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7/16/2015 12:00 AM

Observing the lack of a standard system in place to ensure that people with mental health and substance use disorders receive effective psychosocial interventions, the Institute of Medicine in a new report is proposing a framework to establish standards for such interventions to become available as part of routine clinical care.

Observing the lack of a standard system in place to ensure that people with mental health and substance use disorders receive effective psychosocial interventions, the Institute of Medicine in a new report is proposing a framework to establish standards for such interventions to become available as part of routine clinical care.

The IOM convened an expert committee to identify key steps to ensure that evidence-based, high-quality care is provided to individuals receiving mental health and substance use care. The resulting report, “Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards,” was released July 14.

“We have some new challenges in mental health policy,” Mary Jane England, M.D., clinical professor of health policy and management at the Boston University School of Public Health and report co-author, told MHW. England cited the federal parity law and the Affordable Care Act (ACA) as “changing the whole landscape for insurance coverage.”

Both parity and the ACA present an opportunity for consumers with mental health and substance use disorders to have access to appropriate health care, noted England, who is also chair of the IOM Committee on Developing Evidence-Based Standards for Psychosocial Interventions for Mental Disorders. “Although we have hundreds of very good psychosocial interventions, [they have] never been implemented evenly across systems,” she said.

England added, “There’s a big gap about what we know [about] science and what we’re implementing. We don’t have a common terminology. We developed a definition for psychosocial intervention so that people would have a consistent definition.”

Although the research has been done on the wide variety of psychosocial interventions that can be helpful in treatment, it has not been translated into a clinical perspective, said England. “Currently, there is no standard system to do that. We have to get people working together across all disciplines to make sure to use [the framework] in clinical practice,” she said.

Central to the framework is use of the consumer’s perspective to inform the overall process, according to the report. Evidence shows that consumers bring important personal experiences and knowledge of mental health and substance use disorders. “We need to do research and have an implementation strategy,” said England. “This will require consumer engagement.”

“If you ask a patient with serious mental illness what’s the most important thing they want to get out of treatment, they’ll say a place to live or a job, just like the rest of us,” England said. “The most important outcome is improving health functioning and well-being. Consumers need to become actively involved in any quality of standards development, which is what the ACA movement is all about."

Proposed framework

The proposed framework highlights the need to:

  • Support research to strengthen the evidence base on the efficacy and effectiveness of psychosocial interventions.
  • Identify the key elements that lead to improved health outcomes.
  • Conduct systematic reviews to inform clinical guidelines that incorporate these key elements.
  • Develop quality measures of the structures, process and outcomes of the interventions.
  • Establish methods for successfully implementing, sustaining and improving psychosocial interventions in regular practice.


Further research to expand the evidence base for psychosocial interventions, develop and test quality measures, and design and evaluate implementation strategies and policies should be built around the key elements that drive the effects of intervention, according to the report.

Among its recommendations, IOM notes that the U.S. Department of Health and Human Services (HHS) should designate an entity responsible for the development of quality measures to assess the structure, process and outcomes related to mental health and substance use disorders.

Additionally, a comprehensive quality framework should also consider the context in which interventions are delivered, including the characteristics of the consumer, qualifications of the provider, the clinic or setting in which care is delivered, the characteristics of the health system, and the regulatory and financial conditions that apply to the system, the report noted. Purchasers, plans and providers should design, evaluate and adopt strategies that are aligned across multiple levels to continuously improve the quality of psychosocial interventions.

The recommendations in the report are intended to assist policymakers, health care organizations and payers that are organizing and overseeing the provision of care for mental health and substance use disorders while navigating a new health care landscape, according to the report. The recommendations also target providers, professional societies, funding agencies, consumers and researchers.

Field sponsorship

The Association for Behavioral Health and Wellness (ABHW), the American Psychiatric Association (APA), the National Association of Social Work and other organizations, including HHS, sponsored the IOM report.

“Having evidence-based research helps us in terms of defining the benefits and measuring the effectiveness of care,” said Pamela Greenberg, ABHW president and CEO, told MHW. This sets us up for future work. Now we have to figure out who’s going to implement the framework and get us to the point where we know how to assess whether an intervention is evidence-based or not.

Greenberg added, “The importance lies in making sure the interventions that are delivered to consumers have an evidence base behind them. It’s one thing to have access to care — you have to make sure consumers have access to the right care that works.”

The APA applauded the IOM for its comprehensive new report and for offering recommendations on how best to establish the pathways for psychosocial intervention standards, or nonmedication treatments for individuals with mental health and substance use disorders. “The ongoing focus on quality improvement and increased use of health information technology will be key to improving outcomes for our patients,” APA President Renée Binder, M.D., said in a statement.

Plan of action

The IOM is convening a meeting to begin implementing the recommendations in late September or early October, said England. “It’s really a working meeting,” she said, one that would include providers, consumers, payers, researchers, employers and purchasers.

“We’re going to develop a plan of action,” she said. “The meeting will include representation from all stakeholders. We’ve done the report. Now we have to get a plan.”

It’s important that each stakeholder group educates its own constituents and discusses this when they come to the meeting in the fall, England said. “It’s very timely now,” she said. There’s an “urgency of getting a common approach,” she said. “We recommend stakeholders come together to use this framework for improving patient outcomes.”

For a copy of the IOM report, “Psychosocial Interventions for Mental and Substance Use Disorders,” visit http://iom.nationalacademies.org.

Defining psychosocial interventions

The Institute of Medicine in its new report released July 14 defines psychosocial interventions as “interpersonal or informational activities, techniques, or strategies that target biological, behavioral, cognitive, emotional, interpersonal, social, or environmental factors, with the aim of improving health functioning and well-being. Examples include psychotherapies, such as cognitive behavioral therapy, which aims to correct inaccurate or negative patterns of thinking; peer-support services; and community-based treatment.”

Bottom Line…

The IOM is convening a meeting of all stakeholders in early fall to develop a plan of action based on psychosocial intervention standards recommended in a new report.

7/9/2015 12:00 AM

An Iowa children’s mental health agency uses events to boost its overall fundraising by keeping costs low and the entertainment value high.

Every year on a weeknight in March, groups of costumed adults gather at a Des Moines, Iowa, music venue to participate in a grown-up version of a spelling bee, although there doesn’t appear to be much grown-up behavior going on. As a local entertainer in a bee outfit with a beehive hairdo facilitates the purposely undignified proceedings, which feature contestants “bribing” the bee’s judges to stay in the competition, the event raises critical funding for Orchard Place, a Des Moines organization that offers a continuum of mental health services for children.

“It takes a lot to explain the spelling bee to people,” Orchard Place Vice President of Development Nancy Bobo told MHW. Having completed its 12th annual event last spring, “the concept has evolved and gotten zanier,” Bobo said.

What’s easier to explain is the financial impact of Orchard Place’s two signature annual fundraising events, neither of which resembles the typical fundraiser one might find in a mental health services organization. The March spelling bee and a May Moonlight Classic bike ride through the streets of Des Moines raise around 20 percent of Orchard Place’s overall fundraising revenue, and in both cases the organization has managed to turn these ideas into highly recognizable community events that can be undertaken with fairly minimal expenses.

“Events are one prong of a comprehensive development program,” said Bobo. “You attract people who would not send you a general contribution in the mail. It gives you an opportunity to share information about your agency.”

Seeking something different

But while many mental health treatment organizations conduct fundraising events, Orchard Place seems to make an extra effort to remind everyone that the first three letters in “fundraising” are “f-u-n.”

The idea for the spelling bee originated from the friend of a board member, who had seen a similar event conducted in another state. Half of the revenue from the event is raised through corporate sponsorships. The rest is in the form of “bribe money” that participating teams bring with them to donate at stages of the event in order to stay in the lighthearted spelling competition, Bobo explained. Groups of friends and corporate colleagues often make up the competing teams.

The bee’s judges dress in robes and are accustomed to receiving homemade cookies or other gifts from the teams. Some contestants enter the stage to preselected music that often coordinates with their costumes. Prizes are awarded for creative costumes, team names and enthusiastic cheering sections. “People love competition. They love being able to strut on the stage,” said Bobo.

Another element of the event’s success, she believes, is that participants see a specific benefit to what they’re doing, in that the bee’s proceeds fund summer programming for children served by Orchard Place (as opposed to something less tangible, such as general operations).

This year’s event raised $75,000, with only about a 5 percent expense ratio, Bobo said. The venue donates its facility to Orchard Place for the evening. “We try to get everything donated,” she said. Orchard Place uses a variety of advertising channels for its events, and finds that each of them attracts attention.

Expenses by definition have to be a little higher for the Moonlight Classic, a nighttime bike ride event that involves a police presence, digital signage and other measures to ensure participant safety. Bobo said that in the fourth year of this event on May 30, Orchard Place took in just under $100,000, with around a 25 percent expense ratio.

The Moonlight Classic replaced a daytime biking event that was generating weak results, Bobo said. While the opportunity for riders to see the cityscape by night is considered the main attraction, this event also features music and costumes. “You have to keep events fresh,” Bobo said. “You need something that puts a new shot of interest into the event.”

Corporate sponsorships constitute the major revenue source for the Moonlight Classic, which this year featured a 14-mile route and attracted more than 700 riders. Several of Orchard Place’s programs benefit from the ride’s revenue, including a summer school program at its residential campus, a Latino outreach program and youth enrichment programs encompassing both after-school and summertime activities.

Fundraising advice

Bobo acknowledges that even when the budget for a fundraising event can be kept low, the planning of the event remains a very labor-intensive process. “There are a thousand details,” she said. “People notice if you’re missing a few.” It is important to have buy-in from the executive leadership of an organization for such a commitment, she said.

She advises other organizations in their event planning to try to identify natural partners in the community, based on the nature of the event (such as local bike clubs that are involved in the Moonlight Classic). “Who could we attract who would bring more attention to the event?” she said. She added that it is important not only to attract sponsors and their cash, but to find ways to keep them engaged in the event.

And even if an event has generated results for some time, Bobo believes it is always worthwhile to breathe new life into a concept — and perhaps even to acknowledge that an event might someday have to be replaced with something else. “Every event has a life to it,” she said.

Bottom Line…

Orchard Place’s two signature fundraising events emphasize offering participants an enjoyable experience, but at a reasonable budget for the organization.

6/11/2015 12:00 AM

Although some in the mental health community applaud provisions in Rep. Tim Murphy’s (R-Pa.) long-awaited revamped mental health reform bill, such as promoting early intervention and prevention programs, research advancement and telepsychiatry use in hard-to-reach populations, and bolstering the federal parity law, others fear that reform of the Substance Abuse and Mental Health Services Administration could mean its “dismantling.”

Although some in the mental health community applaud provisions in Rep. Tim Murphy’s (R-Pa.) long-awaited revamped mental health reform bill, such as promoting early intervention and prevention programs, research advancement and telepsychiatry use in hard-to-reach populations, and bolstering the federal parity law, others fear that reform of the Substance Abuse and Mental Health Services Administration (SAMHSA) could mean its “dismantling.”

“The Helping Families in Mental Health Crisis Act of 2015” was introduced by Murphy in a different form in December 2013 following a yearlong investigation, including public forums and hearings, to investigate the country’s mental health system. At that time, groups were divided on the merits of Murphy’s proposal (see MHW, Dec. 23, 2013).

Among its provisions, the bill, H.R. 2646 (formerly H.R. 3717), introduced June 4, would reauthorize the National Child Traumatic Stress Network and launch a new early childhood grant program to provide intensive services for children with serious emotional disturbances in an educational setting.

Lawmakers from the Energy & Commerce Subcommittee on Health are scheduled to examine the bipartisan legislation on June 16. The bill is co-authored by Rep. Eddie Bernice Johnson (D-Texas).

Provisions of the new bill would include requiring psychiatric hospitals to establish clear and effective discharge planning to ensure a timely and smooth transition from the hospital to posthospital care and services. It would also advance telepsychiatry to link pediatricians and primary care doctors with psychologists and psychiatrists in areas where patients do not have access to needed care.

New legislation

Murphy’s legislation is clearly a different bill from what he presented in 2013, said Paul Gionfriddo, president and CEO of Mental Health America. “He didn’t reintroduce last year’s bill,” Gionfriddo told MHW. “We’re treating it as a brand-new bill. The other one no longer exists.”

Gionfriddo said he noted some important changes from the last bill. The earlier legislation tied the receipt of block grants to states adopting assistant outpatient treatment (AOT), he said. Now, states will be incentivized by 2 percent if officials expand community treatment programs, Gionfriddo noted. States will not be penalized, he said, adding that it will remain a state option. “It’s a better approach,” he said.

A provision regarding the interagency coordinating council will enable it to invest more heavily in research, he said. Also, the inclusion of early identification and intervention provisions is “very heartening to see,” Gionfriddo said.

“The legislation [provides] oversight at the federal level with an eye toward elevating and strengthening SAMHSA,” Gionfriddo said.

Murphy spoke about the legislation at the MHA’s annual conference on June 4 in Alexandria, Va., the day the bill was introduced, said Gionfriddo. “We’re still in the early stages of reviewing the bill,” said Gionfriddo. “Clearly, it’s a different bill. It needs to be looked at on its own merit. [The field] should treat it as a brand-new bill and decide how they feel about the provisions of this bill.”

The legislation designates an assistant secretary for mental health and substance use disorders in the U.S. Department of Health and Human Services. The assistant secretary would promote, evaluate, organize, integrate and coordinate research, treatment and services across departments, agencies, organizations and individuals with respect to the problems of individuals suffering from substance use disorders or mental illness.

“This is a great overreach of congressional authority,” Daniel Fisher, M.D., Ph.D., a psychiatrist and founder of the National Coalition for Mental Health Recovery, told MHW. “The first forty-seven pages of the document are designed to dismantle SAMHSA completely.”

The legislation would replace SAMHSA with the new office headed by a government official overseen by Congress, noted Fisher. “It will mean that mental health policy will be driven primarily by Congressman Murphy’s office,” he said. Grant notification, for example, which typically occurs within 48 hours, may now include nearly 60 days of review under the new bill, said Fisher.

Fisher added that such a move would have “dire consequences” for SAMHSA, which focuses on recovery and community integration for people with mental illnesses.

The National Disability Leadership Alliance intends to send a letter to lawmakers expressing their concerns similar to the letter they sent April 23, 2014, to members of the Energy and Commerce Committee and the Health Subcommittee, said Fisher, also a member of the alliance. At the time, they wrote that Murphy’s bill “would weaken current federal efforts to address the unmet needs of people with psychiatric disabilities.…” What remains a concern, however, is the proposed SAMHSA restructuring. “Has there ever been restructuring of another branch of the administration?” he said. “It’s unbelievable.”

At press time, SAMHSA Administrator Pam Hyde was unavailable for an interview. SAMHSA released the following statement to MHW: “SAMHSA appreciates Reps. Murphy and Johnson’s interest in and commitment to addressing issues re services for individuals with mental illness or addiction, and continuing to bring attention to this critically important public health issue. SAMHSA looks forward to working with the representatives to offer technical assistance about the implications of the legislation for current federal programs and for the needs of persons with or at risk of serious mental illness or addiction, and their families.”

MH pilot program expansion

The Excellence in Mental Health Act establishes a two-year demonstration program for eight states to offer a broad range of mental health and substance abuse services that would expand under the reform legislation. The legislation, which certifies behavioral health clinics, passed in 2014.

Under Murphy’s bill, the demonstration program would expand by an additional two years and increase the number of participating states from eight to 10, said Chuck Ingoglia, senior vice president of public policy and practice improvement for the National Council for Behavioral Health. “We’re very happy about that,” Ingoglia told MHW.

“A lot of the provisions are laudable,” said Ingoglia. The legislation includes provisions from the Health Information Technology for Economic and Clinical Health Act, he said. “It would extend meaningful use payments to a variety of mental health and addiction treatment organizations as well as to clinical psychologists,” he said.

Additionally, the legislation clarifies that Medicaid can pay for physical health services and mental health services that are provided at the same time, Ingoglia said. “Right now, in some states the Medicaid program does not allow recipients to receive both a mental health and a substance use service on the same day,” he said. “There is no federal prohibition against this; it’s a state issue. The bill clarifies that would be the expectation.”

Stakeholders have been waiting back as early as January for Murphy to introduce the bill, Ingoglia said. “There’s a lot of excitement about the bill being introduced,” he said. The National Council intends to meet with stakeholders, said Ingoglia. “Obviously we’re looking forward to the hearing and talking with stakeholders as well as staff to understand the next steps,” he said.

Bottom Line…

Some in the field intend to meet with congressional staff and stakeholders to support the bill and determine the next steps, while others intend to write letters opposing its provisions.

From the Field
9/26/2013 12:00 AM
8/7/2013 12:00 AM
In Case
7/11/2013 12:00 AM

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    Valarie Canady
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    Valerie Canady, managing editor of Mental Health Weekly, knows the mental health field inside and out. She uncovers the essential stories and gets the scoop directly from leaders and advocates in the field.
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