2/5/2012 7:23:59 AM
The ultimate objective of transformation is to build a mental health system that promotes wellness, resilience and recovery. Such a system is radically different from the system that exists today in which access to care is limited, quality of care is uneven, and coordination and continuity of care across agencies and providers is, for the most part, disjointed. To move the existing system in the direction of the vision of a transformed system will require broad-based commitment, consensus and support. Transformation will not occur just because there is a plan for transformation.
At one level, the mental health system must address the activities and immediate circumstances that exist in its current operations. At another, the system has to introduce change and innovation to remain responsive to the needs and priorities identified by consumers and family members.
Texas has existing interagency initiatives involving criminal justice, juvenile justice, rehabilitation services, and early intervention, as well as a combination of urgent need and energy to drive transformation. Through a historical capacity to develop partnerships with universities, the mental health system has been able to incorporate the results and lessons learned from research into practice.
The building blocks for implementing transformation will be the use of new technologies, partnerships among agencies, and active and coordinated consumer and family member networks. Identifying key pivotal areas and learning from initial implementation experiences will be basic to the transformation process. The report highlights the findings of the Mental Health Transformation Workgroup which address the issues outlined in the August 7, 2006 letter from Senator Jane Nelson, Chair of the Senate Committee on Health and Human Services:
In the transformed system:
This transformation is depicted in the figure below:
| Current | → | Transformed System |
|---|---|---|
| Persons receiving services | → | Population-based; Early intervention |
| Agency 'silos' | → | Coordinated care; 'No wrong door' |
| Piecemeal, fragmented training | → | Well-defined workforce development / training infrastructure |
| Data Compartments | → | Data sharing and coordination |
| Consumer and family member involvement | → | Consumer- and family-driven system |
| Persons falling through agency 'cracks' | → | Seamless continuity of care |
As the scope of the Texas transformation goals indicate, the ultimate objective is to build a mental health system that promotes wellness, resilience and recovery. Such a system is radically different from the system that exists today in which access to care is limited, quality of care is uneven, and coordination and continuity of care across agencies and providers are, for the most part, disjointed. To move the existing system in the direction of the vision will require broad based commitment, consensus and support. The objectives of transformation are depicted in the table on the previous page.
Transformation will not occur just because there is a plan for transformation or because the rhetoric of transformation permeates the mental health system. It is important, therefore, to be operationally clear how Texas intends to broach the daunting task and challenge of transformation.
At one level, the mental health system is attempting to address the activities and crises that arise in its current operations. At another, the system is trying to introduce change and innovation so that the system is both credible and responsive to the needs and priorities identified by consumers and family members.
How is such a transformation going to happen?
Experts who have studied transformation across a range of industries have identified some general principles that essentially constitute the knowledge base and the best thinking (the “evidence”) on transformation. It is these principles that will be applied in the Texas context. For the purposes of this plan, we will call these principles evidence-based transformation.
Evidence-based transformation essentially identifies three distinct but overlapping components: building the case and vision for transformation, promoting and learning from the implementation of innovative structures and practices, and sustaining and disseminating the innovative structures and practices so that they are key operational features of the envisioned system.
To build the case and vision for transformation, there must be consensus regarding the need and urgency for change and on the broad outlines of the proposed future system. To promote the implementation of innovation, there must be commitment and support for change among many different groups – consumers, providers, legislators and agencies – and at the different levels of leadership with palpable, measurable results. These results must not only be significant but must also be sustained so that the outcomes achieved are not short-lived but achieve a degree of permanence in how business is done as usual. These outcomes also have to become expectations for the larger system and such a transition has to be supported through technology, training, workforce development, and support for consumer and family member leadership, networking, communication and education.
An important component of building innovations into the system is the continuous refinement so that innovation implementation is optimized.
For system-wide dissemination, the alignment of the infrastructural components is essential. From a policy perspective, there needs to be consistent goals across federal, state and local governments, including funding and financing incentives.
Similarly, management and administrative functions such as resource allocation, contracting, quality improvement, technical assistance and training must also support the goals and initiatives related to transformation.
What is needed to implement such a transformation initiative?
There are various models of transformation but the common themes include:
Fortunately, Texas has several strengths on which to build a transformation initiative. Through a historical capacity to develop partnerships with universities, the state has pushed a research agenda with the commitment to incorporate the results and lessons learned into practice. Also, the state has implemented several funding strategies for behavioral health services which can inform transformation efforts. More recently, the state has restructured health and human service agencies so that public health, mental health and substance abuse are part of the same agency.
This organizational merger has also fostered interagency initiatives that involve criminal justice, juvenile justice, rehabilitation services, and early intervention. These initiatives are a platform on which to further develop these existing initiatives as well as new ones. The Systems of Care initiative funded by SAMHSA’S Center for Mental Health Services has also provided a model for implementing interagency initiatives at the local community level.
Several other federally-funded initiatives will also inform and support the Texas transformation initiative. These include the Data Infrastructure Grant through which the state reports National Outcomes Measures for mental health, and projects related to substance abuse related to prevention programs and initiatives facilitating knowledge transfer.
So, while the challenges of transformation are formidable, Texas has a track record that makes them more manageable. Texas has strengths and initiatives, and a combination of urgent need and energy to drive transformation. The building blocks for implementing transformation will be the use of new technologies, partnerships among agencies, and active and coordinated consumer and family member networks. Identifying key pivotal areas and learning from initial implementation experiences will be basic to operationalizing transformation.
First, Mental Health Transformation in Texas will build on current strengths and initiatives.
Second, this mental health transformation will address the priorities and needs identified by consumers and family members and the various agencies participating in the Transformation Workgroup appointed by the Governor.
Third, Transformation efforts will propose innovations through demonstration or community projects which will serve as learning experiences from which the larger promulgation of transformation initiatives can be based. Resources are limited and until innovations can reflect a return on investment that might garner greater funding and support, the innovations introduced will have to be selected judiciously so that they can be successful as transformation “wins.”
Finally, the emphasis will be on initiatives which have the greatest potential for movement towards transformation. The emphasis is on identifying specific populations, services and initiatives on which to build knowledge and experience to further transformation.
The biggest barrier to transformation is the lack of a collective belief in common goals. This lack of common goals exists horizontally across agencies and across stakeholder groups and vertically across state and local systems. A major objective of this plan is to continue the process of shaping and defining this belief so that the benefits are perceived as “wins,” at least in some measure, by all involved.