Advancing Standards of Care Pilot Program 2010 Participation Application

We would like to invite you to participate in a new National Council Advancing Standards of Care Pilot Program. Through participation in this year-long initiative, your organization will be provided with the tools necessary to:

Assess whether their treatment regimen is maximizing patient outcomes Implement a standardized assessment that focuses on functioning and health

status Identify areas in which structural and treatment barriers continue to block efforts

to improve standards of care.

The National Council’s Advancing Standards of Care Pilot Program is a year-long learning collaborative involving ten community behavioral health organizations to be chosen through a competitive application process. Involvement in this project includes both on-site and virtual (web and phone-based) technical assistance from national experts, data management through a web portal, and participation in a day-long Learning Congress.

The project is sponsored by Sepracor, Inc. and all project costs, including conference calls, travel, and consultation time, are free to participants. Additionally, the National Council will provide participating sites with $3,000 to cover incidental expenses.

Participation is limited. To be considered, please submit this application via email to RebeccaF@thenationalcouncil.org by close of business (5:00 pm, eastern time) on September 10, 2010.

Questions? Contact Rebecca Farley at 202.684.7457, ext. 235, or RebeccaF@thenationalcouncil.org.

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Project Goals:

The Advancing Standards of Care Pilot Program for People with Schizophrenia is designed to provide clinicians and program administrators at ten Pilot Program sites with the opportunity and means to: Assess whether their treatment regimen is maximizing patient outcomes Implement a standardized assessment that focuses on functioning and health status Identify areas in which structural and treatment barriers continue to block efforts to

improve standards of care.

To support the attainment of these goals, The National Council has selected MTM Services to provide project management, technical assistance and training for the initiative. The MTM Team of consultants will work with each of the ten selected pilot programs to accomplish the identified goals through using a proven learning collaborative support process that will include both onsite and offsite Internet based consultation/training.

Selection Process and Qualifying Criteria:

Ten Community Behavioral Healthcare Organizations (CBHOs) will be selected by the National Council for participation in this process. The National Council will select sites through review of the application and support information submitted by each applicant as well as through individual telephonic and/or in-person site interviews of prospective candidate organizations.

Specific criteria will be used in the selection process including but not limited to:

CBHO will vary in sizes, geographic location and have a large number of persons with schizophrenia. Selecting pilot sites of various sizes and locations will demonstrate that these approaches and outcomes are achievable for any clinic. CBHO locations will be geographically diverse and represent diverse consumer populations.

CBHO will have demonstrated a commitment to improving care and have Chief Executive Officers and Medical Directors willing to commit the time, energy and enthusiasm to participate in this pilot program.

CBHO must be able to fully participate in completing the goals of the initiative. This requirement is especially important if the CBHO knows about a current or impending fiscal, political, or other crisis that could substantially distract from the organization’s ability to stay on task. CBHOs must work with the MTM Faculty to review and assess organizational commitment in such situations as they arise.

CBHOs must have the capacity to participate in Internet based meetings including an adequate high speed Internet connection, conference phone equipment and an LCD Projector.

Benefits to Participating Organizations:

Participating organizations will receive the benefit of intense consultation by expert national consultants to assist in the achievement of project goals and objectives. All consultant fees and expenses (excluding service encounter data measurement capacity costs) will be covered.

Participating organizations will have access to specialized tools and strategies that they can use beyond the duration of the project.

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Participating organizations will receive consultation support to enhance comprehensive clinical interventions for person with Schizophrenia and will be able to compare on a continuing quality improvement basis the outcomes achieved with the other nine pilot sites.

Each of the ten CBHO participants in the initiative will receive a $3,000 stipend.

Participating organizations will have the opportunity for professional recognition as the initiative receives national, state and local attention and generates presentations and papers.

Organizational Commitments Required:

The Executive Team of each CBHO applying for participation must agree to the following levels of commitment in order to be considered for project involvement:

1. Agree to identify and implement a local Advancing Standards of Care Improvement Team including core membership by the Executive Director and members of Executive Leadership (i.e. Executive Director, Medical Director, Clinical Director, QI Director, etc.) that will commit adequate time, energy and enthusiasm to participate in this CQI process.

2. Agree to participate in an Internet based pilot program orientation session at the beginning of the project

3. Agree to conduct a Pilot Site specific baseline Self- Assessment to determine its current use of the panel’s recommended schizophrenia intervention strategies

4. Agree to conduct assessments on a subset of patients using an assessment tool determined by an Expert Advisory Panel and project leads to help evaluate functional outcomes (e.g., living independently, join workforce), QoL (e.g., relationships with family/friends) and health risks (e.g., weight gain).

5. Commit to selecting and including a cohort of 50 patients with schizophrenia in the pilot program using the selection criteria identified in Appendix A.

6. Commit to implement the Expert Advisory Panel’s recommended intervention strategies, tailoring those interventions to account for clinic and community assets available to each site as well as needs of patients with schizophrenia participating in the pilot.

7. Agree to work with the National Council and MTM Team, using a Continuous Quality Improvement model and a “Rapid Cycle Change” project plan framework to identify and define challenges, generate solutions, implement these solutions and evaluate the outcomes.

8. Agree to engage in and use the comprehensive technical assistance and training that will be provided by the MTM consultants to provide support for change management, solution designs, implementation and evaluation of outcomes achieved efforts. As part of this continuous quality improvement process, each pilot program will conduct periodic patient assessments along the three dimensions of function, QoL and health risk using the assessment tool determined by the panel.

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Technical assistance will include:

a. Review and Consultation: Each pilot program will receive consultation services to support the implementation of identified assessment tools and recommended intervention strategies. This will include on-site training for clinical staff and supervisors in the proper administration, scoring and interpretation of the assessment tools and in the selected interventions.

b. Data Management: Each pilot program will be required to enter assessment tool scores via a SPQM Web-Based Data Submission and Reporting Portal.

This includes the development, deployment and hosting a secure data submission portal for all 10 pilot programs for the duration of the initiative. Each pilot program will be provided secure SSL enabled access to the submission portal. Portal will employ ASP.NET, JavaScript and AJAX technologies to provide dynamic data validation, error trapping, and correction at the point of data entry. Such technologies will provide substantial data quality controls to ensure the authenticity and validity of project data.

All information entered by each pilot program will be stored and analyzed by the all pilot programs, the MTM consultation team and the Expert Advisory Panel to inform the change process.

c. Internet Meetings and Conference Calls: All ten pilot programs will be invited to attend learning collaborative based Internet based meetings and teleconferences with MTM consultants to:

Identify current level of functioning, quality of life and health risks for identified patients and empower clinicians and teams to identify opportunities for improvement, such as treatment changes, the implementation of additional psychosocial interventions, or other changes needed by the patient.

Share progress, explore challenges encountered and brainstorm solutions and next steps.

9. Agree to participate in a one-day Learning Conference at the end of the project period to share strategies used and outcomes achieved. Travel expenses will be paid for up to three staff from each pilot site.

10. Consent to and support publishing the findings of the initiative.

By signing and submitting the application below, the organization is indicating that it has read and agrees to the project commitments outlined above.

Please complete the information requested on the following pages of the Participation Application and return it by 5:00pm eastern time on Friday, September 3, 2010 to: RebeccaF@thenationalcouncil.org.

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Advancing Standards of Care Participation Application

Organization Name:      

Mailing Address:      

City, State and Zip:City:       State:       Zip Code:      

Contact Person/Title:Contact Person:       Title:      

Phone/Fax/Email:Phone Number:

     

Fax Number:

     

Email:

     Advancing Standards Initiative Team Information

Name:

1.      Executive Director Email:      

2.       Medical Director Email:      

3.       Clinical Director Email:      

4.       QI Director Email:      

Verification of CBHO Commitment: The above individuals commit that they will individually and collectively support the Organizational Commitments as outlined in numbers 1 – 10 above.Signed By:

     

Title:

Executive Director

Date:

     

Organizational SummaryWhat was the size of your organization in the most recent fiscal year?

Total Budget      

Total FTEs      

What is your organizational structure?

Private Non Profit Agency

Public Non Profit County Agency

State Authorized Authority

Other (describe):      

Which most closely describes your geographic location?

Rural Frontier Urban

Suburban

Other:     

How many clinical events/encounters did your agency provide in the previous fiscal year?

Number

     

How many unduplicated clients did your organization serve in the previous fiscal year?

Number

     

What percent of clients served were children/ youth, adults, or older adults?

Percent Children/youth

0-17      

Percent Adults 18-64      

Percent Older Adults

65+     

What percent of your clients served in the previous fiscal year received medication services?

Percentage

     

What percentage of your clients served in the previous fiscal year were people with Schizophrenia?

Percentage

     

Of the total number of people with Schizophrenia served the previous fiscal year:

1. What percent are seen at least monthlyPercentage

     2. What percent are receiving more than Medication Management Only Percentage

     Does your organization currently use for persons with Schizophrenia an assessment tool/measure to help evaluate functional outcomes, QoL Yes No

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and health risks? (i.e., DLA-20, LOCUS, BPRS, etc.)

If YES above, please list the name/type of each assessment tool being used for people with Schizophrenia:

1.      

2.      

3.      

4.      

Evidence Based Practices: Has your center implemented and continue to use any Evidence Based Practices (EBPs) for persons with Schizophrenia?

Yes No

EBP Summary How Long Practiced?If YES above, please list the name/type of each EBP being used for people with Schizophrenia:

1.      

2.      

3.      

4.      

1.      

2.      

3.      

4.      

Health Indicators: Please confirm below all of the health indicators your center measures/monitors for persons with Schizophrenia:

1. Personal History of Diabetes, Hypertension, Cardiovascular Disease Yes No

2. Family History of Diabetes, Hypertension, Cardiovascular Disease Yes No

3. Weight/Height/Body Mass Index (BMI) Yes No

4. Blood Pressure Yes No

5. Blood Glucose or HbA1C Yes No

6. Lipid Profile Yes No

7. Tobacco Use/History Yes No

8. Substance Use/History Yes No

9. Medication History/Current Medication List, with Dosages Yes No

10. Social Supports Yes No

If YES to any of the ten indicators above, please confirm how your center uses the health information collected to support services for persons with Schizophrenia:      

What is the approximate wait time (in days) from a routine level initial call for help and the initial Intake/ Assessment for adult clients?

Days

     

What is the approximate wait time (in days) from Intake/ Assessment to first Therapy Appointment for adult clients?

Days

     

What is the approximate wait time (in days) from Intake/ Assessment to first Psychiatry Appointment for adult clients?

Days

     

Does your center use a centralized scheduling system? Yes No

Does your center use concurrent documentation? Yes No

Does your center have a separate scheduling manager for the Medical Team?

Yes No

Do your psychiatrists and/or advanced nurse practitioners routinely have “drop- in” Medication Clinics?

Yes No

Rate (from 1 to 10) the ease with which your organization implements change in clinical practices and operations.

Easy = 1……….Difficult = 10     

Rate (from 1 to 10) how quickly your organization implements changes in clinical practices and operations?

Rapid = 1 ………….Failure = 10     

What type of medical record documentation system does your organization use?

Paper E-Form Electronic

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Additional Information/Comments

Please tell us why your organization would like to participate in this improvement project and/or provide any other supportive comments:      

Thank you for your time, we will be in touch with you after a review of all of the applications submitted.

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Appendix A

Selection Criteria for Inclusion in Schizophrenia Project Pilot Cohort

Each individual entering the pilot cohort must meet the following five criteria:

1. Open Case

2. Age 18 and older

3. Diagnosis Criteria:

Schizophrenia

4. Psychiatric Hospital/ ER utilization

In the most recent 12 months:

One or more admissions of any duration to inpatient psychiatric treatment, and/or two or more psychiatric emergency room visits.

5. Functional Criteria

Must meet at least two of the following functional criteria:

1. Has a serious impairment in social, occupational or school functioning.2. Is unemployed or working only part-time due to mental illness and not for reasons of

physical disability or some other role responsibility (e.g., student or primary caregiver for dependent family member); is employed in a sheltered setting or supportive work situation, or has markedly limited work skills.

3. Requires help to seek public financial assistance for out-of-hospital maintenance (e.g., Medicaid, SSI, SSDI, other indicators).

4. Does not seek appropriate supportive community services, e.g. recreational, educational or vocational support services, without assistance.

5. Lacks supportive social systems in the community (e.g., no intimate or confiding relationship with anyone in their personal life, no close friends or group affiliations, is highly transient or has inability to co-exist within family setting).

6. Requires assistance in basic life and survival skills (must be reminded to take medication, must have transportation to mental health clinic and other supportive services, needs assistance in self-care, household management, food preparation or money management, etc., is homeless or at risk of becoming homeless).

7. Exhibits inappropriate or dangerous social behavior which results in demand for intervention by the mental health and/or judicial/legal system.

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