Will Your Implementation Plan Be Successful? Only If You Pay Attention to the White Space

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Flow chart with gapsby Rick Ybarra

A fellow colleague, Robert Ferguson of the Pittsburgh Regional Health Initiative, recently posted a Health Affairs blog post commenting on an October 2014 Health Affairs article titled, “Few ACOs Pursue Innovative Models That Integrate Care for Mental Illness And Substance Abuse With Primary Care,” in which the authors stated that the quality measures in an Accountable Care Organization’s (ACO) contract affect how well that ACO integrates behavioral and physical health integration. The authors in this article further noted that implementing measures such as depression screening and other screening tools could lead to further treatment improvement. In Robert’s post, he proposes not only additional measures but challenges the view that screening protocols and measures alone will be sufficient to create a health care paradigm shift and advance integrated care models to achieve the Triple Aim: improved population health, patients engaged and satisfied with their treatment, and care delivered at a reduced cost.

Robert articulates what many of us have spent considerable time thinking about. I call it the “white space” in between the program implementation steps that either lead to successful implementation or derail these efforts. Flow charts and process maps give us direction. But it goes way beyond instituting the key components of integrated health care. In many ways, that’s the easy part (such as deciding to institute screening measures). The challenge for health care providers and health care systems is what happens (or doesn’t) in between the implementations steps. Robert’s post highlights that effective implementation of integrated health care calls for “systemic requirements” that support successful implementation efforts. Definitely worth the read!

And whatever process map or flow chart tool you use to illustrate your implementation plan, pay attention to the white space. That’s often where implementation efforts succeed…or fail.

So You Want to Impact Mental Health Stigma? Here is Your Chance!

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mental disorder are not adjectives

by Rick Ybarra

A recent Huffington Post blog post titled We Are People ­­– Not Addicts, Criminals, Inmates, and Convicts by Jag Davies of the Drug Policy Alliance highlighted that today, many media outlets (including some of the most respected and recognized outlets), continue to use inaccurate and offensive language when covering important issues. In taking the industry in a step in different direction, in 2013 the Associated Press announced that it would no longer use the term “illegal immigrant,” the rationale being that labels tend to define people by a single behavior or condition versus using terms and accurate descriptors that humanize the people the media outlets are writing and reporting about.

The Hogg Foundation for Mental Health, along with many other state and national associations, served as leaders to promote and model “person first” language when talking about mental health and other health related conditions. In 2011, the foundation developed a brochure titled “Language Matters in Mental Health.” The brochure emphasizes people-first language, meaning to literally put ourselves and others first in a sentence. For example, instead of referring to someone as “mentally ill” or “the mentally ill person,” the more appropriate, respectful phrase is “a person with a mental illness (or mental health condition).”

Some important facts about mental illness and recovery:

  • The National Institute of Mental Health estimates that one in four adults (approximately 57.7 million Americans) experience a mental health disorder in a given year.
  • Persons afflicted with serious mental illness make up about 6 percent of the population (or 1 in 17 Americans).
  • Mental illnesses are serious medical conditions.
  • The U.S. Surgeon General reports that 10 percent of children and adolescents in the United States suffer from serious emotional and mental disorders that cause significant functional impairment in their day-to-day lives at home, in school and with peers.
  • The World Health Organization reports that four of the ten leading causes of disability in the US and other developed countries are mental disorders. By 2020, Major Depressive illness will be the leading cause of disability in the world for women and children.
  • Serious mental illness often impact individuals during adolescence and early adulthood.
  • Today, treatment approaches for persons with serious mental illness are highly effective; it is estimated between 70 to 90 percent of individuals demonstrate a significant reduction of symptoms and improved quality of life with a combination of medications, psychosocial rehabilitation and social supports.
  • Stigmatizing language erodes public confidence that mental health conditions are treatable and that people can recover or lead productive lives.
  • People with mental health conditions can and do recover!

So you want to impact mental health stigma? Here’s your chance! The Associated Press is currently working on the 2015 edition of the Stylebook and has issued an open call for suggestions for new or updated entries. The AP Stylebook is considered the definitive reference for journalists, setting industry standards for language, usage and journalistic style. The deadline for submissions is October 31. This is a great opportunity to provide the Associated Press your suggestions their Stylebook few could make the cut and get integrated into the 2015 guide. Be a change agent and educate the AP on the importance of person first language! Submit your suggestions today!

Barbara Granger: Amplifying the Family Voice

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by Ike Evans

Barbara Granger
Barbara Granger

It is now accepted wisdom that caregivers are sorely tested by the mental health challenges of their loved ones, as well as by the need to navigate the maze of services and supports that are intended to help. A lot more needs to be said, however, about the truly transformative role that family members are playing in the move toward a more humane, person-centered system of care. For the September 29, 2014 episode of Into the Fold, I had the pleasure of chatting with Barbara Granger, Family Involvement Specialist for the Texas System of Care Initiative and a Family Coordinator for Via Hope, Texas Mental Health Resource, about the trials and rewards of caring for a child with severe emotional challenges, as well as the potential for family members to act as change agents within the mental health system.

Among the things I was curious about was how Barbara defines “family voice”:

Family voice is when a parent or a caregiver realizes that what they say is important, and that we are the experts on our children and no one can discount that. Professionals are trained to diagnose and teach parenting strategies with us, but we’re the ones who know what will work and what won’t. When we’re given the opportunity to share in the decision making for our children, it validates all the work and time and effort that we put into raising them, and it empowers us to want to help others.

Family voice really goes beyond that, though–it’s looking for opportunities to impact society and the mental health profession for all children. So when families find their voice, or when a person finds their voice and can learn to advocate appropriately with others, it is empowering for us to be able to be invited to sit in, not only on the decision making for our own children, but for others and policies, and so taking our lived experiences and using them to make a differences for others.

Our conversation made it clear that family members have more to contribute than just serving as human interest backdrops or models of stoic survivorship. Their experiences collectively amount to a fund of expertise that a a true “system of care” will finally pivot toward utilizing.

To find this episode on iTunes, click the logo:

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Image credit: Texas System of Care

Thank You, Texans Care for Children!

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by Ike Evans


Not only are the Hogg Policy Fellows doing admirable work in the area of mental health policy reform and advocacy, but through the Hogg Mental Health Policy Academy they also function as a learning community with a shared pool of experiences and sense of common purpose. Texans Care for Children, a Hogg grantee and coordinator of the Policy Academy, put together this video in which past and present members of the Hogg Academy reflect on their experiences and the role that the Academy played in their growth and emergence as effective advocates.




Are You OK? What We Can Do As a Community to Address Mental Health

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Are you ok?by Rick Ybarra

Are you OK?  R U OK?

A recent  Huffington Post  blog post with a video clip highlighted how, at times, we are unsure how to approach mental health concerns with friends, family and within our communities. Dr. Lloyd Sederer, Medical Director, New York State Office of Mental Health, joined HuffPost Live host Caroline Modarressy-Tehrani for a video conversation on what individuals can do to connect with a person they may have concerns about.

Dr. Sederer explained that if concerned about a friend, family member, or someone in your community, simply ask, “Are you OK?”

“We shouldn’t be afraid to say, ‘Are you OK?’ and to have a conversation,” said Sederer. “We need to be able to have the courage to ask and then the courage to continue to ask the tough questions because that’s what counts.”

Four simple words (or four simple letters as in “R U OK?”). Anyone can say them. You don’t have to have credentials after your last name to care.

When in the midst of gloom or despair, everyone needs to know that someone cares. The words “Are you OK?” (or text “R U OK?”) could serve as that connection to your friend, family member or that person you see on the street who may not be OK.  A person in deep despair may even be thinking about harming his/herself or contemplating suicide. “Are you OK?” A conversation starter that could change a life…or save a life.

Hogg Foundation Announces New iTunes U Collection!

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The Human Condition iTunes U artworkby Ike Evans

We are very pleased to announce a new iTunes U collection: The Human Condition: Vintage Radio Conversations on Mental Health! The Human Condition was a radio series, produced by the foundation in partnership with KUT, that ran from 1971 to 1983. The series was broadcast weekly by stations subscribing to the Longhorn Radio Network. If you have iTunes, you can download it here: http://ow.ly/BF6U1.

The series featured conversations on subjects that spanned the full range of human interest, including but not limited to mental health. Guests included historically notable figures such as Dr. T. Berry Brazelton, Roy Wilkins, Karl and Roy Menninger, Oscar-winning actress Mercedes McCambridge, and numerous others. There are currently four episodes available, with more on the way.

As the Hogg Foundation embarks on its 75th anniversary celebration, we are excitedly exploring avenues for the exhibition of some of the rich material in our archive — photos, documents, news clippings, and audio interviews. As much as anything we’ve ever done, The Human Condition offers vast possibilities for future archival projects as well as generating new public interest.

Stay tuned!

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The Commonwealth Fund Report: State Strategies for Integrating Physical and Behavioral Health Services in a Changing Medicaid Environment

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by Rick Ybarra

I want to bring your attention to an important report and contribution to the literature released today by The Commonwealth Fund (August 28) titled: State Strategies for Integrating Physical and Behavioral Health Services in a Changing Medicaid Environment.

As we know, states across the country are working to advance integrated health care as part of their efforts to deliver what I call “Triple Aim” care (care that results in better outcomes, increased patient satisfaction, and cost effectiveness) to Medicaid beneficiaries with both physical and behavioral health conditions. The efforts to ensure that Medicaid beneficiaries have access to integrated health care, however, are challenged by the fragmented behavioral health system, administered and regulated by multiple state agencies (health, mental health, substance use, etc) and varying levels of local, county and state government, and by purchasing models that separate behavioral health services from other Medicaid-covered services.

Structures that govern state administration, regulation, and procurement have not kept up with emerging and best practices in the delivery of integrated health care to Medicaid recipients with both physical and behavioral health conditions. Systemic barriers remain: policy, program, practice and financing, just to name a few. Why should we disrupt the status quo?  Turns out that persons with both physical and behavioral health conditions are among Medicaid’s most medically complex and costly cases. But beyond that, there are more effective ways of delivering care that result in better health outcomes! There is also a large body of evidence showing that patients have better health outcomes when both their physical and behavioral health needs are addressed together.

The report emphasizes there is no singular route through which all states will be able to achieve integrated behavioral and physical health care and that the best strategy (or combination of strategies) will depend largely on a state’s political climate, health care environment and political will.  So true. The report concludes that regardless of the approach, states will succeed only with a cohesive framework with policies in place that enable health care providers to deliver high quality, integrated health care to Medicaid beneficiaries with both comorbid physical and behavioral health conditions.

Where does your state stand on this important health care reform issue?  Is the political climate and health care environment in your state conducive to taking bold and necessary steps to transform the system to support integrated health care?