Fall 2009/Winter 2010 Newsletter

 Dear Friends,                                                                                         

Improving behavioral healthcare is an important and strenuous challenge, which IHBI takes seriously. This newsletter will update you on current developments and on opportunities for ways you and your organization can become more involved in improving care.  Organized in 2004, The Institute for Behavioral Healthcare Improvement (IBHI) is a national effort to establish a movement of collaborative professionals, consumers and organizations  to translate a passion for quality into improved care and recovery for people with mental and  substance and related problems. IBHI is guided by an active Board of Directors who meet at least monthly via telephone and gather twice a year around a table to evaluate progress, direction and strategy. 

 Mid-Summer Board Meeting and Learning Session 

July 23-25, 2009 the IBHI Board met in upstate New York and in addition to general business evaluated directions in two strategic, interrelated areasimproving care in hospital Emergency Departments, and improving and development of more integrated approaches to general and behavioral healthcare.  These initiatives are highlighted below along with our newly re-designed web site (please see www.ibhi.net).  The IBHI Board also elected to establish an Advisory Council to establish more formal communication connections with healthcare leaders.

 IBHI Advisory Council organizing

 IBHI has actively listened, networked and sought guidance from a range of organizations, consumers and professionals in developing strategies and programs.  To maintain a more active profile with leaders in healthcare, IBHI will establish an Advisory Council to create multiple communication channels with informed leaders and experts in behavioral health care, general health care and consumer issues to provide:

  • input on IBHI goals and strategies,
  • feedback on needs and resources,
  • direction on important areas to address,
  • enhance understanding of the general level of interest and support for behavioral health quality improvement nationally

 The Council is planned to be up to 25 people, and will be co-chaired by the IBHI Board Vice President and a member of the Council selected by the Board. Membership is by invitation of the IBHI Board of Directors and shall be for three year terms.  An initial organizing meeting will be in early 2010, preceded by one private and one initial group conference orientation call. Over the course of the year at least one face to face meeting is anticipated for those available, as well as, three conference calls and interaction via email and telephone.  To express interest please log onto the website and post a note or email, Peter Brown at Peter@IBHcI.org , with your particular area of interest, and perspective on IHI’s purpose and Aims.  Expressions of interest are open for the year although should be received by March 1, 2010 to meet consideration for participation for most of the year 2010.

 Progress and Opportunities

 Below are updates, opportunities or opinions that encourage inquiry, dialogue and action on key areas of IBHI’s work:  Stimulating Innovation, Spreading Improvement in Emergency Room Care, Building Understanding of Integration and a commentary probing how behavioral healthcare as an industry might rise to the challenges ahead in a “reformed” healthcare environment.  There are also questions for you to consider and send back your thoughts and suggestions.

 Stimulating Innovation

 Adapting Transforming Care at the Bedside (TCAB) to Behavioral Health Care.  

            In strategy sessions with senior leaders of the Institute for HealthCare Improvement (IHI), the Board shared learning from IHI’s groundbreaking pilot, supported by RWJ, which has markedly improved inpatient care and involved front line staff.  They suggested the TCAB method could be applicable to Behavioral Health.  In an effort to refine the methodology and accelerate change, the IBHI Board held a one and one-half day learning session in July to understand this methodology and plan a potential adaptation pilot. Transforming Care at the Bedside (TCAB) brings together the methods and tools of the Model for Improvement, the Elements of IHI’s Idealized Design and the Innovation process to build consumer focus at the front lines of care.  A prototype adaptation of TCAB was created, and organizations are being queried about testing and piloting the framework.   An informational conference call is planned for mid-winter should you want to consider a pilot. Contact Peter@ibhci.org for more information.

The IBHI Website (www.ibhi.net) – Improving Communication Resources

This newsletter includes a direct link to our re-designed Website. www.ibhi.net

Please take a look, and let us know your comments. In the future you will receive brief notes of importance to our field which will take you to the website for greater detail. 

You may unsubscribe at any time.  It is our plan to provide you with at least one item each week which you are likely to find new, which will enhance your efforts to care for your consumers.  You can also participate in discussions of these and other important topics.  

Avoiding Emergency Department Visits – IHI initiative and future efforts

            In June, IBHI was invited to participate in a prototyping effort by IHI to help advance the Triple Aim initiative of improving Quality, Cost and the Experience of Care for the population as a whole. This Collaborative seeks to avoid unnecessary Emergency Room visits. Nine Integrated Health Systems from across the continent are involved in identifying system problems that create unnecessary Emergency Department Care, and piloting possible solutions.  Innovations have begun with patients suffering from general health issues such as people who appear with Chronic Obstructive Pulmonary Disease and people who have multiple visits to the ED and are Medicare or Medicaid insured.  One organization in Ontario is working on reducing visits by people with behavioral health problems. To date they have created a mobile crisis intervention team, which will see consumers in the community rather than the ED, and are planning other significant system re-designs.  This innovation collaborative will complete the first cycle of its work in January 2010.   

 Spreading Improvements in Emergency Care

Emergency Department Care Improvement – Research Meeting Planned

In early 2009, IBHI completed its pioneering collaborative on improving care in the Emergency Department. (Click here for a summary of this collaborative)  As a base for subsequent collaborative learning, IBHI has applied for a federal small meeting grant to assemble key people from the six hospitals which participated in the recent Collaborative and other experts.  The purpose is to identify key improvements in operation which can or did reduce time for behavioral health consumers in Emergency Departments, identify those of immediate use and create a research agenda on additional improvements.  If this grant is received the research meeting will be held in the spring of 2010 and it will be the basis for the next collaborative as well as seminars offered by IBHI.  


On-Site Consultation and Regional Colloquia on Improving ED Care

As noted above, significant learning occurred during the Pioneering Collaborative (Click here for a summary of this collaborative).  A change package of “good ideas” was vetted and can be a reference for organization specific or regional collaboration.  Significant improvements were made in overall time in the ED, time to evaluation, the reduction of agitation and use of restraints.  Future work was outlined in more robust understanding and connection with community resources. 

EDs will likely remain significant centers for emergency behavioral health care and IBHI will continue to acquire and spread information on improving ED care and alternatives to such care.  While this will be accomplished by several co-lateral strategies, the AIM of the Consultation and Colloquia process is to provide options for starting points to build understanding of the current situation and explain what a collaborative plan for improvement could yield.  A small panel of experts, drawn from IBHI faculty will provide an assessment and key benchmarks from the Change Package.  They will facilitate connections and outline an action plan.  The results of this work can be organization specific or shared in a “Colloquium” designed to engage other community stakeholders.  Time required for development is estimated 7-12 days or work, and overall costs are estimated in the range of $15,000.  Some preparation is anticipated by the host organization in terms of data preparation (from existing sources) and a pre-visit self assessment.  We are exited about this strategy to spread learning and gain new perspectives on this continuing area of concern,

Integrating Care in the Community – What now? Actual, Virtual or Business As Usual?


Finding a National Voice for Quality and Outcome Improvement

In 2008 IBHI collaborated with the Institute for Healthcare Improvement (IHI) on a “90 day R&D Project on Integrating Primary Care and Behavioral Health Care. (See(http://www.ihi.org/NR/rdonlyres/2AF9424C-F1BD-430B-875F-7FBD59CEFC79/9906/IHIIntegratingPrimaryCareBehavioralHealth90DayProj.pdf )

The Aim of a 90 Day Project is to investigate a previously unevaluated opportunity for improvement, offer a high level description of the current situation and promising strategies and outline potential directions.   This 90 Day project was in support of IHI’s Triple Aim Initiative (see above).  The success of the Triple Aim is in part determined by the ability to integrate all aspects of health and health care. There is preliminary evidence that successful integration of primary care and behavioral health care leads to better care of both patients’ physical and behavioral health needs.

 The Paper concludes successful integration is occurring in pockets and there is a growing number of organizations who believe in and practice integration. However, the idea remains mostly an intention rather than a practice for the seriously mentally ill. Data demonstrating a significant cost-benefit remains scarce although the intuitive gain appears real and demonstrable.  Further work is needed in this area, as well as more effectively linking of primary care to behavioral health care settings. 

The current rate of development of this key change in practice is well below what is called for to achieve significant breakthrough improvement in life expectancy for behavioral health consumers.  How can we connect and leverage the momentum developing in the pockets of change?  Have we as an industry the will to gather the known ideas and apply them to our settings?  Would a national Forum on the subject help to stimulate a bolder effort?

 Readers are encouraged to review the entire document on line (www.ibhi.net) and provide feedback to IBHI on thoughts and ideas that might address the ongoing need for data, financial/reimbursement alignment, pilots of integrative models and strengthening connections among the existing silos of care.  Please add to the Commentary in a forum open to all below on this page.

 Other Challenges and Opportunities

 IBHI has been pleased to partner with many innovative and enthusiastic organizations and staff.   We are aware that to date IBHI, and indeed healthcare in general, have only worked at the periphery of the issues.  In some areas, for example early diagnosis and care of children and adolescents, progress and manpower are in short supply.  We would welcome your feedback on how we might enhance implementation of the initiatives described, as well as particular areas where you might find other work productive.

 Please review our web-site (www.ibhi.net) for more information including how to join IBHI and become more active in our work.

 How your organization can become involved in IBHI

Join IBHI – For information on membership visit the  https://www.ibhi.net/membership/             portion of our             website; www.ibhi.net

Contact us with specific areas you would like to see addressed or improved

Host, sponsor and/or participate in a Monthly “Innovation Topic” Conference Call

Host or participate in a:

  • Learning session
  • Conference call
  • Webinar, or
  • Regional Consultation or/Colloquia Session or Collaborative


Participate in a Learning Collaborative

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            My organization is:

Thank you for your interest in learning and participating in the challenge to improve behavioral health care.

Best Regards,

Peter and Joe

Peter Brown                                                                             Alden (Joe) Doolittle

Executive Director                                                               Co-Executive Director

18 Clove Rd                                                                             112 Maplewood Dr     

Castleton, NY 12033                                                           Scotia NY 12302

518 732-7178 Brownpcmd@ATT.NET                      518 588-2801 aldenjoe@att.net

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