Field Test of the Feasibility and Validity of Using the Hoosier Assurance Plan Instrument for Adults in a State Mental Health Program

Abstract

The current paper reports on the feasibility of using the HAPI-A, an instrument designed to assess a person's level of functioning in the community: (1) to help determine eligibility to receive behavioral health services, (2) to assign reimbursement case rates; and (3) to provide data for a service provider report card. A 3-year field study of the use of the instrument across an entire state mental health system explored the effectiveness of methods to enhance data accuracy, including annual training and a professional clinical record audit, and the ability of the test to detect differences in improvement rates within risk-adjusted groupings. The combination of training and auditing produced statistically significant, cumulative reductions in data errors across all 3 years of the field test. The HAPI-A also was sensitive in detecting differences among service providers in outcome improvements for six of six risk-adjusted groups rated at the moderate level of impairment and for five of six groups rated at the mild level of impairment, but was inconsistent in detecting outcome differences for persons rated at the severe level of impairment.

The Hoosier Assurance Plan Instrument for Adults (HAPI-A): The Psychometric Properties of a Level of Functioning Assessment Instrument Designed for Use in a State Managed Care Mental Health Program

“…Moreover, the instrument also could be useful in assessing outcomes at the site level. In a 3 year field test across 30 mental health providers in Indiana, the instrument was found to be both reliable and valid in providing data for a report card of services (Newman et al, 2006).…”

“…In addition, the HAPI-A was developed collaboratively, based on the needs of mental health service administrators and providers. Further evidence of the instrumentÕs potentially broad applicability is its relative ease of use and training (Newman, McGrew & DeLiberty, 2006). Since its introduction, the HAPI-A has been used on over 500,000 individuals, and hundreds of mental health practitioners representing a broad array of disciplines and degree levels have been successfully trained to use the instrument.…”

“…Moreover, as the current data attests, practitioners seem to be able to apply the instrument reliably and validly in a mental health service setting. We believe that the development and use of a detailed training manual, the requirement that for every rating the assessing clinician document the evidence used to support the rating, and the possibility that an independent clinical auditor might review the linkages between the ratings and the available evidence for each rating, helped to support and explain these positive results (for more detail, see Newman, et al, 2006).…”

“…Thus, to minimize potential negative outcomes, we required, and recommend that clinicians who administer the HAPI-A be trained to a measurable criterion, and that a clinical audit of the evidence to support the assessment ratings on each item be performed by experienced clinical auditors. In this regard, it is important to note that the combination of training and auditing produced statistically significant, progressively increasing reductions in data errors in the HAPI-A across 3 years of a statewide field test (Newman et al, 2006).…”

“…The current study provides only preliminary data concerning the use of the HAPI-A for persons with substance use disorders; the primary focus was on the use of the instrument for persons with mental illness. Two companion papers (DeLiberty et al, 2001;Newman, McGrew, & DeLiberty, 2006), provide additional detail concerning the usefulness of the scale in meeting some of the other criteria specified by the advisory board (e.g., use in a report card of services outcomes).…”