Remarks by
A. Kathryn Power, M.Ed.
Director
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
American College of Mental Health Santa Fe Summit
Tracking the Transformation— A Celebration of Our Progress Toward Achieving the Promise!
Santa Fe, NM
March 31, 2005
PowerPoint version
Attached is the text prepared for delivery; however, some material may have
been added or omitted at the time of delivery.
[SLIDE 1/Cover]
Thank you, Carolyn.
It is an honor and a personal privilege to join you on this red-letter day . On this day in 1889, the Eiffel Tower was dedicated in Paris. The 1000-foot tower’s avant-garde design was a technological wonder…a concept far ahead of its time. But, as is so often the case with revolutionary ideas, the tower’s architect, Gustave Eiffel, had to triumph over many obstacles to advance his innovation from concept to reality. The tower was greeted with skepticism from critics who argued that it would be structurally unsound. Others feared it would be an eyesore. Unperturbed, Eiffel—who also built the supporting structure for our own Statue of Liberty—completed his creation…under budget…in just two years.
On the day of the dedication, only a handful of guests and 200 construction workers were in attendance. To make matters worse, the elevators were not completed. The determined Eiffel climbed the tower’s 38 flights to raise a flag and set off fireworks from its second platform. Despite the naysayers who resisted the change in the traditional landscape…despite the harrowing uphill climb to reach his destination…Eiffel persevered. And he celebrated!
Rosabeth Moss Kanter, the well-known specialist in change leadership and author of, The Change Masters, endorses Gustave Eiffel’s approach. She says “ People resist change for reasons that make good sense to them.” But, despite the resistance…despite the inevitable challenges…Kanter says, “it is crucial to recognize, reward, and celebrate accomplishments" along the pathway to change.
I am here this morning to do just that. To celebrate our progress toward transformation! Despite the certain challenges…and the uphill struggles we will surely face as we continue to pursue this fundamental, wholesale change of our National mental health system… this is a time to pay tribute to what we have already accomplished in our quest to invent a brighter future for people with or at risk for mental illnesses.
Yes, we have a long way to go. But the forces propelling the future are on the right track. We have good reason to be encouraged.
Transformation is happening! Transformation is real! The hard, risk taking work of transformation has begun! Like Gustave Eiffel, we are making history. And one day, the transformed mental health system we create will be an enduring testimony to our collective will, resources and willingness to believe in possiblity.
Our collective will…our combined resources…and our concerted willingness to believe—that’s what it will take to realize the transformation of our national mental health system. I salute the American College of Mental Health Administration for recognizing that fact, and for using its convening power to bring together leaders from across behavioral health…and from other sectors that have undergone transformation…to share their unique perspectives. This is a natural role for a group like ACMHA to play…a perfect example of the kinds of public/private partnerships that are a critical component of transformation. This Summit is an extraordinary opportuntity for all of us—public and private entities, coalitions, Federal, State and local governments—to put our organizational hats aside…and really listen to and learn from each other…as we fill in the details of a truly shared vision for transformation.
What does this transformation look like? How is it happening? As I’ve traveled the country over the last year-and-a-half encouraging individuals, communities, organizations, and governments to push forward with the changes that are needed to transform the Nation’s mental health care system , I have seen that we are already on our way to achieving the promise. I am here today to share with you some of the progress I have witnessed…and to enlist your help in setting a course for the future.
The Commission Report gave us a clear and vivid vision of a transformed mental health system. But t he possibilities are limitless! And the speed at which these possibilities become reality will depend upon all of us. How much we can achieve in the long-term will depend largely on how much time and effort we are willing to invest right NOW.
SAMHSA/CMHS and the Federal partners have made an unparalleled commitment to work together to create a system that is accountable to people seeking recovery from mental illnesses. But, transformation is a collective endeavor. The most important outcome of the cross-agency collaboration we have achieved at the Federal level is the model it provides for what can happen at every level of the system—from the biggest State to the smallest county.
You are the ultimate locus of accountability for the care that is available. You can create real opportunities for change. You can transform lives! Each of you must pursue this vision. You will put the face on it. You must own this transformation. You must make it real!
(pause)
You are off to an impressive start!
A quick glance at today’s agenda makes it clear: you are, indeed, making transformation happen. From California to the Carolinas, promising models of transformation in behavioral health are being developed. Transformative projects, seeded by the recommendations in Achieving the Promise, are being piloted. Strategies for securing the funding for change are being put into practice. Each of you is answering the invitation extended by the New Freedom Commission…in your own way.
Before I highlight our progress toward transformation, though, I think it will be helpful to take a closer look at exactly what we mean when we say, “transformation.” The word transformation appears 11 times throughout the pages of Achieving the Promise. The Report provided a clear vision of a transformed system, but it did not clearly define transformation…or provide a specific blueprint for achieving it.
Our first inclination might be to look across the mental health field for examples of how this has been done. But, there simply are no examples of change of this magnitude …across whole systems and affecting every dimension of care…in all of healthcare. It becomes imperative for us to look to other fields for help with how to define…as well as how to bring about transformation. I congratulate ACMHA, once again, for being ahead of the curve—for inviting Karolin Cheboski to share lessons learned from the transformation that is taking place in the airline industry.You will hear from Karolin in a few minutes.
In a recently-released report, Concepts of Transformation, author, Noel Mazade, examines a number of theories and operational definitions from other fields to conceptualize transformation. What do these diverse industry views of transformation have in common?
[SLIDE 2/Transformation]
In every case, “transformation” involves a deep…and profound…and continuous process along a continuum of innovation— a process without end! Transformation is a complex and dynamic phenomenon that relies on ongoing change.
Transformation is not a destination…or a point on a continuum that we can put our finger on.
[SLIDE 3/Transformation Step/Jumps]
Rather, transformation is a process that unfolds…in multiple directions and on multiple levels;
…in a combination of continuous small steps…that focus on core missions, improving what the system is already doing;
…in a series of exploratory medium jumps…that push the boundaries of core competencies, trying to create something new within the existing paradigm;
...and in a few big jumps where new rule sets that leverage new ideas are born.
[SLIDE 4/Transformation Begins]
Let’s look at a few of the many small steps…and the larger jumps…that we, collectively, have taken toward our goal.
[SLIDE 5/SAMHSA/CMHS: First Steps]
As soon as the Secretary charged SAMHSA with responding to the Commission’s Final Report, we immediately began to take action.
Internally, we have advanced the work of a cross-center matrix workgroup. The workgroup completed an inventory of all existing SAMHSA activities that relate to the Commission’s six goals, and recommended new initiatives to support transformation .
Together with our Federal Partners, we developed the first Federal Action Agenda for Mental Health Transformation, in conjunction with senior level staff from six Federal Departments and the Social Security Administration.The collective Action Agenda includes 75 time-limited, realistic action steps that we can take during the next year to motivate, facilitate and compel change at State, community, and individual levels.
We are increasing Federal support to States for their formal transformation efforts. A few weeks ago, we announced the availability of $18.8 million for a new Mental Health Transformation State Incentive Grant program that we call, “Transformation SIGs.” These grants will support State efforts to implement the systemic changes needed to meet the multiple needs of consumers and to foster recovery.
We are laying the groundwork for transformation by defining the constructs and values that are essential to the process. Transformation involves collaboration…among Federal, State, and local agencies, organizations, providers, and consumers and their families. To work together to reach our destination—a recovery-focused system that will truly serve the needs of all Americans—we need a common ground…a language that makes it possible for us to communicate effectively…to interpret, embrace, and apply these concepts with a shared understanding. We need a common ground to establish consistent benchmarks for measuring effectiveness of care. We have initiated several efforts to make sure we find that common ground.
As part of our effort to ensure a consumer- and family-driven mental health system, for example, SAMHSA—together with the Centers for Medicare and Medicaid Services—will sponsor a series of videoconference trainings on self-determination and self-direction in mental health. This series, starting this spring, will address issues such as how the States can implement self-determination and self-direction in their mental health systems.
[SLIDE 6/Defining Key Constructs and Values]
We have already brought together a family-led workgroup to address issues related to the concept of family-driven and youth-guided care. “ Family driven” means that families have a decision making role in the care of their own children as well as the policies and procedures governing care for all children in the community, State, and Nation. Our definition of “youth guided” is that youth have a role in guiding their own care. For older youth, it may mean directing their own care. We now are working to refine these definitions and to identify meaningful ways to involve families in decision making at every level.
Last December, we joined with the Interagency Committee on Disability Research to sponsor the National Consensus Conference on Mental Health Recovery. This conference brought together consumers, family members, providers, researchers, and public officials to identify the common key principles and elements that define recovery…and to determine how we can implement recovery in various levels of the mental health system. We are finalizing a working definition of recovery and its application in practice.We are involved in a parallel process with the children’s mental health community to look at how the concept of recovery should be defined in children’s mental health.
We are aligning our investments with transformation priorities. Throughout SAMHSA/CMHS, we are turning our internal ship of state toward alignment with the external movement to transform mental health service delivery. As part of this effort, we have also identified six key areas of concentration for FY 2005—prioritized critical system needs— for moving forward. And, our plan of action for 2005 is an ambitious one!
[SLIDE 7/Transformation Action Initiative]
One of our priorities—The Transformation Action Initiative, or TAI—will provide a cohesive, coordinated, and strategic structure for the provision of technical assistance within the Mental Health Transformation SIG program and for CMHS programs focused on assisting individuals and families to achieve recovery and promote resilience.
The TAI will deliver technical assistance via virtual learning communities—networking groups of grantees to ensure tools and guidance are relevant to their objectives.
[SLIDE 8/Transformational Leadership]
Transformation begins with a vision. But a vision—no matter how compelling—cannot be achieved without strong leadership. We must have people to drive the transformation process—leaders who can blaze a trail…and inspire others to follow. We need transformational leaders to energize and mobilize others around a shared vision of what is possible…the vision of recovery.
One of the issues we are examining at SAMHSA is how we can invest in leadership. We recognize that we need to be smarter about how we train people to be leaders. We are in the very early stages of our work in this area, but o ur goal for this priority is to stimulate and facilitate interest within State and consumer teams for leadership development. We also intend to develop a strategic plan for transformational leaders in behavioral health care.
As part of this transformational leadership strategy, we will establish a comprehensive framework for grantees that:
- Incorporates core competencies for leadership.
- Builds on existing leadership development models and efforts within and beyond the mental health community.
- Reflects varied methodologies for building leadership capacity.
- Addresses the need to develop diverse leadership teams.
- Reinforces the impact of effective communication on maintaining leaders and their accomplishments; and
- Addresses the continuum of identifying, educating, and motivating leaders.
We will explore Leadership Coaching as apossible means for sustaining the transformation of leaders and service delivery systems. The coach, as a guide, facilitator and educator, would engage in one-on-one relationships with individuals to increase and sustain leadership effectiveness.
[SLIDE 9/Leadership Competency Chart]
This Transformational Leadership Competency wheel, describes the competencies that CMHS will use to guide the development of transformational leaders in each of the SIG States and beyond. These competencies can be used to assess…and continually improve… the effectiveness of an individual leader's style.
[SLIDE 10/Disparities Reduction/Elimination]
This priority is the same as Goal 3 in Achieving the Promise. At SAMHSA/CMHS we understand the importance of expanding and educating the workforce so that it is equipped to provide culturally appropriate, evidence-based care and deliver quality mental health services to culturally and linguistically diverse populations. We have proposed an entire portfolio of activities to address issues such as cultural competence in behavioral health care training programs… public education for underserved communities…and the adaptation and evaluation of innovative and evidence-based practices that meet the needs of diverse populations. In the coming year, we plan to rally our Federal partners and experts from across the country to develop a National Strategic Plan that will provide a roadmap for how we, as a Nation, can work planfully to make meaningful progress toward eliminating racial and ethnic disparities in mental health services.
[SLIDE 11/Workforce Development]
As you well know, there is a national crisis in the training of our behavioral health workforce. This issue demands concerted and urgent attention. I commend the members of ACMHA for your pioneering…and continuing…efforts through the Annapolis Coalition to build a national consensus on the workforce crisis and to promote, identify, and implement strategies for improvement. We can thank the Annapolis Coalition for helping the New Freedom Commission recognize the extent and implications of our serious workforce problems—and the urgency behind solving these problems. We will not be able to achieve or sustain any of the Commission's recommendations if we don’t address these issues…now!
SAMHSA/CMHS is committed to developing a workforce that has been trained and is supported through a competency-based approach. We also want the workforce to respond to and shape an environment that supports recovery.
One of our 2005 priorities is to look at workforce development from every angle, including education and training, consumer involvement, integrated care, and disparities in care. The work of the Annapolis Coalition will drive this effort to create a mental health workforce capable of delivering competent, evidence-based, 21 st century health care. Its examination of workforce development issues is unique and exceptionally important to the Nation’s transformation effort.
[SLIDE 12/Science
-to-Service]
We know that well-grounded evidence-based practices that take into account individual variables such as culture, geography, literacy, disability, faith, and so on are essential to helping consumers and families achieve recovery. We are working hard across SAMHSA/CMHS to help communities implement evidence-based practices…and to train clinicians to provide these evidence-based services to culturally diverse populations.
We have a two-part goal for this priority. The first is to expand the number and distribution of evidence-based practices available through NREPP. NREPP has just recently been re-named the National Registry of Evidence-Based Programs and Practices to reflect the critical role of evidenced-base care in a transformed system. NREPP is currently being revised and expanded to include all interventions to prevent and/or treat mental and addictive disorders. Revised review and screening criteria will be posted on the new NREPP Web site by fall 2005, at www.nationalregistry.samhsa.gov
Part 2 of this goal is to ensure that States and providers can implement these practices. As part of our National Evidence-based Practices Project, we are supporting the evaluation of a national demonstration project, a National EBP Center, and development of a series of EBP implementation resource kits.
Last August, we made six Evidence-Based Practice implementation resource kits available on our Web site. Each kit contains an implementation manual, fidelity measures, and other information that providers need to replicate the practice. We intend to produce four more toolkits this year. We will be looking at practices related to supportive housing, aging, consumer-operated services, and children.
[SLIDE
13/Individualized Plans of Care (IPC)]
Individualized plans of care will be a cornerstone of the transformed mental health system. Our goal here is to identify prototypes that will address the unique needs of individuals throughout the lifespan and that will create a foundation for coordinated services. We are working with NASMHPD to develop prototypes for customized recovery plans that consider the individual needs and concerns of every person with a mental illness.
[SLIDE
14/Model Comprehensive State Mental Health Plans]
The second cornerstone of our transformed system will be truly Comprehensive State Mental Health Plans. SAMHSA and NASMHPD are working hard to have a model plan template available by the time we award the first mental health transformation grants.
Finally, we are developing strong partnerships and collaborative activities with other Federal partners.One of the most exciting outcomes of the transformation process has been the great synergy among all of the Agencies that touch the lives of mental health consumers—Labor…Housing…Education…Justice…Social Security—coming together…breaking down the barriers…the silos…that have existed for so long…to determine how we can cooperate and collaborate to better serve the whole consumer…mind and body.
[SLIDE 15/Federal Partners: Spotlight on DOL]
The Federal Partners have responded wholeheartedly to the call for system transformation. The work already in progress at the Department of Labor, one of our Federal partner agencies, provides an excellent example of initiatives that are underway to facilitate fundamental systems level change.
DOL has initiated a department-wide mental health transformation workgroup with representatives from 6 of its Centers and Offices—including its largest office, the Employment and Training Administration—to ensure leadership and accountability for transformation activities across the organization.
Through its transformation workgroup, the Department of Labor is developing an employer initiative to increase the recruitment, hiring, and retention of persons with psychiatric disabilities. Customized employment strategies, including self-employment and micro-enterprise development, are being explored. Labor is also exploring workforce opportunities for ex-offenders with psychiatric disabilities who want to work in their communities…as well as promoting successful transitions for young adults with serious emotional disturbances from school to post secondary opportunities and/or employment. The Agency’s Employer Assistance Referral Network, or EARN, connects employers to employment service providers with direct access to candidates with disabilities and provides technical assistance to employers. As you can see, the Department of Labor understands that employment, self-direction, and empowerment are all critical to recovery for many consumers. I think it is a fantastic sign of transformation that RECOVERY is a central value to all of these initiatives.
[SLIDE 16/States: First Steps]
SAMHSA and the Federal partners have a clear role to play in transformation. But, Achieving the Promise gave enormous responsibility for transformation to the States. This is where we have the opportunity to impact the greatest number of lives. This is where Achieving the Promise will come to life. I am happy to report that nearly every State has begun the work of transformation. Some have already started to achieve great things.
With the passage of the Mental Health Services Act, planning is underway in every county of California toward the development of comprehensive plans to address the needs of adults and children with or at risk for mental health problems. Nevada and South Carolina are two examples of States who have vigorously embraced the work of the Commission. The Nevada legislature has passed a law creating the Nevada Mental Health Plan Implementation Commission, a group tasked with formulating strategies to move the State toward the goals laid out in Achieving the Promise. South Carolina has appointed a proviso committee to make recommendations to its General Assembly on how to best incorporate all six of the Commissions goals into its State mental health plan.
Two years ago, some of you heard Pam Hyde discuss the plans for New Mexico’s ambitious initiative to transform its behavioral healthcare system. This is one of those few great leaps I mentioned earlier. SAMHSA hopes to help New Mexico capture some of its learning so that we can share lessons with other States and systems. While we are celebrating transformation, we should look around us and observe what is happening in this very State!
The New Mexico Interagency Behavioral Health Purchasing Collaborative will replace the currently fragmented system with a single behavioral health delivery system that will minimize confusion for providers, consumers and families, and minimize ineffective or duplicative administrative costs. The result will be better, more efficient, more effective services and improved access to care for consumers.
Finally, many others are sharing in the work of transformation. Mental health associations, guilds, and advocacy groups are moving mental health system transformation to the forefront of their agendas. Every day, I learn about provider groups, third party insurers, corporations and others who are recognizing their stake in mental health…and stepping forward to transform how mental health care is delivered in America.
Just two months ago, the Texas Mental Health Association, the State’s oldest and largest mental health non-profit education and advocacy organization, released a landmark report documenting the economic and human costs of failing to prioritize mental health care in that State. The report, aptly entitled, Turning the Corner: Toward Balance and Reform in Texas Mental Health Services, reframes the goals of the New Freedom Commission to make the case that investments in mental health care will save money and help millions lead more productive lives. The Report presents State legislators with a comprehensive agenda for improving the lives of the 4.2 million Texans who live with mental illnesses and the families who care for them.
The National Governor’s Association, in cooperation with the National Association of State Mental Health Program Directors, is assisting Kansas Governor Kathleen Sebelius’ office with a kick-off meeting to celebrate the formation of a one-of-a-kind transformation task force in that State. Governor Sebelius has just released an Executive Order to form a transformation task force made up of cabinet level representatives from each of the State agencies involved in mental health. This task force will meet monthly to address infrastructure concerns, coordination of fundingstreams, and other issues critical to advancing transformation.
SAMHSA/CMHS is collaborating with the NGA Center on another event designed to enlist those at the highest levels of State government as partners in transformation. We are inviting Offices of the Governor from every State to appoint 4-person teams to attend a 2-day regional meeting, Transforming State Mental Health Systems . These events will bring together State, Federal and national experts to examine a wide range of topics—the Federal vision of transformation, the availability of funding for transformative initiatives, the goals and recommendations outlined by the New Freedom Commission, and effective ways for States to develop and implement a shared vision and plan for transformation. The State teams will come away with strategies they can use immediately to build on the coordination and collaboration they already have in place. And, they’ll have a head start on the long-term strategic planning and decision making that will be required to advance the continuous process of transformation.
Importantly, these meetings provide the opportunity to forge the new Federal/State partnership that is necessary to achieve the promise in every State…and to ensure that our success ripples outward to benefit all Americans.
[SLIDE 17/Stakeholders: Spotlight on IBM]
One of the most exciting developments I have witnessed is the way organizations outside of the circle of mental health are embracing the principles and values of mental health transformation. One corporate giant, IBM, has taken a particularly innovative approach. The company’s Mental Health Care Program developed a holistic strategy of care to promote early identification and intervention as well as care coordination across carriers for individuals who may have co-occurring behavioral health problems and other medical conditions.
The program uses claims information, surveys, and other tools to proactively identify members who have or who are at risk for behavioral health issues…to provide personalized outreach…and to guide members to the appropriate level and duration of care. The results are impressive. IBM’s behavioral health vendor reports that 95% of individuals were satisfied with the help they received from the outreach program. Overall rates of outpatient behavioral health treatment increased from 2.2% to 8.8%. The program generated savings of $500,000 in outpatient costs in 2003…$100,000 more than it generated in 2002. And IBM expects to achieve or exceed savings of $500,000 each year…all this while increasing utilization. What a difference transformation makes!
These success stories…and the many others you will hear about over these next few days…are the fuel that is driving this transformation forward…the fuel that will keep us moving forward until we realize the vision.
hese stories demonstrate the incredible synergy that results when individuals and organizations and governments collaborate…when they dare to innovate…when they venture into new territories without being absolutely sure where their quests will lead them…when they take risks in order to succeed. These stories are transformation in action!
[SLIDE 18/Transformation Equation]
Action is one of the key ingredients of transformation. This is what I call the transformation equation. Transformation equals vision, plus belief, plus action…multiplied by continuous quality improvement to the second power. Why is CQI squared? Because we must continuously ask ourselves if the resources and technical assistance we provide are effective and meeting the mark. We must continuously seek to improve. Without these elements, transformation cannot, will not, happen.
Achieving the Promise has given us the vision. Now, each of us must complete the equation through personal action. Each of you is critical to this undertaking. Transformation cannot happen without you.
You have made great strides. And I congratulate you on the work you have done so far. But the difficult, risk-taking work of transformation is ongoing…and it takes persistence and courage.
As you continue on this road to transformation, keep working to help your communities understand what is involved in developing a system that is consumer-driven and focused on recovery. Continue involving consumers to the greatest extent possible. Keep building public support for transformation! Your commitment to building a transformed system is a start. But you will need to continue advocating for expanded services and funding. You can help shape State and local priorities by generating the community feedback and data that can influence these priorities.
This is an uncertain journey. But, I am here to say definitively: you are on the right path. Transformation is the right course…the only course…that will lead you to your goal: a system that delivers the real hope of a life in the community for everyone . A community in which every individual fits, regardless of gender, age, race, color, creed, disability, addiction, or mental health issue.
You are agents of transformation. Put your power to work to make this change happen…to help us achieve the promise across this Nation. And take a lesson from another change agent, Gustave Eiffel, the forward-looking architect who engineered a transformation in the Parisian cityscape a century ago.
[SLIDE 19]
Never give up …even when the steps feel too steep to climb. Claim your successes…plant your flag. And don’t forget the fireworks…to celebrate every victory along the way! Thank you.
|
