MAY 1999

Much has happened since the last MHSIP Updates newsletter was issued, not the least of which for me is that Vijay Ganju handed over the chair’s gavel to me last September. I look forward to Vijay’s continued input, and to help from MHSIP Policy Group (MPG) members and the rest of the MHSIP community to make the next two years interesting and productive.

There are several articles in this edition that will bring you up to date on events in the MHSIP world. I will discuss three topics here: the MHSIP Policy Group (MPG) meetings, Policy Group membership, and plans for the future.

1. The MHSIP Policy Group has met three times since the last MHSIP Updates were issued. The group held its annual wrap-up session after the National Mental Health Statistics Conference last May to review the conference process. Five major observations were made: (1) the pendulum needs to swing back to having more data presentations and fewer policy sessions, (2) the agenda needs to have more annotation to give attendees better clues about session contents, (3) pre-conference sessions the day after Memorial Day require holiday travel and should be avoided, (4) presenters need more instructions to ensure displayed materials are easily visible to attendees, and (5) planning for the conference should start earlier. The members of the conference planning session held last Fall considered these points as they planned this year’s meeting.

A meeting was held with RUG members and Policy Group members during the national conference (and another is planned this year). RUG members asked that MPG meeting minutes be distributed to the RUGs to let them know the content and decisions made. We’ve done that once and aim to make them available via the MHSIP website in the future. RUG members also suggested the MPG establish better relationships with CMHS and other federal agencies. How to best establish and maintain such partnerships is one of many issues MPG members wrestled with at the Fall and Winter meetings, held in September and February.

The Fall Policy Group meeting was held in conjunction with the Southern Regional Mental Health Statistics Conference in New Orleans--yes, the food was great, but the 11 inches of rain could have held up for a day or two. Topics included a review of MHSIP projects (FN-11, Recovery, and Implementation of the MHSIP Consumer-Oriented Mental Health Report Card). Ron Manderscheid also gave a review of projects CMHS is supporting or involved in, including the "Abt project" to develop clinical and system guidelines. Demonstrations were also given of the MHSIP website, developed for MHSIP by staff at the Oklahoma DMHSAS, and the revived PIE On-Line website, developed by staff of the Missouri Institute of Mental Health (see articles in this issue describing these new resources). Gordon Neligh, MD, also presented info on a website he is developing with HSRI to demonstrate new technology and the consultation and information possibilities of the Internet. Two other topics discussed were selection of new Policy Group members and planning for future projects--those topics are covered separately below.

The Winter meeting was held in Alexandria, VA, in February. The two main topics of discussion were membership and the future of MHSIP. See #2 and #3 below for a discussion of each of these important topics.

2. There were five vacancies to be filled on the MHSIP Policy Group this Fall--two state representatives, two local provider positions and a consumer position. At the September Advisory Group meeting, members decided more notice of the vacancies was needed and voting was postponed. Letters were sent to state MHSIP representatives, commissioners, NAMI, consumer groups, the county behavioral health association and others to solicit nominations. We got many excellent candidates and the choices were very difficult to make. Selections for the local provider positions were Leslie Tremaine, LA, and Neal Adams, CA. The new consumer representative will be Cynthia Hopkins, TX, and the new state representatives are Mary Smith, IL, and Randy Koch, VA. I encourage you to contact these people and share your ideas and questions about mental health data, data standards, and statistics.

3. Another major topic of discussion at the Fall and Winter Policy Group meetings was the need to make clear and manageable plans for future MHSIP activities. Topics that were identified include MPG organization, the vision and scope of MHSIP, partnerships with other public and private sector organizations, informatics and technology, population-based data and the public health model, phase 2 of the MHSIP Consumer-Oriented Mental Health Report Card, disintegration and integration issues, future mental health services, and a work plan for MHSIP projects. Based on Fall meeting and subsequent conference call discussions, Ron Manderscheid wrote a context paper to which several people from various mental health perspectives replied. Cecil Wurster also wrote a paper on the history of MHSIP. MPG members agreed using these documents as background and getting outside viewpoints shared in two focus group meetings would provide a basis for productive planning for a future structure and content for MHSIP. Invitees were identified for meetings May 4 (in Alexandria) and June 1 (in DC). The first meeting has been held and some very creative suggestions were made by participants. We look forward to hearing what the June 1 group comes up with. The output from both groups will be summarized at the MHSIP session at the National Conference, will be put on the MHSIP website, and will be the focus of a retreat from which a white paper proposal will be written and submitted to CMHS for support. Please come to the MHSIP plenary session, read the reports on the MHSIP website, and provide your input to this important process.

You can contact me at 405-522-3813, by e-mail at sdavis@odmhsas.org, or via the new MHSIP website at www.mhsip.org.

MHSIP WEBSITE LAUNCHED!

At the May 1998 MHSIP Policy Group meeting, members discussed the need to take advantage of Internet technology to communicate information about MHSIP values, data standards, and projects. Because of their recent experience developing a website for another state agency, staff at the Oklahoma Department of Mental Health and Substance Abuse Services were given the charge to establish a MHSIP website. The preliminary website development was presented at the MHSIP Policy Group meeting and Southern Regional Mental Health Statistics Conference in New Orleans last September. Revisions are still being made, but we encourage you to visit the site at www.mhsip.org and send in your feedback. We are pleased to make FN-10, the Children’s Data Task Force Report, the Performance Indicator Task Force Report, and other MHSIP documents and project information available on the web for the first time. So, take a look at what we’ve put together so far, and leave us a message with your comments and suggestions!

The Southern States MHSIP Users Group held its fall meeting November 19-20, 1998, in Savannah, Georgia. It seemed an ideal locale to discuss the topic of data warehousing. The Savannah meeting was attended by 21 persons from the 13 States that comprise the SoSMUG region. The guest speaker was Chip Felton, Chairperson of ONE-MHSIP. The meeting opened with Steve Davis (OK) giving the group an update on the "FN-11" project.Vijay Ganju (TX) discussed the status of the MHSIP Consumer-Oriented Mental Health Report Card.

The main topic for the Fall meeting was data warehousing. Data warehouse initiatives in selected States were described by Chip Felton (NY), Sen-Yoni Musingo (FL), Randy Lemoine (LA), and Deborah Merril (NC).

Carroll Benson of Georgia provided an update on activties of the State of Georgia’s 13 Regional Boards and 27 Community Service Boards operating in the 159 counties of the State. Other initiatives discussed included the "20 by 2000" project, which has set a target of 20% persons enrolled in community day treatment programs transitioning into moving into employment by the year 2000. The PERMES project being implemented with the Regional Service Boards was also discribed.

The WSDSG continues to develop the planning and evaluation capacity among western states through meetings and a special project on needs assessment. The group met three times last year, once with ONE-MHSIP. The main focus of the meetings has been state development of performance indicators, particularly indicators whose source is the MHSIP Consumer Survey. The WSDSG includes two active consumer representatives, and meetings include presentations by consumers about consumer participation in implementing performance indicators. As some states gain experience with implementing performance indicators the questions are turning toward 1) validity of the data (including sample size and response rate), 2) reporting of the indicators (including "risk adjustment"), 3) assessing cultural competence, and 4) incorporating performance indicators into a continuous quality improvement process.

Another meeting topic has been communication in the frontier using emerging tele-video technologies. The group also continues a special project assessing needs in the population. The focus of the Needs Assessment Project so far has been on using existing data to develop estimates of the prevalence of mental disorders in counties of the 15 western states. The WSDSG has engaged three consultants starting in late 1997 (Dr. James Ciarlo, Dr. Harold Goldsmith, and Dr. Charles Holzer). The project has resulted in 1) presentations by consultants at two WSDSG Meetings , 2) a one day workshop on assessing needs , and 3) two models estimating the prevalence of mental disorders and groups of disorders for each county in the 15 states . States are at different places of involvement with the project. Some of the western states have already used results from the project. Some states are assessing the utility of the project, while others are considering options which go beyond the scope of this project to date. One state has recently finished a needs assessment which incorporated results from a population survey in the state.

Colorado: Colorado is using the last of its State Reform Grant funds to pull together some unique datasets to study commonly used client assessment tools. The state requires all mental health agencies it contracts with to complete the Colorado Client Assessment Record (CCAR) on clients being admitted. Some agencies use additional instruments for various purposes at admission. For children and adolescents, three agencies have been located that use either the CAFAS or the Child Behavior Checklist (CBCL or Achenbach) to assess the same children already assessed using the CCAR. For adults, some agencies use the BPRS, the BASIS-32, and one agency uses its own instrument for SPMI persons in addition to the CCAR. Contracts will be let with each of these agencies to acquire cleaned up copies of existing files complete with identifiers needed to match records for the same persons in state CCAR files. In addition at least one prospective study will be supported in which CCAR and the CBCL will be collected on children entering programs at Colorado’s Children’s Hospital. Analyses will be done to verify the underlying structure of each instrument and how these instruments might be rated. These studies will then be used to cross-validate the CCAR and make recommendations regarding its use with these populations.

IDAHO: For several years, Region IV Mental Health Center (one of seven regional community mental health centers in the Idaho Department of Health and Welfare’s state operated system) has been exploring ways to improve its service delivery system, resulting in what is now known as the Region IV "Demonstration Project." Region IV includes the Boise metropolitan area, and has found itself challenged by significant and rapid population growth and a resulting increase in the demand for services, without any increase in its budget allocation.

During their 1998 Session, the State Legislature passed House Concurrent Resolution (HCR) No. 46, endorsing the Region IV Demonstration Project and its incorporation of concepts such as single stream funding, local governance, public/private partnerships and increased consumer participation. Of particular significance was HCR 46's direction that "the project be developed with a particular focus on data collection, performance indicators and outcomes which will give legislators information to apply statewide."

The State of Idaho was very pleased to be awarded a MHSIP State Reform Grant at the end of 1998 to provide some of the data analysis, statistical support and other technical assistance needs of the Region IV Demonstration Project, in its planning and managed care reform efforts.

During the course of the next two years the MHSIP Grant, under the direction of an Oversight Committee consisting of Department of Health and Welfare staff, consumers, family members and other stakeholders, will seek to: 1) Integrate revelant data from existing databases 2) Refine and expand our outcome-based performance measurement system 3) Provide technical assistance and training on statistical analysis and data presentation 4) Develop reporting formats for multiple stakeholders 5) Provide other types of technical assistance to the Region IV Demonstration Project as needed.

We would like to take this opportunity to acknowledge the hard work and committment of Bill McFarland, who was responsible for the writing and submission of this successful grant application, prior to his retirement from the Idaho Department of Health and Welfare. We wish him the very best in his retirement.

New Mexico: The public mental health system has undergone enormous changes in the past several years predominantly as a result of health care reform on both the national and state levels. New Mexico has been redesigning public mental health care to be consistent with managed care trends yet tailored to the needs of the more chronic population. The evolution of the system towards a managed care environment promoting cost efficiency and service effectiveness has necessitated a more holistic approach to service intervention. Five years ago, the Department embarked on its commitment to restructure the system by implementing Mental Health in the 90s – an initiative promoting a client-centered, family-based, community-driven system of care focused on rehabilitation and improving quality of life. This initiative has transitioned into our Division’s efforts at a more efficient, effective approach to managing care¼.The Regional Funding Plan (RFP).

To ensure the delivery of quality services and appropriate regional network management, behavioral health network standards were created. Collaboration with the Division of Health Improvement will ensure that 1) quality assurance oversight of providers and regional care coordinators occurs; 2) performance indicators are achieved; 3) providers are in compliance with state statutes and DOH regulations; and 4) a consumer satisfaction system of evaluation is developed and implemented. The establishment of statewide, regional and consumer advisory committees to oversee the RFP will promote community empowerment over the design/redesign of the regional continuum of care and the use of funding revenues.

With the Regional Care Coordinators assuming more responsibility for quality management, outcome accountability, community-empowered system development, etc., the Division will be continually re-engineering staff responsibilities and associated skills in order to maintain its leadership role in this initiative.

Nevada: Nevada did not obtain funding in this cycle for the CMHS Indicator Grant. Therefore, most of our efforts in outcomes development have been focused on enhancing and completing goals in the Reform Grant utilizing our no cost extension funds which carried over into this year. Accomplishments include:

- Nevada’s first Annual Report for the MH/MR Division,

- A published outcomes primer for the Nevada Legislature

- New performance indicators in the FY 2000 –2001 Budget based on Reform Grant efforts

- New case management productivity tracking and reporting process

- Research studies on staff turnover in our hospitals

- Standardized methodologies for the statewide deployment of BASIS 32 and the Lehman Quality of Life Instrument

Efforts are underway to complete a data warehouse of five years of demographic, diagnostic, encounter and outcome data for the State’s mental health programs. This should be completed in February and useful in responding to the State Legislature. Year 2000 upgrades for the mental health MIS system will be complete by the end of this fiscal year.

The FY 2000 biennial budget looks bleak. Hiring for vacant positions is currently frozen. It is projected that there will be no pay raises for Nevada State employees. Almost all of MH/MR’s proposed budget enhancements have been cut by the Governor’s office. There will be no new MIS enhancements for MH/MR in fiscal year 2000 or 2001. Nevada MH/MR is hopeful that it will obtain funding in the next round of Indicator Grants to help facilitate our outcome indicator development efforts.

Oregon: Oregon is in the final stages of completing the State Reform Grant. We are currently fine tuning our Information Network. This network enhances our existing information system by placing more actionable data into the hands of Administrators, mangers, professional staff, consumers, providers, and others. Further, Oregon is continuing to collect and integrate measures from the MHSIP Consumer-Oriented Mental Health Report Card into the Information Network. Additionally, Oregon is conducting an audit of the Client Process Monitoring System (CPMS). The CPMS system contains records for services delivered in community programs and intensive treatment programs. Once the quality of this information is analyzed it will be placed on the network and become accessible to managers, policymakers and the general public. Response and feedback from the audit will provide needed information on the health of our information system. Running concurrently with the CPMS audit is a Provider Profile survey. The survey will be used to capture the service characteristics and treatment philosophies of our mental health programs throughout the state. It will also be used examine potential gaps within our current service system. These two remaining projects are the final phases of Oregon’s reform grant.

South Dakota: As part of the development of performance indicators, statewide surveys of consumers and family members are underway. The SD Division of Mental Health has worked with NAMI-SD to develop the survye instrument and plan for the surveys. The WICHE Mental Health Program has provided consultation during the process. A survey instrument has been developed which includes the MHSIP Consumer Survey. In October 1998, NAMI-SD, WICHE, and the SD Division of Mental Health worked together to start a pilot project to test our survey instruments. We should have the results in house from this survey by April or May, 1999.

The survey of adult consumers began with a test of the process in the southeast part of the state. WICHE pulled a random sample of names from 3 mental health centers in the southeastern part of the state. The Division then contacted the mental health centers for addresses of individuals, and sent out consent letters and surveys to 160 primary consumers. We received 42 completed surveys back (after two mailings), and found that 60 of the consumers had either moved with no forwarding address, or were unable to participate. WICHE has agreed to analyze the data received from this pilot survey. A decision will be made shortly about how to continue the surveys of adult consumers in the rest of the state. The survey of consumers will eventually result in 200-300 adult consumer surveys.

Concurrent with the survey of adult consumers is a survey of family members of adult and child/youth consumers. The NAMI-SD sent out family surveys across the state to 356 families of adults, and 84 families of children. These surveys were filled out and returned to the Division of Mental Health. We have received about 125 of the family of adult surveys back, and about 20 of the family of child. These surveys will be incorporated in with the data collected from the statewide survey that we are preparing.

Jennifer Fahey
SD

UTAH: The Utah Division of Mental Health was one of 16 states funded by CMHS on the State Indicator Pilot (SIP:  The 16 State Study) grant. A primary technical mechanism for the grant will be two ongoing, statewide data systems in mental health-- the integrated information system and the outcomes system. Many of the indicators are already being collected, but will be fine tuned throughout the grant period. A primary process mechanism will be the statewide planning council which will play a major coordinating role in the project. Focus groups with key stakeholders conducted by a national MHSIP consultant will assure broad input to expanding indicators beyond those required in the grant. A special emphasis will be the attempt to play a national leadership role in the development of children’s indicators. A full time coordinator, Craig W. Colton, Ph.D., was hired on the grant, and will complement the efforts of the project director and other consultants.

A review of literature (published and unpublished) on recovery in mental health, the collection of a compendium of instruments which measure recovery, and the development of an advisory committee* to guide these efforts have been commissioned by the Survey and Analysis Branch of CMHS, HSRI, and NTAC. Ruth O. Ralph, Ph.D., consumer representative on the MHSIP Group, is the project director, and an advisory group of consumer leaders has been meeting monthly through conference calls.

Thoughtful discussions about the definition(s) of recovery have taken place during the advisory group calls. The group has decided that the development of a typology or logic model of recovery is the logical next step before examining measurement tools, which may measure only some aspects of recovery. This will be the focus of the next conference call. A background paper on recovery developed for the Surgeon General’s Report on Mental Health by Ruth Ralph will provide the basis for the literature review. She continues to search for new and unpublished articles or measurement efforts, and would welcome hearing from anyone about work completed or in progress.

*Members of the Recovery Advisory Group are: Jean Campbell, Sylvia Caras, Ph.D., Jeanne Dumont, Dan Fisher, J. Rock Johnson, Carrie Kaufmann, Ed Knight, Ann Loder, Darby Penny, Jean Risman, Wilma Townsend, Laura VanTosh and CMHS representatives Ron Manderscheid and David Brown.

MHSIP GRANTS

We are pleased to announce the recent funding awarded through CMHS for 16 FY’98 State Indicator Pilot (SIP:  The 16 State Study) Grants. Awardees are: Arizona, Colorado, Connecticut, District of Columbia, Illinois, Indiana, Missouri, New York, Oklahoma, Rhode Island, South Carolina, Texas, Utah, Vermont, Virginia, and Washington.

FY’98 State Reform Grantees are: Alaska, California, Delaware, Idaho, Indiana, Nebraska, New Hampshire, North Carolina, and Oklahoma.

This 2-year project collected information on public and private sector developments in managed behavioral health care through an array of mechanisms, including a comprehensive search of available published and unpublished literature, analysis of quantitative data, and a series of focus and expert panel meetings. The project identified current information and data gaps, defined additional specific information and data needed for managed behavioral health care, and conducted essential policy analyses to inform the field regarding key issues in managed behavioral health care. A compilation of policy analyses were published as the special centennial issue of the Journal of the Washington Academy of Sciences (December 1998). Many people were involved in the production of these analyses, and we’re excited about their publication. The papers focused on: consumer issues, family issues, integrating services for children, integration of mental health and other services for adults, Medicaid and the State Mental Health Agency, public sector purchasing of managed behavioral healthcare, issues affecting clinical practice, clinical practice guidelines, measuring outcomes, and mental health report cards. Copies of the journal are available from SAB.

We described this project in the last issue of MHSIP Updates, and promised to provide information as it progresses. After a little more than 1 year into the project, we have completed several tasks: 1) literature reviews on the status of clinical and system-level practice guidelines; 2) focus groups that looked at issues around the development and use of practice guidelines, the evolution of measurement issues with respect to practice guidelines, system structure and performance indicators, and the ideal information system within the managed care environment; 3) a draft requirements analysis of the prototype management information system; and 4) a technical workgroup meeting to refine the requirements analysis and point us toward next steps. All of these activities are being guided by a technical coordinating panel made up of multiple stakeholders. We are currently revising the requirements analysis, and are looking for sites to serve as case studies of real life experiences with components of the information system. What we learn will feed into the policy analyses to be completed at the end of the project and will also feed into ongoing FN11 document.

MHSIP Consumer Survey

The County of Los Angeles Department of Mental Health is using the MHSIP Consumer Survey in several studies. The first was completed in 1997 and involved the MHSIP Survey (25 item version excluding outcome questions) along with the BHRS developed in Florida and the CSQ-8 administered during a one month period at five mental health outpatient clinics in the county. The purpose of the study was to compare the three measures and to address some of the questions Surrounding client satisfaction including instrument selection, optimal length, content, and structure of the measures as well as client preference, The results of that study have been published in the 1999 Medicaid Managed Care Sourcebook. The second study involved the administration of the MHSIP Consumer Survey (21 item short version) along with the CSQ-8 at 10 Institutes for Mental Disease (TMD) facilities in Los Angeles. An analysis of that study is being prepared. A third study is using the MHSIP Consumer Survey (21 item short version) at 11 outpatient programs which have been using the CSQ-8 on-going over the last two years. The results using each instrument will be compared.

Los Angeles is also considering the use of the MHSIP Consumer Survey (21 item short version) with the newly consolidated Medicaid managed care populations as a measure of outcome, access, appropriateness and satisfaction, The MHSIP Consumer Survey has had good consumer acceptance in Los Angeles and appears to provide comparable information to other measures of treatment satisfaction while also providing client perspectives on outcome and other areas.

For further information on the Los Angeles MHSIP projects, call Astrid Beigel or Chris Torre at (213) 738-3290.

Mental Health, United States, 1998

Risk Adjustment for Mental Health and Substance Abuse. February 1999

Fitting the Pieces Together: Building Outcome Accountability in Child Mental Health and Child Welfare Systems.

October 1998

Facing our Future Together: Policy Perspectives on Behavioral Health Care

September 1998

National Conference on Mental Health Statistics
June 1-4, 1999
Washington, DC
(301) 443-3343

Employer Invitational Summit
September 23-24, 1999
Location TBA

Primary Care/Behavioral Healthcare
Invitational Summit
September 23-24, 1999
Location TBA

Public Private Invitational Summit
September 23-24, 1999
Location TBA

Behavioral Healthcare Tomorrow
September 23-25, 1999
San Francisco, CA
800 258-8411

Southern Regional Conference on Mental Health Statistics
October 31-November 3, 1999
Charleston, SC
(515) 244-7181 (Deb Westvold)

10th Residential School of EAP Management and Clinical Practice for the Year 2000
April 30-May 5, 2000
University of Maryland at Baltimore
Graduate School of Social Work
(202) 223-2399

A dusting of snow highlights deep green winter wheat and a bow of bright yellow leaves frames a fading blue sky. Tall white sentinels, stuffed with unwanted grain, stand guard over rusty ribbons of steel that run westward, leaving town like so many others have over the years.

Bare trees cast afternoon shadows over faded seed and feed signs while grain dust and road dirt share the air with the silence of boarded school house windows and the creaking of no-longer-used swings that move lazily in the breeze drifting in from the empty fields.

Streets, vacant, cracked and worn, turn to gravel, then dirt, run away into a setting sun; marking off unplowed fields, assets of a bank gone under. Homes, gray and worn, mostly empty, recede; shrinking from bright red "For Sale" signs.

A tattered gray cat, a left-behind mouser, wanders from porch to porch, crossing the church steeple's long black shadow that creeps down mainstreet running back to peeling white paint, dust laden pews, and empty collection plates.

Like cattle at a feed trough, a few mud splattered pick-ups line the curb, staring into dark storefronts, whose windows reflect less and less comings and more and more goings and stare back as empty reminders of days gone by.

The only sounds are the rustling of leaves on old brick streets and the faint talk of the weather drifting from the tavern, where gray stubbled faces with farmer tans and sad, weather wom eyes, blankly search the Hamm's beer sign.

Rolled up coveralls hover over old scuffed boots that shift with discomfort at the mention of foreclosure. In each other's faces they see the loss of friends and family, survivors or hangers on, not sure which, or if it matters; together, they share the passing of a way of fife.

NASMHPD has released a set of operational measures and definitions to assist States and other mental health programs in implementing mental health performance indicators. The NASMHPD report was prepared by a Technical Workgroup of State mental health agency staff, mental health consumers, university based researchers and focuses on the 33 mental health performance indicators in the NASMHPD Framework of Mental Health Performance Indicators. These indicators were selected from national and state performance indicators systems based on their appropriateness, implementability, and scientific validity.

In December 1997, the fifty State Mental Health Agencies, through their national association, NASMHPD, unanimously endorsed a Framework of Mental Health Performance Indicators. Developed by a Task Force of State Commissioners, other SMHA Staff, and mental health consumers, the NASMHPD Framework includes domains of Access, Appropriateness/Quality, Outcomes, Structure/Management, and Prevention/Early Intervention. The Framework consists of 33 "reporting set" indicators for which the commissioner’s felt States could report quickly, and a "developmental set" of indicators they felt were important to measure, but for which no good instruments or agreement on how to implement measures existed.

At the December, 1998 NASMHPD Commissioners’ Meeting, Vijay Ganju (Texas Department of Mental Heath and Mental Retardation) presented the work of the NASMHPD Technical Workgroup on Performance Indicators. Working through the last year, the Technical Workgroup developed recommended operational definitions and approaches to each of the "initial reporting set" of mental health performance indicators included in the NASMHPD "Framework." The Technical Workgroup Report includes information about the specific aims, target populations, recommended definitions, numerators, and denominators, and implementation status of the indicator by States. The report also includes an assessment of many standardized instruments in terms of their psychometric properties, reliability, validity, time for completion, availability in other languages, and number of items.

The report: "Performance Measures for Mental Health Systems: A Standardized Framework" can be found at the NASMHPD web site: www.nasmhpd.org/nri. Please contact Vijay Ganju (512) 206-4569 or Ted Lutterman (703) 739-9333 ext 21 with questions or comments.

At the December 1998, Winter Meeting of State Mental Health Program Directors, the NASMHPD Research Institute announced that it has a signed contract with the JCAHO to be a "performance measurement system" vendor to help State’s meet the JCAHO ORYX requirement. Starting in the Spring of 1999, 43 SMHAs with about 170 State psychiatric inpatient programs will being submitting monthly performance indicator data to the NASMHPD Research Institute (NRI) to meet the new ORYX requirement.

In July, 1999, each JCAHO-accredited facility must start reporting performance indicator data on at least 2 JCAHO-approved performance indicators. The NRI’s ORYX system will allow State facilities to report data on indicators of: readmission rates, use of seclusion, use of restraints, medication errors, patient injuries, elopements, change in functioning, change in symptoms. Each participating facility will receive monthly feedback reports that track the performance of their facility over time, as well as comparisons to similar facilities.

The NRI ORYX system has been developed by a workgroup of SMHA staff led by Robert Littrell, Pharm.D., (NRI ORYX Project Director and KY DMH), Robert Hornstra, MD (Missouri DMH), Barbara Carey, RN (Maryland DMH), and Mederic McLaughlin (NY OMH). Operational definitions of each indicator, as well as data layout and coding requirements have been developed by the workgroup. The data definitions from MHSIP FN-10, the MHSIP Consumer-Oriented Mental Health Report Card, and the Five-State Feasibility Study on Mental Health Performance Indicators, have been extensively used to assure compatibility between the NRI ORYX System and SMHA information systems. Complete data definitions and record layouts are available on the NRI’s site.

The National Association of State Mental Health Program Directors Research Institute (NRI) is completing a special component of its CMHS-funded State Mental Health Profiles System that documents state implementation of performance indicators recommended by the MHSIP Consumer-Oriented Mental Health Report Card and the NASMHPD Framework of Performance Indicators.

To date, 47 SMHAs have responded to the survey and a searchable database containing the results is available on the NRI’s Internet site: www.nasmhpd.org/nri. This database includes information on the implementation status of over 40 different performance indicators, the perceived utility and burden, information about programs reporting data, special population focuses, and the timing of data collection.

Preliminary analysis of the implementation status of indicators shows that every state mental health agency is currently implementing some of the performance indicators recommended by NASMHPD and MHSIP. The results show that indicators in the Outcome’s domain have the highest perceived utility and the highest burden to collect, followed by indicators of quality/appropriateness.

For further information about this project, please contact Robert Shaw (703) 739-9333 ext 24 or e-mail at robert.shaw@nasmhpd.org or Ted Lutterman (703) 739-9333 ext 21 or e-mail at ted.lutterman@nasmhpd.org.

MHSIP Policy Group
c/o Steve Davis, Ph.D.
ODMHSAS
P. O. Box 53277
Oklahoma City, OK 73152