Proposal for a Comprehensive Strategic Planning Process

Proposal for a Comprehensive Strategic Planning Process

For Nebraska’s Behavioral Health System

Behavioral Health

Strategic Planning Process Design Work Group

August 18, 2006

Table of Contents

Introduction2

Strategic Planning Purpose Statement2

Priority Areas for Strategic Planning3

Participatory Process for Comprehensive Behavioral Health Strategic Planning…..7

List of Organizations and Individuals to be Involved 15

Appendices

Appendix A: Behavior Health Strategic Planning Process Design 19

Appendix B: Behavior Health Strategic Planning Work Group 20

Appendix Table A. Strategic Planning Work Group Members 21

Appendix C: Behavioral Health Strategic Planning Logic Model 22

1. INTRODUCTION

The Behavioral Health Divisionof the Nebraska Department of Health and Human Services chartered theBehavioral Health Strategic Planning Process Design Work Group to design an inclusive process leading to a five-year comprehensive strategic plan to guide the behavioral health system in Nebraska. The Department included stakeholders in the planning process design to ensure inclusiveness and maximize opportunities for stakeholder input.The Work Group included 19 individuals representing consumers, families, advocacy organizations, services providers, and system partners (see Appendices for more information about the work group composition and activities). Staff from the University of Nebraska Public Policy Center facilitated the process, which ran from April 2006 to August 2006.

The Work Group produced a purpose statement for the planning process, planning priority areas, stakeholders to include in the process, a detailed process map for developing the strategic plan with a timeline for completion by June 2007, and a logic model(see Appendix C) linking outcomes with the priority areas/goals through the planning process activities. The strategic planning process will include all systems that affect the lives of people in Nebraska with behavioral health challenges.[1]The plan extends to populations across the life span, including children, youth, adults, and the elderly, and will address the full array of existing and emerging services and supports to promote consumer choice and self determination. Central to the planning process is the primary decision-making role of consumers and families in all aspects of strategic planning.

The Process Design Work Group recommends using resources efficiently to implement the proposed process and cautions against diverting resources designated from direct service provision for strategic planning; however, to implement the proposed strategic planning process, it is important to provide resources to maximize access for consumers, families and youth. The Process Design Work Group also requests that the strategic planning process begin as soon as feasible. Finally, the Work Group respectfully requests feedback on its proposal including how the actual planning process compares to the proposed process.

2. STRATEGIC PLANNING PURPOSE STATEMENT

In accordance with statutory mandate¹, the Work Group resolved to prioritizethe interests of consumers and their families, including, but not limited to, their inclusion and involvement in all aspects of services design, planning, implementation, provision, education, evaluation, and research. The following is the recommended goal for the strategic planning process:

Goal: The behavioral health strategic planning process shallbe consumer/family-driven and youth guided, inclusive, and comprehensive and will result in a strategic plan with specific action steps designed to achieve a behavioral health² system that is:

3. PRIORITY AREAS FOR STRATEGIC PLANNING

The priority areas are based on the President’s New Freedom Commission on Mental Health goals developed in July 2003. For Nebraska’s strategic planning process, the goals were broadened to include substance abuse and gambling as well as mental health. These priority areas form an organizing framework to help structure critical issues to be addressed in the strategic plan including public safety, access, quality, and cost effectiveness related to resources needed to implement the plan.

Americans Understand that Behavioral Health is Essential to Overall Health

Communications and marketing to help people in Nebraskaunderstand behavioral health disorders, the cost of behavioral heath care, and the possibility of recovery through effective treatment, services, and supports, including but not limited to housing and employment
Develop policy and fundingstrategies to address the increase in the number of people using the public system due to lack of private insurance by increasing both the capacity of government systems and the involvement of the private sector
Address the issue of medication affordability and accessibility
Educate policy-makers and legislators through involvement in the strategic planning process and to use outcome data appropriately to inform policy decisions
Ensure adequate funding to finance a system of behavioral health services and supports that is consumer/family directed and recovery-based

Behavioral Health Care is Consumer and Family Driven

Integrateprivate and public partnerships particularly integrating private providers into the public system to increase capacity of the public system
Need for the same mission
Organizations and individuals; hospitals, non-profits
Examine how to fund peer support services with Medicaid
Focus on wellness and the principles of recovery(including self-direction, individualized and person centered, empowerment, holistic, non-linear, strengths-based, peer support, respect, responsibility, and hope)
Address the utilization and integration of volunteers including, but not limited to training, informal supports/networks, peers, and funding
Encourage, develop, and maintaincollaborative and egalitarian partnership-based alliances in behavioral health care among practitioners, policy-makers, and providers with an ongoing minimum of 50% consumer/family member representation at all levels
Develop a system of supportive education and training for consumers and family members that ensures their meaningful participation at all levels
Provide education/training to consumers and family members regarding federal evidence-based practices, strategies about how to access behavioral health services and information about alternative services and supports that promote recovery and wellness
Develop both statewide and regional plans for consumer and family inclusion that incorporate benchmarks andincorporate outcomes measures to document the extent to which consumer and family members are actually involved in decision making and policy development
Secure adequate funding to ensure behavioral health care is consumer and family driven

Disparities in Behavioral Health Care are Eliminated

Improve access to quality care that is culturally competent
Set standards for culturally competent care
Collect data to identify points of disparity
Evaluate services for effectiveness and consumer satisfaction.
Develop collaborative relationships with culturally driven, community-based providers
Promote increased opportunities to include individuals from diverse cultural backgrounds in the behavioralhealth workforce.
Recruit and retain racial and ethnic minority and bilingual professionals.
Develop and include curricula that address the impact of culture, race, and ethnicity on behavioral health and mental illnesses, on help-seeking behaviors, and on service use
Engage minority consumers and families in all aspects of service planning and delivery, including…workforce development, training, and advocacy
Improve access to quality behavioral health care, services, and supportsfor persons in rural and geographically remote areas
Develop a Rural Behavioral Health Plan with specific, measurable targets and benchmarks
Increase access to behavioral health emergency response, early identification and screening, diagnosis, treatment and services and supports that promote wellness and recovery among rural Americans
Improve access to quality care, service, and support for persons currently in or transitioning from the criminal and juvenile justice system
Improve access to affordable behavioral health care and develop strategies to ensure parity for behavioral health services
Adequate funding to ensure disparities in behavioral health care are eliminated

Early Behavioral Health Screening, Assessment and Referral to Services are Common Practice

Marketing of the screening, assessment and service delivery options that are available so individuals know where to turn for help
Develop a seamless system that involves collaborative partnerships with other entities including law enforcement, justice/corrections, advocacy groups, medical groups,early childhood, primary, secondary, and post-secondary education, and child and adult protection
Address the issue of Transitional Age Services
Establish a seamless system for persons with symptoms of an illness
Early intervention, right service, right place right time
No reject no eject policy
Adequate funding to ensure early behavioral health screening, assessment and referral to services are common practice

Excellent Behavioral Health Care is Delivered and Research is Accelerated

Address human resource issues such as:
The promotion of consumer operated and delivered services, such a peer specialists and funding for the education and training of consumers to enter the professions in which there are shortage
Staff shortages in critical professions – psychiatry, substance abuse professionals, mental health professionals and practitioners, gambling professionals, children specialists
Training, including recovery competencies and the knowledge and skills needed for working in and promoting a consumer and family driven system
Turnover
Retention
Quality improvement
Essential data are collected and used to improve quality
Data are used to identify promising practices, gaps, weaknesses, and strengths (findplaces where they are doing it right)
Decisions in planning are based on relevant data
Feedback component is integral to make things work better
Systemic feedback and data from region/provider and state levels
Information about quality isuser friendly and accessible to consumers
The involvement of consumers and family members in decisions about data collection, in the collection of data, in the interpretation of data and in providing feedback to policy makers and providers
Address funding issues
Adequate salaries to attract and retain competent staff
Based on rational cost methods that takes into account differences in rural and urban costs
Flexible funding
Adequate funding to ensure excellent behavioral health care is delivered and research is accelerated
Address the inclusion and involvement of consumers and family members in all aspects of services design, planning, implementation, provision, education, evaluation, and research.

Technology is Used to Access Behavioral Health Care and Information

Improving access through technology
Establish a system for coordination of grant writing
Adequate funding to ensure technology is used to access behavioral health care and information
Providing resources and support for consumers and family members to acquire and use computers, PDAs, cell phones and video conferencing

Consensus Conferences

6 Regional/

1 State

Six Priority Area Work Teams

1 / 2 / 3 / 4 / 5 / 6
BH is Essential to Health / BH is Consumer FamilyDriven / Disparities in BH are Eliminated / Early BH Screening / Excellent BH Care Delivered / Technology Improves Access

Feedback Focus Groups

Component Summary

Steering Committee

The Steering Committee would oversee the strategic planning process to ensure maximum participation by stakeholders and to advise process facilitators
Made up of 12 - 20 representatives of state agencies, consumers and family members, service providers, and other stakeholders
Steering committee members would be educated about strategic planning techniques and methods to maximize meaningful consumer and other stakeholder involvement
Key functions:
Develop format for Kick-Off Conference
Develop structure for web site
Develop structure for focus groups
Develop structure for regional consensus conferences
Synthesize regional conferences to help develop work team charges
Monitor progress of work teams
Monitor the compilation of work team products into final strategic plan
Media outreach

Outcome:Outcomes from the steering committee will be oversight of work products and background documents for all phases on the strategic planning process

Process Facilitators

The process facilitators are responsible for meeting logistics, developing and maintaining the web site, compiling and disseminating background information, developing participant lists, developing team charters, producing documents resulting form the planning process, and facilitating meetings. The process facilitators could be state agency staff, stakeholder volunteers, contractors or a combination

Outcome: Outcomes from the process facilitators will be all work products and background documents for all phases of the strategic planning process including analysis of survey and focus group results

Kick Off Conference

Wide participation from across state
Key aspects:
Media event to publicize strategic planning initiative
Use technology to involve people in remote areas (e.g. via telehealth, and/or live videostream on website)
Provide education to conference participants regarding planning process, recovery-based services and supports, evidence-based practices, current state initiatives, national outcome measures, New Freedom Commission goals, needs assessments, emerging and promising consumer operated alternatives to traditional services and supports, and approaches to achieving meaningful consumer/family member inclusion and involvement
Obtain input on key issues, needs, and future directions
Commitment by conference participants to participate throughout the planning process

Outcome: Outcomes include 1) a report documenting the issues, needs, and future directions identified by conference participants and 2) a report identifying the interests of participants in participating in various aspects of the planning process.In addition, all conference presentations and materials will be documented and posted on the web site for interested persons to access

Web Site

Provides information about resources for use by individual participants and groups (e.g. various reports, studies, and links to other sites)
Easy to use and accessible
Designed to make the process transparent
Broader dissemination of information throughout the planning process
Conduit to surveys to provide input from persons who cannot or choose not to participate in person
Broad e-mail list – encourage people to sign up if interested in the process; the e-mail list will be used to disseminate information and provide another opportunity for input from all stakeholders involved in the strategic planning process and to other interested individuals.

Outcome:The process will track the number of web site hits and compile evaluation data on the usefulness of the web site. All surveys administered through the web site will yield data that will be analyzed and reported. Note: for individuals without computer access or knowledge about how to use the internet, all surveys would be available in hard copy.

Related Initiatives and Committees

Includes other initiatives related to behavioral health that willbe incorporated into the comprehensive strategic planning process. The following are examples:
Behavioral Health Oversight Commission
Behavioral Health Advisory Committees
Child and Adolescent Behavioral Health State Infrastructure Grant
Coercion Free Nebraska
Data Infrastructure Grant
Department of Health and Human Services Aurora Consumer Conference
Family Centered Practice Initiative
Gamblers Assistance Program Strategic Plan
Inclusion Task Force
Medicaid Reform
Mental Health and Substance Abuse Block Grant Reports
Substance Abuse Prevention SICA

Outcome: The strategic plan will include a description of the other related initiatives and how the comprehensive strategic planning process interfaced with these efforts. The strategic plan will also include a description of how the information from planning process contributed to the activities of the related processes.

Input Focus Groups

The initial round of focus groups is designed to inform the planning process by obtaining input regarding critical behavioral health issues from diverse stakeholders.
Focus groups are structured interviews with groups of people. They involve a group facilitator who asks a series of prepared questions, then encourages group members to offer their own points of view. Frequently, group members build on what others say, adding context and depth to the discussion. Their responses can lead the facilitator to ask follow-up questions in addition to the prepared ones, which further enriches the information gleaned from consulting the group.
Consumer Focus Groups: Designed toidentify how consumers and family members can be meaningfully involved in the strategic planning processand maximize input from consumers and families from across the state. Variables: Urban/Rural, Leadership Training, Information Provided
Regional Focus Groups: One in each region with broad stakeholders
Special Focus Groups: Targeted for Hispanic, Native American, Asian, African Americans
Policy Maker Focus Groups: To obtain information about current initiatives, planned directions, and opportunities/limitations.

Outcome: The outcome of the focus groups will be a report that identifies themes for each group and across groups. This information will be available for the regional and state consensus conferences.

Regional/State Consensus Conferences

One consensus conference held in each behavioral health region; designed to involve diverse stakeholders in providing regional perspectives on direction for the six priority areas
Consensus conferences take a diverse group of stakeholders with varying amounts of knowledge about and interest in a topic and puts them on a level playing field so they can, it is hoped, reach consensus on some decision that needs to be made. Ideally, the process allows each participant a full and fair opportunity to influence the outcome, even when a large number of people need to be consulted. Consensus conferences are designed to minimize or eliminate some negative things that can happen when diverse groups interact, such as domination of the discussion by one or two influential or high-ranking people. They can also be more efficient, stimulating and rewarding for participants than alternative processes such as brainstorming sessions and formal committee meetings.
Key aspects:
Information provided from focus group/needs assessment
Select regional folks to recommend for work team participation
Proposed work team charters

One state consensus conference to obtain input from state agencies and state-level organizations

Outcome: The outcome of the six regional and state consensus will be a report identifying regional issues, proposed charters for the work teams and a list of individuals willing to participate on the work teams. The product will be organized by the process facilitators in conjunction with the steering committee and used to develop final team charters and membership lists.