Best Practices: New York State's Campaign to Implement Evidence-Based Practices for People With Serious Mental Disorders

There is a widespread recognition that the mental health system is not effective in meeting the needs of the children, adolescents, and families who seek its services. In response to this recognition, researchers and policy makers are developing and implementing strategies to transform mental health systems. This paper suggests that transformational interventions should not proceed faster than our understanding of the complexities of a mental health system. In a complex system, all component parts are interactive and interdependent. Problems with one component cannot be solved in isolation from other components. The inter-relationships between problems create inter-dependencies; and changes in the balance of these inter-dependencies can cause dramatic shifts in policy priorities, such as when managers of mental health systems respond to budget reductions in a recessionary economy. This paper examines the problem domains in mental health systems that are affected by complexity dynamics, and proposes that a well-built infrastructure is a necessary foundation for structural change in a child-adolescent mental health system. The concept of metastructure is proposed to account for the rule-based processes that govern the actions of agents within a system.

Section: As Shown Inmentioning

confidence: 99%

The Role of Infrastructure in the Transformation of Child–Adolescent Mental Health Systems

Stelk¹,

Slaton

2010

“…These range from state and federal law to stakeholder resistance to state's lack of expertise in adequately contracting and incentivizing their use. The use of a multi-pronged approach to address these barriers is recommended (Carpinello & Rosenberg, 2002;Corrigan, Steiner, McCracken, Blaser, & Barr, 2001;Goldman et al, 2001).…”

Section: Lessons Learnedmentioning

confidence: 99%

Overview Of Publicly Funded Managed Behavioral Health Care

Coleman¹,

Schnapp²,

Hurwitz³

et al. 2005

Using MEDLINE and other Internet sources, the authors perform a systematic review of published literature. A total of 109 articles and reports are identified and reviewed that address the development, implementation, outcomes, and trends related to Managed behavioral health care (MBHC). MBHC remains a work in progress. States have implemented their MBHC programs in a number of ways, making interstate comparisons challenging. While managed behavioral health care can lower costs and increase access, ongoing concerns about MBHC include potential incentives to under-treat those with more severe conditions due to the nature of risk-based contracting, the tendency to focus on acute care, difficulties assuring quality and outcomes consistently across regions, and a potential cost-shift to other public agencies or systems. Success factors for MBHC programs appear to include stakeholder involvement in program and policy development, effective contract development and management, and rate adequacy.

“…Congress, 1986; U.S. Department of Health and Human Services, 2005; U.S. Department of Health and Human Services, 1999). The bulk of efforts to improve access and quality of mental health services have focused on the adoption and implementation of specific evidence-based practices at the provider level (Carpinello, Rosenberg, Stone, Schwager, & Felton, 2002;Hoagwood, Burns, Kiser, Ringeisen, & Schoenwald, 2001;LeBel et al, 2004;Sackett, Rosenberg, Muir-Gray, Haynes, & Richardson, 1996;Tanenbaum, 2003;Torrey, Finnerty, Evans, & Wyzik, 2003). These high-quality interventions are often packaged within implementation ''toolkits'' or manuals suitable for adoption by providers Ganju, 2003;NASMHPD Research Institute, 2005;Substance Abuse and Mental Health Services Administration, 2005;Torrey et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

“…It is important to know if public mental health agencies are aware of existing standards since awareness is recognized as a necessary precursor to successful adoption (Carpinello et al, 2002;Dixon et al, 2001;Goldman, et al, 2001). Even when agencies are aware of standards, it is unclear to what extent they have adopted roles and responsibilities that promote services consistent with prevailing standards.…”

Section: Introductionmentioning

confidence: 99%

Administrative Barriers to the Adoption of High-Quality Mental Health Services for Children in Foster Care: A National Study

Raghavan

Inkelas

Franke

et al. 2007

While the need to provide appropriate mental health services to children in foster care is well recognized, there is little information on administrative barriers to assuring that such services are provided. This article presents results from a national survey of mental health agencies to profile their awareness of currently available practice standards, the roles these standards play in guiding practice of mental health agencies, common reimbursement strategies in use for mental health services, and collaborations between mental health and child welfare agencies that enhance children's access to appropriate mental health care. Implications and recommendations for mental health policymakers are discussed.