Index

A

Academic Behavioral Health Consortium, 300

Accreditors of M/SU health care organizations, recommendations for, 12, 21, 318, 384–385

Acute stress disorder (ASD), knowledge gaps in treatment for, 152

Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice, 299

Addiction Severity Index (ASI), 160

Administration for Children, Youth, and Families, 13–14, 17–18, 174–180, 374–375, 377–378

Administrative datasets, 155–159

Advance directives, 119–120

Advances in care and treatment, 32–34

Agency for Healthcare Research and Quality (AHRQ), 13–14, 17–18, 22–23, 110, 155, 161, 176–180, 268, 358, 374–375, 377–378, 383

Evidence-based Practice Centers, 164

Evidence Report/Technology Assessment, 71

Integrated Delivery Systems Research Network, 359–360

User Liaison Program, 176–177

Agenda for change, 350–390

Aims of quality health care, 8

Alcohol and Drug Services study, 292

American College of Mental Health Administration (ACMHA), 45–46, 182–183, 300

American Health Information Community (AHIC), 264

American Managed Behavioral Health Association, 183

American Psychiatric Association, 30n, 65, 168

Amphetamine dependence, knowledge gaps in treatment for, 153

Analysis of evidence

organizations and initiatives conducting systematic evidence reviews in M/SU health care, 163–166

strengthening and coordinating mechanisms for, 161–167

Annapolis Coalition on Behavioral Health Workforce Education, 300

Anticipation

of comorbidity, and formal determination to treat or refer, 235–236

of needs, 9, 78



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Improving the Quality of Health Care for Mental and Substance-Use Conditions Index A Academic Behavioral Health Consortium, 300 Accreditors of M/SU health care organizations, recommendations for, 12, 21, 318, 384–385 Acute stress disorder (ASD), knowledge gaps in treatment for, 152 Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice, 299 Addiction Severity Index (ASI), 160 Administration for Children, Youth, and Families, 13–14, 17–18, 174–180, 374–375, 377–378 Administrative datasets, 155–159 Advance directives, 119–120 Advances in care and treatment, 32–34 Agency for Healthcare Research and Quality (AHRQ), 13–14, 17–18, 22–23, 110, 155, 161, 176–180, 268, 358, 374–375, 377–378, 383 Evidence-based Practice Centers, 164 Evidence Report/Technology Assessment, 71 Integrated Delivery Systems Research Network, 359–360 User Liaison Program, 176–177 Agenda for change, 350–390 Aims of quality health care, 8 Alcohol and Drug Services study, 292 American College of Mental Health Administration (ACMHA), 45–46, 182–183, 300 American Health Information Community (AHIC), 264 American Managed Behavioral Health Association, 183 American Psychiatric Association, 30n, 65, 168 Amphetamine dependence, knowledge gaps in treatment for, 153 Analysis of evidence organizations and initiatives conducting systematic evidence reviews in M/SU health care, 163–166 strengthening and coordinating mechanisms for, 161–167 Annapolis Coalition on Behavioral Health Workforce Education, 300 Anticipation of comorbidity, and formal determination to treat or refer, 235–236 of needs, 9, 78

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Improving the Quality of Health Care for Mental and Substance-Use Conditions Application of the Quality Chasm approach to health care for mental and substance-use conditions, 10–23, 70–72. See also Recommendations applicability of the Quality Chasm framework, 72 relationship between M/SU and general health care, 70–72 Association for Medical Education and Research in Substance Abuse (AMERSA), 299 Auditing, to ensure that performance measures have been calculated accurately and according to specifications, 187 B Behavioral Health Data Standards Workgroup (BHDSW), 272 Behavioral health information management, and the NHII, nationwide summit on, 273–274 Benefits and risks of different treatment, providing information about, 117 Brief Psychiatric Rating Scale (BPRS), 160 Budgeted systems of care, 343 C Campbell Collaboration, 165 Care coordination and related practices defined, 211–214 care coordination, 213 care integration, 213 collaboration, 212–213 communication, 212 integrated treatment, 213–214 Care delivery gaps in knowledge about effective, 353–355 need to navigate a greater number of arrangements in health care for mental/substance-use conditions, 66–67 by or through non-health care sectors, 275 Care integration, 213 clinical integration, 213 physician (or clinician) integration, 213 Carve-out services in Medicaid, 341–342 by private payers, 332–333 Case (care) management, 238–239 Center for Studying Health System Change, The, 278 Center for Substance Abuse Treatment (CSAT), 299 Centers for Disease Control and Prevention (CDC), 13–14, 17–18, 174–180, 374–375, 377–378 centers, institute, and offices of, 175 Centers for Medicare and Medicaid Services, 13–14, 22–23, 174–180, 358, 377–378, 383 Certification Commission for Healthcare Information Technology, 265 Change, need for a sustained commitment to bring about, 315–317 Change agenda, 350–390 knowledge gaps in treatment, care delivery, and quality improvement, 351–355 marketplace incentives leveraging needed, 325–349 review of actions needed for quality improvement at all levels of the health care system, 360–388 strategies for filling knowledge gaps, 355–360 summary, 350–351 Changes in MH/SA service delivery in the VHA, 436–437 Child welfare services, 226–227 increased burden on, 41–44 Childhood conditions, gaps in knowledge about therapies for high-prevalence, 352–353 Chronic Care Model, 83, 121–122, 241–242, 306 Clinical integration, 213 Clinically active (CA) mental health personnel, 292 Clinically trained (CT) mental health personnel, 292 Clinicians diverse types of health care providers, 278 financial issues, 279 in health care for mental/substance-use conditions, 65–66

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Improving the Quality of Health Care for Mental and Substance-Use Conditions less use of information technology among M/SU providers, 276 mode of practice, 65–66 numbers in solo or small practices, 277–278 participating in the NHII, 276–279 reporting individual practice as their primary or secondary place of employment, 309 reporting solo practice as their primary or secondary place of employment, 66 varied reimbursement and reporting requirements, 278–279 Clinicians providing M/SU services, recommendations, 14, 179–180, 361–364, 366 Cocaine dependence, knowledge gaps in treatment for, 153 Cochrane Collaboration, 35, 163 Coding CPT psychotherapy codes, 156–157 ICD-9 procedure codes, 157–158 Coerced treatment, 1, 103–108 coercion and mental illnesses, 104–107 coercion and substance-use illnesses, 107–108 defined, 103n gaps in knowledge about, 354 recommendations concerning, 12–13, 127–128, 362, 366, 373–374 summary, 108 Collaboration, 212–213 and coordination in policy making and programming, 245–247 defined, 212–213 effective communication, 212 New Mexico’s Behavioral Health Collaborative, a case study in policy coordination, 247 with other agencies, 439–440 recommendations concerning, 16–17, 248–249, 282, 363, 367, 370–371, 374, 379–380, 385 shared decision making, 212 a shared understanding of goals and roles, 212 Collaborative public- and private-sector efforts, establishing, 190–191 Collection of outcome data from patients, 159–160 Collocation and clinical integration of services, 237–238 Combating stigma and supporting decision making at the locus of care delivery, 110–115 endorsing and supporting consumer decision making in organizational policies and practices, 110–114 involving consumers in service design, administration, and delivery, 114–115 Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders, xi, 10 convening, 46 study process, 391–393 Committee on the Future of Emergency Care in the U.S. Health System, 47 Communication defined, 212 effective, 212 underused sources of, 173–177 Community Mental Health Services (CMHS) Block Grants, 223 Comorbidity, anticipation of, and formal determination to treat or refer, 235–236 Compensated Work Therapy (CWT) program and Compensated Work Therapy/Transitional residence (CWT/TR) program, 476–477 outcome measures, 477 process measures, 476–477 program participation, 476–477 Competencies in discipline-specific and core knowledge Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice, 299 Annapolis Coalition on Behavioral Health Workforce Education, 300 evaluating, 95–96 interdisciplinary project to improve health professional education in substance abuse, 299–300 little assurance of, 298–300 Competition for enrollees, 339–341 Conceptual framework for decision-making capacity, 93–96 ability to understand, appreciate, reason, and communicate preferences, 93–95

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Improving the Quality of Health Care for Mental and Substance-Use Conditions characteristics of the competency evaluator, 95–96 contextual risk-benefit factors, 95 Conceptualizing the aspects of care to be measured, 182–185 difference between the public and private sectors, 183 different types of evidence, 184 more diverse stakeholders, 183 unclear locus of accountability, 184–185 Consequences of failing to provide effective care demands on the juvenile and criminal justice systems, 42–44 great cost to the nation, 38–41 increased burden on the child welfare system, 41–44 mitigating adverse consequences of M/SU problems and illnesses, 44 M/SU illnesses a leading cause of disability and death, 37–38 serious personal and societal, 37–44 Consolidated Health Informatics (CHI) interagency initiative, 266–267 Constraints on sharing M/SU treatment information imposed by federal and state medical records privacy laws, 405–422 HIPAA privacy regulations, 406–407 information sharing for treatment purposes under state law and HIPAA, 412–417 introduction, 405 North Carolina General Stat. Ann. § 122C-55, 418–422 relationship between federal and state privacy laws, 407–409 state laws governing mental health records, 409–411 state laws governing the confidentiality of substance abuse records, 411 state medical records confidentiality laws, 409 Consumer decision making in organizational policies and practices, 110–114 continuing education, 111 leadership and policy practices, 110–111 tolerance for “bad” decisions, 111–114 Consumer role in health care for mental/substance-use conditions, 61 providing them real choices, 116–117 as service providers, 114–115 Content of continuing education, 306 Contextual risk-benefit factors, 95 Continuing advances in care and treatment, enabling recovery from mental and substance-use conditions, 4–5, 32–34 Continuing education, 111 content of, 306 financing, 307–308 inadequacy of, 305–308 methods, 306–307 organizational support, 308 Continuity of care among outpatients with psychotic diagnoses, 481 with PTSD diagnosis, 478 Continuous healing relationships, 9 Continuum of linkage mechanisms, 236 Co-occurring mental, substance-use, and general health problems and illnesses, 214–217 co-occurrence with general health conditions, 215–217 co-occurring mental and substance-use problems and illnesses, 214–215 Cooperation among clinicians, 9 in health care, 58 Coordinated care for better mental, substance-use, and general health, 210–258 care coordination and related practices defined, 211–214 difficulties in information sharing, 232–233 failed coordination of care for co-occurring conditions, 214–218 numerous, disconnected care delivery arrangements, 218–232 recommendations concerning, 17, 248–250, 364, 368 structures and processes for collaboration that can promote coordinated care, 233–247 summary, 210–211 Cost to the nation, 38–41 decreased achievement by children in school, 39–41 decreased productivity in the workplace, 39 Council on Graduate Medical Education (COGME), 287, 316

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Improving the Quality of Health Care for Mental and Substance-Use Conditions Council on Social Work Education, 302 Council on the Mental and Substance-Use Health Care Workforce, recommendations for, 20–21, 317–318, 382–383, 386 Counseling, 295 Counselor education, paucity of content on substance-use care in, 302–303 CPT psychotherapy codes, 155–157, 178 insight oriented, behavior modifying and/or supportive psychotherapy, 156 interactive psychotherapy, 156 Criminal justice system, 43–44, 227–229 involvement, 439 Critical role of the workforce and limitations to its effectiveness, 288 workforce shortages and geographic maldistribution, 289 Cross-agency research efforts, recommendations concerning, 22–23, 358, 383 Crossing the Quality Chasm: A New Health System for the 21st Century, ix, xi, 1–2, 11, 30, 44–48, 56–59, 65, 70, 72, 77–78, 108, 111–112, 116–118, 123, 185, 211, 213–214, 229, 260, 278–279, 353, 392 Customization, based on patient needs and values, 9, 78 in health care, 58 D Dangerousness, risk of, 100–103 Data access, need to balance privacy concerns with, 274–275 Data availability, 359 Data interchange, 266 Data standards, 17–18, 262–263, 265–267, 374–375 knowledge representation, 266 recommendations for, 19, 281, 371 terminologies, 266 Davies Award, The, 274 Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care, 263 Decision Support 2000+, 270–271 Decision-making abilities of individuals, xii, 93–100 conceptual framework, 93–96 Decision-making abilities of individuals with and without M/SU illnesses, 96–100 among people with substance-use illnesses, gaps in knowledge about, 354 effects of substance use on decision making and compulsive behavior, 99–100 impaired decision making by individuals not mentally ill or using substances, 100 mental illnesses, 96–98 Decision-making support providing all M/SU health care consumers with, 116–122 providing consumers with real choices, 116–117 providing decision support to all patients, 117–118 providing information about the benefits and risks of different treatment, 117 providing stronger decision support mechanisms for individuals with significantly impaired cognition or diminished self-efficacy beliefs, xii, 118–120 supporting illness self-management practices and programs, 120–122 Deference to the patient as the source of control, 9 in health care, 58 Demands on the juvenile and criminal justice systems, 42–44 criminal justice, 43–44 juvenile justice, 42 Department of Defense (DoD), 13–14, 177–180, 377–378 Department of Education, 13–14, 177–180, 377–378 Department of Health and Human Services (DHHS), 13–14, 177–180, 211n, 377–378 recommendations for, 14–15, 17–18, 370, 374–375, 378–380 Department of Justice, 13–14, 161, 164–165, 177–180, 377–378 Department of Labor, 88

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Improving the Quality of Health Care for Mental and Substance-Use Conditions Department of Veterans Affairs (VA), 13–14, 18–19, 22–23, 177–180, 189–193, 358, 377–378, 380–381, 383, 426 patients diagnosed with mental health and substance abuse disorders, 432–433 quality measurement and quality management in the VA, 424–425, 440–446 VA health service use, 468–470 VA MH/SA services among veterans who used any MH/SA care, 471–472 Diagnostic methods for mental/substance-use conditions, 64–65 improving, 167–169 Differences between general health care and health care for mental and substance-use conditions in decision-making ability, 96–97 in health care for mental/substance-use conditions, 62–64 in the marketplace for health care for mental/substance-use conditions, 69–70 between the public and private sectors, 183 Disability-adjusted life years (DALYs), 37 Disconnected care delivery arrangements, 218–232 frequent need for individuals with severe mental illnesses to receive care through a separate public-sector delivery system, 223–224 involvement of non-health care sectors in M/SU health care, 224–232 separation of health services for M/SU conditions from each other, 222–223 separation of M/SU health care from general health care, 219–222 unclear accountability for coordination, 231–232 Discrimination by health care providers, gaps in knowledge about preventing unintentional, 354 Discrimination impeding patient-centered care, 79–92 adverse effects on patients’ ability to manage their care and achieve desired health outcomes, 81–84 relationship between stigma and discriminatory policies, 87–92 stigma affecting clinician attitudes and behaviors, 84–87 Discrimination in health insurance coverage, 88–90 coverage of mental health care, 88–89 coverage of substance-use health care, 89–90 Discriminatory policies, 87–92, 122–126 minimizing risks in involuntary treatment, 125 needed research, 125–126 potential lifetime ban on receipt of food stamps or welfare for felony drug conviction, 91–92 preserving patient-centered care and patient decision making in coerced treatment, 124 restrictions on access to student loans for some drug offenses, 90–91 transparent policies and practices for assessing decision-making capacity and dangerousness, 123–124 Dissemination of the evidence, 169–180 conclusions and recommendations, 177–180 key efforts, 171–173 key factors associated with successful, 170 National Institutes of Health, 172 professional associations, 173 recommendations concerning, 13–14, 177–180, 377–378 Substance Abuse and Mental Health Services Administration, 171–172 underused sources of communication and influence, 173–177 Veterans Health Administration, 172–173 Diversity of providers, in health care for mental/substance-use conditions, 10, 68–69 Domiciliary Care for Homeless Veterans (DCHV) program, 475–476 outcome measures, 476 patient characteristics, 475 process measures, 475–476 program participation, 476 program structure, 475 Drug Evaluation Network System (DENS), 273 Duke University, 120

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Improving the Quality of Health Care for Mental and Substance-Use Conditions E Educational institutions. See also Professional education and training; recommendations for, 21, 318, 386 Effective communication, 212 Effective health care, 8, 57 gaps in knowledge about delivering, 353–355 Effectiveness, 448–451 evaluating, 158 knowledge gaps in, 153 of performance measures, and measure sets and policies, 188–189 relative, of different treatments alone and in combination, 353 Efficacious treatments, 151. See also Self-efficacy Efficacy-effectiveness gap, 151–153 Efficient health care, 8, 57, 453 Electronic health records (EHRs), 17–18, 238, 259, 264–265, 279, 374–375 and personal health records, 272 recommendations for, 19–20, 281, 371–372, 375, 381–382 Employee assistance programs (EAPs), 230–231 Ensuring National Health Information Infrastructure (NHII) benefits to persons with mental and substance-use conditions, 259–285 summary, 259–260 Epidemiological Catchment Area (ECA) study, 101–103 EQUIP project, 261 Equitable health care, 8, 57 Equity for minorities, 453–454 Evidence different types of, 2, 184 improving the production of, 151–167 Evidence base and quality improvement infrastructure, 140–209 applying quality improvement methods at the locus of care, 193–194 better dissemination of the evidence, 169–180 improving diagnosis and assessment, 167–169 improving the production of evidence, 151–167 problems in the quality of care, 141–151 public-private strategy for quality measurement and improvement, 195–196 strengthening the quality measurement and reporting infrastructure, 180–193 Evidence base gaps, 151–160 better capture of mental and substance-use health care data in administrative datasets, 155–159 collection of outcome data from patients, 159–160 efficacious treatments, 151 the efficacy-effectiveness gap, 151–153 knowledge gaps in treatment for M/SU conditions, 152–153 studies other than randomized controlled trials, 154–155 Evidence of decision-making capacity, 93–100 conceptual framework, 93–96 decision-making abilities of individuals with and without M/SU illnesses, 96–100 Evidence Report/Technology Assessment, 71 Evidence-based decision-making, 9 in health care, 58 Evidence-based Practice Centers (EPCs), 164 Experience of Care and Health Outcomes (ECHO) Survey, 160 External providers, formal agreements with, 239–240 F Faculty development inadequacy of, 303 recommendations concerning, 21, 318, 383 Failed coordination of care for co-occurring conditions, 214–218 co-occurring mental, substance-use, and general health problems and illnesses, 214–217 failure to detect, treat, and collaborate in the care of co-occurring illnesses, 217–218

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Improving the Quality of Health Care for Mental and Substance-Use Conditions Failure to treat and prevent problems in the quality of care, 144–147. See also Consequences of failing to provide effective care failure to prevent, 146–147 failure to treat, 144–146 FDA. See U.S. Food and Drug Administration Federal Employees Health Benefit Program (FEHBP), 331 Federal policy makers, recommendations for, 377–383 Federal privacy law, 407–409 Felony drug conviction, potential lifetime ban on receipt of food stamps or welfare for, 91–92 Female veterans, 454 Financing, 279 continuing education, 307–308 methods for mental health/substance-use care, 326 of M/SU health care research, recommendations for, 387–388 recommendations for health care, 22, 344, 372, 375 Flexibility, in professional roles, 242 Food Stamp Program, 91 Formal agreements, with external providers, 239–240 Framework for improving quality, 56–76 aims and rules for redesigning health care, 57–59 applying the Quality Chasm approach to health care for mental and substance-use conditions, 70–72 distinctive characteristics of health care for mental/substance-use conditions, 59–70 summary, 56–57 Front-line experience, 425, 454–456 G Gaps in knowledge, 355 General medical/primary care providers, 293–294 Global Appraisal of Individual Needs (GAIN), 160 Global Assessment of Functioning (GAF) scale, 160, 482 improvement after inpatient discharge, 482 improvement during outpatient treatment, 482 National Mental Health Program Performance Monitoring System, 160 Government Performance and Results Act (GPRA), 272–273 Government purchasing, 2 dominance of, 326–327 H HCPCS codes, 178 Health care anticipation of needs, 58 based on continuous healing relationships, 58 Health Care for Homeless Veterans (HCHV) program, 475–476 outcome measures, 476 patient characteristics, 475 process measures, 475–476 program participation, 476 program structure, 475 Health care for mental/substance-use conditions, 59–70 consumer role, 61 diagnostic methods, 64–65 differences between general health care and health care for mental and substance-use conditions, 62–64 differences in the marketplace, 69–70 greater diversity of types of providers, 68–69 greater separation from other components of the health care system, 59–61 information sharing and technology, 68 integrating into the NHII, 279–283 mode of clinician practice, 65–66 need to navigate a greater number of care delivery arrangements, 66–67 quality measurement infrastructure, 67–68 solving the problems of, xi Health care organizations, 13–14, 177–180, 377–378 Health care provider and organization strategies, 234–243 anticipation of comorbidity and formal determination to treat or refer, 235–236

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Improving the Quality of Health Care for Mental and Substance-Use Conditions linking mechanisms fostering collaborative planning and treatment, 236–240 organizational support for collaboration, 240–243 screening, 234–235 Health care providers, diverse types of, 278 Health care quality, 8, 57 Health Insurance Portability and Accountability Act (HIPAA), 13–14, 68, 158, 177–180, 232–233, 377–378, 405 privacy regulations, 68, 406–407 Health maintenance organizations (HMOs), 277–278, 310 Health of the Nation Outcome Scales (HoNOS), 160 Health plans and purchasers of M/SU health care, recommendations for, 369–372 Health Privacy Project, 405 Health professional education in substance abuse, interdisciplinary project to improve, 299–300 Health Resources and Services Administration (HRSA), 268, 299 Healthplan Employer Data and Information Set (HEDIS), 155, 183–184, 186–187, 221, 271 High quality health care, six aims of, 57 Higher Education Act, 90 High-prevalence childhood conditions, gaps in knowledge about therapies for, 352–353 High-risk populations, 17 I ICD-9 procedure codes, 155, 157–158 Illness self-management practices and programs gaps in knowledge about, 355 impaired, 82–83 supporting, 12, 120–122 Improving care, ix using information technology, 261–262 Improving diagnosis and assessment, 167–169 Improving the production of evidence, 151–167 filling the gaps in the evidence base, 153–160 gaps in the evidence base, 151–153 strengthening and coordinating mechanisms for analyzing the evidence, 161–167 Information infrastructure initiatives for health care for M/SU conditions, 270–275 relationship to quality, 260–262 Information sharing difficulties in, 232–233 technology, in health care for mental/substance-use conditions, 68 for treatment purposes under state law and HIPAA, 412–417 Information technology (IT), 2, 307 improving care using, 261–262 less use among M/SU providers, 10, 276 Information technology (IT) initiatives balancing privacy concerns with data access, 274–275 care delivered by or through non-health care sectors, 275 for health care for mental/substance-use conditions, 270–275 information infrastructure initiatives for health care for M/SU conditions, 270–275 private-sector initiatives, 274 SAMHSA initiatives, 270–274 unique characteristics of M/SU services with implications for the NHII, 274 Innovations key factors associated with successful adoption of, 170 NIATx, 195 within psychiatry, 167 Inpatients care measures for, 480–481 improvement after discharge, 482 satisfaction measures, 481 specialized (residential) PTSD programs for, 478 Institute of Medicine (IOM), ix–xi, 8–10, 30, 32, 44, 211n, 220, 243, 245, 260, 267, 279, 425 Instructional directives, psychiatric, 119 Insurance coverage, more limited for M/SU conditions, 7, 328–329 Integrated Delivery Systems Research Network (IDSRN), 359–360 data availability, 359

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Improving the Quality of Health Care for Mental and Substance-Use Conditions management authority to implement a health care intervention, 359 research expertise, 359 Integrated treatment, 213–214 defined, 213–214 integrated programs, 214 integrated systems, 214 Interactions between the mind/brain and the rest of the body, 11, 71–72, 361, 365, 369, 373, 377, 384, 386 Interactive psychotherapy, 156 Interdisciplinary Project to Improve Health Professional Education in Substance Abuse, 301, 303–304 Interventions to improve decision-making capability, 98 Involuntary treatment, minimizing risks in, 125 J Jamison, Kay Redfield, 112–113 Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 157, 244 Jost, Timothy Stoltzfus, 405–422 Justice systems, 227–230 Juvenile justice system, 42, 229–230 K Keeping Patients Safe: Transforming the Work Environment of Nurses, 307 Knowledge about effective care delivery coercion into treatment, 354 demonstrations of illness self-management programs, 355 gaps in, 353–355 potential modification of certain public policies, 354 preventing unintentional discrimination by health care providers, 354 providing patient-centered care, 353–354 understanding decisional capacity among people with substance-use illnesses, 354 Knowledge about effective treatments gaps in, 351–353 medication treatments for certain substance dependencies, 352 optimal pharmacotherapy for psychosis, 352 prevention and treatment of PTSD, 352 prevention studies, 353 relative effectiveness of different treatments (alone and in combination), 353 therapies for high-prevalence childhood conditions, 352–353 therapies for other population subgroups, 353 treatment of multiple conditions, 351 Knowledge about quality improvement practices for M/SU health care, recommendations about disseminating, 15, 196, 379, 387 Knowledge gaps in treatment for M/SU conditions, 152–153, 351–355 acute stress disorder, 152 amphetamine dependence, 153 cocaine dependence, 153 gaps in treatment knowledge, 351–355 marijuana dependence, 153 posttraumatic stress disorder, 152 psychotic illnesses, 153 relative effectiveness of different treatments, 153 shortcomings in public policy, 355 therapies for children and older adults, 152 therapies for other population subgroups, 153 treatment of multiple conditions, 152 Knowledge representation, 266 L Leadership, 242–243 and policy practices, 110–111 Leadership by Example: Coordinating Government Roles in Improving Health Care Quality, 245, 250 Linkage of the VA with the Department of Defense (DoD) and other mental health, medical, and social service systems, 424, 437–440 collaborative relationships with other agencies, 439–440 criminal justice involvement, 439 cross MH/SA system use, 437–438

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Improving the Quality of Health Care for Mental and Substance-Use Conditions primary care and specialty medical services, 438–439 transition from DoD to VA, 437 Linkages with community and other human services resources, 231 Linking mechanisms fostering collaborative planning and treatment, 236–240 case (care) management, 238–239 collocation and clinical integration of services, 237–238 the continuum of linkage mechanisms, 236 formal agreements with external providers, 239–240 recommendations concerning, 16, 248, 282, 363, 367 shared patient records, 238 M MacArthur Research Network on Mental Health and the Law, 113 MacArthur Violence Risk Assessment Study, 102 Making Health Care Safer: A Critical Analysis of Patient Safety Practices, 307 Managed behavioral health organizations (MBHOs), 67, 220, 222, 243–244, 327–328, 332–335 Management authority, to implement a health care intervention, 359 Marijuana dependence, knowledge gaps in treatment for, 153 Market and policy structures budgeted systems of care, 343 direct public purchase of behavioral carve-out services in Medicaid, 341–342 effects on quality, 339–343 private payer direct procurement of carve-out services, 342 quality distortions in the purchase of health plan services through competition for enrollees, 339–341 traditional Medicaid programs, 342 Marketplace for mental and substance-use health care, 1, 326–329 dominance of government purchasing, 326–327 financing methods for mental health/substance-use care, 326 frequent direct provision and purchase of care by state and local governments, 329 more limited insurance coverage, 328–329 purchase of M/SU health insurance separately from general health insurance, 327–328 Marketplace incentives to leverage needed change, 325–349 characteristics of different purchasing strategies, 330–337 conclusions and recommendations, 343–346 effects of market and policy structures on quality, 339–343 procurement and the consumer role, 337–339 summary, 325 Marriage and family therapy, 296 Measurement and reporting infrastructure analyzing and displaying the performance measures in suitable formats, 187–188 auditing to ensure that performance measures have been calculated accurately and according with specifications, 187 conceptualizing the aspects of care to be measured, 182–185 ensuring calculation and submission of the performance measures, 186–187 maintaining the effectiveness of performance measures and measure sets and policies, 188–189 necessary components of a quality, 181–189 pilot testing the performance measure specifications, 186 translating quality-of-care measurement concepts into performance measure specifications, 185–186 Medicaid, 69, 330, 332 traditional programs, 342 Medical Expenditure Panel Survey, 330 Medicare, 88n, 90, 159 Medication, xii errors, 36n, 148–149 treatments for certain substance dependencies, gaps in knowledge about, 352

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Improving the Quality of Health Care for Mental and Substance-Use Conditions Mental and substance-use health problems and illnesses, ix–x Americans annually receiving care for, 2–4, 30–32 among veterans and nonveterans in the general population, 428–429 and general health care, 70–72 a leading cause of disability and death, 37–38 mitigating adverse consequences of, 44 Mental and substance-use health services, clinicians in solo or small practices, 277–278 Mental and substance-use health services for veterans America’s veterans, 427–432 development of MH/SA quality measurement and quality management in the VA, 424–425, 440–446 experience with performance evaluation in the Department of Veterans Affairs, 423–482 front-line experience, 425, 454–456 introduction to the Department of Veterans Affairs in American mental health care, 426–427 linkage of the VA with the Department of Defense and other mental health, medical, and social service systems, 424, 437–440 performance measures used by the Northeast Program Evaluation Center in the evaluation and monitoring of VA mental health programs, 475–482 population characteristics of veterans who used VA services, 464–467 quality of VA MH/SA care, 425, 446–454 status among veteran and nonveteran users of mental health services, 429–430 summary, 423–425 tables, 464–474 treatment of MH/SA in the VA, 424, 432–437 U.S. veterans, 424 VA health service use, 468–470 VA MH/SA services among veterans who used any MH/SA care, 471–472 veterans treated for mental health diagnosis in the VHA, by specialty, 473 workload of specialized VA mental health programs, 474 Mental Health: Culture, Race, and Ethnicity, 290 Mental health and substance-use treatment information constraints on sharing imposed by federal and state medical records privacy laws, 405–422 HIPAA privacy regulations, 406–407 information sharing for treatment purposes under state law and HIPAA, 412–417 introduction, 405 North Carolina General Stat. Ann. § 122C-55, 418–422 relationship between federal and state privacy law, 407–409 state laws governing mental health records, 409–411 state laws governing the confidentiality of substance abuse records, 411 state medical records confidentiality laws, 409 Mental health care discrimination in health insurance coverage of, 88–89 introduction to the Department of Veterans Affairs in, 426–427 Mental Health Corporations of America, 274 Mental health intensive case management (MHICM), 479–480 appropriateness of admissions, 479 outcomes, 480 program structure, 479 treatment process, 480 Mental Health Parity Act, 88n Mental Health Statistical Improvement Project (MHSIP), 269–271, 283 survey, 160 Mental illnesses, 96–98 ability of interventions to improve decision-making capability, 98 difference in decision-making ability, 96–97 poor decision-making abilities better predicted by cognitive than by psychotic symptoms, 97–98 summary, 98

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Improving the Quality of Health Care for Mental and Substance-Use Conditions Multi-Agency INitiative on Substance abuse TRaining and Education for AMerica (Project MAINSTREAM), 300 Multiple conditions, gaps in knowledge about treating, 351 N National Advisory Council on Nurse Education and Practice (NACNEP), 287, 316–317 National Alliance for the Mentally Ill (NAMI), 109 National Association of Alcohol and Drug Abuse Counselors (NAADAC), 302–304 National Association of State Alcohol and Drug Abuse Directors (NASADAD), 158, 232 National Association of State Mental Health Program Directors (NASMHPD), 158, 187, 232 National Committee for Quality Assurance (NCQA), 186, 244 Healthplan Employer Data and Information Set, 155, 183–184, 186–187, 221, 232–233, 271 National Committee on Vital and Health Statistics, 267 National Compensation Survey, 88 National Coordinator. See Office of the National Coordinator of Health Information Technology National Epidemiologic Survey on Alcohol and Related Conditions, 214 National Health Information Infrastructure (NHII), 18–19, 260, 280, 380–381 activities under way to build, 262–268 data standards, 265–267 electronic health records, 264–265 a secure interoperable platform for exchange of patient information across health care settings, 267–268 National Health Information Infrastructure (NHII) benefiting persons with mental and substance-use conditions, 259–285 activities under way to build a national health information infrastructure, 262–268 building the capacity of clinicians treating mental and substance-use conditions to participate in the NHII, 276–279 information technology initiatives for health care for mental/substance-use conditions, 270–275 integrating health care for mental and substance-use conditions into the NHII, 279–283 need for attention to mental and substance-use conditions in the NHII, 268–270 National Health Interview survey, 3 National Healthcare Quality Report, 180 National Institute of Child Health and Human Development, 13–14, 177–180, 377–378 National Institute of Mental Health (NIMH), 13–14, 22–23, 172, 177–180, 222, 358, 377–378, 383 Outreach Partnership Program, 109 National Institute on Alcohol Abuse and Alcoholism (NIAAA), 13–14, 22–23, 172, 177–180, 214, 222, 303, 358, 377–378, 383 National Institute on Drug Abuse (NIDA), 13–14, 22–23, 172, 177–180, 222, 358, 377–378, 383 National Institutes of Health (NIH), 32, 172, 222 National Inventory of Mental Health Quality Measures, 180 National Library of Medicine, 267 National Mental Health Program Performance Monitoring System, 160 National Quality Forum, 14–15, 182, 195–196, 370, 378–379 National Quality Measurement and Reporting System (NQMRS), 182 National Registry of Evidence-based Programs and Practices (NREPP), 163–164, 310 National Research Council, 154, 357 National Survey of Child and Adolescent Well-Being (NSCAW), 226 National Survey on Drug Use and Health, 145 National Treatment Plan Initiative, 87 Nationwide summit on behavioral health information management, and the NHII, 273–274

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Improving the Quality of Health Care for Mental and Substance-Use Conditions Network for the Improvement of Addiction Treatment (NIATx), 194–195, 360 the innovation initiative, 195 the single state agency initiative, 195 the treatment provider initiative, 194–195 New Freedom Commission on Mental Health, 218, 220, 246, 282, 289, 391 New Mexico’s Behavioral Health Collaborative, case study in policy coordination, 247 Non-health care sectors child welfare services, 226–227 employee assistance programs, 230–231 involvement in M/SU health care, 224–232 justice systems, 227–230 linkages with community and other human services resources, 231 schools, 225–226 North Carolina General Stat. Ann. § 122C-55, 418–422 Number of Americans annually receiving care, 30–32 Nursing education, paucity of content on substance-use care in, 302 O Office of Minority Health, 13–14, 177–180, 377–378 Office of the National Coordinator of Health Information Technology (ONCHIT), 17–18, 263, 268, 282, 374–375 Organizational support for collaboration, 240–243 for continuing education, 308 facilitating structures and processes at treatment sites, 240–242 flexibility in professional roles, 242 leadership, 242–243 Organizations conducting systematic evidence reviews in M/SU health care, 163–166 providing M/SU health care, recommendations for, 365–368 Outcome measures, 476–477, 479–480 the Global Assessment of Functioning scale, 482 Outpatient care measures, 481 all VA PTSD treatment, specialized and non-specialized, 478 continuity of care among outpatients with psychotic diagnoses, 481 continuity of care among outpatients with PTSD diagnosis, 478 improvement during treatment, 482 service utilization and continuity of care, 478, 481 Outpatient programs (specialized for PTSD), 477–478 costs, 478 patient characteristics, 477–478 workload, 478 Outreach Partnership Program, 109 P Partnerships public-private, 189–193 researchers and stakeholders, 23, 358, 388 Pastoral counseling, 296 Patient activation, 83–84 Patient as the source of control, 78 Patient characteristics, 475, 477–478 Patient decision making, 12 preserving in coerced treatment, 124 Patient Health Questionnaire, 235 Patient information, exchanging across health care settings, a secure interoperable platform for, 267–268 Patient needs and values, customization based on, 9 Patient Outcomes Research Team (PORT) Pharmacotherapy Guidelines, for patients with schizophrenia, adherence to, 33, 482 Patient-centered care, xii, 8, 57, 77, 451–452 actions supporting, 108–128 anticipation of needs, 78 combating stigma and supporting decision making at the locus of care delivery, 110–115 customization based on patient needs and values, 78 eliminating discriminatory legal and administrative policies, 122–126

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Improving the Quality of Health Care for Mental and Substance-Use Conditions gaps in knowledge about providing, 353–354 the need for transparency, 78 obstacles to, 11 the patient as the source of control, 78 preserving in coerced treatment, 124 providing decision-making support to all M/SU health care consumers, 116–122 recommendations concerning, 11–12, 126–128, 361–362, 365–366, 369, 384 rules helping to achieve, 78–79 shared knowledge and the free flow of information, 78 Patients’ ability to manage their care and achieve desired health outcomes adverse effects on, 81–84 decreased self-efficacy, 82 diminished self-esteem, 81 impaired illness self-management, 82–83 weakened patient activation and self-determination, 83–84 Patients’ decision-making abilities and preferences supported, 77–139 actions supporting patient-centered care, 108–128 coerced treatment, 103–108 evidence countering stereotypes of impaired decision making and dangerousness, 92 rules helping to achieve patient-centered care, 78–79 stigma and discrimination impeding patient-centered care, 79–92 summary, 77–78 Peer support programs, xii, 118–119 Performance measures analyzing and displaying in suitable formats, 187–188 ensuring calculation and submission, 186–187 pilot testing specifications for, 186 public-sector efforts to develop, test, and implement, 192–193 recommendations for, 17–18, 374–375, 380 Performance Measures Advisory Group (PMAG), 157 Performance measures used by the National Mental Health Program Performance Monitoring System, 480–481 inpatient care measures, 480–481 inpatient satisfaction measures, 481 outpatient care measures, 481 population coverage, 480 Performance measures used by the Northeast Program Evaluation Center in the evaluation and monitoring of VA mental health programs, 475–482 adherence to PORT Pharmacotherapy Guidelines for patients with schizophrenia, 482 Compensated Work Therapy and Compensated Work Therapy/Transitional residence programs, 476–477 Health Care for Homeless Veterans and Domiciliary Care for Homeless Veterans programs, 475–476 mental health intensive case management, 479–480 outcomes on the Global Assessment of Functioning scale, 482 PTSD performance monitors and outcome measures, 477–479 Personal health records (PHRs), 264n, 272 Personal Responsibility and Work Opportunity Reconciliation Act, 91 Pharmacotherapy for psychosis, 5 gaps in knowledge about optimal, 352 Physicians integrating, 213 paucity of content on substance-use care in education of, 300–301 Poor care, hindering improvement and recovery for many with mental and substance-use conditions, 5–6, 35–36 Poor decision-making abilities, better predicted by cognitive than by psychotic symptoms, 97–98 Populations coverage issues, 480 gaps in knowledge about therapies for other subgroups, 353 high-risk, 17 Posttraumatic stress disorder (PTSD) inpatient care (generalized and specialized programs), 479 knowledge gaps in treatment for, 152

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Improving the Quality of Health Care for Mental and Substance-Use Conditions Posttraumatic stress disorder (PTSD) performance monitors and outcome measures, 477–479 all PTSD inpatient care (generalized and specialized programs), 479 inpatient/residential programs (specialized PTSD programs), 478 outcomes, 479 outpatient care measures (all VA PTSD treatment, specialized and non-specialized), 478 outpatient programs (specialized PTSD outpatient programs), 477–478 Practices of purchasers, quality oversight organizations, and public policy leaders, 243–247 collaboration and coordination in policy making and programming, 245–247 purchaser practices, 243–244 quality oversight practices, 244–245 President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 180 President’s New Freedom Commission on Mental Health, 218, 220, 246, 282, 289, 391 Prevention studies failure of, 146–147 gaps in knowledge about, 352–353 Primary care, and specialty medical services, 438–439 Privacy concerns, 17–18, 374–375 need to balance with data access, 274–275 Private payer direct procurement, of carve-out services, 342 Private-sector initiatives, 274 The Davies Award, 274 Mental Health Corporations of America, 274 Procedure codes, 13–14, 174–180, 377–378 ICD-9, 157–158 Process measures, 475–477 Procurement, and the consumer role, 337–339 Professional associations, 13–14, 166, 173, 177–180, 377–378 Professional education and training, 294–304 deficiencies in, 297–304 inadequate faculty development, 303 little assurance of competencies in discipline-specific and core knowledge, 298–300 paucity of content on substance-use care, 300–303 summary, 303–304 variation in amounts and types of, 294–297 Program participation issues, 476–477 Program structure, 475, 479 integrated, 214 Project MAINSTREAM. See Multi-Agency INitiative on Substance abuse TRaining and Education for AMerica Project MATCH Form 90, 160 Proxy directives, psychiatric, 119–120 Psychiatric instructional directives, 119 Psychiatric nursing, 295 Psychiatric proxy directives, 119–120 Psychiatry, 112–113, 294 innovation within, 167 Psychologist education, paucity of content on substance-use care in, 301 Psychology, 294–295 Psychosocial rehabilitation, xii, 5, 296 Psychotherapy insight oriented, behavior modifying and/or supportive, 156 interactive, 156 Psychotic illnesses, knowledge gaps in treatment for, 153 Public and publicly funded programs recommendations for, 22, 346, 372, 376 requiring submission of jointly agreed-upon public- and private-sector measures in, 191–192 Public policy gaps in knowledge about potential modification of, 354 shortcomings in, 355 Public policy leaders, practices of, 243–247 Publicly budgeted systems of care, 336–337 Public-private leadership and partnership to create a quality measurement and reporting infrastructure, 189–193 continuing public-sector efforts to develop, test, and implement new performance measures, 192–193 establishing collaborative public- and private-sector efforts, 190–191 recommendations regarding, 19, 280–281, 364, 368, 371, 375

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Improving the Quality of Health Care for Mental and Substance-Use Conditions requiring submission of jointly agreed-upon public- and private-sector measures in public and publicly funded programs, 191–192 strategy for quality measurement and improvement, 195–196 Purchasers of M/SU services practices of, 243–244 recommendations for, 22, 345, 372, 376 Purchase of M/SU services direct, of carve-out services by group payers, 332–333 of M/SU health insurance separately from general health insurance, 327–328 of services by carve-out organizations, 334–335 of services in traditional Medicaid programs, 335–336 through competitive insurance markets, with competition for enrollees, 330–332 Purchasing strategies, 330–337 publicly budgeted systems of care, 336–337 Q Quality Chasm in health care for mental and substance-use conditions, 29–55 continuing advances in care and treatment enabling recovery, 32–34 gaps in knowledge about how to improve, 355 numbers of Americans annually receiving care, 30–32 poor care hindering improvement and recovery for many, 35–36 scope of the study, 47 serious personal and societal consequences of failing to provide effective care, 37–44 a strategy to improve overall health care, crossing the Quality Chasm, 44–46 summary, 29–30 ten rules to guide the redesign of health care, 9, 58 Quality distortions in the purchase of health plan services through competition for enrollees, 339–341 Quality Enhancement Research Initiative, 173 Quality improvement at all levels of the health care system, review of actions needed for, 360–388 at the locus of care, 193–194 Network for the Improvement of Addiction Treatment, 194–195 recommendations for, 22, 344–345, 372 workforce capacity for, 286–324 Quality management, in the “new VA,” expansion of, 443–446 Quality measurement and quality management in the VA, 424–425, 440–446 evaluation and monitoring of specialized VA MH/SA programs, 441–443 expansion of quality management in the “new VA,” 443–446 Quality measurement and reporting infrastructure, 1, 180–193 in health care for mental/substance-use conditions, 67–68 necessary components of, 181–189 need for public-private leadership and partnership to create, 189–193 Quality of care problems, 141–151 failure to treat and prevent, 144–147 unsafe care, 147–151 variations in care due to a lack of evidence, 143–144 Quality of VA MH/SA care, 425, 446–454 effectiveness, 448–451 efficiency, 453 equity minorities, 453–454 female veterans, 454 patient-centered care, 451–452 safety, 447–448 timeliness, 452–453 Quality oversight organizations, practices of, 244–245 R Recommendations, 126–128, 177–180, 317–319 for accreditors of M/SU health care organizations, 12, 21, 318, 384–385 for clinicians, 361–364

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Improving the Quality of Health Care for Mental and Substance-Use Conditions for clinicians providing M/SU services, 14, 362, 366 concerning coerced treatment, 12–13, 362, 366, 373–374 concerning collaboration, 16–17, 363, 367, 370–371, 374, 379–380, 385 concerning coordinating care for better mental, substance-use, and general health, 17, 248–250, 364, 368 concerning cross-agency research efforts, 22–23, 358, 383 concerning dissemination of the evidence, 13–14, 377–378 concerning faculty development, 21, 318, 383 concerning linking mechanisms to foster collaborative planning and treatment, 16, 363, 367 concerning patient-centered care, 11–12, 361–362, 365–366, 369, 384 concerning research designs, 15–16, 387 on coordinating care for better mental, substance-use, and general health, 248–250 for data standards, 19, 371 for the DHHS, 14–15, 370, 378–379 about disseminating knowledge about quality improvement practices for M/SU health care, 15, 379, 387 for educational institutions, 21, 318, 386 for electronic health records, 19–20, 371–372, 375, 381–382 for federal policy makers, 377–383 for funders of M/SU health care research, 387–388 for health care financing, 22, 344, 372, 375 for health plans and purchasers of M/SU health care, 369–372 for institutions of higher education, 386 for organizations providing M/SU health care, 365–368 for performance measures, 17–18, 374–375, 380 for public and publicly funded programs, 22, 346, 372, 376 for purchasers, 22, 345, 372, 376 for quality improvement, 22, 344–345, 372 regarding public-private leadership and partnership to create a quality measurement and reporting infrastructure, 19, 364, 368, 371, 375 for state policy makers, 373–376 for workforce capacity for quality improvement, 20–21, 382–383, 386 Redesigning health care, 57–59 anticipation of needs, 9, 58 care based on continuous healing relationships, 9, 58 continuous decrease in waste, 9, 58 cooperation among clinicians, 9, 58 customization based on patient needs and values, 9, 58 deference to the patient as the source of control, 9, 58 evidence-based decision-making, 9, 58 need for transparency, 9, 58 recommendations for, 11, 72, 365, 369 safety as a system property, 9, 58 shared knowledge and the free flow of information, 9, 58 six aims of high quality health care, 57 ten rules to guide, 9, 58 Regional health information organizations (RHIOs), 275 Reporting. See Measurement and reporting infrastructure Research designs, 357–359 recommendations concerning, 15–16, 196, 387 Research expertise, 359 Restrictions on access to student loans for some drug offenses, 90–91 Risks. See also Benefits and risks of different treatment of dangerousness, 100–103 in involuntary treatment, minimizing, 125 Rules to guide the redesign of health care, 9, 58 S Safety in health care, 8, 57, 447–448 heightened concerns, and need for multiple actions, 150–151 as a system property, 9, 58

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Improving the Quality of Health Care for Mental and Substance-Use Conditions School achievement by children, 39–41 Screening, 234–235 Self-efficacy, 81 Self-esteem, diminished, 81 Separate public-sector delivery system, 1 frequent need for individuals with severe mental illnesses to receive care through, 223–224 Separation of health care system components for mental/substance-use conditions, 60–61 from each other, 59–61, 222–223 from general health care, 219–222 Serious personal and societal consequences of failing to provide effective care for mental and substance-use conditions, 6–7 Service design, administration, and delivery consumer participation in service design and administration, 114 consumers as service providers, 114–115 involving consumers in, 114–115 Service utilization and continuity of care, 478, 481 Services Accountability Improvement System (SAIS), 272–273 Shared decision making, 212 Shared knowledge in health care, and the free flow of information, 9, 58, 78 Shared patient records, 238. See also Constraints on sharing imposed by federal and state medical records privacy laws Shared understanding of goals and roles, 212 Single state agency initiative, of NIATx, 195 Social work, 295 paucity of content on substance-use care in education for, 301–302 Software and Technology Vendors’ Association (SATVA), 271, 273–274 Solo practice, 309–310 clinically trained specialty mental health personnel reporting individual practice as their primary or secondary place of employment, 309 Source of control, 9, 58 Specialized VA MH/SA programs, 434 evaluation and monitoring of, 441–443 Specialty medical services, and primary care, 438–439 Specialty mental health providers, 291–292 clinically active (CA) or clinically trained (CT) mental health personnel, 292 Specialty substance-use treatment providers, 292–293 Stakeholders, 435–436 more diverse, 183 Stanford University, 83 State and local governments, 165–166 frequent direct provision and purchase of care by, 329 State data infrastructure grants, 271 State laws governing mental health records, 409–411 governing the confidentiality of substance abuse records, 411 State medical records confidentiality laws, 409 State Outcomes Measurement and Management System, 183 State policy makers, recommendations for, 373–376 State privacy law, 407–409 Stereotypes of impaired decision making and dangerousness, 92–93 evidence countering, 92 evidence of decision-making capacity, 93–100 harmful stereotypes of impaired decision making and dangerousness, 92–93 risk of dangerousness, 100–103 Stigma, 79–92 affecting clinician attitudes and behaviors, 84–87 pathway to diminished health outcomes, 81 Strategies for filling knowledge gaps, 355–360 Agency for Healthcare Research and Quality’s Integrated Delivery Systems Research Network, 359–360 Network for the Improvement of Addiction Treatment, 360 research designs, 357–359 Strategies to improve overall health care, 8–10, 44–46 six aims of high quality health care, 8 ten rules to guide the redesign of health care, 9

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Improving the Quality of Health Care for Mental and Substance-Use Conditions Strong information infrastructure improving care using information technology, 261–262 as vital to quality, 260–262 Structures and processes for collaboration that can promote coordinated care, 233–247 health care provider and organization strategies, 234–243 practices of purchasers, quality oversight organizations, and public policy leaders, 243–247 Student loans, 90–91 Substance Abuse and Mental Health Services Administration (SAMHSA) initiatives, 13–14, 17–19, 22–23, 32, 60, 158, 171–172, 177–180, 189–193, 270–274, 291, 358, 374–375, 377–378, 380–381, 383 Alcohol and Drug Services study, 292 Behavioral Health Data Standards Workgroup, 272 Center for Substance Abuse Treatment, 299 Drug Evaluation Network System, 273 EHRs and personal health records, 272 mental health Decision Support 2000+ and statistics improvement program, 270–271 National Treatment Plan Initiative, 87 nationwide summit on behavioral health information management and the NHII, 273–274 Recovery Community Services Program, 115 state data infrastructure grants, 271 substance abuse information system, 272–273 Uniform Reporting System, 272 Substance Abuse Prevention and Treatment (SAPT) Block Grants, 223, 337 Substance-use health care. See also Mental and substance-use health problems and illnesses discrimination in health insurance coverage of, 89–90 professional training on, 300–303 treatment counseling, 296–297 Systems, integrated, 214 T Temporary Assistance for Needy Families (TANF), 91, 354 Terminology issues, 86–87, 266 Therapies for children and older adults, knowledge gaps in, 152 Therapies for high-prevalence childhood conditions, gaps in knowledge about, 352–353 Therapies for other population subgroups, gaps in knowledge about, 153, 353 Timely health care, 8, 57, 452–453 To Err Is Human: Building a Safer Health System, 44, 45n Tolerance for “bad” decisions, 111–114 Traditional Medicaid programs, 342 Transforming Mental Health Care in America , 246 Transition from DoD to VA, 437 Transparency, 9 needed in health care, 58, 78 in policies and practices for assessing decision-making capacity and dangerousness, 123–124 Treatment, failure of, 144–146 Treatment knowledge, 351–355 about effective care delivery, 353–355 about effective treatments, 351–353 gaps in effective, 351–353 about how to improve quality, 355 Treatment of mental health and substance abuse in the VA, 424 administrative organization, 434–435 changes in MH/SA service delivery, 436–437 patients, administration, relationships with other federal agencies, stakeholders, and changes, 432–437 relationships with other federal departments, 435 specialized MH/SA programs, 434 stakeholders, 435–436 VA patients diagnosed with mental health and substance abuse disorders, 432–433 Treatment of multiple conditions, knowledge gaps in, 152 Treatment process, 480 Treatment provider initiative, of NIATx, 194–195 Treatment sites, facilitating structures and processes at, 240–242

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Improving the Quality of Health Care for Mental and Substance-Use Conditions U Unclear accountability, 184–185 for coordination, 231–232 Underused sources of communication and influence, 173–177 Agency for Healthcare Research and Quality, 176–177 Centers for Disease Control and Prevention, 174–176 Uniform Reporting System (URS), 272 Unquiet Mind, An, 112–113 Unsafe care, 147–151 heightened safety concerns and need for multiple actions, 150–151 medication errors, 148–149 seclusion and restraint, 149–150 U.S. Bureau of Justice Statistics, 7 U.S. Food and Drug Administration (FDA), 162, 353 U.S. Government Accountability Office (GAO), 7, 41, 89, 149 U.S. Preventive Services Task Force, 163, 234, 357 U.S. Surgeon General, 32, 290, 391 Use levels of the Internet and other communication technologies for service delivery, 310–311 of VA mental health services, 431–432 of VA services, 430–431 User Liaison Program (ULP), 176–177 V VA. See Department of Veterans Affairs Variations in care, due to a lack of evidence, 143–144 Variations in the workforce treating M/SU conditions, 288–294 in amounts and types of education, 294–297 counseling, 295 general medical/primary care providers, 293–294 insufficient workforce diversity, 290 in licensure and credentialing requirements, 304–305 marriage and family therapy, 296 pastoral counseling, 296 psychiatric nursing, 295 psychiatry, 294 psychology, 294–295 psychosocial rehabilitation, 296 social work, 295 specialty mental health providers, 291–292 specialty substance-use treatment providers, 292–293 substance-use treatment counseling, 296–297 Varied reimbursement and reporting requirements, 278–279 Veterans. See also Mental and substance-use health services for veterans of America, 424, 427–428 female, 454 mental health and substance abuse disorders among veterans and nonveterans in the general population, 428–429 mental health and substance abuse status and use of VA services, 427–432 MH/SA status among veteran and nonveteran users of mental health services, 429–430 quality measurement and quality management in the VA, 424–425, 440–446 treated for mental health diagnosis in the VHA, by specialty, 473 use of all VA services, 430–431 use of non-VHA M/SU treatment services, 437–438 use of VA mental health services, 431–432 who used VA services, population characteristics of, 464–467 Veterans Health Administration (VHA), 160, 172–173, 181, 427 administrative organization, 434–435 Quality Enhancement Research Initiative, 173 Violent behavior. See Dangerousness W Waste in health care, continuous decrease in, 9, 58 Weakened patient activation and self-determination, 83–84

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Improving the Quality of Health Care for Mental and Substance-Use Conditions Wellness Recovery Action Plan (WRAP), 121 Workforce capacity for quality improvement, 2, 286–324 chronology of well-intentioned but short-lived initiatives, 312–315 critical role and limitations to its effectiveness, 288 greater variation in the workforce treating M/SU conditions, 288–294 inadequate continuing education, 305–308 insufficient diversity of, 290 more solo practice, 309–310 need for a sustained commitment to bring about change, 315–317 problems in professional education and training, 294–304 recommendations for, 20–21, 317–319, 382–383, 386 summary, 286–288 use of the Internet and other communication technologies for service delivery, 310–311 variation in licensure and credentialing requirements, 304–305 Workforce shortages and geographic maldistribution, 289 Workload, 478 of specialized VA mental health programs, 474 Workplace productivity, 39 World Bank, 37 World Health Organization, 37