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Massachusetts Department of Mental Health


Evidence Based Practice 'Evidence-based practice (EBP) is an approach to health care ... How can we account for and encourage regional variations in practice? ... – PowerPoint PPT presentation

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Title: Massachusetts Department of Mental Health

Massachusetts Department of Mental Health
Implications and Next Steps for Massachusetts
Department of Mental Health Strategic Plan
  • Elizabeth Childs, MD
  • Commissioner

Vision Statement
  • Mental health is an essential part of health
    care. The Massachusetts Department of Mental
    Health, as the State Mental Health Authority,
    promotes mental health through early
    intervention, treatment, education, policy and
    regulation so that all residents of the
    Commonwealth may live full and productive lives.

Mission Statement
  • The Department of Mental Health, as the State
    Mental Health Authority, assures and provides
    access to services and supports to meet the
    mental health needs of individuals of all ages,
    enabling them to live, work and participate in
    their communities. The Department establishes
    standards to ensure effective and culturally
    competent care to promote recovery. The
    Department sets policy, promotes
    self-determination, protects human rights, and
    supports mental health training and research.
    This critical mission is accomplished by working
    in partnership with other state agencies,
    individuals, families, providers and communities.

  • Excellence Pursuing quality, adopting evidence
    based treatment practices and operating in a
    continuous quality improvement framework to
    produce accountable outcomes
  • Innovation/Creativity Adopting promising
    treatment practices that promote recovery and
    implementing best of breed administrative
    practices to support system operations
  • Efficiency Ensuring cost effective, local
    services and supports that maximize outcomes.
  • Value Promoting effective care that has high
    value to consumers, citizens and our communities.
    Value is the product of excellence, efficiency
    and innovation.

The SMHA Value Proposition
Ensure high value treatment and supports to
people with mental illnesses to empower personal
growth and to promote an optimal and productive
life in the community.
National Context New Freedom Commission
  • In a Transformed Mental Health System
  • Americans understand that mental health is
    essential to overall health
  • Mental health care is consumer and family driven
    and recovery oriented
  • Disparities in mental health services are
  • Early mental health screening, assessment, and
    referral to services are common practice
  • Excellent mental health care is delivered and
    research is accelerated
  • Technology is used to access mental health care
    and information
  • Citation Presidents New Freedom Commission

National Context Institute of Medicine
Crossing the Quality Chasm
  • Ten simple rules that provide a basis for all
    improvement activities
  • Care is based on continuous healing relationships
  • Care is customized according to patient needs and
  • The patient is the source of control
  • Knowledge is shared and information flows freely
  • Decision making is evidence based
  • Safety is a system property
  • Transparency is necessary
  • Needs are anticipated
  • Waste is continuously decreased
  • Cooperation among clinicians is a priority
  • Six specific aims for improvement. Health care
    must become
  • Safe
  • Effective
  • Patient centered
  • Timely
  • Efficient
  • Equitable

Evidence Based Practice
  • "Evidence-based practice (EBP) is an approach to
    health care wherein health professionals use the
    best evidence possible, i.e. the most appropriate
    information available, to make clinical decisions
    for individual patients. EBP values, enhances and
    builds on clinical expertise, knowledge of
    disease mechanisms, and pathophysiology.  It
    involves complex and conscientious
    decision-making based not only on the available
    evidence but also on patient characteristics,
    situations, and preferences.  It recognizes that
    health care is individualized and ever changing
    and involves uncertainties and probabilities. 
    Ultimately EBP is the formalization of the care
    process that the best clinicians have practiced
    for generations. 
  • Source McKibbon KA (1998). Evidence based
    practice. Bulletin of the Medical Library
    Association 86 (3) 396-401.

Evidence Based Practice
  • The time has come has come for Evidence Based
    Practice in Massachusetts.
  • We must seize the opportunity created by a
    Unified Behavioral Health System and an
    overarching quality structure that will highlight
    performance through transparent data, critical
    indicators and established benchmarks and
  • The implementation of Evidence Based Practice is
    a critical component of these combined

Evidence Based Practice
The Departments model for this effort will
follow the dashboard aims identified by the
Institute of Medicines goals set forth in its
seminal article Crossing the Quality Chasm.
  • Safe Avoiding injuries to patients from care
    that is intended to help them.
  • Effective Providing services based on
    scientific knowledge to all who could benefit,
    and refraining from providing services to those
    not likely to benefit.
  • Patient-centered Providing care that is
    respectful of and responsive to individual
    patient preferences, needs and values and
    ensuring that patient values guide all clinical
  • Timely Reducing waits and sometimes harmful
    delays for both those who receive and those who
    give care.
  • Efficient Avoiding waste, including waste of
    equipment, supplies, ideas, and energy.
  • Equitable Providing care that does not vary in
    quality because of personal characteristics such
    as gender, ethnicity, geographic location and
    socio-economics status.

The DMH Dashboard Model Comprehensive Quality
Improvement System
  • Facility Review
  • Critical Incidents
  • Substance Abuse
  • EBPs
  • Restraint/ seclusion
  • Drop-Out Rate
  • Client Satisfaction
  • Access
  • LOS
  • Overtime
  • Data Integrity
  • ADC
  • Eligibility

EBP is embedded in DMH CQI initiative
  • Goal
  • Develop a customer-informed, data-driven
    infrastructure to continuously improve behavioral
    health services in the Commonwealth
  • Strategies
  • Use reliable, transparent and accessible data
  • Quality will be defined by the needs of
    individuals, families and communities
  • Commitment to evidence based practices and the
    sharing of best practices
  • Commitment to innovation and creativity

Emerging Opportunities for Evidence Based Practice
  • Redesign of the system of services within DMH and
    the MHBH unit is a significant opportunity to
    repair inconsistencies in the overall system,
    eliminate duplication and cover gaps in care,
    restructure clinical and administrative
    accountability, develop information technology
    and reinforce the adoption of Evidence Based
  • National efforts such as the New Freedom
    Commission and Institute of Medicine provide a
    framework that articulates the goals of the
    Departments priority projects.

Challenges for a culture change
  • The Department of Mental Health, through its
    priority projects, uses its leadership role to
    address the challenges of how we can implement
    evidence based practice in the delivery of
    behavioral health services.

Challenges We Face
  • Training
  • What are our priority needs in determining which
    evidence based practice to implement?
  • What standardized trainings can we develop and
    how should they be sustained among our provider

Challenges We Face, cont.
  • Funding
  • Can we develop and agree to a rate structure that
    rewards evidence based practice in the public
  • How will funding be used as a culture change

Challenges We Face, cont.
  • Quality monitoring
  • How can we demonstrate to the consumer, payers,
    and the public of the value of evidence based
  • What transparent mechanisms can we develop to
    ensure that evidence based practice maintains
    fidelity to the established model?
  • How can we account for and encourage regional
    variations in practice?