measurement-based care in behavioral health - joint … · measurement-based care in behavioral...

Measurement-Based Care

in Behavioral Health

Peggy Lavin, LCSW, Senior Associate Director

Lynn Berry, MLA, Project Director

Scott Williams, PsyD, Director of Health Services Research

April 11, 2017

What Makes The Joint Commission Stand Out?

Reputation/Recognition

High Touch/High Tech

Surveyor Cadre

Tracer Methodology

SAFER Matrix

Transparency

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What Makes The Joint Commission Stand Out?

Guidance for Good Practices

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Measurement Based Care

and

Outcome Measures Standard

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Today we will…

� Review current requirements regarding outcome

measures.

� Talk about the revised requirements, and how and

why they were developed.

� Review the rationale behind the change.

� Cover some frequently asked questions about

instrument selection and implementation.

� Respond to any additional questions.

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Current Requirement

� Standard CTS.03.01.09 – The organization assesses the outcomes of care, treatment, or services provided to the individual served.

EP 1 – The organization monitors the individual’s progress in achieving his or her care, treatment, or services goals.

EP 2 – The organization evaluates the outcomes of care, treatment, or services provided to the population(s) it serves.

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Current Requirement

� Long standing requirement

� Organizations were always expected to

measure outcomes, but The Joint Commission

did not say how that was to be done.

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Why the change?

� Recently, more focus has been placed on

measurement-based care in the behavioral

health care field.

� The Kennedy Forum has made available a paper on this subject and a list of tools.

� https://thekennedyforum-dot-org.s3.amazonaws.com/documents/KennedyForum-MeasurementBasedCare_2.pdf

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Why the change?

� The revised standard will help organizations improve

the quality of their care, treatment, or services.

� The standard will help organizations to know

whether what they’re doing is working.

� More detail on this in a

few minutes…

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What is changing?

EP 1 – The organization uses a standardized tool or instrument to monitor the individual’s progress in achieving his or her care, treatment, or service goals.

� Standard CTS.03.01.09 – The organization

assesses the outcomes of care, treatment, or

services provided to the individual served.

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What is changing? (continued)

� EP 2 – The organization gathers and analyzes the data

generated through standardized monitoring, and the

results are used to inform the goals and objectives of the

individual’s plan for care, treatment, or services as

needed.

� EP 3 – The organization evaluates the outcomes of care, treatment, or services provided to the population(s) it serves by aggregating and analyzing the data gathered through the standardized monitoring effort.

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How did we make this change?

� Conducted research and literature review to learn

about the value of using standardized tools in

regard to outcome measures.

� Convened Technical Advisory Panel (TAP) consisting of experts in the field – very supportive of this effort.

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How did we make this change? (Cont’d)

� Conducted “field review” of proposed revisions:

Six week review by the behavioral health field

Respondents supported use of a tool or instrument

Some concerns were raised about how to implement and comply

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How did we make this change? (Cont’d)

� Held five focus group calls with field review

respondents to discuss types of support that

would be helpful; suggestions included:

List of tools; variety of tools

Starter kit

Case studies

Series of webinars/town hall meetings

Guidance from experts

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How did we make this change? (Cont’d)

� Using all of this information, made final edits to

revised standard.

� Standard was approved in November 2016.

� Field was given one year to prepare for

implementation, which is January 1, 2018.

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What’s next?

� We are in the process of developing support materials and other resources for the field.

� An introductory document is currently available on the Joint Commission’s website, visit https://www.jointcommission.org/accreditation/bhc_new_outcome_measures_standard.aspx

� Working on providing a list of instruments to assist organizations in their search.

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Understanding the Rationale that supports

Measurement-Based Care

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What is Measurement-Based Care?

� Refers to the use of an objective measure to track the impact

of care, treatment, or services over the course of those

services.

� Data are routinely collected at multiple points in time

Data are typically collected at first contact and then at

regular intervals (i.e., each subsequent point of

contact, every “nth” contact, weekly, monthly, etc.)

� Progress (i.e., toward the desired outcome) is monitored

and evaluated

Progress can be compared with instrument norms or through use of a statistical model

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What is Measurement-Based Care? (Cont’d)

� After data are collected through a standardized instrument:

� They are analyzed and delivered to the service provider as

objective feedback

� Analysis can be used to inform goals and objectives,

monitor individual progress, and inform decisions related

to changes in individual plans for care, treatment, or

services.

� Can be used to identify individual cases that may benefit

from treatment team discussion and supervision

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� At the organization-level, data collected through

standardized instruments can be aggregated to:

� Inform quality improvement priorities

� Evaluate progress on organizational

performance improvement efforts

� Demonstrate the effectiveness of

organization services with:

Stakeholders in the community

Prospective clients and families

Payers/Insurers/Employers

What is Measurement-Based Care? (Cont’d)

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Why now?

� Measurement based care is not new (although the name has

repeatedly changed)

� Nearly two decades of research suggest that the effects

are robust, cutting across treatment modalities,

populations and settings

� Especially useful for identifying potential treatment failures

� Reduce the un/intentional influences of provider bias

� Justify changes in treatment plans and levels of service

� Growing emphasis on demonstrating outcomes

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Selecting a Standardized Instrument

� An instruments should:

� Have well-established reliability and validity for use as a repeated measure

� Be sensitive to change

� Be appropriate for use as a repeated measure

� Be capable of discriminating between populations that may or may not benefit from services (if appropriate)

� e.g., clinical/non-clinical, healthy/non-healthy functioning, typical/non-typical, etc.

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Selecting a Standardized Instrument

� Other factors to consider:

� Feasibility

Time and effort spent administering,

scoring, aggregating and reporting

data

� Cost

Public vs. proprietary

Instrument vs. measurement system

� Automation and integration

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Selecting a Standardized Instrument

� In June 2017, The Joint Commission will provide a list of instruments that could be used to meet the new standard.

� We will NOT endorse any instrument

� The list will NOT be exclusive

� To see if your instrument will work, visit https://manual.jointcommission.org/BHCInstruments/WebHome

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Selecting a Standardized Instrument

� In the meantime, you can find some good instruments here:

� The Journal, Integrating Science and Practice provides a 45-

page issue that summarizes 10 well-established and frequently

used instruments (or suites of instruments).

(https://www3.ordrepsy.qc.ca/pdf/2012_11_Integrating_Sand

P_10_Tools_for_Progress_Monitoring_in_Psychotherapy.pdf)

� The Kennedy Forum provides a list of dozens of instruments that are appropriate tools for measurement-based care categorized by type, setting, and other factors. (http://thekennedyforum-dot-org.s3.amazonaws.com/documents/MBC_supplement.pdf)

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Implementation of the Standard

� For many organizations, implementation of this standard will be a significant change.

� Success will be highly dependent upon leadership’s ability to manage change

Creating a shared need

Shaping a vision

Mobilizing commitment

Making change last

Monitoring progress

� Many free resources on facilitating change are available at the Joint Commission’s Center for Transforming Healthcare at http://www.centerfortransforminghealthcare.org/

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Evaluating the Standard

� Instrument(s) selected and used by organization

� Patient Tracer

� Is there evidence that a standardized instrument was used to assess and monitor the individual served?

� Is there evidence that data derived from the instrument was used to inform care? (when appropriate)

Do notes indicate that progress (or deterioration) was discussed with the individual served?

Are changes in treatment goals or objectives related to or associated with data?

� Treatment team or supervision activity reviews or is informed by data

� Quality Improvement activity informed by aggregate data

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References

Boswell JF, Kraus DR, Miller SD and Lambert MJ. Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research. 2015; 25(1):6-19.

Goodman JD, McKay JR and DePhilippis D. Progress monitoring in mental health and addiction treatment: A means of improving care. Professional Psychology: Research and Practice. 2013; 44(4):231–246.

Scott K and Lewis CC. Using Measurement-Based Care to Enhance Any Treatment. Cognitive and Behavioral Practice. 2015;22(1):49-59.

Reese RJ, Duncan BL, Bohanske RT, Owen JJ, and Minami T. Benchmarking Outcomes in a Public Behavioral Health Setting: Feedback as a Quality Improvement Strategy. Journal of Consulting and Clinical Psychology. 2014.

Gondek D, Edbrooke-Childs J, Fink E, Deighton D and Wolpert M. Feedback from outcome measures and treatment effectiveness, treatment efficiency, and collaborative practice: A systematic review. Adm Policy Ment Health. 2016; 43:325–343.

Shimokawa K, Lambert MJ and Smart DW. Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of Consulting and Clinical Psychology. 2010; 78(3):298–311.

Chow DL, Miller SD, Seidel JA, Kane RT, Thornton JA, Andrews WP. The Role of Deliberate Practice in the Development of Highly Effective Psychotherapists. Psychotherapy. 2015; Vol 52, No 3, 337-345.

De Jong K. Challenges in the Implementation of Measurement Feedback Systems. Adm Policy Ment Health. 2016; 43:467–470.

Hannan C, Lambert MJ, Harmon C et al. 2005. A lab test and algorithms for identifying clients at risk for treatment failure. J Clin Psychol 61(2):155-63.

Brown GS, Jones ER. 2005. Implementation of a feedback system in a managed care environment: What are patients teaching us? J Clin Psychol 61(2):187-98.

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Today’s Faculty

Scott WilliamsDirector of Health Services Research

swilliams@jointcommission.org

Lynn BerryProject Director

lberry@jointcommission.org

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Behavioral Health Care Accreditation Business Development/MarketingTeam

Darrell Anderson, BA

Senior Business Development Specialist

danderson@jointcommission.org

630/792-5866

Melinda Lehman, MBA

Associate Director

mlehman@jointcommission.org

630/792-5695

Susan Bullivant

Senior Secretary

sbullivant@jointcommission.org

630/792-5791

Julia S. Finken, BSN, MBA, CPHQ, CSSBB

Executive Director

jfinken@jointcommission.org

630/792-5790

Peggy Lavin, LCSW

Senior Associate Director

plavin@jointcommission.org

630/792-5411

Megan Marx, MPA

Associate Director

mmarx@jointcommission.org

630/792-5131

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Behavioral Health Care Accreditation Operations Team

Peter Vance, LPCP

Field Director

pvance@jointcommission.org

630/792-5788

Merlin Wessels, LCSW

Associate Director

mwessels@jointcommission.org

630/792-5899

Allison Kikilas

Associate Director

akikilas@jointcommission.org

630/792-5123

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