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Statewide Outcomes Project

Contact: John Ward, PhD; Michael Dow, PhD; Teri Saunders
The de la Parte Institute

When the Government Performance and Accountability Act of 1994 was passed by the Florida State legislature, it required all state agency budgets to be evaluated annually by performance measures using the Performance Based Planning and Budgeting (PB2) process. These measures encompass three areas of evaluation. The first is the input component, which refers to the amount of resources used; the second is output, which is related to the types of services provided including the recipients of the service, and finally, the outcome which consists of the results of those services delivered. Its intention is to measure the impact of mental/behavioral health services on the individual and community as well as an attempt to establish agency accountability to their consumers and stakeholders. Consequently, this legislation induced the inception of this project along with the task of developing instruments and testing their reliability/validity for efficacious measurement of the outlined state requirements.

The Department of Mental Health Law and Policy was chosen to conduct a multi-faceted research project to measure the outcome of mental health services provided to consumers by state funded agencies. The Florida Department of Children and Families funded two projects: the Statewide Outcomes Project and the District 7 Project.

Several instruments are used to measure outcome and satisfaction. The Functional Assessment Rating Scale (FARS) was developed from the Colorado Client Assessment Record. The Behavioral Healthcare Rating of Satisfaction (BHRS) was developed with consumer and provider input to measure consumer satisfaction and experience with services. Another instrument that was implemented fiscal year 1999-2000, was the Children's version of the FARS, known as the Children's Functional Assessment Rating Scale (CFARS). The state of Wyoming is also using the FARS and CFARS and Arizona is using the CFARS to monitor behavioral healthcare outcomes. In addition, the FARS, CFARS, and BHRS are included as JCAHO approved outcomes measures in the ORYX outcomes system operated by the investigators of this project. The prospect exists for more states to engage in similar endeavors as the competition increases for the circumscribed fiscal resources allocated for mental/behavioral healthcare.

FARS allows the clinician to document and standardize clinical impressions using cognitive, social, and role functioning as the assessment focus. However, the FARS software provides a means of collecting, aggregating, and evaluating data that is pertinent to the mission and function of the agency. It can identify consumers who benefit from particular types of services, provide comparisons of outcomes from similar services or programs, evaluate if consumers' needs are being met with available resources, and distinguish services that can serve as portent for effective models of care. The software also allows for rapid reporting to various governmental departments interested in the PB2 outcome measures. Overall, this may tell us if the agencies treating mental health are actually addressing the issues that led to the admission.

The target population for this study was every adult and child admitted to a State funded agency contracted to treat persons who are indigent. A FARS is completed on admission by a clinician by either a scan sheet or through software and then forwarded to the Institute's Data Center. It attempts to measure five domains: Biological and Demographic Information Quality of Life Levels of Care (Admission, Discharges, etc.) Cognitive, Behavioral, Social, and Role Functioning Level of Disability, and Population Certification

The Behavioral Healthcare Rating of Satisfaction (BHRS) measures consumers' satisfaction with mental health services and is administered at discharge. The CFARS follows the same format. With the institution of accountability into the mental health system within the State of Florida, this project provided an opportunity to explore the strengths and limitations of our current system of care and hopefully improve the quality of life for those citizens suffering with a mental illness.

The de la Parte Institute has recently been accepted by Joint Commission on Accreditation of Healthcare Organizations [JCAHO] as an approved vendor with the ORYX Initiative, which monitors Performance Initiative Measurement Systems. This will increase the usage of the FARS, CFARS, and BHRS instruments to meet the legislative requirements for the Performance Based Planning and Budgeting process.

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