A Unique Approach To Performance Standards For Clinicians In A CMHC

by

JOHN QUINN

ABSTRACT:

Performance standards were developed for clinicians of a large comprel~ensive mental health center. Clinicians were required to provide a minimum average o] 20 hams o] Jace-to-Jace service per week. Credit values, rangh~g from .5 to 3.0, were assigned for each hour o/service provided based on the diMiculty o f the service to de#ver and the amount o[ paperwork required. Total credits u,ere comidered as an extra accomplishment and utilized as a criterion for determin- h~g merit increases. The results indicated an increase in the utilization of [amily and group therapy as well as a more equitable system /or evaluath2g widely dif/ering services.

A UNIQUE APPROACH-TO PERFORMANCE STANDARDS FOR CLINICIANS IN A CMHC

A survey1 of twenty-seven comprehensive mental health centers in a four state area indicated that twenty- three centers based their performance standards on the number of hours of face-to-face therapy with patients. The remaining centers required their clinicians, to generate a certain level of revenue to justify employ- ment.

A CMHCZ, not included in the above survey, has developed a model for rating staff performance which involves an assessment of the patient's level of functioning, patient satisfaction, patient cost and number of hours.

Red Rock is a four year old comprehensive mental health center which provides the V, velve standard services. The agency discovered that the traditional performance standards of one credit for each hour of therapy were not sufficient to measure the productivity of the staff since their tasks varied greatly from one service element to another. An additional drawback was that individual therapy was being utilized almost exclusively, even in cases where family or group therapy was more appropriate, due to the vast amount of paperwork-required by state guidelines on eada patient seen.

Performance standards based on the amount of income generated by clinicians were not feasible since most of Red Rock's clientele have low incomes and pay for services according to a.sliding scale.

In the fall of 1981, Red Rock began developing

utilization of treatment modalities other than individual and provide credit for each clinician's responsibilities, regardless of service. The Director of Clinical Services met with each service director following input from the clinicians. A credit value was established for the important activities of each service (Table I) . Credits ranged from .5 for each service hour in transporting clients to 3.0 credits for each hour in conducting a family intake. Each clinician is expected to average a minimum of 20 hours of face-to-face service per week to be eligible for a merit pay increase with the total number of credits utilized as a criterion for determining the amotmt.

Since this procedure was implemented two jrears ago, there has been an increase in the utilization of family and group therapy of 57 and 12 percent respectively, when compared with the previous year. Clinicians report that they perceive an increased aware- ness by the administration of dxe importance of their role as a result of the new performance standards.

Data is currently obtained for each patient's level of functioning, satisfaction with treatment and unit cost as part of the agency's quality review process, but is presently not included as part of performance standards. Future plans are to revise the existing point scale to take these factors into account and encourage more difficult clients to be seen by clinicians.

A UNIQUE APPROACH TO PERFORMANCE STANDARDS FOR CLINICIANS IN A CMHC

Table I

Individual Therapy Family Therapy Group Therapy (5 or less) Group Therapy {6 or more} Consultation and Education Supervision Given Complete Psychological Evaluation Transporting Patients Medicine Clinic Hospital Liaison Home visit, Outreach Resource Development Case Management Advocacy Individual or Marital Intake Family Intake Telephone/Emergency

1 hour service/1 credit 1 hour service/i 1/2 credits 1 hour service/1 I/2 credits I hour service~2 credits 1 hour service/I credit 1 hour servke/1 credit 1 hour service/1 credit 1 hour servicell/z credit 1 hour service/11/2 credits 1 hour service/1 credit 1 hour service/1 credit 1 hour servlce/l credit 1 hour service/1 credit 1 hour service/1 credit 1 hour service/2 credits 1 hour service/3 credits i hour service/1 credit

page) performance standards that would fairly compensate (continued on next - 3 1 -

THE LEFT HAND FINALLY MEETS THE RIGHT: DEVELOPMENT OF LINKAGES BETWEEN A STATE HOSPITAL AND COMMUNITY MENTAL HEALTH CENTERS- W H Y IT WORKED AND CONTINUES TO WORK

by KIM B. KUETEMAN AND GREER FITES

ABSTRACT

In January, 1981, Central State Hospital and eight Community Mental Health Centers within the Hospital's Service Area formed a Task Force for the purpose o~ strengthening linkages. Several concrete accomplish- ments have resulted and continue to result due to the efforts o/this Task Force. The Authors describe why they believe the Task Force has bee;; so successful. (This article was part o/ a presentation made at the 1983 Annual Meeting o/ the Association of Mental Health Administrators in San Antonio.)

INTRODUCTION - - During the early months of 1981, Central State Hospital, one of three (3) State Hospitals in Oklahoma, together with eight (8) Community Mental Health Centers within the Hospital's Service Area, formed a Linkage Task Force3 The purpose of the Task Force was to strengthen the over- all planning process; to formalize the linkages between the mental health service providers in the Service Area; to identify the gaps in services with the aim of converting these gaps into linkages; and to serve as an on-going forum for communication and exchange of ideas.

Over a period of almost three (3) years, the Linkage Task Force has met on a regular monthly basis. Some very fundamental and concrete accomplish- ments have grown out of the activities of this group. A written agreement formalizing the referral process, specifying roles, responsibilities, and procedures has

(A UNIQUE APPROACH - - Cont.)

REFERENCES

! Zawadski , S. Results at an unpublished survey af CMHC's in a faur state a rea , 1980.

2 Barrett, T.; DeHaan, J. "A Model far Evaluating Staff Per. formance in a Mental Health Center" , HOSPITAL AND C O M - MUNITY PSYCHIATRY, 3115): 547-548, 1980.

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BIOGRAPHICAL SKETCH

Quinn, lohn, Ph.D. - - is the Director o/ Clinical Services at Red Rock Comprehensive Mental Health Center, 214 East Madison, Oklahoma City, OK. This paper was presented at the Annual Meeting o/ the National Council o/ C.M.H.C., March, 1983, in Detroit, Michigan.

been developed. Orientation to the services of the Hospital and the CMHC's has been presented. A comprehensive and detailed review of the gaps in services within the Service Area, including recommend- ed actions to convert these gaps into linkages has been conducted, summarized into a written report, and presented to the Regional Executive Committee (com- posed of the Hospital Superintendent and CMHC Directors). The Regional Executive Committee, having reviewed and endorsed the Task Force's report, has begun to address those issues which the Task Force identified as needing further clarification and authority to produce change. A Patient Tracking Mechanism has been developed which includes pre-discharge confer- ences with patients and CMHC personnel, as well as weekly reports to the CMHC's from the Hospital detailing names, addresses, and other pertinent infor- mation about patients discharged into their Service Area.

WHY IT WORKED (AND CONTINUES TO WORK) - - After almost three years of operation, it is difficult to imagine functioning without the Linkage Task Force. Although the concept of a linkage group is neither unique nor innovative, previous efforts at organizing such a group failed. While reasons for previous failures are not known, there are some indications for why this latest effort succeeded. We have identified six (6) reasons involved with the success of the Task Force. While several of these are essential to the organization of any profitable meeting, others 'are specific to the formation of such a linkage meeting.

1) Consistency - - Meetings were always held on the same day of the month, the same day of the week, the same time, and in the same location. Meeting notices were always sent out two weeks prior to each meeting, as an additional reminder.. Membership remained essentially the same, being Aftercare or Clinical Directors from the CMHC's and unit representatives from the Hospital. Meetings started on time and always ended at the designated time, regardless of the .discussion. A "fifteen minute warning" was given when needed to allow time to wind down and bring closure to discussion. Each meeting had a printed agenda, which was sent out with the meeting notices. All items on the agenda were addressed, even if very briefly.

2) 1Veil-planned Meetings - - A great deal of effort

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