Transforming Behavioral Health Care Services

Drs. Theresa Early and Keith Warren are involved with the Ohio Department of Mental Health’s efforts to transform the mental health service delivery system. Their research investigates the recovery orientation in two inpatient units—known as Behavioral Health Organizations or BHOs--of the Ohio Department of Mental Health's Integrated Behavioral Healthcare System.  "Recovery" is an ideology of care for people with serious mental illness that is increasingly being adopted in both community and hospital settings of mental health care.  Its focus is on people with serious mental illness living lives that are as full of relationships, meaningful roles, and self-direction as possible.  They are studying changes in the organizational culture and function in relation to a change in role of the client rights advocates, using secondary data collected for administrative purposes, a staff survey of recovery attitudes, and qualitative interviews with staff. Secondary data include a patient exit survey, a family/visitor survey, committee meeting attendance records, committee participant evaluations, counts of incidents, counts of restraints and seclusion, statistics on time between discharge and first mental health appointments in the community and rates of readmission within 30 days of discharge. This study is expected to shed light on aspects of organizational change in the context of moving toward a recovery-oriented mental health system. To date, there is little empirical literature on recovery-oriented changes in mental health programs other than those run by consumers.  Study of these concepts within an in-patient setting is particularly unique.

Dr. Cynthia Fontanella aims to improve behavioral health care services for youth by developing a profile of those characterized as “high users” of services.  The provision of high quality, appropriate, and effective services to children with serious emotional disturbances (SED) who are high users of mental health care is costly and challenging. These are youth with complex needs who require comprehensive services of varying levels of intensity over extended periods of time as well as involvement with multiple service systems (child welfare, juvenile justice etc). Many will have co-occurring disorders and experience significant functional impairments, that if left untreated, may lead to a number of adverse outcomes including substance abuse, suicide, school dropout, teen pregnancy, and incarceration (Offord & Bennet, 1994; Rutter, 1995). Despite the social and economic burdens associated with severe childhood mental disorders, little is known about the clinical and/or service delivery characteristics that contribute to high service utilization for children or optimal care that best services this population.  The overall objective of her research is to broaden the knowledge base about characteristics and service utilization patterns of children with SED who are high users of mental health care. She expects this work to aid in the development of effective specialized programming/treatment planning within the context of a publicly-financed managed care system.