MACRO AND MICRO LEVELS PROCESS AND OUTCOME MEASURES

BROAD OVERARCHING MEASURES  Definition: Behavioral health is used to refer to both mental health services and substance abuse (or substance use disorder) services. The population we serve includes individuals and families with substance use disorders, severe and persistent mental illness and serious emotional disturbance.  multiple layers of both process and outcome measures in the behavioral health arena which build on each other.  Process measures are defined as activities which lead indirectly to an outcome. Examples are: measuring the time in which a client can access a service (24 hours, 5 days, etc).  An outcome measure is defined as a change in a client’s behavior or experience such as: reduction in number of psychiatric hospitalizations).

 Some measures are fairly universally applied to all services, such as time to access to care.  Some measures apply to broad groups of clients, such as Consent Decree requirements..

 DHHS licensing standards  Credentialing requirements by each payer source.  MaineCare rules, both general and service specific. Most relevant are under Chapter 101, Sections 13,17,23,65,46 and 92 (the newest which is still a proposed rule).

 These four documents form the context for the delivery of behavioral health services in Maine. They include general expectations as well as specific process and outcome measures:  1) the Consent Decree ( also known as the AMHI consent decree)  2) the Co-occurring Capable document  3) the Recovery Oriented Systems of Care document  4) the Trauma Informed Systems of Care All documents can be found online.

 Found in each contract an organization has with DHHS  Specific by service such as Outpatient Substance Abuse, Outpatient Mental Health, Crisis, etc.  Both process and outcome measures.

 BEHAVIORAL HEALTH HOME QUALITY MEASURES (measured against baselines)  1). Clients will have same day access to providers  2) BHHO will show improvement on one or more specific integration goals based on the BHHO’s baseline assessment.  3) Family input will be gathered at least once per year.  4) Avoidable hospitalizations will be reduced  5) Avoidable Emergency Department visits will be reduced.

The first measure is subject to financial reward or punishment:  Fewer than 80% of face to face assessments will occur in either the Emergency Department or the Crisis agency office.  All crisis services standards shall be met (this is yet another document which identifies a lengthy list of additional requirements)  Evidence Based Practices (EBPs) shall be used whenever possible (there are many of these is some services areas and none in others, SAMHSA has an official list)

 SUBSTANCE ABUSE SERVICES MEASURES (OUTPATIENT) Note: SA measures are subject to financial rewards and punishments.  Agencies will deliver 90% of their contracted units  Access to services will be within 5 days.  50% of clients will stay in treatment for 4 or more sessions  30% of clients will stay in treatment for 90 days.  There are also 8 additional measures that are tracked but not subject to financial reward or punishment.

 1. Abstinence from drug and/or alcohol use for specified period of time  2. Getting and keeping a job or enrolling/staying in school  3. Decreased involvement w/criminal justice system  4. Decreased inpatient hospitalizations  5. Securing safe, decent and stable place to live

 Behavioral health services operate within a context of articulated values and expectations which are codified in rules and legal agreements.  Behavioral health services are accountable to funders through the use of specific outcome and process measures tailored to each type of service.  Due to earlier emphasis and higher allocation of resources, substance use disorder services are more outcome oriented than mental health.