Going to scale: dissemination and implementation of EBPs across large publicly-funded health care systems - initiatives targeting system-level change

Abstract

This panel will examine strategies and outcomes across three initiatives aimed at translating evidence-based care models and practices in the treatment of low-income, disadvantaged patients with behavioral health and other complex conditions at scale, across states and cities. The initiatives include translation across states of measurement-driven QI initiatives in mental health in the six-state MEDNET consortium; translation across cities of the care coordination model developed for low-income super-utilizers by Brenner and colleagues in Camden; and the implementation across 91 California sites of the Full Service Partnership (FSP) model for persons with severe mental illness who are homeless or at risk of homelessness. The discussion will initially be framed by a brief overview from the organizer/discussant placing the three interventions within an overall conceptual model. Following the presentations, comments from the discussant will compare and contrast the effectiveness of the alternative strategies utilized across care processes and sites. Common themes across the three initiatives will be discussed, in terms of types of barriers and facilitators experienced in the process of dissemination at scale. We will discuss the barriers and facilitators experienced with respect to sustainability of the interventions beyond the initial project period; e.g., variations in successful incorporation metrics for evidence-based practices into ongoing management processes in public programs, and in incorporating guidelines for the use of evidence-based practices into state and health plan clinical guidelines, such as the Texas foster care psychotropic prescribing parameters and clinical guidelines promulgated by health plans across sites. We will discuss the important distinction between the types of barriers and facilitators experienced in the translation of specific program models across sites at small to medium scale, and the different set of barriers and facilitators that are encountered in efforts to bring these translational efforts to statewide and other large-scale systems with sustained impact. Meaningful antipsychotic metrics for state medicaid programs: strategies for sustainable change and quality mental health care Safe and effective use of antipsychotic medications across multiple populations, often off-label, presents many challenges for Medicaid programs. We will discuss the experience of a 6-state consortium, the Medicaid Mental Health Network for Evidence Based Care (MEDNET), in developing consensus quality metrics for safe and judicious antipsychotic use and translating measurement-driven QI initiatives at scale in large statewide populations. The presentation of barriers and facilitators experienced in development and use of metrics and translation of interventions across states with different policy and organizational environments.