover from their psychological reactions and regain their pre-disaster level of functioning. Features: Free short-term outreach and educational counseling services to affected individuals and groups who reside in New York City or a surrounding county. Referrals to longer-term mental health services are provided when necessary. The program's crisis counselors provide face-to-face disaster-related services by outreaching to those in need in their homes, businesses, schools, and places of religious worship, and in recovery centers, shelters or community centers. Outcomes: More than 400,000 individuals have received direct face-to-face counseling and public education through Project Liberty. It is the single largest and most rapidly implemented public mental health program in the history of the United States. Biggest Challenge: The Federal Emergency Management Agency (FEMA) Crisis Counseling Program (CCP) community outreach model has typically, though not exclusively, been deployed in response to natural disasters in geographic areas with smaller, more homogeneous, and less dense populations than the New York City metropolitan area. For Project Liberty, it was necessary to adapt the model to respond to a man-made disaster of catastrophic proportions and meet the crisis counseling needs of the large, diverse population in the broad geographic area that includes New York City (one of the world's largest and most densely populated metropolitan areas) and the surrounding metropolitan counties. How Other Organizations Can Adopt: More than 100 mental health providers as well as many other community service organizations have coordinated Project Liberty activities in New York City and the surrounding counties. Organizations interested may contact the individual below for implementation guidance. Contact
Point: April Naturale, Statewide Project Director, 212-330-6361 |
Examples of Ongoing Work to Advance EBPs and Quality Care Agenda
- Assisted Outpatient Treatment (AOT) - OMH in conjunction
with local governments implemented AOT as a mechanism to enforce New York
State’s assisted outpatient treatment statute, named Kendra’s Law. AOT
works to identify individuals with severe mental illness in each locality
who have high needs but are not currently participating in the services necessary
to ensure their safe community living; rapidly assesses the ability of these
individuals to determine whether they require court-ordered treatment; ensures
that these individuals get priority access to services; and closely monitors
the results of treatment.
- Downstate Alliance - a group of OMH psychiatric centers
working together to improve the quality of care for recipients. This group
produced the pamphlet “Recommendations for the Pharmacological Management
of Schizophrenia- 2001” which is a tool to assist in clinical decision-making.
- The New York Work Exchange - promotes work and career opportunities for consumers of mental health services by offering assistance to the New York City provider community, through expert trainings, focused technical assistance, information updates, research and evaluation, and special demonstration projects.
- Treatment Recommendations for Aggressive/Assaultive Youth (TRAAY ) - The purpose of TRAAY is to carefully examine the use of antipsychotic medications with children and adolescents in OMH state-operated programs (inpatient and day treatment) who are aggressive/assaultive. The TRAAY workgroup has been developing treatment recommendations based on the existing evidence-base for using antipsychotic medications with young people who could benefit from them.