Summary of the Second Meeting
Hilton Hotel, Gaithersburg, MD
January 15 – 16, 1998
DAY ONE
Dr. Bernard S. Arons, then Director of the Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), welcomed the second gathering of technical assistance (TA) center directors, their government project officers, and other attendees. He provided the group with a general overview of the meeting.
Dr. Arons noted that CMHS has been honing its work and rethinking the role of the federal government regarding mental health services. The National Institute of Mental Health's (NIMH's) role will continue to be that of conducting controlled studies and investigator research projects. CMHS will continue with its responsibility of identifying critical issues, developing knowledge on the best ways to do things, synthesizing and disseminating information, and applying the information in real-world settings. The TA, training, and research centers are an integral part of that process.
Dr. Arons emphasized that CMHS and the programs it supports have an obligation to show coordination and efficient use of federal resources. SAMHSA's National Mental Health Information Center is an excellent resource that all TA, training, and research centers should use, he said, to get the valuable information generated by the centers to people swiftly and efficiently.
Over the course of the day, Dr. Arons asked the center directors to consider a number of questions:
- How do we orchestrate evidence-based systems change?
- How do we make the information we have available?
- What are some new approaches to making information available?
- How do we use this information to change the system of care throughout the country?
Community action grants are one way CMHS is working to gain local consensus on the best ways to put exemplary practices into place. Dr. Arons asked the group to provide feedback on the "innovation packets" CMHS recently distributed to state planners. The purpose of these packets is to help build consensus with regard to exemplary practices.
Another focus of the meeting was brainstorming about ways to contribute to the Surgeon General's Report on Mental Health. The high profile awarded the Surgeon General's report provides an excellent opportunity to focus public attention on all CMHS goals: promoting mental health, ending the stigma associated with mental illness, encouraging early recognition and intervention for mental health problems, and promoting innovative service delivery systems.
In closing, Dr. Arons suggested that the centers serve the function of drum major by leading efforts to organize and orchestrate the critical work facing all stakeholders in mental health.
John Gates, meeting facilitator and director of the Mental Health Program at the Carter Center in Atlanta, jump-started the meeting by asking everyone to introduce themselves and give a 10-minute presentation on what their center is doing. He asked that the presentations highlight each center's uniqueness and the niche it serves and that participants begin to identify some of the gaps between centers. Identifying such gaps will flag opportunities for synergy and collaboration at this meeting and in the future.
Gates asked the center directors to approach the breakout sessions in terms of three overarching goals:
- To improve each center's work;
- To advance the mental health field; and
- To contribute to the Surgeon General's Report on Mental Health.
Gates suggested that the center directors use the following questions as a framework for breakout session goals:
- What are the best practices?
- How do we put them together?
- How do we "package" them?
- What are the delivery mechanisms?
- How do we follow through on their application?
- How do we evaluate the effects of that application?
Ed DeBeri, representing the National Resource Center on Homelessness and Mental Illness, gave the first presentation. The center provides technical assistance, offers access to a growing consultant network, develops knowledge, and disseminates information. It conducts these activities largely through telephone consultation with its target audiences which include CMHS homelessness grantees, researchers, service providers, city or state government officials, and others in the public sector. The center's 800 phone number receives approximately 170 information requests monthly. In addition to other resources, the center has the largest database in the country dedicated to homelessness, with 4,300 documents.
The center prominently displays CMHS on its Web site. It also links with the Information Center and all CMHS TA centers with Web sites. The center holds coordinated training institutes with other TA centers such as the National Women's Resource Center. The center participated in one workshop with 10 different federal agencies and had lead responsibility for another workshop to develop national protocols and standards on discharge plans. The center also will play a role in the Walk the Walk campaign.
Krista Kutash of the Research and Training Center on Children's Mental Health noted that the center's mission has been the same since 1996. It is to improve services for children with serious emotional and behavioral disorders by developing new knowledge or disseminating existing knowledge.
Collaboration is ongoing. The center contacts a sister center at least once per week. Topics usually include early intervention, ways to build capacity in prevention, and the challenges of fully integrating family advocates into the system.
One of the center's most interesting and exciting collaborative endeavors is the health care tracking project with the National Technical Assistance Center for Children's Mental Health. The project is looking at how managed care has been applied to Medicaid programs in all 50 states and the District of Columbia. Rapid changes in public mental health services delivery are occurring solely as a result of sea changes in policy, without any data on the best ways to approach them. The states are networking in an attempt to learn quickly what is working.
The center also is documenting effective collaborative efforts between mental health programs and public schools. Kutash emphasized that this is one of the biggest gaps in the children's mental health field, largely because of turf issues. Another project is documenting exemplary management information systems for states to replicate. In addition, the center is working with the Federation of Families for Children's Mental Health to examine the effects of SSI changes on children and their families.
Morton Wagenfeld, co-director of Frontier Mental Health Services Resource Network, began his presentation by informing the group that the U.S. has 27 states containing 394 frontier counties, almost all located west of the 98th meridian. Frontier counties are those with populations of six or fewer people per square mile. Today the frontier still represents 45 percent of U.S. land mass yet holds less than 1 percent of the population. Services, where they exist, are sparse because of enormous geographic distances, harsh terrain, and poverty.
The center provides state-of-the-art information on:
- Monitoring the need and demand for mental health services;
- Promoting knowledge about the efficacy of mental health treatment;
- Monitoring the availability and accessibility of mental health services;
- Developing solutions to providing services and interventions for general and special populations (the elderly, children, people with serious and persistent mental illness) who reside in frontier areas, and recruiting, training, and retaining skilled mental health providers;
- Identifying models for integrating services; and
- Following managed care as it comes to rural areas.
Since little published information exists, the center completed a comprehensive review of both published and fugitive literature on rural mental health. The center has developed a series of papers that synthesizes state-of-the-art information on the above topics and is conducting provider and consumer focus groups on mental health needs in frontier areas.
Telemedicine and needs assessment are two center priorities. The center recently held a well-attended conference on telemedicine.
Kathy Furlong-Norman said the Center for Psychiatric Rehabilitation has been operating for almost 20 years and has a service division and an academic program for master/doctoral students. The center focuses on research that can be easily translated into practice and stimulate changes in practitioner attitudes and behavior, program development, and service systems. There has been a recent push to find ways of integrating the concept of wellness into psychosocial rehabilitation programs.
The center produces a number of publications on rehabilitation and recovery including a newsletter, journal, and books. In addition, a new section on the center's Web site provides employers and educators with information about dealing with the many issues that arise in supported employment and supported education programs for people with psychiatric disabilities. The center also produced a training manual to help people successfully navigate the Social Security Administration's work incentives program.
James Winarski said the Projects for Assistance in Transition from Homelessness (PATH) Technical Assistance Center funds approximately 350 programs across the nation and in four territories. State mental health authorities distribute the funding. A main component of these programs is outreach to homeless people with serious mental illnesses.
The center develops relationships with its target audiences of executive administrative staff, supervisory staff, and frontline workers, with a focus on presenting information in an efficient and useful way. Major initiatives are:
- Providing technical assistance packages as a basis for on-site visits on topics such as outcome measures, fiscal and strategic planning, interventions for people with co-occurring disorders, and employment and vocational programs;
- Holding monthly teleconferences;
- Establishing a network of state administrators; and
- Creating a FAX information system.
Marie Verna discussed the activities of the National Mental Health Consumers' Self-Help Clearinghouse. A foremost responsibility of the center is referring callers to resources that can help meet their needs. The center has recently been improving both its Web site and its database of about 8,000 entries representing consumer, provider, or government organizations.
One of its collaborative projects is the National Managed Care Consortium. The center is also working closely with NMHA, which includes helping to develop the National Mental Health Association's (NMHA) office of consumer advocacy.
In addition, the center plans to revamp its publications, develop "toolkits," and address the complexities of the Americans with Disabilities Act to help consumers easily understand their rights.
Speaking for the National Empowerment Center, Laurie Ahern emphasized a main mission of the center to publicize the numerous accomplishments of the consumer/survivor/ex-patient movement. The center works especially hard to generate media interest in the consumer/survivor/ex-patient movement. The center recently hosted the crew of NBC's evening television program, "Dateline," as it filmed several days of the center's recovery activities.
In addition to providing an 800 telephone number and referrals to peer support groups around the country, the center produces a newsletter with a circulation of about 10,000 and a number of video tapes that sell for $1. Last year the center sold about 10,000 videos.
Every other year the center sponsors the "Alternatives Conference." This year attendance is expected to include 600 to 700 consumers and others interested in mental health.
Over the last two years, center staff gave a number of keynote speeches that reached approximately 40,000 people. The center works with national and international police and fire departments to train officers to respond appropriately and effectively to people with mental illnesses.
CMHS recently provided funding to the center for recovery research. No research to date has seriously investigated the critical components of recovery, since recovery is a relatively new concept in mental health. Although the study is still in the early stages, the center is finding that employment appears to be an important element.
The center is working on a number of projects with federal agencies such as the Department of Housing and Urban Development and with other TA centers including the Center for Psychiatric Rehabilitation, Projects for Assistance in Transition from Homelessness (PATH) Technical Assistance Center, and the National Technical Assistance Center (NTAC) for State Mental Health Planning.
Joan Dodge began her presentation of the National Technical Assistance Center for Children's Mental Health by reporting that the center receives funding through a cooperative agreement with CMHS, the Maternal and Child Health Bureau, and the Administration on Children and Families. In addition to working directly with children and families, the TA center also works with agencies in juvenile justice, education, health, and child welfare.
To meet its technical assistance goal, the center takes several main approaches: building coalitions with key national and state organizations and agencies; fostering consensus on seminal issues; developing and disseminating information and materials; offering consultation; and brokering information.
All of its activities require joining forces and sharing information with other organizations including many of the CMHS TA centers. The center is involved in the health care reform tracking project mentioned earlier. It also is involved in a support network which includes organizations such as National Resource Network for Children, the Center for Study of Social Health Services, the Washington Business Group on Health, and the Federation of Families for Children's Mental Health.
The center recently collaborated on a survey to determine the differences between the needs of child welfare practitioners and mental health practitioners regarding what information they require, how they acquire it, how they use it, and where the information gaps lie. The center is also currently engaged in a joint project to identify mental health areas needing further exploration.
An important factor to the center's success is that it brings people together as a team. For example, conference attendees are often asked to take the lead in inviting someone from a seemingly disparate agency in their area to participate. This gives participants an opportunity to obtain information and forge personal relationships that can be useful when they return to their agencies.
Kutash briefly discussed "intellectual capital." The term refers to an organization's greatest asset, which is its staff, and what they know, what they do, and how to preserve and retrieve that knowledge when they leave. What is known within organizations often gets stored in files, on bookshelves, or elsewhere in an office. It is rarely captured in a systematic way to ensure quick and easy access. As a result, information often gets lost, and time is wasted trying to retrieve or recreate it. To avoid these pitfalls, the center created a database to capture, catalog, and abstract critical resources.
Kaye Exo said the mission of the Research and Training Center on Family Support and Children's Mental Health is to improve services for families who have children with serious mental, emotional, or behavioral disorders. The underlying philosophy is that services are most effective when they are community-based, family-centered, and culturally-competent. The framework for achieving this mission is to engage in partnerships with parents and other family members, policy makers, administrators, service providers, and educators, where values, information, and power are shared.
The center has a project to gauge the level of involvement of family members in policy making in mental health settings. Results are showing that, despite state laws to encourage family participation, few examples exist where family members actually participate at the policy level. Another project looks at the inter-relationship between work and caring for a child with a disability.
Many of the center's activities are collaborative. For example, a number of other TA centers work with this center on its annual "Building on Family Strength" conference. The center also shares its mailing list with other TA centers for special events and links its home page with Web sites such as the Information Center and other TA Centers. The center is developing a workshop in conjunction with the Research and Training Center for Children's Mental Health on parental involvement in research.
To disseminate information, the center produces a free biannual newsletter with a circulation of approximately 28,000, provides a national clearinghouse on family support and children's mental health, and recently co-edited two special issues of The Journal on Emotional Behavior Disorders.
Bruce Emery highlighted the National Technical Assistance Center (NTAC) for State Mental Health Planning activities. This center has four audiences: consumers, family members, state mental health planning and advisory councils, and directors and commissioners of state mental health agencies. Like many TA centers, it provides on-site technical assistance, sponsors collaborative regional and national conferences, and produces and distributes documents. A relatively new and major focus of its work is long-term systems reform, which generally requires a series of on-site technical assistance visits rather than a one-shot approach.
The center also collaborates on managed care at a number of levels. For example, it works with others to track and understand what is happening to state/county partnerships as authority and liability shifts from the state to the regional and local level.
The National Consumer Operated Business Roundtable is among the center's current projects. A joint effort with the National Mental Health Consumers' Self-Help Clearinghouse, the project brings together consumers who own and operate businesses to learn what they can teach state mental health agencies. Another project goal is to nudge state mental health agencies to provide funding for those businesses or to use them as vendors. The center also hosted a roundtable on welfare reform to determine its impact on persons with psychiatric disabilities.
The center also conducted a national executive training institute on housing to help teams from 25 states develop strategic plans on homelessness and mental illness. This event had a number of co-sponsors which included CMHS.
Kathy Skowyra said the National GAINS Center receives funding from CMHS, the Center for Substance Abuse Treatment, and the National Institute of Corrections. The center was created to serve as a national site for collecting and disseminating information about effective programs for individuals who are involved in the criminal justice system and have co-occurring mental health and substance abuse disorders.
The GAINS acronym stands for gather relevant information (G); assess what works, why, and for whom (A); interpret and convert facts into useful packets of information (I); network with those who produce, use, or need information (N); and stimulate the use and application of the information (S).
The center works as a team with multi-disciplinary representatives of agencies, such as corrections administrators, treatment providers, consumer/survivors, and family members, to promote systems change. Three-day, regional forums are used to create these multi-disciplinary teams with the goal of developing plans that can be put into action in local areas. The center's newsletter, Connections, reports on the forums' activities and is sent to forum participants.
The GAINS Center maintains a comprehensive database of relevant literature, innovative programs, related technical assistance centers, and national experts. With the help of local and national experts, GAINS also provides technical assistance to jurisdictions interested in developing or enhancing programs to help the target population.
The center's growing portfolio of publications includes a one-page bulletin on issues such as emerging programs and funding opportunities. The center's most recent publication, the Women's Program Compendium, describes 64 programs across the country that provide services to women with co-occurring disorders who are also involved in the criminal justice system. This publication will be updated annually. A similar publication on juvenile programs is being considered.
The center has been working with the Office of Juvenile Justice and Delinquency Prevention and the Council of Juvenile Correctional Administrators to create mental health and substance abuse standards for youth entering residential facilities. The center recently sponsored a groundbreaking meeting on the needs of adolescent girls with co-occurring disorders in the justice system. It is also planning a March workshop on best practices and promising programs on a continuum of care for juveniles. In addition, the center is collaborating with NMHA on an initiative to promote awareness of the mental health needs of juveniles in criminal justice facilities. Plans are underway for a February meeting with state and local corrections officials, treatment providers, consumers, and family members to establish standards on what does and does not work.
Lawrence Woocher described the work of the Center for Evaluation of Adult Mental Health Systems. Its goal is to promote and facilitate the use of rigorous and appropriate methods for evaluating adult mental health systems. Like other TA centers, this center has found that long-term technical assistance is often more effective than one encounter and that collaboration is a lynch-pin to much of its work.
The center's consultation program has expertise in a number of evaluation areas and conducted a recent survey with Georgia on its state mental health authorities. The survey examined how medical necessity is defined under managed care, what criteria state mental health authorities are using, and how services are being affected.
The center's "toolkits" are complete packages of information that an organization can use to evaluate various aspects of their programs. The center recently put together a "toolkit" on effective and persuasive case studies and is working on another on practical cost measurement. The center provides working papers and other resources that require further testing prior to becoming established methodologies.
Topical evaluation network programs support a number of Internet listservs or electronic mailing lists. One example of this service, called MBHEVAL (managed behavioral health evaluation), provides an opportunity to discuss problems, pose questions, and get responses from experts on managed care.
The center's newest area of focus is multicultural issues and evaluation. It recently co-sponsored a symposium on multicultural mental health research in the 21st century and is exploring the possibility of collaborating with Harvard University on the evaluation needs of refugee trauma programs.
The center's conference and training program sends staff members or associates to national meetings to present state-of-the-art information on topics such as performance indicators. Roundtable discussions are also organized through this program.
Carol Schauer discussed the Advocacy Training and Technical Assistance Center. The center receives funding from two separate components within the Department of Health and Human Services and from two agencies within the Department of Education. As a result, all center activities are coordinated among many programs and among a diverse pool of federal officials. The center's activities are primarily orchestrated with other disability organizations, rather than with CMHS TA centers, which sets it apart from other centers represented at the meeting.
The center provides information, training, and a conduit for communication. It primarily serves the 56 protection and advocacy (P & A) program grantees across the states, territories, and islands. Services are directed to the managers, lawyers, advocates, boards of directors, and advisory councils (largely comprised of consumers) that make up the grantees.
The center offers training several times a year on fiscal management, strategic planning and budgeting, and performance measurement. It also provides peer review teams. Its Web site offers information for the general public; a closed section for grantees that serves as a repository of statutes, regulations, and court case dockets; and a bulletin board for attorneys and advocates to communicate on particular issues. The center is currently developing information technology to collect data from the P & A programs and to tie the data to strategic budgeting and performance.
Working with its affiliated government agencies and all the grantees, the center is developing performance outcome measures. This undertaking should be completed this year.
The center develops model policies and procedures, such as grievance procedures, that the P & A programs can use. The center also provides legal back-up services and analyses to the P & A attorneys and advocates. In addition, it has responsibility for making grantees aware of cutting edge issues related to mental health or other disabilities.
The center also produces monthly newsletters that highlight grantees' activities and conducts press relations to generate media attention for its success stories.
Constance Dellmuth briefed meeting participants on the National Resource Network on Child and Family Mental Health Services, an organization within the Washington Business Group on Health. This center provides technical assistance to the 31 grantees of the CMHS Comprehensive Community Mental Health Services Program for Children and Their Families. Funding comes from the Department of Justice, the Department of Education, CMHS, and other agencies within the Department of Health and Human Services.
The center provides technical assistance through three hubs: small city and county, rural, and urban. A new program, called "Circles of Care," is designed specifically to meet the needs of the American Indian population.
The remainder of Day One was allocated to the following breakout sessions:
Session One –
- Knowledge Development and Application
- Community Action Grants for Service Systems Change
Session Two –
- Knowledge Development and Application
- Community Information Needs
Session Three –
- Evaluation of Technical Assistance Centers
- Innovation Packages
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