We successfully completed a 3.5-year evaluation of Colorado’s State Innovation Model (SIM) project, a statewide effort to support greater integration of behavioral and physical healthcare, encourage the expansion of value-based payment models, and improve population health by helping communities address stigma and other barriers to care access across the state. SIM was funded by a $65 million federal grant from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. Serving as the program’s evaluator, we worked with SIM leadership, state and local stakeholders comprising eight subject matter work groups, University of Colorado program technical support providers, public and private payers, and complex data systems to design and complete an evaluation that responded to 26 distinct questions that addressed lessons learned from the statewide implementation as well as practice, patient, and cost outcomes. The project utilized a complex matched comparison group design for some outcomes analyses.
We are working with the Anne and Henry Zarrow Foundation in Tulsa, Oklahoma to assist in the formation of a new mental health policy endeavor, Healthy Minds Policy Initiative of Oklahoma. The foundation-funded effort aims to develop, with broad community collaboration, a behavioral health system improvement strategy. Our role includes helping the community assess, educate, design, and support implementation of large system-level improvements. The project involves data analysis, program development, and convening dozens of stakeholders across adult, child, and family systems in diverse fields (justice, public education, mental health care, substance use services, higher education, state and local governments, private foundations, and community organizations).
We provided qualitative data collection and analysis in support of a pilot project that tested better ways to serve people with developmental or intellectual disabilities during a mental health crisis. We conducted site visits, including a desk review of client files and program planning documents, and compliance reviews to compare practice to requirements. Likewise, we interviewed clients, families, staff, and administrators to obtain diverse perspectives about current challenges and as well as to include information about the impact of social determinants of health on access to services. We were selected for this project, in part, because of our clinical expertise in working with people who have mental illnesses and developmental disabilities. We were praised for the high quality of our written products and our team’s ability to quickly build relationships with clients, staff, and administrators.
For five years, we worked together with the state of Washington to evaluate its Family Assessment Response (“FAR”) program, implemented under a federally monitored Title IV-E Waiver Demonstration. For this project, we interviewed administrators and caseworkers at over 40 offices across Washington. We designed and implemented an evaluation plan that included interviews with parents who were participating in FAR, which were conducted by “parent allies” who have had involvement with child protective service. We also worked with large data systems from multiple state agencies to analyze outcomes for children, youth, and families as well as program costs. We implemented a matched comparison group design to take advantage of the programs’ rolling implementation plan to ensure the most robust evaluation design possible. We were able to provide ongoing program feedback through regular agency briefings, reports, and legislative testimony that led to substantive changes in legislative policy and helped reduce out-of-home placements for children and families.
On behalf of the United States District Court appointed court monitor, and in collaboration with the Washington Department of Social and Health Services, TriWest conducted a forensic bed demand study focused on inpatient competency evaluation and restoration. We analyzed factors that were potentially driving a recent spike in statewide bed demand. Using referral data, we designed a model that calculated how long patients were likely to wait for available beds at the two state hospitals. The model showed how many additional beds were needed to satisfy court-ordered limitations on waitlists. We also created a web-based tool that allowed our client to make future changes in the forecast model based on changing assumptions about the growth rate of bed demand.
We worked with the Saginaw County Community Mental Health Authority for eight years as evaluator and consultant for their System of Care and Expansion Grants. The SAMHSA-funded grants were intended to develop and expand a single, integrated system of care to provide comprehensive, community-based mental health services and supports for Saginaw County youth and their families. In the early stages, we helped develop the grant application and then provided technical assistance on grant implementation, service components, and project staffing and facilitated strategic planning and logic model development. Local evaluation activities included a Cultural and Linguistic Competency assessment of the family leadership team, a Family Involvement assessment, key informant interviews to assess stakeholder perceptions of the grant process and progress, Wraparound fidelity assessments through team observations, and management of the project Government Performance and Results Act National Outcome Measures requirements. The national evaluation activities included data analysis, monthly reporting, completion of a services and costs study, and completion of longitudinal outcome study interviews with youth and their caregivers, which were conducted by a parent interviewer with the experience of raising a child who has a mental illness or serious emotional disturbance. We also convened an evaluation advisory group with community stakeholders, including youth and family members, to help us interpret data through a local context.
We worked as the evaluator of the Paso del Norte Health Foundation’s Think.Change Stigma Reduction Initiative, which was aimed at reducing the prevalence of mental health stigma in El Paso, Texas; Las Cruces, New Mexico; Deming, New Mexico; and Juarez, Chihuahua, Mexico. We developed surveys and outcome instruments to assess the impact of grantee-selected mental health stigma reduction activities such as Youth and Adult Mental Health First Aid, National Alliance on Mental Illness (NAMI) courses, and locally developed courses for promotoras (health workers) in colonias. We completed a population survey to assess mental health stigma in the region and evaluated the perception of stigma among residents with mental illness and their families. We translated surveys and tools into Spanish to ensure that individuals who preferred Spanish or were primarily Spanish speaking were able to complete surveys.