USDOJ ADA Oregon Investigation Matrix

Oregon Behavioral Health System Development and Program Outcome Measures
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Targeted Population: Adults with serious and persistent mental illness (SPMI) with a special emphasis on those eligible to receive Title
XIX services.

Targeted Areas

System Development Measures

Program Outcome Measures

I. Behavioral
Health Crisis
System

A. Identification of statewide and regional barriers to development of
comprehensive behavioral health crisis system and strategies that will
be implemented to achieve identified program outcome performance
standards/goals.

1. Ability to effectively manage behavioral health crises in a
community setting as measured by:
___# of emergency room visits for adults with SPMI who
are in crisis
___# of inpatient hospital admits for adults with SPMI that
are the result of a behavioral health crisis
___# of adults with SPMI whose incarceration or jail time is
related to a behavioral health crisis
__# of individuals diverted from the criminal justice system
by law enforcement referral or linkage to the behavioral
health crisis system
___# of adults with SPMI whose homelessness or loss of
housing is related to a behavioral health crisis(es)
Note: Last three bullets are a system issue, for subsequent
discussion/

2. Ability to provide appropriate access to behavioral health
crisis services as measured by:
Behavioral health crisis hotline call standards, e.g., 24/7
coverage, response rates of 5 rings/30 seconds, abandonment
rate
CCOs meeting geographical access standards for each of the
following behavioral health crisis services: mobile crisis,
crisis walk-in clinic visit, crisis apartment/respite, and short-
term crisis stabilization, frontier alternatives
___% of mobile crisis teams that meet the timeliness of
response standard
___% of walk-in/drop-off crisis centers that meet the wait
time standard Note: Last three bullets for 2
nd
or 3
rd
year.
B.
1. ___# of Coordinated Care Organizations (CCOs) that operate a
single 24/7 behavioral health crisis hotline.

2. ___# of CCOs that teach law enforcement Crisis Intervention
Training and how to access the behavioral health crisis system

3. ___# of providers offering each of the following behavioral health
crisis services:
Mobile crisis teams
Walk-in/drop-off crisis centers
Crisis apartments/respite
Short-term crisis stabilization units
Agreed-upon alternatives to above crisis services in frontier area

C.
___% of service dollars for adults with SPMI that are used for each
of the following behavioral health crisis services:
Crisis hotline calls
Mobile crisis team
Walk-in/drop-off crisis centers
Crisis apartments/respite

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Targeted Areas



Short-term crisis stabilization days/visits

___# of service units per month per adult with SPMI who
receive each of the following behavioral health crisis
services: crisis hotline, mobile crisis, walk-in/drop-off crisis
center visit, crisis apartments/respite, short-term crisis
stabilization, and frontier alternatives.
___% of adults with SPMI (and or their family) that report
positively about the system response to a behavioral health
crisis event

3. ___% of adults with SPMI who have had a behavioral health
crisis and who experienced an improved level of functioning XX
months after the crisis event.

4. For those adults with SPMI who have a behavioral health
crisis event:
___% of adults who had a crisis intervention plan
___% of crisis intervention plans that were followed during
the crisis
___% of crisis intervention plans that were effective in
preventing an inpatient admission and/or emergency room
visit and/or jail admission.

D.
1. ___# of service units per adult with SPMI per month for each of
the following behavioral health crisis services:
Mobile crisis team
Walk-in/drop-off crisis center visits
Crisis apartment/respite visits

2. ___# of adults with SPMI who received each of the following
types of behavioral health crisis services:
Mobile crisis team
Crisis apartment/respite visits

E.
___% of the care plans for adults with SPMI that include a current
crisis intervention plan.


Targeted Areas



II. Independent
Supported Housing
independent supported housing for adults with SPMI and strategies
that will be implemented to achieve identified program outcome
performance standards/goals.

1. ___% of adults with SPMI who have been living (e.g., own
home, supported housing) in the community in a safe, stable
living environment for XX days. Note: Not first year.

2. ___# of adults with SPMI who reside in each of the following
settings:
Supported housing or own home
State Hospital
Adult foster care
Residential treatment home
Residential treatment facility
Secured residential treatment facility

3. The average length of stay for adults with SPMI in each of the
following settings:
An inpatient hospital setting
A State Hospital
Adult foster home
Secure residential treatment facility

4. ___% of adults with SPMI who are living in a setting that is
at the appropriate level of care.

B.___# of available independent supported housing units for adults
with SPMI.

C. ___# of adults with SPMI who:
Reside in each of the following types of settings: independent
supported housing, own home, State hospital or a residential
care
1
setting
Moved from the State Hospital, inpatient hospital or residential
care setting into an independent supported housing setting
Moved from homeless shelters or jails into an independent
supported housing setting
Note: First bullet is for CCOs, second is for state to measure

D.1. ___% of service dollars for adults with SPMI living in supported
independent housing that are used for each of the following services:
Non-Title XIX supported housing services (e.g., rental subsidy,
move-in costs)
Community-based behavioral health services (e.g., ACT teams,
peer support, supported employment)

2. ___% of service dollars for adults with SPMI that are used for care
provided in:

1
Residential care refers to the four types of residential care in Oregon: adult foster homes, residential treatment homes, residential treatment facilities and secure
residential treatment facilities. The information for the measure would be provided for each type of residential care.

Targeted Areas



State Hospital
Each of the four types of residential care settings

___% of adults with SPMI who are homeless.

5.
___% of adults with SPMI reporting positively about:
Their living environment
Availability of independent supported housing and housing
support services (e.g., rental subsidy, move-in costs)
Note: OHA to measure, not CCOs.

E. ___# of services units per adult with SPMI per month for each of
the following:
Non-Title XIX supported housing services (e.g., rental subsidy,
move-in costs)
Community-based behavioral health services (e.g., ACT teams,
peer support, supported employment)
Services provided in each of the four types of residential care
settings
Services provided in the State Hospital

III.Community-
Based Behavioral
Health Services

comprehensive community-based behavioral health services for
adults with SPMI and strategies that will be implemented to achieve
identified program outcome goals/benchmarks

1. ___% of adults with SPMI who:
Are employed
Have abstained from drug/alcohol use
Had a criminal justice event (jail, arrest, other interaction
with law enforcement, etc.)
Had a homeless event
Note: OHA to survey, not CCOs.

2. ___% of adults with SPMI who report that their se functional
level improved.

3. ___% of adults with SPMI reporting positively about each of
the following:
Outcomes (i.e., perception of care)
Improved level of functioning

B. ___# of providers offering each of the following community-
based behavioral health services:
Assertive community treatment
Crisis apartment/respite care
Intensive case management (out of office)
Peer support
Supported employment
Psycho-education and living skills training
Note: Above will be measured ifcovered by Medicaid.


Targeted Areas



Mobile crisis team

Service quality and appropriateness.
Social connectedness

___% of adults with SPMI who filed complaints related to:
Quality of care (substantiated and unsubstantiated)
Access and availability to services
Effectiveness/appropriateness of services
Note: OHA to gather complaint data for all receiving MH
services

5. Ability to provide appropriate access to community-based
behavioral health services as measured by:
CCOs meeting geographical access standards for each
community-based behavioral health service
___% of newly enrolled adults with SPMI who receive their
first routine services within XX days of their initial
assessment
___% of community-based behavioral health providers who
met the appointment availability standards for emergency,
urgent and routine care
___% of community-based behavioral health providers who
met the wait time standard
___% of adults with SPMI who reported positively about
their ability to access community-based behavioral health
services
___# of service units per month per adult with SPMI who
receive each of the community-based behavioral health
services.
For those with SPMI, the lengthy of time from enrollment
until first visit with provider of health services?

C. ___% of service dollars for adults with SPMI that are used for
each of the following community-based behavioral health services
2
:
Peer support
Non-Title XIX supported housing services
Mobile crisis team

D. ___# of service units per adult with SPMI per month for each of
the following community-based behavioral health services:

2
The list of community-behavioral health services may need to be modified once a specific description of the covered behavioral health services for
adults with SPMI is developed.
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Targeted Areas



Peer support
Mobile crisis team

community-based behavioral health services:
Peer support
Mobile crisis team
Note: For those receiving Medicaid servicescies
___% of those with SPMI who receive routine health care
visists after enrollment?

6. ___# of adults with SPM residing in each of the following
settings:

Own home/supported housing
A State Hospital
Adult foster home

7. The average length of stay, admission and readmission rate
for adults with SPMI in each of the following settings:
An inpatient hospital setting
A State Hospital
Adult foster home

8. Coordination of care between physical health and behavioral
health providers is demonstrated by:
___% of behavioral health providers that communicate the
outcomes of a referral and/or service plan to the adult with
SPMIs primary care provider (PCP)
___% of behavioral health providers that have ongoing
communicate with the PCP for the adult with SPMI
___% of adults with SPMI who have had a PCP visit within
the past 12 months

E. ___% of adults with SPMI that have a current care plan (e.g., has
been reviewed and updated with the past XX months).


Targeted Areas



F. ___% of adults with SPMI that have had a PCP visit within the
past 12 months.

IV.Screening,
Assessment and
Early Intervention
Services

screening, assessment and early intervention services and strategies
that will be implemented to achieve identified program outcome
performance standards/goals.

Ability to provide effective early intervention services as
reflected by:
___# of emergency room visits for adults with SPMI
___# of inpatient hospital admits for adults with SPMI
___# of 30 and 180 day readmission rates for inpatient
psychiatric care for adults with SPMI
___# of adults with SPMI that are referred/moved to the
State Hospital and/or one of the four residential care settings
___% of adults with SPMI with a criminal justice event (jail,
arrest, other interaction with law enforcement, etc.)
___% of adults with SPMI with a homeless event
Note: Last two are longer term issues.

Ability to provide appropriate access to early intervention
services as measured by:
CCOs meeting geographical access standards for each early
intervention health service
___% of newly enrolled adults with SPMI who receive their
first routine services within XX days of their initial
assessment
___% of providers who met the appointment availability
standards for early intervention services
___% of providers who met the wait time standard
___% of adults with SPMI who reported positively about
their ability to access assessment and early intervention
services
____# of service units per month per adult with SPMI who
B.
1. ___% of adults with SPMI that have current bio-psycho-social
assessments and a care plan that has been reviewed and updated
within the past XX months.

2.___% of adults with SPMI who have had a level of care assessment
during the past 12 months.

3. ___# of behavioral health screens (e.g., depression, substance
abuse) conducted by PCPs during initial health screens of newly
enrolled adults (all adults enrolled in a CCO not just adults with
SPMI).
Note: CCOs to baseline category B in second year.

C. ___# of providers offering each of the following early intervention
services:
Assessment (initial and review)
EASA program
Intensive in-home services/Assertive Community Treatment
Intensive case management


Targeted Areas



D. ___% of service dollars for adults with SPMI that are used for
each of the following early intervention services:
EASA program

receive each of the assessment and early intervention
services.
For those with SPMI, the length of time from enrollment
until first visit with provider of health services?
___% of those with SPMI who receive routine health care
visists after enrollment?

3. ___% of adults with SPMI whose report that their functional
level improved.

4. ___% of adults with SPMI reporting positively about each of
the following:
Satisfaction with the screening and assessment process
(including participation in the service planning process)
Note: Above bullet is longer term issue.
Outcomes (i.e., perception of care)
Improved level of functioning
Service quality and appropriateness

E.
1. ___# of service units per adult with SPMI per month for each of
the following early intervention services:
EASA program

assessment and early intervention services:
EASA program

3. ___% of adults with SPMI who had a follow-up after
hospitalization within 7 days and within 23 days.

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Targeted Areas



V. Quality
Assessment and
Process
Improvement
(QAPI) Program

A. Conduct assessment of current Quality Assessment and
Performance Improvement (QAPI) program and develop a plan for
establishment of a QAPI program that integrates behavioral health
and physical health at the State and individual CCO level. For the
CCOs this includes development of contractual requirements related
to QAPI.

1. New QAPI program is successfully implemented at the State
and each CCO establishes a QAPI program that meets
contractual requirements.

2. QAPI program structure at the State and CCO level is able to
demonstrate the operation of an effective system for continuous
quality improvement (identification of areas for improvement,
implementation of interventions, and improved outcomes).

3.The statewide comprehensive data system:
Includes accurate and timely encounter/claims/and client
demographic/clinical data for adults with SPMI.
Generates key management reports, including dashboards
with program outcome scores (statewide and at individual
CCO level).
Note: Timely and clinical data need to be defined.
4.The individual CCOs have methods data systems that are able
to
Identify adults with SPMI who are high-risk and would
benefit from intensive services. such as intensive case
management, ACT etc.
Generate key QAPI-related management reports, including
those that are submitted to the State

5. State meets agreed-upon outcome benchmarks and/or
implements interventions that result in improved outcome
values. Statewide PIPs successfully achieve outcome goal(s)
and demonstrate the ability to sustain the positive outcomes.

B. Establishment of integrated QAPI structure (committees, staff) at
State and individual CCO that includes expertise in the delivery of
care to adults with SPMI.

C. Development and implementation of comprehensive data system
(data warehouse) that allows for real time analysis of
encounter/claims and client demographic/clinical data and
monitoring of care delivered to adults with SPMI at level of
individual client, individual provider, individual CCO and overall
system of care.

D. Development of management reports and dashboards that allow
for monitoring of system performance for adults with SPMI.

E. Identification of statewide Performance Improvement Projects
(PIPs) that seeks improvement in an one of the identified areas of
poor performance in the behavioral health system for adults with
SPMI, one of which is behavioral health. .


Targeted Areas



VI.Maximization of
Title XIX
Funds

A. Identification of statewide and regional barriers to
maximizing use of Title XIX funds and strategies that will be
implemented to achieve identified program outcome performance
standards/goals. This includes examining:
The Supplemental Security Income (SSI) and Title XIX
eligibility process for adults with SPMI
The types of funding (e.g., Title XIX, non-Title XIX) that are
used to pay for specific types of behavioral health services
The Title XIX status and qualifications of providers offering
behavioral health services to adults with SPMI

1. ___% of adults with SPMI in the Oregon behavioral health
system who:
Have been determined Title XIX eligible and are enrolled in
the States Medicaid program
Have been determined SSI eligible
Are eligible for Title XIX but are not enrolled in the States
Medicaid program
Have been denied Title XIX eligibility due to non-
completion of the application

2. ___% of Title XIX behavioral health services that are
provided to Title XIX adults with SPMI that that are paid for
with:
Title XIX funds
Non-Title XIX funds

3. ___% of behavioral health service dollars for Title XIX adults
with SPMI that are paid for with Title XIX funds.

4.___% of behavioral health providers/practitioners who are
qualified Title XIX providers and are able to receive Title XIX
dollars for the services they provide.

Notes:
1. Except if indicated the system development and program outcome measures will be calculated:
For the adult population with SPMI as a whole as well as for the Title XIX and non-Title XIX adult population with SPMI
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On a statewide basis and for each individual CCO (or the state-contracted entity responsible for delivering the behavioral health
services to adults with SPMI).
Using a comprehensive behavioral health data set that includes data from the mental health and substance abuse systems.
2. For each of the system development measures, a baseline along with two years of annual interim benchmarks will need to be
established.
3. For each of the program outcome measures, a baseline along with a program outcome goal and an annual minimum performance
standard will need to be established.

USDOJ ADA Oregon Investigation Matrix

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USDOJ ADA Oregon Investigation Matrix

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Oregon Behavioral Health System Development and Program Outcome Measures

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