1. Implications for Massachusetts EBP Implementation Jonathan Delman, MPH, JD Consumer Quality Initiatives, Inc. CQI ( @ www.cqi-mass.org) Implications for Massachusetts EBP Implementation Jonathan Delman, MPH, JD Consumer Quality Initiatives, Inc. CQI ( @ www.cqi-mass.org)www.cqi-mass.org

2. CQI, Inc. 9/28/05 Implementing EBPs2 Consumer Quality Initiatives, Inc. CQI A Massachusetts-based consumer-directed and staffed quality improvement, evaluation & research organization “… to give consumers a greater voice and an integral role in evaluating the effectiveness of their treatment… an honest, fair and balanced evaluation for providers, policy makers and consumers… To initiate changes that will improve the system for all…”

3. CQI, Inc. 9/28/05 Implementing EBPs3 EBPs Based on High level legitimate science High level legitimate science Implementation with strong degree of organizational standardization to achieve fidelity Implementation with strong degree of organizational standardization to achieve fidelity

4. CQI, Inc. 9/28/05 Implementing EBPs4 DMH QM Decentralized with varied approaches to QM in the areas Decentralized with varied approaches to QM in the areas Data in general not a driving force in policy and practice decisions Data in general not a driving force in policy and practice decisions Quality largely managed through relationships sites are able to develop with providers Quality largely managed through relationships sites are able to develop with providers Greatest QI success is kid’s seclusion/restraint initiative, a collaboration of CPS and MHS, and with tremendous effort. Greatest QI success is kid’s seclusion/restraint initiative, a collaboration of CPS and MHS, and with tremendous effort. See Crossing the Mental Health Quality Chasm in Massachusetts, J Delman, 2004 http://www.cqi-mass.org/quality-chasm.pdf See Crossing the Mental Health Quality Chasm in Massachusetts, J Delman, 2004 http://www.cqi-mass.org/quality-chasm.pdf

5. CQI, Inc. 9/28/05 Implementing EBPs5 Massachusetts Advantage Moving to a Unified Behavioral Health System Moving to a Unified Behavioral Health System Commissioner’s commitment to a establishing a DMH QM system Commissioner’s commitment to a establishing a DMH QM system

6. CQI, Inc. 9/28/05 Implementing EBPs6 Statewide performance improvement teams for each EBP Statewide performance improvement teams for each EBP Central Office Director of Quality Central Office Director of Quality Coordinate PI teams Coordinate PI teams Work with area quality directors to share information, such as best practices Work with area quality directors to share information, such as best practices Explaining and coordination of fidelity waivers Explaining and coordination of fidelity waivers Assessment of resource allocation Assessment of resource allocation Coordinate statewide measures and assessments Coordinate statewide measures and assessments Can EBPs be established with both fidelity and effectiveness? Not Yet:

7. CQI, Inc. 9/28/05 Implementing EBPs7 How can the we, as a research and policy community, do better? Most dollars spent on MH services research have been wasted. Most dollars spent on MH services research have been wasted. Focus on services consumers/families did not want Focus on services consumers/families did not want Continued debate on desired outcomes Continued debate on desired outcomes Postulated effects sizes are small Postulated effects sizes are small Translated into practice? Translated into practice? Invest in CPAR- “…a collaborative process that equitably involves all partners in the research process and recognizes the strengths that each brings. CPAR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities.” Invest in CPAR- “…a collaborative process that equitably involves all partners in the research process and recognizes the strengths that each brings. CPAR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities.”

8. CQI, Inc. 9/28/05 Implementing EBPs8 CPAR will result in CPAR will result in -Relevant Research -Community buy-in -Long-term and sustainable outcomes -Ultimately, more EBPs, and greater potential for successful implementation of them. -Ultimately, more EBPs, and greater potential for successful implementation of them. Studies demonstrate that quality of research is not compromised by CPAR. Studies demonstrate that quality of research is not compromised by CPAR. See generally: Minkler M. & Wallerstein N. (editors), Community Based Participatory Research for Health, San Francisco CA. Jossey.