Telesage Outcomes Measurement System (TOMS) Tracking and Improving Behavioral Health Care Throughout Louisiana

What is TOMS? The Telesage Outcomes Measurement System is a state-of-the art means for collecting and reporting client self-report outcomes and obtaining regular client treatment progress reports. TOMS is sponsored by the state of Louisiana Office of Mental Health (OMH), and has been developed jointly with TeleSage, Inc., based on experience in several other states implementing the system

What is TOMS? Specifically designed for public behavioral health populations Developed and used statewide in states of Tennessee, Iowa, Pennsylvania, & Washington Uses short items stated in simple language and at 5th grade reading level Easy to understand 5-point response scale: Never, Rarely, Sometimes…

What are Consumer Outcomes? Consumer outcomes are indicators of quality of life that measure domains, such as symptom severity and social functioning, as well as recovery. Outcomes must by definition measure change over time, so taking the survey at regular intervals is necessary.

Who Benefits from Outcomes Tracking? Client Clinician Regions & LGE’s Office of Behavioral Health

What are the Benefits of Outcomes Tracking? For the Client Contributes to a client-centered, recovery-oriented approach to treatment TOMS self-assessment is from the client’s viewpoint Gives the client a “voice” and empowerment in recovery process Benefits client involvement in treatment with the clinician, contributing to outcome-focused care

Who Benefits from Outcomes Tracking? For the Clinician Contributes to client-centered, outcome-focused treatment Provides a comprehensive & concise view of clients functioning & needs at-a-glance Provides standard measures of symptom severity, functional impairment, medication adherence and changes in these over time

What are the Benefits of Outcomes Tracking? For Regions/ LGE’s Contributes to service quality improvement Demonstrates accountability for resources Helps to meet requirements for certification, accreditation and/or payor organizations For Office of Behavioral Health/ DHH Contributes to program quality improvement Demonstrate accountability for resources Helps identify best practices

Guiding Principles of TOMS Development Minimal burden on clients and providers Actionable outcome reports for clinicians and agencies User-friendly and flexible administration technologies Web-based: Minimal hardware requirements or additional software needed onsite Telesage incorporates feedback from users contributing to ongoing system improvements

The TOMS Outcome Instruments 1-Adult (age 18+) Self-assessment Total: 44 items 2-Youth (age 13-17) Self-assessment Total: 53 items 3-Parent/Guardian (age 6-12) assessment Total: 52 items Estimated Client Completion Time: 6-12 minutes

Self-assessment Domains - Adult - Depression Anxiety Anger Psychoticism Physical Impairment Social Functioning (Peer) Recovery Daily Functioning Medication Adherence Medication Side Effects Substance Use Emergency/Hospital Use Work Safety Legal Living Situation Transportation

Self-assessment Domains -Youth and Parent/Guardian- Depression Anxiety Anger Attention Deficit Hyperactivity Conduct Social Functioning (Peer) Social Functioning (Family) Empathy Daily Functioning Resiliency Medication Adherence Medication Side Effects Participation in Physical and Group Activities School Substance Use Emergency/Hospital Use Work Legal Living Situation

Self-assessment Intervals New Clients Intake Self-assessment (within 30 days of admission) Every 3 months thereafter Existing Clients* (phase in at client review) Intake Self-assessment (next treatment plan update) *Existing clients are those who have been receiving services at your clinic for at least one month.

Technology Options for Self-assessment Administration Immediate Reports TOUCHSCREEN ON-LINE (mouse) PC PHONE (planned) ODBC Database PAPER* Export in any format *Rapid Data Entry

Touchscreen/ Online Survey Administration Consumer completes online self-assessment 1

Touchscreen/ Online TOMS Administration- w/ OMH-IIS Users 2 Provider receives instant results

Touchscreen/Online TOMS Administration- No OMH-IIS 2 Provider can receive instant results

Paper Survey Administration

Louisiana TOMS Home Page

TOMS Secure Clinic Site

TOMS Clinician Report TOMS Clinician Reports are an informative and easy-to-read summary of a client’s self-assessment(s). They contain graphs and summary sentences of important questions, as well as the client’s actual self-assessment responses. They compare the client’s self-assessment responses over time, displaying responses at four time points (intake plus the three most recent assessments). Graphs display the client’s domain scores. *Intake = Initial/First self-assessment completed

Sample Adult Clinician Report

Sample Adult Clinician Report

Sample Adult Self-assessment

Other Telesage Instruments Client Quality-of-Care Surveys (C’est Bon and La Fete programs) Adult Survey (MHSIP-based) Total: 42 items Parent/Guardian Survey (YSS-F) Total: 32 items

Client Quality of Care Domains Access to Care Appropriateness/Quality of Care Outcomes of Care Treatment Involvement

TOMS Administration Process TOMS is completed at the point-of-service prior to a regular treatment session at the clinic TOMS is introduced by reception staff using the Client Information Sheet, which also accomplishes client informed consent The client is instructed on how to log-on and use the Touchscreen/On-line self-assessment via the TOMS Instruction Sheet When the client completes the self-assessment, TOMS automatically prepares the outcome report The TOMS is then ready for the next client

TOMS Implementation- Where we are now… TOMS Initial Implementation Started March, 2010 6 Initial Implementation Sites Lafourche MHC Terrebonne MHC Lake Charles MHC Shreveport MHC Ruston MHC Jonesboro MHC

TOMS Implementation- Where are we now As of 06/04/10: Number of self-assessments administered: 900+ Positive Feedback from Clients & Clinicians Clients think it’s FUN!! Clinician’s have instant useful information Initial Implementation Report

TOMS Implementation- Some Lessons Learned Importance of staff who will introduce & administer the TOMS Have someone nearby should client need assistance Make TOMS a routine part of everyday practice Administer prior to Service Session Offer option of Touchscreen or Mouse Begin with New Admissions- establish baseline

TOMS Help Ongoing Support Thru weekly implementation GoToMeetings TOMS Website Technical Issues with the Site or Self-assessment Contact TeleSage at LAhelp@telesage.com

TOMS Help continued Other Contact Annette Giroir at (225) 342-8641 or annette.giroir@la.gov Or Randall Lemoine at (225) 342-8605 or randall.lemoine@la.gov

In conclusion… TOMS provides a state-of-the-art, easy-to-administer client outcome measurement system for monitoring and improving service outcomes at both the level of the individual client-clinician and the local/state administrative levels Q&A

Our TOMS is up! Thank You!