2005-2009 Statewide Comprehensive Plan for Mental Health Service Services
Chapter 9: Implementing OMH's Strategic Plan
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Introduction
Society places high value on performance information because of universal interest in learning how much return taxpayers receive on their social investments. In the health care field, including mental health, societal concerns are creating an increasing demand for information on the quality and value of services delivered. OMH shares this concern and is committed to performance improvement in the delivery of mental health services. The formal "vehicle" for using performance information is found in an organization's strategic plan, which translates its mission and values into desired goals and sets forth measurable objectives for performance improvement. This chapter focuses on the OMH Strategic Plan. Its goals and related objectives will form the framework for agency quality improvement activities during this Plan's life cycle. On a regular basis, OMH will publish progress reports on its achievement of the objectives related to these goals.
The 2004-2008 Statewide Comprehensive Plan described OMH's conceptual framework for performance measurement, which focuses on the outcome domains of accessibility, quality and appropriateness, service system outcomes and cost. Last year's Plan also highlighted our ongoing efforts to produce performance indicators from analysis of mental health service delivery and outcomes data available to the agency. These efforts will continue throughout the planning horizon covered by this year's Plan, yielding a year-by-year increase in the number of performance indicators available for use by OMH and in the agency's capacities for using performance indicator data to guide management decision-making and quantitatively assess progress.
OMH Performance Management Model
The OMH performance management model, first conceptualized in the late 1990s, describes performance management as a continuous process enabling data-driven quality improvement. The processes include gathering input from stakeholders on relevant areas of performance, collecting and analyzing data related to the area of performance, reporting performance results, and subsequently refining programs and services based on user feedback. Together, these processes form a continuous quality improvement cycle (Figure 9.1). This model continues to guide agency efforts to produce performance measures and it will be used to implement the long-term quality improvement processes needed to realize the goals and objectives in our Strategic Plan.
Figure 9.1 Performance Measurement Model
Figure 9.1 is also intended to describe the mental health planning process itself in which progress toward implementing the goals and objectives in the Strategic Plan is regularly reviewed, prioritized, and refined by interactions with the public. The goal of "welding" this performance management and measurement approach to strategic planning is two-fold: improved likelihood that the goals and objectives of the Strategic Plan will be achieved, yielding over time quantifiable improvements in the quality of the public mental health system through accessible, individualized recovery-oriented services.
Through this performance management model, OMH will continuously solicit stakeholder input on the Strategic Plan and through this interactive process prioritize its content into sets of short- and long-term agency objectives. The process for setting goals and measuring performance against them is an ongoing management activity consistent with the values and operating principles contained in our Strategic Planning Framework, as described in Chapter 1. While it is the State's role as the public mental health authority to determine goals and objectives, this process will be conducted in partnership with Local governments and the stakeholder community. The result will be an open and inclusive planning process that provides the public with a "road map" of agency initiatives, priorities, management strategies, and measures of success.
OMH Strategic Plan
The OMH Strategic Plan guides agency executives in the development and oversight of a targeted set of management activities and in the initiation of new planning activities. This Strategic Plan reflects OMH's response to the significant public input received on the 2004-2008 Statewide Comprehensive Plan. During the series of 2004 public events and the numerous planning advisory meetings described in Chapter 3, OMH made a concerted effort to understand the nature and magnitude of response to the agency's current set of initiatives. Of specific note is the input received from people who use mental health services and the resulting publication of a White Paper (Appendix 4) with recommendations for improving mental health care.
Major Goals and Objectives Included in the Strategic Plan
OMH has crafted, with assistance from the expanded stakeholder input efforts of 2004, a Strategic Plan consisting of: overarching goals, objectives related to each goal, specific management strategies to advance each objective, and specific performance indicators to gauge success. Figure 9.2 (page 110), defines the seven goals and related objectives included in the Strategic Plan; together, these form a high-level view of what OMH intends to achieve during the 2005-2009 planning period.
We believe these seven goals and related objectives capture the hopes and expectations regarding continuous quality improvement in the public mental health system expressed by stakeholders during 2004. We intend to validate the degree to which this Plan is responsive to public feedback by implementing it through our renewed emphasis on Local-level planning and public participation, and through use of OMH's performance management system.
Figure 9.2
OMH Strategic Plan
Goal 1 Improve the mental wellness and resiliency of all New Yorkers through an effective public education function. |
Goal 2 Improve the quality of mental health services currently available to all adults with serious mental illness and all children with serious emotional disturbance. |
Goal 3 Increase State and Local accountability for improvements in access to services, quality and appropriateness of services, and cost of services. |
| 1.1. Increase public awareness of the prevalence of suicide and of risk and preventive factors | 2.1. Increase the availability of evidence-based practices in routine care. | 3.1. Improve the State/Local mental health planning process to promote accountability. |
| 1.2. Maintain agency capacity to rapidly and effectively provide mental health support in response to natural and man-made disasters. | 2.2. Decrease the risk of experiencing adverse consequences resulting from harm, neglect or sub-optimal care or treatment. | 3.2. Improve care coordination for people with multiple inpatient admissions and little connection to appropriate outpatient services. |
| 1.3. Improve public understanding of the causes and treatment for mental illness in adults and serious emotional disturbance in children. | 2.3. Increase the State's capacity to measure and monitor the quality of care. | 3.3. Improve oversight of medication practices for both adults and children. |
| 1.4. Promote rapid response to the detection and treatment of the psychological aspects of eating disorders. | 2.4. Increase the State's and counties' capacity to improve performance based on outcomes measurement. | 3.4. Improve the service provider certification and licensing process. |
| 1.5. Promote early intervention and prevention strategies, particularly with primary care physicians and other health care providers. | 2.5. Maintain adequate resources to ensure that high quality services are able to be provided. |
Goal 4 Reduce the burden of illness through strengthened ties with the scientific community engaged in both basic and applied research. |
Goal 5 Improve outcomes for adults with serious mental illness and children with serious emotional disturbance through use of proven, effective treatments. |
Goal 6 Increase access to appropriate and effective services for special populations. |
Goal 7 Improve the capacity of State and Local governments to achieve agency goals. |
| 4.1. Improve knowledge about the causes of mental illness. | 5.1. Increase planning efforts concerning inpatient admissions and readmissions. | 6.1. Improve services for children with depression. | 7.1. Maintain sufficient resources for State and Local service delivery at levels necessary to ensure appropriate access to services. |
| 4.2. Promote the development of new treatments. | 5.2. Decrease use of treatments shown to be ineffective. | 6.2. Improve services for people with mental illness who use forensic systems of care. | 7.2. Improve retention and recruitment to ensure a qualified workforce. |
| 4.3. Improve culturally competent models of service delivery using consumer input. | 5.3. Increase consumer and family input and participation in the treatment planning process. | 6.3. Improve services for young adults. | 7.3. Improve system capacity for delivery of culturally competent services. |
| 4.4. Improve the length of time it takes to disseminate research findings to relevant audiences. | 5.4. Increase use of underutilized services known to be effective. | 6.4. Improve services for older adults. | 7.4. Improve system capacity for delivery of consumer-requested services. |
| 4.5. Improve the degree to which research scientists provide technical assistance (both continuing education and consultation) to service practitioners. | 5.5. Improve access to services with the potential to help individuals achieve success and satisfaction in living, learning, work, and social environments. | 6.5. Improve services for people with mental illness who reside in adult homes | 7.5. Improve system capacity for employee skills development and competency. |
| 4.6. Improve the degree to which the agency can assess the magnitude of social cost and burden in order to prioritize resource utilization. | 6.6. Improve services for people who require intensive levels of care coordination, including people served by the SPOA system, ACT teams, and people served through the Assisted Outpatient Treatment program. | 7.6. Maintain system capacity to articulate cost-effectiveness. |
Management Strategies and Performance Indicators
Achieving progress on any of the goals and objectives contained in the OMH Strategic Plan requires specific and sustained management activities, and measuring success requires the definition of relevant indicators of performance against which progress can be measured. OMH already has in place many of the required management activities and performance indicators. The agency is currently in the process of identifying areas in which existing management strategies need to be altered or augmented to better advance Plan goals and objectives, and specific targets for change that can be measured using existing performance indicators to document progress. Figure 9.3 illustrates, for a subset of the goals and objectives included in the Strategic Plan, some of the management strategies already in place and related performance indicators.
Figure 9.3
Subset of Goals and Objectives from the
OMH Strategic Plan
| Goal | Objective | Management Strategy | Performance Indicator |
|---|---|---|---|
| Improve the Mental Health and Resiliency of all New Yorkers | Increase public awareness of the prevalence of suicide and risk and preventive factors Improve public understanding of the causes and treatment for mental illness in adults and serious emotional disturbance in children |
Continue implementation of SPEAK campaign Continue to expand production of public education materials and outreach activities |
Stakeholder ratings of the value of public educational materials (assessed via online questionnaires) Stakeholder ratings of the value of public educational materials (assessed via online questionnaires) |
| Improve the Quality of Mental Health Services Currently Available to Adults with Serious Mental Illness and Children with Serious Emotional Disturbance | Increase the availability of evidence-based practices in routine care. Increase the State's capacity to measure and monitor the quality of care. |
Continue ACT implementation. Expand implementation of the Child and Adult Integrated Reporting System (CAIRS) to additional service sectors. |
Number of ACT enrollees per 1000 Adults with SPMI. Number of agencies and county mental health authorities using the CAIRS system. |
| Increase State & Local Accountability for Improvements in Access to Services, Quality & Appropriateness of Services & Cost of Services | Improve the State/Local planning process to promote accountability Improve oversight of medication practices for both adults and children |
Continue 2004 dialogues and implement plans for common set of data elements and performance measures; conduct dialogue meetings in all regions of the State; increase the number of counties with access to the DWH and CAIRS; Develop new county planning data set in conjunction with CLMHD. Full implementation of PSYCKES and TRAAY (medication guidelines and associated decision-support tools) |
Frequency of use by county staff of OMH data warehouse, including new county planning data set (via web-based portal). Proportion of OMH physicians using PSYCKES to review prescribing histories of OMH inpatient service recipients under their care. |
| Reduce the Burden of Illness through Strengthened Ties with the Scientific Community Engaged in both Basic & Applied Research | Improve culturally competent models of service delivery using consumer input Improve the degree to which research scientists provide technical assistance (both continuing education and consultation) to service practitioners |
Continue implementation of research demonstration funded by SAMHSA on cultural adaptation of family psychoeducation. Expand OMH's telemedicine service to additional localities throughout the State. |
Ratings by culturally-diverse family members of the quality and appropriateness of OMH family psychoeducation services. Number of telemedicine sessions conducted; Number of locations participating in telemedicine sessions. |
| Improve Outcomes for Adults with Serious Mental Illness & Children with Serious Emotional Disturbance through Use of Proven, Effective Treatments | Increase family input and participation in the treatment planning process Improve access to services with the potential to help individuals achieve success and satisfaction in living, learning, work and social environments |
Continue statewide implementation of family psychoeducation services. Continue ACT implementation. Begin first phase of Personalized Recovery-Oriented Services for adults (PROS) implementation. |
Family ratings of their level of involvement in treatment and treatment plan participation (via Parent Assessment of Care survey). Ratings by service recipients of their quality of life (Mental Health Services Survey) |
| Increase Access to Appropriate & Effective Services for Special Populations | Improve services for older adults Improve services for people who require intensive levels of care coordination, including people served by the SPOA system, ACT teams, and people served through the Assisted Outpatient Treatment Program |
Continue development of internal work plan; vet plan with stakeholders. ACT team implementation and evaluation to continue; SPOA's are all operational and many are starting to report using CAIRS; finalize evaluation report summarizing findings from first five years of AOT. |
To be determined based upon finalized workplan. Ratings by case managers of recipients' engagement in community-based services. |
| Improve the Capacity of State and Local Governments to Achieve Agency Goals | Improve system capacity for employee skills development and competency. | Continue educational forums to educate workforce in evidence-based practice approaches. | Employee ratings of usefulness and quality of EBP practice trainings. |
OMH Monitoring of Strategic Plan Progress
OMH will expand its current performance improvement structures to further foster cross divisional review of performance data related to our Strategic Plan. A new agency Performance Improvement Committee will be established to integrate across the agency's operational Divisions the performance management and planning processes necessary to achieve goals in the Strategic Plan. This Committee will consist of high level managers with representation from all parts of the agency. Specific activities of this Committee will include:
- Using input from stakeholders, develop a "short list" of near-term goals within the Strategic Plan. Prioritize plan goals based on this list so that there are core goals for immediate attention and developmental goals.
- Review and validate the appropriateness of specific performance measures in relation to the selected goals and reach consensus on which measures are to be used to monitor progress toward goal achievement.
- Select relevant management strategies that are most likely to prove beneficial in achieving each goal. Develop specific indicators for each strategy. Incorporate indicators into existing work plans or develop new work plans as needed.
- Review performance indicators and assess whether desired changes are occurring and if established targets are being met. Much of this review process already occurs in OMH for ongoing initiatives; however, those subsumed within the Strategic Plan will have progress monitored as part of Performance Improvement Committee activities.
- Identify management strategies and interventions that could be expected to improve performance.
- These "improvement" ideas would then be developed into specific action steps and work plans amended by the appropriate organizational unit(s).
- The role of the Committee would then be to monitor implementation of these plans and review subsequent impact on outcomes.
Examples of OMH progress monitoring reports are included in Figure 9.4, located at the end of this Chapter.
Conclusion
As OMH begins the implementation of its 2005 Strategic Plan, county governments and stakeholders will have the opportunity to provide significant input on our Strategic Plan and its associated management strategies, performance indicators, and appropriate performance targets through the planning process. Progress reporting components associated with this process will have utility both within OMH for internal performance improvements, but will also have public benefit in that progress toward the achievement of goals will be regularly transmitted to the public through OMH's Web site and other means of dissemination. Using OMH's performance management model, the Strategic Plan will remain a living plan, one that adapts to stakeholder feedback and as objectives are achieved. Through a reinvigorated, more inclusive planning process, it will continually change to reflect the needs of New Yorkers whose lives are touched by mental illness. Our commitment to quality is paramount.
We urge all readers of this report to comment on any aspect of this year's Statewide Plan, including the OMH Strategic Plan outlined in this Chapter. One easy way to do this is to submit feedback electronically via the OMH Web site at: http://www.omh.ny.gov/ (you will find instructions in the Statewide Plan section of the Web site).
| Figure 9.4 Progress Monitoring Report Example |
|||||
| Goal: | Improve oversight of medication practices for both adults and children | ||||
| Management Strategy / Program Initiative: | Extend availability of PSYCKES to all OMH operated inpatient facilities serving adults | ||||
| Performance Measures Selected for Monitoring Progress | Current Performance | Short-term target (one year interim goal unless otherwise specified) | Actions to be taken to achieve target | Responsible Party | Next Committee Review Date |
| 1. Access to PSYCKES: | OMH Center for Information Technology and Evaluation Research (CITER)
OMH Division of Adult Services |
3 Months | |||
| a. Number and % of OMH operated adult facilities trained to use PSYCKES | 1.a. 11 out of 20 (55%) adult facilities have been trained | 1.a. 100% of adult facilities will be trained in PSYCKES | 1.a. Complete implementations in progress (7 sites) by scheduling and conducting trainings | ||
| b. % of attending physicians with access to PSYCKES | b. 140 out of 275 (50%) attending physicians have access to PSYCKES | b. 100% of attending physicians have access to PSYCKES | b. Initiate implementations at remaining sites (6 facilities), including meeting with leadership, coordinating access requests, and scheduling/conducting trainings | ||
| 2. Use of PSYCKES Number and % of attending physicians with PSYCKES access who access PSYCKES at least 1/month | 2. 52 out of 140 (37%) of attending physicians with access to PSYCKES accessed the program (11/2004) | 2. 75% of attending physicians will access PSYCKES monthly | 2. Investigate and share facility-level best practices for supporting PSYCKES use by attending psychiatrists
Continue to provide e-mail and telephone technical support |
||
| Goal: | Increase public awareness of the prevalance of suicide and risk and preventive factors | ||||
| Management Strategy / Program Initiative: | Continue implementation of SPEAK awareness campaign using multi-media and trained personnel (OMH staff and community "gatekeepers") | ||||
| Performance Measures Selected for Monitoring Progress | Current Performance | Short-term target (one year interim goal unless otherwise specified) | Actions to be taken to achieve target | Responsible Party | Next Committee Review Date |
| 1. Self-inflicted injury rates for general population and adolescents, ages 15-19 | 1. 2000-2002 self-inflicted injuries and rates available as "baseline performance" for all 62 counties (DOH website) | 1. Monitor self inflicted injury rates in counties adopting SPEAK. | Overall activity pursuant to the foregoing targets will be pursuant to a marketing plan developed in consultation with the New York State Suicide Prevention Council, the OMH Suicide Prevention Working Group, and the Office of Public Affairs and Planning. | OMH Office of Public Affairs and Planning | 3 Months |
| 2. Suicide rates for general population and adolescents, ages 15-19 | 2. 1993-2002 trend data for completed suicides available (DOH) | 2. Monitor suicide rates for all age groups in counties adopting SPEAK. | |||
| 3. Number of SPEAK Kits and booklets produced and available | 3. 30,000 (English) 3,500 (Spanish) |
3. Increase supply of SPEAK Kits and booklets by 10% within one year. | |||
| 4. Number of SPEAK Kits distributed | 4. Direct mail audience for SPEAK news release and sample kit -125 persons | 4. Increase distribution of SPEAK Kits and booklets by 10% within one year. | |||
| 5. Percent of respondents rating the kit components favorably (4 or 5 on evaluation scale) | 5. Reviewing evaluation | 5. Increase return of evaluation forms by 10% this calendar year. | |||
| 6. Attendance at SPEAK presentations | 6. Total numbers who have received an in-person presentation on SPEAK exceeds 2,000 | 6. Increase attendance at SPEAK presentations by 10% this year. | Overall activity pursuant to the foregoing targets will be pursuant to a marketing plan developed in consultation with the New York State Suicide Prevention Council, the OMH Suicide Prevention Working Group, and the Office of Public Affairs and Planning. | OMH Office of Public Affairs and Planning | 3 Months |
| 7. Number of presenters trained (OMH workforce, community "gatekeepers") | 7. Training to begin January 2005. | 7. Increase number of SPEAK - trained personnel by 20% this year. | |||
| 8. Electronic media outlets utilized | 8. Taping of PSA's for both television and radio by Commissioner for later broadcast planned. | 8. Provide media coverage of SPEAK in five media markets within one year (print and electronic) | |||
| 9. Number of cooperating organizations (e.g. United Way, Samaritans) | 9. Organizations and entities who have engaged with OMH over SPEAK include, individual physicians (15); not for profit agencies (157), psychiatric centers (48), voluntary hospitals (57), school districts (121), local governments (57), state agencies (40), university/colleges (17), associations (31), advocacy groups and consultants (27), court/ judicial (1), pastoral (3), organizations (28), other (individuals, professional disciplines, companies, etc. (110), and local police and law enforcement (2). | 9. Grow the number of cooperating organizations by 8% this year in 5 metropolitan areas throughout the State. | Overall activity pursuant to the foregoing targets will be pursuant to a marketing plan developed in consultation with the New York State Suicide Prevention Council, the OMH Suicide Prevention Working Group, and the Office of Public Affairs and Planning. | OMH Office of Public Affairs and Planning | 3 Months |
| Progress Monitoring Report Example | |||||
| Goal: | Improve fidelity and outcomes of Assertive Community Treatment (ACT) programs. | ||||
| Management Strategy / Program Initiative: | Management Strategy: Combine data sources (e.g., CAIRS, Medicaid, Licensing, AOT, and State inpatient data) to produce performance indicators measuring fidelity to the ACT model and individual outcomes for consumers. | ||||
| Performance Measures Selected for Monitoring Progress | Current Performance | Short-term target (one year interim goal unless otherwise specified) | Actions to be taken to achieve target | Responsible Party | Next Committee Review Date |
| 1. Use of CAIRS by ACT Teams | |||||
| # and % of total ACT consumers who have CAIRS baselines submitted | Baselines on 2,305 ACT consumers have been submitted (represents 50% of total when all teams have full caseloads) | Baselines submitted on all 4,700 ACT consumers | 1. Produce and disseminate benchmarking reports on # and % of baselines submitted by each team
2. Follow up with teams ona regularly scheduled basis to review submission statistics |
1. OMH Center for Information Technology and Evaluation Research (CITER)
OMH Division of Adult Services |
3 months |
| 2. Fidelity Measures | |||||
| % increase in DACTS score for ACT teams | Current mean DACTS score is 4.04 (0.33 SD) | 0.5 SD increase in mean DACTS score to 4.2 | 1. Produce data analysis on DACTS scores
2. Provide training and consultation as needed to improve scores on individual fidelity items |
1. OMH Center for Information Technology and Evaluation Research (CITER)
OMH Division of Adult Services |
3 months |
| 3. Outcome Indicators | |||||
| % reduction in inpatient days for ACT clients | Average 45% reduction for new admissions (6 months post vs. 6 month pre) | Increase average reduction by 5%, to 50% | 1. Produce indicator reports on hospitalization for teams
2. Discuss performance with teams and identify and assist in resolving any barriers to goal achievement |
1. OMH Center for Information Technology and Evaluation Research (CITER)
OMH Division of Adult Services |
3 months |
Comments or questions about the information on this page can be directed to the Office of Planning.