ࡱ> @(7 ?@  2Kingdavis@mail.utexas.edu@mailto:Kingdavis@mail.utexas.edu/ 0DArialgsRomantt- 0DGaramondRomantt- 0 DTimes New Romantt- 00DWingdingsRomantt- 0@DTahomagsRomantt- 0"PDTimesgsRomantt- 0 C .  @n?" dd@  @@`` :2 rFL FG)    > 1            ## $     '#.T  ,    5 HI,->?(*   STVW- Z[\]^fc $0e0e     A@ A5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||S" ȾӰժ@3f8DAEB g4ddddq 0(ppp@ g4BdBdr 0Xp pp<4!d!d@k 0t-<4dddd@k 0t-MW ʚ;%f8ʚ;<4dddd@l 0@m___PPT10M .,King Davis.6*___PPT9 z? %O =&SBarriers, Strategies, and Solutions to Increasing Quality in the Public EnvironmentTT,November 3, 2005 King Davis, PhD, Executive Director Hogg Foundation for Mental Health Services, Research, Policy & Education Robert Lee Sutherland Chair in Mental Health & Social Policy School of Social Work The University of Texas at Austin Austin, TexasDZ$"O ,Quality Convergence Challenge: Intersections--( HKSix Cycles of Quality EffortshCommunity Based Care  Pre 1750 Institutionalization  1763 -2005 Deinstitutionalization Community Mental Health Managed Health Care Behavioral HealthCare [Integrated Health Care]&LRemaining Barriers to QualityxHuman Resource Impediments: Relationship between quality, race, ethnicity, and class: Political & economic pressure to maintain state hospitals States Rights  Control of policy at state level: Budget as Policy: Absence of a business case Segregated vs. integrated health: Absence of knowledge management: Inconsistent ties between Human Rights and quality: Change by committee  Policy diffusion Medicine without science - Conceptualization:  ConclusionsPublic environments are disproportionately for people of color and the poor; quality is low or absent; Key resistance to transformation is at the state level  prospective impact on costs, control, and jobs are paramount  must involve state governors/legislators Evidence based approaches must be adapted to include the 4 populations of color; Cultural competence offers promise but requires national field testing, cost estimation, educational trials, linkages to licensure, accreditation, and further development; State governors and legislators have not signed off on key reports and recommendations calling for change; qZqMConclusions (continued)pThe future is in integrated health approaches Change requires major alteration in professional schools and licensure  enormous implications Need a place to house the responsibility for change to quality Major contradictions in what is proposed, fund, and support  Medicaid and housing cuts There is no federal or state sense of urgency to change Must alter the management of knowledge Transformation may not survive a new administration IMajor RecommendationsConvene Governors and Legislators re Vision, Change, Cost, Planning, Future - Nationalize State Mental Health Systems - 5 years  Federal/State Funding  State Hospital Plans Develop a National/State Policy to Require Behavioral Health in General Hospital/Primary Care Settings  Open Medicaid/Disproportionate Share Policy/Tele-Health Integrated Health as the National Policy - National/State Quality Goals & Standards National/State Workforce & Training Goals Implementation Strategy for Tracking Quality DataZNMinor RecommendationsRelease Sub-Reports  New Freedom Report Increase Research Dollars  Causality Eliminate Medicaid Reductions in Congress New Training/Education Grants- Universities Private Sector Involvement in Policy Changes New Media Portrayals of Behavioral Health Broader Concept of Health/MH/SA Issues Publish Data on Effective MH Hospitals Tie Accreditation to Quality JContact InformationKing Davis, Ph.D. Executive Director Hogg Foundation for Mental Health Robert Sutherland Chair in Mental Health Policy The University of Texas at Austin Kingdavis@mail.utexas.edu 512-471-5041 0/2  0` 3` ff>>\fg` J*T333` QYmx~3ft` \ғhEy`` cb^DDf`Y˵W` sg7xGr` K%ޯd{mG/` 33f>?" dd@,?nFd@    @ `  n?" dd@   @@``PR    @ ` `<p>>L0  0t (  t  t 6, #" `b `  \*   t 6 #" `` `  ^*  xT ~ t  "~\ { t  "{ t  c BB CDEFd @ bb   H   T W6Vw}\gFQ6<1++11 1L b6xQrq 6\}N   - c    0 A Q g     S    6N KawF bFy0 a*ly7lE;uz  B | a F 0 ! 1 < B < & l L 0  @`"T  t  c |BC+DEFyd @ ==gL6cI}\eA& w6m!W<! &<W!r6W}F6\}>68QNlX^XH8+Sgg|@`"Jo 5 J t   B! 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