Maine focuses on efficacy of services

Maine is gearing up for sweeping changes in how the efficacy of services is evaluated and how clients make progress toward mental health goals. Implementing these changes will be the state’s main priority in 2010, says Ron Welch, MBA, director of Maine’s Office of Adult Mental Health Services.

Training is now underway for the use of an assessment tool that will let clients and clinicians or case managers know whether treatment is meeting targets or needs adjustment. The assessment, developed by Ohio-based company OQ Measures, is relatively short and can be completed on a personal digital assistant, such as a Blackberry or a small computer. Responses are processed immediately, and feedback is made available quickly.

The questionnaire has been reviewed and approved by the Substance Abuse and Mental Health Services Administration (SAMHSA) as part of an evidence-based program – a big draw for Maine mental health officials. At a time when Maine, like many states, is budget-challenged, the new assessment system is expected to make threatened mental health dollars go further.

“We spend $300 million a year in Maine on mental health services, and we measure everything about everything except the changes we make in people’s lives,” Welch says. “Are they learning skills? Are they living more independently? What are the changes?”

Welch adds that the assessment, which was chosen unanimously after around 50 instruments were evaluated, will be used primarily by people with severe and persistent mental illness. It will allow clinicians to pinpoint specific issues and orient treatment toward resolving them. “The instrument enjoys reliability and validity because of many decades of use,” Welch says. (It is based on more than 30 years of research). “SAMHSA said nothing comes close to this.”

Patients (whom Welch refers to as “consumers”) would fill out the questionnaire frequently at first, and then less frequently over time.

Mental health officials also hope to align outcomes with indicators of recovery. Welch notes the transformation state incentive grants that SAMHSA has given in recent years, including one awarded to Connecticut in 2005. “Connecticut, with theirs, was able to develop practice guidelines for recovery-oriented care,” he says. “They have defined operationally what one should expect if service is defined as recovery-focused or not.”

Connecticut, whose adult mental health system was ranked among the country’s best last year by the National Alliance on Mental Illness, developed guidelines describing eight domains of recovery-oriented systems, complete with concrete examples of progress in each. The domains touch on issues of access (provider ability to travel to clients, rather than clients always going to the service); autonomy; client strengths; and community involvement. Recovery goals can also relate to spirituality, recreation and friendships.

“The consumer is in the driver’s seat, and determines where they want to go,” Welch says.

Maine’s plan is to evaluate all behavioral health services through the lens of recovery-oriented standards similar to those in place in Connecticut. “In theory and in practice, we can determine whether people are on track to becoming more independent and making more decisions about their lives,” he says.

Integrating the OQ measure with the recovery-focused guidelines will allow Maine to build an entirely new system of support, he adds.

“These are huge systemic changes that we’re making,” he says. “We don’t know this, but our suspicion is that as people rely more on themselves, they’re quality of life improves. We’re still going to need an array of treatment options; there could be less reliance on those.”

At a time when budgets everywhere are still being cut, placing greater emphasis on self-reliance perhaps makes good economic sense. “This is the most important thing we can do while living within a tight budget,” Welch says. “We’re totally reforming how we do business. That’s the exciting part of this service. The history of treaters is something along the lines of ‘here’s what I’m going to do…,’ and [this new system] turns that upside down.”