Assessing the Impact of Behavioral Health Services: Local and Statewide Strategies Debbie Innes-Gomberg, Los Angeles County Department of Mental Health Adrienne Shilton, County Behavioral Health Directors Association

MOQA Background CMHDA/CBHDA Governing Board priority and directive County commitment to the collection and reporting of outcomes County commitment to using data to tell a statewide story on the impact of behavioral health services Represents a county-to-county structure to improve use of outcomes CBHDA MHSA Committee and workgroup has informed the development of 8 outcome domains

From MOQA - 1 From Adult FSP Programs (Mental Health Data Alliance Data Quality Report, 2013): Reduction in days spent homeless since partnership Reduction in clients homeless since partnership Reduction in days psychiatrically hospitalized since partnership Reduction in clients psychiatrically hospitalized since partnership Reduction in days incarcerated since partnership Reduction in clients incarcerated since partnership

From MOQA - 1 FSP Costs and Costs Offset (one-time analysis) From County EQRO Self-Assessment: Average number of days to receive an outpatient appointment after a psychiatric hospitalization (adult and child) Percent of clients re-hospitalized within 30 days (adult and child) Time to first appointment (adult and child) Pre and post treatment symptom reductions after receiving Trauma Focused Cognitive Behavioral Therapy (CiMH) Consumer Satisfaction Survey results (CiMH Analysis)

Transitioning to MOQA - 2 Outcomes should have local as well as statewide relevance Outcomes should follow from program goals Program goal Objectives in support of program goal Program strategies (approach, interventions, practices) Outcomes Measurement method and frequency of measurement Support county measurement choices that map to overarching domains

County Behavioral Health Outcomes Domains: Housing Employment and Education Criminal Justice Involvement Acute Care Use Emotional and Physical Well-Being Stigma and Discrimination Services Access and Timeliness Administrative Timeliness

Domain Details 1) Housing Homelessness % decrease in homelessness year prior to FSP vs. 1 year in partnership and 2 years in partnership- partners and days Emergency Shelter Use For TAY & adults: % decrease in emergency shelter use year prior to FSP vs. 1 year and 2 years in partnership- partners and days Independent living % increase in living in an apartment alone or SRO from the year prior to FSP vs. 1 year and 2 years in partnership- partners and days Out-of-home placement Combining group home 0-11, 12-14 and CTF, the % decrease in out of home placement the year prior to FSP vs. year 1 and 2 in FSP- partners and days 2) Employment and Education Employment status For FSP clients with employment as a goal, % increase in employment 1 year prior to partnership vs. employment during partnership- partners and number of weeks employed School attendance For FSP child clients, % increase in children with good school attendance (always or most of the time) or with improved school attendance since enrolling in FSP Grades in School % of FSP children with good, very good or improved grades since enrolling in FSP

Domain Details 3) Criminal Justice Involvement 4) Acute Care Use Arrests For each age group, % reduction for FSP partners who completed 1 and 2 years of service Incarcerations in County Jail and Juvenile Hall For each age group, % reduction in incarcerations for FSP partners who completed 1 and 2 years of service 4) Acute Care Use Psychiatric hospital use For each age group, % reduction in psychiatric hospitalizations – partners and days for clients who completed 1 least 1 year and at least 2 years Mental Health emergency events For each age group, for clients who completed at least 2 years of partnership, % reduction in the number of MH emergency events the year prior to FSP vs. year 1 of FSP and year 2 of FSP

Domain Details 5) Emotional and Physical Well-Being Reduction of trauma and depression symptoms Using the PHQ-9, PTSD Reaction Index or Trauma Symptom Checklist, by measure, % reduction in instrument score from time 1 to time 2 for the same cohort of individuals Substance use reduction* Improved physical health * Improved quality of life/level of recovery * 6) Stigma and Discrimination 7) Service Access and Timeliness* For adults and children, the number and percentage of non-urgent SMHS appointments offered within 10 or 15 business days of the initial request by the beneficiary or legal representative for an appointment; The number and percentage of acute psychiatric discharges that are followed by a psychiatric readmission within 30 calendar days during a one year period. The year is defined as a Fiscal Year July 1-June 30; The number and percentage of acute (psych inpatient and PHF) discharges that receive a follow- up outpatient SMHS (face to face, phone or field) within 30 calendar days of discharge, except for those beneficiaries transferred to an IMD or SNF; and

Domain Details Administrative timeliness The number and percentage of treatment authorization requests (TARS) approved or denied within 14 calendar days of receipt. TAR receipt must include completed TAR and related medical records to support review. * Indicators will be finalized by DHCS as part of the 1915b Waiver renewal, Special Terms and Conditions, for inclusion in MOQA 2  

Role of Functional vs. Symptom-Based Outcomes Functional outcomes: System/societal and life impact – status of housing, institutional care, justice involvement, employment, education and overall quality of life Symptom-Based Outcomes: Reduction in specific symptoms based on a course of treatment Role of both in documenting effectiveness and impact of behavioral health treatment

Reporting FSP data – FSP data entered into the Data Collection and Reporting System (DCR). Extracted via the Enhanced Partner Level Data (EPLD) template created by Mental Health Data Alliance County MOQA data elements entered at an aggregate level (no PHI) into EBHS – web-based application developed for county use through CiBHS contract with DHCS

MOQA FSP Data Flow for Statewide Reporting DCR EPLD eBHS

Using the Data Statewide At the County Regionally CBHDA – Allows us to tell a statewide story about the impact of MHSA Advocacy in the legislature Creates accountability and consistency that is driven by counties At the County Quality improvement tool Opportunity to manage to data Tool for program monitoring Tool to use with local stakeholders Help to inform PIPs? Regionally Potential for regional outcome data workgroups to share best practices to enhance data quality, use of data for clinical and administrative purposes

Using eBHS September - November, 2015: eBHS system tested and reports functions reviewed November- December, 2015: Train and implement use of eBHS as the aggregate data collection and reporting system for MOQA for FSP Joint commitment to accountability and quality- CBHDA, MHSOAC, DHCS and the Steinberg Institute-March, 2016 report

Ensuring Data Quality Utilizing data collection strategies that are sensitive to culture Language Culturally congruent dialog- this information helps us help you…. Engaging staff in the importance of collecting and entering outcome data Using outcome reports for quality improvement, with a focus on learning  Importance of establishing a culture of learning

Balancing Learning and Accountability Accountability and performance Establishing a culture of learning and experimentation

Next Steps Use of CBHDA MHSA Committee as a vehicle to promote improved data quality and improved services. Continue to establish metrics for domains Establish data quality parameters Not limited to MHSA funded programs Ensuring reporting is value-added to other data initiatives such as DHCS’ EPSDT Performance Outcomes System, DHCS Metrics Workgroup, 1915b Special Terms and Conditions reporting

For More Information Adrienne Shilton, Director of Intergovernmental Affairs, County Behavioral Health Directors’ Association Ashilton@cbhda.org Debbie Innes-Gomberg, Co-Chair MHSA Committee and MOQA Workgroup, Los Angeles County Department of Mental Health, DIGomberg@dmh.lacounty.gov