NCPIC was formed under the direction of Flo Stein, chief, community policy management, to address a key element in statewide transformation of the mh/dd/sas system, namely what services should be available for consumers. This advisory group makes recommendations for supporting services known to actually lead to improvements in consumers’ lives. Programs that have been evaluated are available for review on the web at www.ncpic.net.

Robert Gettings, executive director, National Association of State Directors of Developmental Disabilities Services provided a keynote address at the Congress. In this role, he is responsible for representing the interests of the fifty state developmental disabilities agencies in Washington, D.C. and facilitating communication among the states concerning the most effective means of serving citizens with lifelong disabilities.

Gettings described several key issues for improving the quality of services. He discussed the need for reducing reliance on state institutions, improving case management performance, having better capacity for intervening in a crisis, promoting grassroots acceptance of people with disabilities, improving strategies for serving individuals with co-occurring disabilities and building stronger community support agencies.

Another keynote speaker, Dr. H. Westley Clark, director of the Center for Substance Abuse Treatment under the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, leads the agency's national effort to provide effective and accessible treatment to all Americans with addictive disorders. Clark noted that “selecting evidence-based practices is one stage but that actually implementing an evidence-based practice is a very different thing.” He described several initiatives sponsored by SAMHSA to assist states and local consumers and providers in improving services.

Mike Moseley, Divison director, closed the program by saying, “In the next year, I would like to set forth these goals for the NCPIC and our Division, to consider practices for underserved consumers, to provide leadership in the difficult areas of adopting evidence-based practices and to consider issues of workforce education.”

Robert M. Gettings, Executive Director, National Association of State Directors of Developmental Disabilities Services, presented on “National Goals regarding Improving Quality for Clients and Families”. A copy of his PowerPoint presentation can be downloaded from www.governorsinstitute.org.

Mary Powell, Associate Executive Director, Governor’s Institute on Alcohol and Substance Abuse, provided a brief overview of the best practices that were recommended to the Division by the three subcommittees. The Division will conduct the analysis to determine the feasibility of adopting these practices in North Carolina. The evidence-based practices (EBPs) included the following:

Developmental Disability PIC

• The CMS Quality Framework, Shealey Thompson, Ph.D., NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services
• Community-Based Crisis Services for DD, Don Kincaid, University of South Florida

Substance Abuse PIC

• Matrix Model of Methamphetamine, Sam Minsky, Clinical Trainer, UCLA Integrated Substance Abuse Programs and Matrix Institute on Addictions
• TELE Protocol, Robert Hubbard, Ph.D. , National Development and Research Institute
• Seeking Safety: Treating Post Traumatic Stress Disorders, Lisa M. Najavitz, Ph.D., Associate Professor, Department of Psychiatry, Harvard Medical School
• Cognitive Behavioral Therapy for relapse prevention, George Parks, Ph.D., University of Washington

Mental Health PIC

• Evidence Based Practices for Childhood Trauma: Trauma-Focused Cognitive Behavioral Therapy, Abused-Focused Cognitive Behavioral Therapy, and Parent Child Interaction Therapy, Robert A. Murphy, Ph.D., National Child Trauma Stress Network, Duke University
• Integrated Treatment for Dual Disorders and Illness Management and Recovery, Kim T. Mueser, Ph.D., Professor, Departments of Psychiatry and Community and Family Medicine, NH-Dartmouth Psychiatric Research Center, Dartmouth Medical School
• Family Psychoeducation/Family to Family Education Program/Family Member Provider Outreach, Lisa Dixon, MD, MPH, Professor of Psychiatry, University of Maryland School of Medicine, VA Capitol Health Care Network, MIRECC

A panel from each PIC subcommittee then presented.

Developmental Disability PIC

• Connie Cochrane talked about the future of quality services for consumers and the need for the State, providers, and consumers to agree on outcomes. Each stakeholder has its own perspective, which affects how outcomes are viewed. He presented a graph that depicted the interest level of these three stakeholders outcomes such as price, access, standards, and person-centered goals, to name a few.
  
  Future of Quality Presentation
• Jeff Holden emphasized the need for common definitions and language. We must meet the challenge of operationalizing issues on which we agree (e.g., staff training, EBPs).
• Martha Thompson advocated for more staff and administrative training on the concept and value of person centeredness. Existing community resources must be used to support consumers, and providers must connect more with community supports. Service practices must be enhanced to reflect the needs of consumers, thereby preventing crises and hospitalizations.

Substance Abuse PIC

• Robert Hubbard emphasized that the collaboration between researchers and clinicians is bidirectional and interactive. In order to improve services, we must try to implement what we already know, using results from clinical trials and NC-TOPPS data more effectively.
• David Turpin stated that his agency, SouthLight, had been involved in community-based research through NC-TOPPS, the Clinical Trials Network, and the CSAT-funded Practice Improvement Collaborative. He identified implementation barriers, which included ongoing staff training, need for credentialed staff, and money to implement new and improved clinical services. He stated that most community programs don’t have sufficient money to address all the barriers adequately. He also noted that we must continue to work to decrease the stigma associated with substance abuse.
• Breque Tyson found that the evidence-based practice, Seeking Safety, was highly generalizable to different populations (e.g., abused women, combat veterans). The fact that the practice is manualized into 25 modules is also helpful in that staff can implement the model with little training. However, she felt that training is still necessary and touted the use of train-the-trainers since staff turnover can be an issue. Trained clinical supervisors to conduct the monitoring and evaluation are also needed. Evaluation that looks at fidelity to the model is also desirable.

Mental Health PIC

• Jack Haggerty promoted the value of the PIC and stated that it must be an ongoing, creative process, to review both existing best practices and emerging practices, possibly from North Carolina researchers. He noted that one of the challenges is to take best practices developed by those in the community to academic programs so that students may be educated on EBPs. He stated that this is currently not happening in psychiatry programs due to various pressures (e.g., meeting external program certification standards, curricular pressure to include specific content, intense financial pressure to keep the department afloat). He then talked about the strategy, “see one, do one, teach one”, and applied it to the psychiatric residents. Under “see one”, residents receive lectures on the EBPs. “Do one” requires that residents gain valuable hands-on experience—this is beginning to happen, primarily through ACT teams. “Teach one” entails the concept of evidence-based thinking and problem solving, with the idea of continuous quality improvement. It is important to remain flexible, however, to local needs and culture.
• Kim Franklin stated that as a provider, she is very much interested in the EBP toolkits. The approach in the MH toolkits is recovery oriented and is cognizant of the value of peer support staff, with a focus on empowerment and skill building. She noted that specific service definitions—community support, community support team, peer support specialist, and psychosocial rehabilitation—served as umbrellas for EBPs. She emphasized the need for training and accountability. EBPs enable providers to hold up under audit since they provide structure and definitions and build the case for medical necessity. Fidelity tools take the burden off of clinicians and assist in staff training and accountability. Dr. Franklin listed five challenges: (1) assisting clinicians in making the shift to a more focused, structure, EBP approach, (2) assisting clinicians in making the shift to more accountability, (3) attempting to compete with providers who provide more familiar, traditional approaches to treatment which may be preferred by consumer, (4) loss of staff to providers who continue to provide more traditional approaches to treatment, and (5) considerable cost to provider in terms of training and supervision of staff involved in the model.

Flo Stein identified adoption as the primary problem. The Division may be able to absorb some of the costs associated with training and supervision. The PIC is prepared to move forward, with the Division conducting the analyses (e.g., cost, feasibility) of the recommended best practices. She recommended that the audience review the PIC website (www.governorsinstitute.org). She also noted that Secretary Carmen Hooker Odum is on an EBP task force for the Institute of Medicine and is very much interested in the work of the PIC.

In his closing remarks, Michael Moseley, Director, Division of Mental Health, Developmental Disabilities and Substance Abuse Services, NC Department of Health and Human Services, noted that the Division gives the PIC initiative high priority. He said that the system is about to receive a significant infusion of funds from the Governor and state legislature and that he is pleased with the level of commitment and investment. At the October 2005 meeting of the PIC, the Division emphasized its commitment to providing quality services to consumers in their home communities. He said that stigma continues to be a problem, and the challenge is to change the culture and the communities so that they support consumers with disabilities. This time marks a period of significant change in our service delivery system, with the need for highly trained providers, an improved service array through the service definitions and enhanced benefits, and improved management. However, the essential goal has not changed—to provide the most effective supports and services. The Division will look at the recommendations and analyze that practices that were presented. He will meet with Mike Lancaster, Flo Stein, and the clinical leadership to review the analysis. Three goals were identified: (1) analyzing the counseling needs of underserved populations, (2) providing leadership for adoption, and (3) considering workforce leadership and education.