# Presentation: 202491

## Change Management—	A Key Strategy for 		    Transforming Mental 	       Health Systems

***Change Management—******	******A Key Strategy for ******	******	******    Transforming Mental ******	******       Health Systems***

**June 23, 2005**
**Albuquerque, NM**

**A. Kathryn Power, M.Ed., Director**
**Center for Mental Health Services**

## Attempting change without leadership is like putting a car in gear without a driver behind the wheel. 

- Attempting change without leadership is like putting a car in gear without a driver behind the wheel.

## Everybody has accepted by now that change is unavoidable. But that still implies that change is like death and taxes—it 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*
*21**st** Century*

## The time has long passed for yet another piecemeal approach to mental health reform.  Instead, the Commission recommends a fundamental transformation of the Nation’s approach to mental health care.

*The time has long passed for yet another piecemeal approach to mental health reform.  Instead, the Commission recommends a **fundamental transformation** of the Nation’s approach to mental health care.*

## 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

## 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 recovery**—a process, sometimes lifelong, through which a consumer achieves independence, self-esteem, and a meaningful life in the community
**Builds resilience**—the ability to face life’s challenges

## 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)

## Federal Partners Workgroup

- Leadership

**Federal Partners Workgroup**

| Department of Health and Human Services |  | Other Federal Partners |
| --- | --- | --- |
|  |  |  |
| AoA | NIH/NIDA | Department of Agriculture |
| ACF | NIH/NIMH | Department of Education |
| AHRQ | OS/ASPE | Department of Housing and Urban Development |
| CDC | OS/OCR | Department of Justice |
| CMS | OS/OD | Department of Labor |
| HRSA | OS/OPHS | Department of Transportation |
| IHS | SAMHSA | Department of Veterans Affairs |
|  |  | Social Security Administration |
|  |  |  |

## Evidence-based Practices—How 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

## 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

## National Demonstration Project

**Phase I – (Fall 2000–Summer 2002**)
- Develop six Implementation Resource Kits for evidence-based practices
**Phase II – (Summer 2002–Summer 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)**

## Developing Skills and Supports To Implement Change

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

## 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.

## 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.

## 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.

## 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.

## 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.

## 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 person’s 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.

## Sustaining the Change

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

## 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*

## Systemwide Change as Part of EBP Implementation

**Systemwide Change as Part of EBP Implementation**

**Notes:**
I think this slide is a nice visual to emphasize that it is not just about having evidence – there are a lot of things that impact on the use of that evidence and what evidence is needed to improve the lives of those with mental illnesses.  We need to research all these interfaces --- in fact, we are doing that now.  We are developing the sciences of dissemination/implementation, and adaptation (of EBPs)

## Traveling the Transformation Highway

## 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