Evidence Based Practices for Adults

1. Evidence Based Practices for Adults NAMHPAC Technical Assistance to West Virginia Planning Council October 13, 2005 Wheeling, WV Jerry Goessel

2. Evidence Based Practices • Evidence Based Practices (EBP’s) for Adults • 1. Illness Self Management • 2. Family Psychoeducation • 3. Assertive Community Treatment • 4. Supported Employment • 5. Integrated Treatment for Co-Occurring Mental and Substance Use Disorders • 6. Medication Management

3. Evidence Based Practices: Illness Self Management • Illness Self Management • Psychiatric rehabilitative practice designed to empower people to understand and manage their illness effectively. • Weekly sessions where a team of mental health practitioners aid consumers in developing their own tailored strategies for coping with the illness. • Nine topic areas covered in the program. * • Practitioner techniques include: cognitive behavioral therapy, motivational strategies, education.

4. Evidence Based Practices: Family Psychoeducation • Family Psychoeducation • Practice that forges partnerships between families, consumers and practitioners, to support recovery, create an atmosphere of hope, and improve collaboration. • Several phases to the practice – first two of which involves family members in sessions with a practitioner to learn of illness, coping strategies. • Final component is problem-solving sessions in which the consumer and family meet every two weeks for the first few months to learn to deal with problems – sessions may last up to two years.

5. Evidence Based Practices: Assertive Community Treatment • Assertive Community Treatment (ACT) • Provides a full range of services in a community-based setting. Treatment is flexible and tailored. • Primary goal is to prevent hospitalization, and afford the person a life not dominated by illness. • Multi-disciplinary team assistance areas include: health, medication support, daily activities, counseling, financial management, substance abuse treatment, housing assistance, family life. • Low staff to to consumer ratio (each team works with about 10 consumers).

6. Evidence Based Practices: Supported Employment • Supported Employment • Program that aids consumers in finding competitive jobs that are well-suited to their interests and abilities. • Recognizes work as an important component of the recovery process. * • Based on six principles, including consumer preference and choice. • Employment specialists work alongside consumers to ensure the six principles are met. • Specialist also works with business manager and consumer’s treatment team.

7. Evidence Based Practice:Integrated Treatment for Co-Occurring • Integrated Treatment for Co-Occurring Mental and Substance Use Disorders • Treatment model in which same treatment team provides both mental health and substance abuse treatment for persons with dual disorders. • Integrated treatment improves chances for meaningful recovery. • Consumers receive case management, outreach, housing, supported employment and other services. • Counseling is tailored to the dual disorders, in part to prevent relapse.

8. Evidence Based Practices: Medication Management • Medication Management Approaches in Psychiatry (Med-MAP) • Systematic use of medications in the treatment of Schizophrenia and Bipolar Disorders. • Recognizes that medication is often a central component of treatment of these disorders, but has been administered in a less than systematic way – resulting in over or under medication. • Basic elements include careful measurement of medication outcomes, and active consumer involvement in the decision-making process.

9. Evidence Based Practices: A National Agenda • SAMHSA produced Toolkits for Evidence Based Practices EBP). • Required as Developmental Tables 16 and 17 within the Uniform Reporting System of the Data Infrastructure Grant. • National Outcome Measures (NOMS) data reporting regarding EBP are now required as part of FY 2006 Block Grant Application. • Use of Evidence Based Practices (Number of Evidence Based Practices being implemented). • Number of Persons (Adults with SMI and Children with SED Receiving Evidence Based Practices).

10. Evidence Based Practice Data Reporting Example Description: The Performance Indicator represents the state’s Community Mental Health Block Grant funds, Medicaid funding, and general fund support of adult Evidence Based Practices throughout the state. Block Grant funds were used to launch pilot programs in FY 2004. Promoting the expansion of EBP’s for adults has been identified as one of the top three funding priorities in the Planning Council’s FY 2006 plan of action. Performance Indicator: Number of Evidence Based Practices Population: Adults Diagnosed with a Serious Mental Illness Criterion: 1: Comprehensive Community Based Mental Health Service Systems

11. Evidence Based Practices: National Impact • Prevalence of Evidence Based Practices * • The 2003 survey of state mental health authorities found that adult Evidence Based Practices (EBP’s) are actively promoted across the country, but to varying degrees. • Supported employment was the most widely implemented EBP among state respondents -23 states reported statewide implementation and 19 states reported implementation in parts of their states. • Results are quantifiable (wages), and thus easy to “sell” to the public.

12. Evidence Based Practices: National Impact (cont.’) • Prevalence of Evidence Based Practices • Assertive Community Treatment (ACT) was rated as the second most widely implemented of EBP for adults (11 states have implemented statewide and 26 states report implementation in parts of states). • Highly promoted by NAMI’s nationally • Medication Management was the least implemented. • Texas medication management program (TMAP) was a leader, with many states following. • Being piloted with various populations (e.g., state hospitals in Pennsylvania).

13. Evidence Based Practices: Planning Council’s Role • Council’s Role vis a vis EBP’s • The Council can play a substantial role in promoting the use of EBP’s within the state (e.g., Alabama Planning Council). • Evaluation and monitoring of EBP’s by the Council are natural applications of Council duties. • Reporting on EBP success or failure can lead to expansion of programs, or at least to quality improvement measures.