Change Management A Key Strategy for Transforming Mental Health Systems

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June 23, 2005 Albuquerque, NM
Change Management A Key Strategy for
Transforming Mental Health Systems
A. Kathryn Power, M.Ed., Director Center for
Mental Health Services
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Attempting change without leadership is like
putting a car in gear without a driver behind the
wheel.
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• Everybody has accepted by now that change is
  unavoidable. But that still implies that change
  is like death and taxesit should be postponed as
  long as possible and no change would be vastly
  preferable. But in a period of upheaval, such as
  the one we are living in, change is the norm.

Peter Drucker Management Challenges for the 21st
Century
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The time has long passed for yet another
piecemeal approach to mental health reform.
Instead, the Commission recommends a fundamental
transformation of the Nations approach to mental
health care.
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In a Transformed Mental Health System?

• Goal 1. Americans understand that mental health
  is essential to overall health
• Goal 2. Mental health care is consumer and family
  driven
• Goal 3. Disparities in mental health services are
  eliminated
• Goal 4. Early mental health screening,
  assessment, and referral to services are common
  practice
• Goal 5. Excellent mental health care is delivered
  and research is accelerated
• Goal 6. Technology is used to access mental
  health care and information

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Ultimate Goal of Transformation

• A system that
• Is consumer and family driven
• each adult and child will have access to the
  full spectrum of services needed to support
  recovery
• Focuses on recoverya process, sometimes
  lifelong, through which a consumer achieves
  independence, self-esteem, and a meaningful life
  in the community
• Builds resiliencethe ability to face lifes
  challenges

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Stages of Change

• Engaging and motivating for change (Why we do it)
• Developing skills and supports to implement
  change (How we do it)
• Sustaining the change (How we maintain and extend
  the gain)

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Federal Partners Workgroup
Shared Transformational Leadership
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Evidence-based PracticesHow To Operationalize
Transformation

• Goal 5
• Excellent mental health care is delivered and
  research is accelerated

Recommendation 5.2 Advance evidence-based
practices using dissemination and demonstration
projects, and create a public-private partnership
to guide their implementation
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Engaging and Motivating for Change

• Robert Wood Johnson Foundation convened a
  consensus panel to determine which practices
  currently demonstrated a strong evidence base
• SAMHSA launches Phase I of a three-phase project
  to disseminate six resource implementation kits
  for evidence-based practices

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National Demonstration Project

• Phase I (Fall 2000Summer 2002)
• Develop six Implementation Resource Kits for
  evidence-based practices
• Phase II (Summer 2002Summer 2005)
• Pilot-testing of Implementation Resource Kits
• Gather information to improve kits, including
  recommendations for consultation and training
  support
• Learn about factors that facilitate or impede
  implementation in routine treatment settings
• Phase III National demonstration (in 2006)

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Developing Skills and Supports To Implement Change

• Six Implementation Resource Kits
• National EBP Center
• EBP implementation centers

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Illness Management and Recovery

• Emphasizes how to help consumers set and pursue
  personal goals and to implement coping strategies
  in their everyday lives
• Core strategies
• Identifying recovery strategies
• Understanding practical facts about mental
  illness
• Using the Stress-Vulnerability Model and
  strategies for treatment
• Building social support
• Using medication effectively
• Reducing relapses and coping with stress
• Coping with problems and symptoms
• Getting needs met in the mental health system.

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Medication Management Approaches in Psychiatry

• Focuses on using medication in a systematic and
  effective way, as part of the overall treatment
  for severe mental illness
• Core strategies
• Guidelines and steps for medication
  decisionmaking, based on current evidence and
  outcomes
• Systematic monitoring and record keeping of
  medications
• Consumer and family member involvement.

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Assertive Community Treatment

• Offers services that are customized to the
  individual needs of the consumer, delivered by a
  team of practitioners, and available 24 hours a
  day
• Core strategies
• Symptom management
• Housing
• Finances
• Employment
• Medical care
• Substance abuse
• Family life
• Activities of daily life.

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Family Psychoeducation

• Involves a partnership among consumers, families
  and supporters, and practitioners to find ways to
  help consumers move toward recovery in an
  atmosphere of hope and cooperation
• Core strategies
• Through relationship building, education,
  collaboration, problem solving, families and
  supporters
• Learn about mental illness
• Master new ways of managing their mental illness
• Reduce tension and stress within the family
• Provide social support and encouragement to each
  other
• Focus on the future.

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Supported Employment

• A well-defined approach to helping people with
  mental illnesses find and keep competitive
  employment within their communities.
• Core strategies
• Eligibility based on consumer choices and
  preferences
• Supported employment as an integrated treatment
• Continuous follow-along supports
• Help with moving beyond the patient role and
  developing new employment-related roles as part
  of the recovery process.

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Co-occurring Disorders Integrated Dual Diagnosis
Treatment

• Helps individuals with both mental and substance
  abuse disorders recover from both disorders at
  the same time and in one setting.
• Core strategies
• Individualized treatment, based on a persons
  current stage of recovery
• Education about the illness
• Case management
• Help with housing
• Money management
• Relationships and social support
• Counseling designed specifically for people with
  co-occurring disorders.

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Sustaining the Change

• Phases II and III of the National Demonstration
  Project (i.e., refinement and widespread
  distribution of kits)

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Principle Objectives for Organizational Change
Management

• To change attitudes or values
• To modify behavior
• To bring about change in structure, policy, and
  culture

Organizational Transformation Strategies for
Change and Improvement, in Improving
Organizational Effectiveness Through
Transformational Leadership
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Systemwide Change as Part of EBP Implementation
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Traveling the Transformation Highway
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• The more cutting-edge ideas, concepts, guiding
  principles, and best practices you have in your
  leadership toolbox, the greater the rewards you
  will reap.

Harvard Management Update June 2005