Translating Evidence Based Research into Quality Services: Hawaii

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Translating Evidence Based Research into
Quality Services Hawaiis Experience

• Christina M. Donkervoet, M.S.N., APRN
• Chief, Child Adolescent Mental Health Division
• Department of Health

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Hawaii System of Care - 1999

• Solid statewide foundation framework
• Broad access availability
• Strong team-based decision making value

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1999 .A Not so Good Time

• Dramatic cost increase
• Results inadequate to poor
• Substandard system performance

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The 1998 AHA Experience

• Framework of system of care
• Solid values, good intentions willingness to
  collaborate are a beginning.
• Good will ? Meaningful Results
• for Children, Youth, Families, Systems

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Taking a Step Toward EBS

• Desire to learn what services resulted in
  meaningful life changes for youth
• Presenting Problem Areas
• Age
• Gender
• Culture Ethnicity
• Develop mechanism for implementing these types of
  services across communities and islands

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Initial Charge

• Focus on the Research Data
• INITIAL TARGET CONDUCT DISORDER
• high cost,
• low satisfaction,
• low effectiveness

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Critical Factors of the EBS Committee

• Broad Membership
• Cross disciplinary
• Family membership
• Cross agency
• Public Private
• Community State
• Child serving agencies Higher education
• Unifying Lead
• Defined Framework of Evaluating
• Design Linkage to Practice Development Activities
  Performance Management

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Hawaii Blue Menu of Evidence-Based
Services(abbreviated)
Problem
Level 1 best support
Level 2 good support
Level 3 moderate support
Level 4 Minimal support
Level 5 known risks
Anxious or Avoidant Behaviors
CBT Exposure Modeling
CBT parents Ed support
None
EMDR Play Tx GIST
None
Behavior Therapy
None
None
Biofeedback Play Tx GIST
None
Attention/ Hyperactive Behaviors
Bipolar Disorder
None
Interpersonal and social rhythm therapy
Family Psycho education
All other psychosocial therapies
None
Delinquency Willful Misconduct
None
MST FFT
MTFC Wrap around Foster care
Juvenile Justice Individual Tx
Group Therapy
Depressive or Withdrawn Behaviors
CBT
CBT parents IPT Relaxation
None
Behavioral problem solving Fam. Tx Ind. Tx
None
Disruptive Oppositional Behaviors
Parent Teacher Training PCIT
Anger Coping Assertiveness PSST
Social relations training Project Achieve
Client-centered comm. Skills HR therapy
Group Therapy
Substance Use
CBT
Behavior Tx Purdue Brief Family Tx
None
Ind.tx family drug educ conjoint fam. tx
Group Therapy
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Level of Care
Diagnostic History
Accepted
Authorized
Services
Sep-03
Oct-03
Nov-03
Dec-03
Feb-04
Mar-04
Apr-04
Jan-04
May-04
Jun-04
Sep-03
Oct-03
Nov-03
Dec-03
Jan-04
Feb-04
Mar-04
Apr-04
May-04
Jun-04
May-04
Jun-04
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EBS Tips of the Week

• Week of 10-10-05
• Two types of foster care have evidence for
  their efficacy in treating adolescents with
  conduct problems Multidimensional Treatment
  Foster Care and Wrap-Around Foster Care (source
  EBS Biennial Report 2004). 18
• Week of 07-04-05Relaxation alone has been shown
  to be as effective as many more complicated
  treatments for child depression. Two
  well-designed studies support its effects
  (source EBS Biennial Report 2004). 4

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Monitoring Outcomes

• Quality Case Based Reviews
• Quantitative Outcomes
• Role of Families
• Publicly Shared Quarterly Reports

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System Performance since EBS
Quality Dimension Examples Functional
Assessment Service Coordination Transition
Long-term view Caregiver Supports Service
Plan Implementation Effective Results
Service Array Integration Monitoring
Modification
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Avoid Use of Hospital Residential Services for
Conduct Disorders
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Challenges in Sustaining Focus

• System Constraints
• Clinician Constraints
• Rural Communities

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Satisfying Legislative Mandates

• Need for levels or degrees of evidence
• Increase the awareness of the value and
  limitations of the evidenced based services (the
  other 35-40)
• Balancing the value of choice and options with
  effectiveness and cost

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HawaiisEvidence Based Services

• WHAT IT IS
• A component of the system of care
• A means to strengthen the quality of services
• A strategy to increase positive outcomes
• For youth families
• For stakeholders
• For clinicians, agencies, administrators

• WHAT ITS NOT
• A way to force change
• A way to limit services
• A way to reduce options