Medication, Treatment, Evaluation, and ManagementMedTEAM

An Evidence-Based Practice

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What Are Evidence-Based Practices?

Services that have consistently demonstrated their effectiveness in helping people with mental illness achieve their desired goals 

Effectiveness was established by different people who conducted rigorous studies and obtained similar outcomes

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Examples of Evidence-Based Practices
        - Medication, Treatment, Evaluation, and Management (MedTEAM)
        - Assertive Community Treatment
        - Family Psychoeducation
        - Illness Management and Recovery
        - Integrated Treatment for Co-Occurring Disorders
        - Supported Employment

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Why Implement Evidence-Based Practices? 

According to the New Freedom Commission on Mental Health:

	State-of-the-art treatments, based on decades of research, are not being transferred from research to community settings

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According to the New Freedom Commission on Mental Health:

	If effective treatments were more efficiently delivered through our mental health services system ... millions of Americans would be more successful in school, at work, and in their communities

—Michael Hogan, Chairman

Why Implement Evidence-Based Practices?(continued) 

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What Is MedTEAM?

MedTEAM is a systematic, evidence-based approach for offering medication management to people with mental illnesses 

It helps those who prescribe medications to integrate the best current research evidence, clinical expertise, and consumer experience 

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Practice Principles of MedTEAM
        - The latest scientific evidence guides medication decisions 
        - Medication management requires a team approach
        - Systematically assessing medication-related outcomes is key to evaluating clinical progress
        - High-quality documentation provides a record of medication response over consumers’ lifetime
        - Consumers and prescribers share in the decisionmaking process

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Informed Medication Decisions

Mental health systems and agencies develop a systematic plan to ensure that decisions integrate the latest scientific evidence, consumer experience, and clinical expertise 

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Informed Medication Decisions

Medication choice

Scientific evidence 

Consumer experience

Clinical expertise

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Team Approach

Consumers and prescribers work together with a team of practitioners to systematically gather the information needed for effective medication management 

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Integration is important because you are treating “the whole person.”  Studies have found if you broker services, communication breaks down and important tasks are not done in a coordinated fashion.

Integration includes the following:
          - Supported employment works best if offered by same agency that provides mental health treatment.
          - Employment specialists attend and participate in treatment team meetings.
          - They are in continuous contact with case managers. Co-locating offices with case managers facilitates communication.
          - Employment specialists are informed of medication changes. Medication changes are based in part on work functioning.
          - Treatment team and supported employment unit are “thinking together.” All staff help to identify job leads and contacts. 
          - All staff share in a work culture.

This principle is strongly supported by numerous studies comparing integrated programs to brokered programs (Drake, McHugo, 1996; Drake, 1999; Mueser, submitted; McFarlane, 2000; Chandler, 1997; Meisler, 2000)

Despite these findings, a survey of over 125 supported employment programs in 6 states found this was the main evidence-based principle of supported employment most often not implemented (Bond, Vogler, 2001).

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Medication-related Outcomes 

The routine use of medication-related outcome measures helps prescribers and consumers evaluate whether medications have the desired effect 

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Research has been published on the conversion of 6 different day treatment programs to supported employment in New Hampshire, Rhode Island, and Massachusetts.  The findings have been consistent:

Better employment outcomes, especially for regular attenders of day treatment (If you can make it to day treatment, you probably are going to be conscientious about making it to a job.)

No negative outcomes (no increase in hospitalizations, dropouts, symptoms, homelessness, etc.)

Programs that treat supported employment as an add-on while retaining other vocational options have poorer employment outcomes (Drake, 1998; Gowdy, 2000)

Agencies that devote resources to sheltered workshop, agency-run businesses, and other noncompetitive work options often become diverted from the goal of competitive employment (Mank, 1994). 

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High-Quality Documentation 

Mental health systems and agencies evaluate current paperwork requirements and streamline documentation to ensure that the team has access to all information needed to make effective medication decisions 

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High-Quality Documentation

Developing a systematic plan for high-quality documentation includes improving transferring information after visits to:
        - 	Hospitals 
        - 	Emergency rooms
        - 	General medical practitioners
        - 	Other mental health providers

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Shared Decisionmaking 

Consumers are given information about their medications, share in the decisionmaking process, and are involved in evaluating their progress 

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Studies dating from the 1980s have consistently shown that helping consumers to find real jobs is more effective than requiring them first to attend prevocational training (Dincin, 1982; Bond, 1986; 1995; Drake, Becker, 1996; 1999; Mueser, submitted).

Most consumers prefer the rapid job search approach over stepwise approaches, such as work units, transitional employment (Lucca,1998; Bond, 1995; Bedell, 1998).  If we really believe in designing services consistent with consumer preferences, then we should be hesitant to promote lengthy pre-employment services.

Requiring a consumer to attend prevocational training first appears to be demoralizing for some.

Once a consumer begins attending a prevocational work crew, they paradoxically are rated as less work ready than those who begin paid employment immediately (Bond, 1987).

Consumers are assisted in making contact with employers usually within one month of entering the supported employment program and at a pace consumers determine.  

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Systematic Plan for Medication Management

Good medication management 

Consumer education materials

Treatment team integration

Quality improvement program

Monitoring prescriber practices

Monitoring consumer outcomes

Evidence-based guidelines

Rapid access to internal and external records

Electronic records

User-friendly documentation

Flexible scheduling

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Summary

Effective medication management requires  integrating the best current research evidence, clinical expertise, and consumer experience into the decisionmaking process

MedTEAM offers an evidence-based approach to help mental health systems and agencies develop systematic plans to guide medication management

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Additional Resources 

For more information about MedTEAM and other evidence-based practices, visit:

http://www.samhsa.gov 

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