Ensuring Quality Care (Performance Outcomes System)
The goal of any mental health system must be to stabilize and improve the lives of people with mental health needs. For youth, that means having access to treatment that helps them live safely at home, succeed in school, avoid delinquency, build healthy relationships, and go on to become productive members of society. In California we spend more than a billion dollars every year delivering mental health services to low-income youth. With that level of investment, we should expect to see positive outcomes throughout the State for youth with mental health needs. However, data showing whether or not that is happening, are hard to find or non-existant. In fact California does not have a reliable, accurate, statewide system to gather information about what services youth are receiving or what outcomes they are experiencing. Without this information it is impossible to evaluate whether our system provides services that are adequate in quality, scope, duration or intensity, much less whether we are meeting our goal of improving the lives of families and youth.
California’s multi-billion dollar children’s mental health system needs a data management tool that allows the State to cost-effectively manage the public mental health system. Towards that end, Young Minds has been part of a coalition of advocates collaborating with the State and counties to develop a Performance Outcome System for the public mental health system for youth in California.
Young Minds’ Impact
When it comes to mental health services, quality is the magic bullet. Studies (or data) show that ineffective treatment is at best, a waste of time and money, and at worst, leads to increased trauma and hardship for youth and their families. That’s why in 2011, Young Minds insisted in a letter to the Governor of California, that the State make a commitment to developing and implementing a Performance Outcome System that measures and reports on access to and benefits from Early and Periodic, Screening, Diagnosis, and Treatment (EPSDT) mental health services. Since then, Young Minds, other advocates for youth, and clinical experts have been working with the State to develop and implement a comprehensive management tool.
The process has not been easy. But, after many delays, the tool is in development and the State recently released its first data report. This marks an important forward step towards assessing and improving the quality of California’s youth mental health system.
How’d we get here? Issue Background
Data gathering typically serves the direct and specific purpose of the agency collecting the data. One of the best–known examples of this is Medi-Cal billing data. In order for a provider to get paid, it must demonstrate that an eligible youth was treated using an approved service at a specified cost. By providing these data to Medi-Cal, a provider may be reimbursed for its eligible expense. But, if what you want is information about whether the service resulted in improvement for the youth receiving care, billing data are woefully inadequate. If you want to evaluate the results of treatment, you have to look elsewhere.
Why don’t we have outcomes data? Largely it’s because Medicaid is an insurance program that began as a fee-for-service system. The system relied on the medical provider to do what was necessary for delivering appropriate care, and payment was made for the services rendered. Hospitals, doctors and nurses were relied upon to manage patient services and quality. Most children’s mental health systems are no longer primarily fee-for-service, and our treatment providers are often not hospitals, doctors or nurses who are responsible for ensuring that care is coordinated and successful. The shift from fee-for-service and clinic-based care to managed care by multiple providers delivered in the home and community has dramatically increased the need for service and outcome information. And yet, our information management systems have not kept pace with these system changes.
Because gathering useful and accurate information requires long-term planning, funding and expertise, many jurisdictions simply put it off, or seek to shift the responsibility of acquiring, analyzing, and sharing data to others. In so doing, they limit their ability to manage quality, provide cost-effective care, or achieve improved child and family outcomes. They also miss the opportunity to develop a holistic System of Care that can effectively serve young people with serious mental health needs.