Important Next Steps In Measuring Success Dr. Brian Rush, Senior Scientist, Homewood Research Institute; Scientist Emeritus, Centre for Addiction and Mental Health

Homewood Research Institute (HRI) is an independent, charitable organization that partners with leading scientists, practitioners, and Homewood Health Inc., to conduct applied research that is designed to improve care and outcomes in mental health and addiction.

The Institutes’ focus is the immediate application of research into practice to benefit individuals, families, workplaces and society.

“You mean to tell me that we are throwing all these resources into mental health and addiction and we don’t know if anyone is getting better?” Bob Rae HRI Board Member

“In many respects, Mental Health and Addiction research is where cancer research was 50 years ago, especially in regards to measuring service delivery, costs and outcomes”. Dr. Roy Cameron, Executive Director Homewood Research Institute

There is a lengthy list of national, provincial, regional and organizational initiatives that address various aspects of evaluation and performance measurement. Two critical questions arise: How are all these initiatives connected conceptually from a conceptual and measurement point of view; and Are they really measuring the important recovery outcomes”.

Canadian Context Nationally (examples) Mental Health Commission of Canada review and synthesis CIHI’s current initiative on performance indicators related to access to services Research collaboration on inter-provincial comparison of selected indicators CCSA’s national treatment indicators for substance use services Health Canada’s SUAP initiative to enhance substance use services and systems Ongoing and expanding surveillance systems (e.g. Opioid overdose and other harms)

Canadian Context Provincially and Regionally Performance measurement frameworks that are tied to broad mental health and addiction strategies Provincial level (e.g., Ontario) Health authority level (e.g., Ontario Southeast LHIN – focus on integrated MH/systems Major system transformation Manitoba MyHTs; wait time reduction Ontario – centralized access

Canadian Context Organizational-level HRI’s work on developing and implementing an outcome monitoring system for addiction treatment No doubt one of several organizational level evaluation initiatives that have a lot to contribute to a national framework with a stronger focus on recovery outcomes

What’s Missing? There is no unifying vision or framework to consolidate key features of these various initiatives and thereby facilitate: Application of information for quality improvement on a large scale – including system-level improvements Comparison across provinces/regions/organizations – including benchmarks of success Collection and application of reliable and valid information on recovery outcomes for system improvement and accountability

Need for inclusion of surveillance Challenges continue to emerge with respect to particular substances (e.g., opioids, crystal meth), and particular mental disorders (e.g., trauma/ PTSD, incoming refugees). This speaks to the need of flexibility and ensuring that surveillance systems for emerging trends also have a place in a unifying framework that integrates needs, processes and outcomes. And all within the context of our health care systems as “complex adaptive systems”

Important contextual trends: Prevention is possible and makes good business sense A truly system approach that addresses population need at all levels – a “whole-of-government” and “whole-of-society” approach Ongoing integration of MHA services; a trend that has been going on for the last two decades – slow progress but progress is being made Efforts to build more collaborative care among primary care and mental health and addiction services.

Homewood Research Institute proposes developing, in partnership with key stakeholders (national, provincial, and territorial), a national evaluation and performance measurement framework on mental health and addictions prevention and treatment.

Key activities would include: Creating a national advisory committee/working group Conducting an environmental scan of key national and provincial (and international) performance measurement frameworks and related projects Developing and drafting a draft framework including a strong focus on recovery outcomes to be achieved Convening a national consultation process for validation and culminating in a report for consultation with stakeholders and application in their work

In addition, HRI proposes initiating work to address three key gaps, that have already been identified by experts in this area.

These include:  (1) Building upon work in addictions to expand outcome measurement to mental health (2) Developing evaluation and performance indicators of collaborative care between mental health and addictions and primary care services (3) Developing and testing models of measurements-based care, an emerging best practice in the field.

Addiction Recovery Monitoring System In-patient Measurement (admission and discharge) Post-discharge Measurement (1-, 3-, 6- and 12-months) Patient Perspective Program Perspective Content Expertise Administrative Perspective Best Practice

Addiction Recovery Monitoring System Recovery monitoring questionnaires Automated email follow up system Knowledge translation

Addiction Recovery Monitoring System reported use of alcohol or drugs at 12-months post-discharge

Collaborative Primary Care Integrating mental health and addictions into the health care system more broadly is a strong recommendation from research and leading thinkers in the field not the only sector within a systems-approach but a particularly important one Increasing the role of primary care is a key element of almost all provincial strategies While the precise model may vary (e.g., Family Health Team, CLSC’s, Medical Home, My Health Team) there is room for standardization of the recovery-related outcomes

Measurement-based Interventions Research has been pointing for some time to the value of using immediate outcome feedback to guide the course of treatment and support Particularly appropriate for community/outpatient services Again lots of room for developing/refining recovery-oriented outcome measures for both mental health and addiction and evaluating the optimal approach for implementation for example, addressing significant differences among clinicians in their comfort level and perceived value-add

HRI is one of several national stakeholders that have been working on different components that would be part of a national framework and is willing and well-positioned to lead a truly national evaluation framework with a strong focus on recovery outcomes and including work in the identified critical areas.

The Point of it All!

Questions

No life held back or cut short by mental illness or addiction. MISSION To improve outcomes of mental health and addiction treatments and services by joining forces with key partners to plan, do, and use research that enhances practice. VISION No life held back or cut short by mental illness or addiction. HOMEWOODRESEARCH.ORG Charitable Registration # 86307 3334 RR0001