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Lessons Learned From Federal Programs

Lessons Learned From Federal Programs. Neal Brown November 5, 2013. Community Support Program. NIMH response to problems of deinstitutionalization Systems change initiative Beyond just mental health treatment - concentration on rehabilitation

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Lessons Learned From Federal Programs

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  1. Lessons Learned From Federal Programs Neal Brown November 5, 2013

  2. Community Support Program • NIMH response to problems of deinstitutionalization • Systems change initiative • Beyond just mental health treatment - concentration on rehabilitation • Small grants to states (most funding $150-$300K per year) • Contacts in each State • Established System of Care – “Community Support System” • National CSP Network • Consumer empowerment • Support to families • Most funding 1978-1987

  3. CSP Accomplishments • Thousands of community rehabilitation programs established (e.g. ACT, clubhouses, supported housing) • Established SMI as a priority population • Helped states move resources from institutions to community care • Facilitated the expansion of the consumer movement • Helped launch and support the national family movement

  4. Lessons from CSP • A small amount of strategic money can leverage major system changes • Supporting consumers and families facilitates system changes • People learn from others in a network

  5. Community Action Grants • SAMHSA program to help communities adopt exemplary mental health practices by building community “buy-in” and support • Sponsors were primarily community and consumer/family organizations • Phase I – consensus building ($150K) • Phase II – training and preparation for implementation ($150K) • Best practices determined locally • Focus on adults with SMI and children with SED • Diversity of programs and populations involved • Program lasted five years (1997-2002)

  6. CAG Accomplishments • Funded 137 sites for new programs in 48 states and territories • More than 70% achieved full consensus and implemented best practices • Supported a diversity of organizations and practices • Became a catalyst to change policies at the state and local levels • Promoted culturally competent services

  7. Lessons Learned from CAG • Implementation of Best Practices is enhanced by consensus building • Community organizations can successfully manage a process leading to new program implementation • Consensus building process can lead to changes in policies and practices at the state level

  8. Mental Health Transformation Grants • Mental Health Transformation State Incentive Grants (MHT-SIG) • SAMHSA supported infrastructure grants to states to improve service delivery, access to care and the provision of effective services • To implement President’s New Freedom Commission recommendations • Focus on adults and children • Grants to nine states (governors) of up to $2.7 million a year for 5 years • Connecticut, Maryland, New Mexico, Ohio, Oklahoma, Texas, and Washington (starting in 2005) • Hawaii and Missouri started in 2006

  9. MHT Logic Model Transformation Working Group Needs Assessment and Inventory of Resources Comprehensive Mental Health Plan I Infrastructure Changes Service Improvements Improved Consumer Outcomes

  10. State Transformation Highlights All states conducted infrastructure activities such as: • Creating and revising policies • Involving consumers, family members and youth in advisory bodies • Developing innovative financing strategies • Conducting public awareness campaigns • Engaging in workforce development activities

  11. Practices Promoted Across All Nine States • Assertive Community Treatment (ACT) • Family Pschoeducation • Illness Management and Recovery (ILR) • Integrated Treatment for Co-Occurring Disorders • Multi-Systemic Therapy (MST) • Permanent Supportive Housing • Trauma-Informed Care • Supported Employment • Wellness Recovery Action Plan (WRAP)

  12. MHT State Successes • CMHP implemented • New Freedom Commission goals achieved • Significant policy changes in each state • Political changes overcome (Ohio, Hawaii, Maryland) • Washington – significant gains in consumer involvement • Connecticut – maximized support for criminal and juvenile justice initiatives • Oklahoma – enhanced tribal – state relations • Missouri – implemented MH First Aid

  13. Maryland Transformation Highlights • Promoting recovery and system change (through WRAP training, recovery training, Recovery Centers of Excellence) • Changing public perceptions of mental illness (focus on Mental Health First Aid training) • Strengthening the Public Mental Health System (pilot for Self-Directed Care; first state to launch Network of Care site for Veterans; workforce development; statewide implementation of EBPs – SE, ACT, FP; reduction in use of seclusion and restraint; coordination of primary and mental health care; increased access to high quality services through tele-psychiatry; increased housing resources; developed consumer quality teams (CQT);Outcomes Measurement System to track trends in services) • Services to Children, Youth, and Families (Systems of Care and Wrap-around Services, Transition-aged Youth activities)

  14. Lessons from MHT-SIG • Engaging consumers, family members and youth in every step in the change process is fundamental to bringing about services that are consumer-driven, family-centered, youth-guided, and recovery oriented. • Possible to promote changes simultaneously at multiple levels. • Partnerships can be powerful vehicles for change at all levels. • Adoption of a recovery approach is fundamental to transformation.

  15. Overall Lessons • Personal relationships make a difference • Significant consumer involvement is absolutely necessary

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