Robert W. Myers

Performance-based contracting: turning vocational policy into jobs.

The New York State Office of Mental Health has implemented a 2-year demonstration to determine if performance-based contracting (PBC) improves rates of competitive employment for people with serious persistent mental health conditions, and promotes best practice among providers. This article reports the interim findings from the demonstration. Initial results suggest that PBC is reaching the target population and promoting employment for a significant proportion of participants. It is also stimulating agency re-evaluation of consumer recruitment strategies, job development models, staffing patterns, coordination with support services, methods of post-placement support, and commitment to competitive employment for consumers.

Use of Learning Collaboratives by the Center for Practice Innovations to Bring IPS to Scale in New York State

This column focuses on use of learning collaboratives by the Center for Practice Innovations to help programs implement the evidence-based individual placement and support model of supported employment in New York State. These learning collaboratives use fidelity and performance indicator data to drive the development of program-specific individualized quality improvement plans. As of 2014, 59 (69%) of 86 eligible programs have joined the initiative. Programs are achieving employment outcomes for consumers on par with national benchmarks, along with improved fidelity.

Public-Academic Partnerships: A Public-Academic Partnership to Support a State Mental Health Authority's Strategic Planning and Policy Decisions

Mental health authorities across the country face numerous challenges in developing effective and practical strategies to adopt and sustain research-supported and stakeholder-endorsed mental health practices. This column describes how an academic center assists a mental health authority in making policy decisions by the use of advisory panels of multiple stakeholders, including members of the research community, advocacy organizations, service providers, and consumers. An advisory panel that focused on services involving family members for adults with serious mental health problems serves as a case example.

Reengagement of High-Need Individuals with Serious Mental Illness After Discontinuation of Services

OBJECTIVE The study determined rates of reengagement in services for individuals with serious mental illness who had discontinued services. METHODS As part of a quality assurance program in New York City involving continuous review of Medicaid claims and other administrative data, clinician care monitors identified 2,834 individuals with serious mental illness who were apparently in need of care but disengaged from services. The care monitors reviewed monthly updates of Medicaid claims, encouraged outreach from providers who had previously worked with identified individuals, and determined whether individuals had reengaged in services. RESULTS Reengagement rates over a 12-month follow-up period were low, particularly for individuals who had been incarcerated or for whom no service provider was available to provide outreach. CONCLUSIONS Subgroups of disengaged individuals with serious mental illness have different rates of reengagement. Active outreach by providers might benefit some, but such targeting is inefficient when the individual cannot be located.

Adoption of a Blended Training Curriculum for ACT in New York State

Scant evidence exists in the literature for best practices in training assertive community treatment (ACT) teams to deliver highly effective services to consumers. This column describes a blended training curriculum, which includes both face-to-face and distance learning strategies, developed by the ACT Training Institute in New York State to meet the ongoing training needs of teams across New York State. Data on training uptake, which has steadily increased over time, are reported. The role of the state is crucial in driving adoption of training activities. The column also describes how the ACT Training Institute uses fidelity and outcome data to identify training needs.

Acceptability, Feasibility, and Effectiveness of Internet-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in New York

Cognitive-behavioral therapy (CBT), consisting of exposure and response prevention (EX/RP), is both efficacious and preferred by patients with obsessive-compulsive disorder (OCD), yet few receive this treatment in practice. This study describes the implementation of an Internet-based CBT program (ICBT) developed in Sweden in individuals seeking OCD treatment in New York. After translating and adapting the Swedish ICBT for OCD, we conducted an open trial with 40 adults with OCD. Using the RE-AIM implementation science framework, we assessed the acceptability, feasibility, and effectiveness of ICBT. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure. Of 40 enrolled, 28 participants completed the 10-week ICBT. In the intent-to-treat sample (N = 40), Y-BOCS scores decreased significantly over time (F = 28.12, df = 2, 49, p < . 001). Depressive severity (F = 5.87, df = 2, 48, p < . 001), and quality of life (F = 12.34, df = 2, 48, p < . 001) also improved. Sensitivity analyses among treatment completers (N = 28) confirmed the intent-to-treat results, with a large effect size for Y-BOCS change (Cohens d = 1.38). ICBT took less time to implement than face-to face EX/RP and participants were very to mostly satisfied with ICBT. On a par with results in Sweden, the adapted ICBT program reduced OCD and depressive symptoms and improved quality of life among individuals with moderate to severe OCD. Given its acceptability and feasibility, ICBT deserves further study as a way to increase access to CBT for OCD in the United States.

Using incentives for training participation.

TOPIC This column describes how public partners can help incentivize participation in training. Specifically, a state mental health agency and its implementation center applied financial and nonfinancial incentives to encourage participation in training and implementation supports. PURPOSE Although training is not sufficient to change practice, it is a necessary first step in implementing evidence-based treatments. Finding ways to incentivize participation, particularly strategies with minimal resource involvement, is important for the psychiatric rehabilitation workforce and cash-strapped public systems. SOURCES USED This description draws from published material and experiences from New York State. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Engaging public partners to incentivize training can significantly increase participation in training. Incentive programs exist that do not require additional funding-an important consideration, given the fiscal climate for most public payers.