Division of Behavioral Health Services

Behavioral Health Systems Transformation for Persons with Serious Mental Illness (SMI)


Why is System Transformation Needed?

During the past several years, Arizona has been confronted with perhaps the biggest financial challenge in its history. State agencies have been asked to reduce operating expenses by instituting hiring freezes, salary reductions, mandated furloughs and by reducing or eliminating entire programs and critical services throughout our state. Like most state agencies, the Arizona Department of Health Services, Division of Behavioral Health Services (ADHS/DBHS) was asked to reduce or eliminate services. In addition to the budget crisis, the long-standing class action lawsuit, Arnold vs. Sarn, is currently "on hold" until June 2012. In response to this unique set of circumstances, ADHS/DBHS is taking the opportunity to make improvements to the system during the next year to year and a half to better serve adults with serious mental illness. We are seeking community input to help design improvements based on a set of principles that the parties agreed to when the lawsuit was placed "on hold." These principles, in part, require the following:

  1. A mechanism to include member and family input in both the development of revised court orders and ongoing performance;
  2. Compliance measures must align with recovery principles and report on outcomes rather than solely on process;
  3. Compliance measures must be flexible in order to address system transformation, new treatment modalities, promote consumer voice, recovery principles and innovations in clinical practice and service delivery;
  4. Compliance measures must be consistent with nationally recognized professional standards in public sector behavioral health systems;
  5. ADHS/DBHS has the primary responsibility to conduct compliance audits, with appropriate safeguards that ensure reliability and accuracy. Audits, reviews, surveys or any other measure that determine compliance must be objective, reliable, accurate, flexible, cost-effective and data-driven;
  6. Compliance measures must be consistent with ADHS operations in order to ensure sustainability;
  7. A mechanism for regular and periodic review of Court orders and the ability to make adjustments as needed;
  8. Compliance measurement must be by system performance standards, which may include a case review component.
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Arizona Department of Health Services
150 North 18th Avenue
Phoenix, Arizona 85007
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How Will ADHS/DBHS Begin a System Transformation?

The first and most important step is to include peers and family members in the process of evaluating and developing improvements to the system. In other words, ADHS/DBHS is asking peers and family members what services they want and need from the behavioral system. ADHS/DBHS began its work earlier this year by forming a DBHS System Transformation Work Group in which peers and family members are actively involved. Working from existing court orders and related documents, the Workgroup developed a list of questions to gather peer and family member opinion.

In order to gather the collective opinion of members, the Workgroup has set up a number of focus groupsPDF throughout the state during the next several weeks and will use the questions developed by the Workgroup. The focus groups will be conducted using an evidenced-based practice called Community Based Participatory Research (CBPR). CPBR has been used in public health systems for many years to help officials design services that the public want and needs. It is an opportunity to gather the collective opinion of peers and family members while learning from each other on ways to improve our system.

A key element of each focus group will be to have a peer or family member lead each session, either as a facilitator or an assistant to the facilitator. To make this happen, the Workgroup recruited peer and family member volunteers who have completed training to be a facilitator.

To ensure privacy and confidentially, peers and family members will not be asked to provide personal information in the focus groups.

What Will Happen with Information Gathered in the Focus Groups?

As each focus group is completed, the collective opinion of peers and family members will be written down, analyzed and summarized in a report that will be released to the public. The information will describe the services or other resources peers and family members want or need from our system. ADHS/DBHS will use that information to make improvements, whenever possible, and to begin the process of negotiating revised court orders in Arnold vs. Sarn, which the parties agreed to when the lawsuit was placed "on hold." If ADHS/DBHS is not able to use the information to make improvements due to circumstances outside of its authority, such as budget limitations, legal restrictions or mandates, ADHS/DBHS will explain why. It is important to remember that all opinions are welcome, even those that are critical of ADHS/DBHS and the Regional Behavioral Health Authorities (RBHAs).

What if I'm Unable to Attend a Focus Group?

We understand that some members may not be able to attend a focus group. Nonetheless, you can still make your voice heard in the following ways. You may complete the focus group questionnaireWord and send your response via email. For those persons who do not have access to email, you can mail your questionnaire to: System Transformation, C/O Office of Individual and Family Affairs, Division of Behavioral Health. 150 North 18th Avenue, Suite 220, Arizona 85007. Another way to make your voice heard is to contact a peer run or family run agency. Staff will assist you in gathering your responses in writing and will make sure they are sent to ADHS/DBHS. Finally, tell a friend about this opportunity. If you cannot attend, perhaps someone can attend on your behalf and express your point of view. We want to gather as many opinions as possible so please feel free to communicate with us in whatever way works best for you.

What is the Best Way to Get the Most Current Information?

We will continue to update this web page periodically as more information becomes available. Peer run and family run organizationsPDF are a good resource to ask questions to get information. The ADHS/DBHS Office of Individual and Family Affairs is routinely involved in community activities and will be providing updates to individuals or groups as needed. Finally, you can write or email ADHS/DBHS and we will do our best to respond within a reasonable time. If you choose to write, please write to:

Division of Behavioral Health Services
ATTN: DBHS System Transformation
Arizona Department of Health Services
150 North 18th Avenue, Suite 250
Phoenix, AZ 85007

What happens with the information collected at the focus groups?

The Workgroup met on Friday, December 3, 2010 and discussed this topic.  Currently we have the notes written down by each focus group and some of the verbal comments written down by the peer facilitator/scribe.  The next step is to enter that information into a database.  After that, we will utilize a computer program-SPSS software-to group the data into categories to identify trends and issues.  All of that will be published in a report which will be released to the community sometime early in 2011.

As a first step in the data entry process, one of our peer members with a background in statistics has volunteered to conduct a data entry trial run with the information from one focus group.  We will analyze this data to make sure the process is sound and make adjustments to the process if necessary.  Once we are confident that the process works, we will enter all of the data from each focus group.

When can expect to see changes based on the feedback given at the focus groups?

We do not have a specific date in answer to this question.  We do know that at some focus groups staff was present taking notes and reported that based on some of the feedback, changes could be made quickly and easily.  For example, at one of the focus groups I attended, a member expressed frustration at not receiving help with applying for benefits.  It turned out that the clinic employed a benefit specialist who was available to help.

It will take more time to address issues that require a longer term solution. Until we complete the process and analyze the data, it would be premature to speculate on time frames.

If any members have observed changes from their provider or at a service location based on focus group feedback, let us know and we will gladly report those to the community on this web page.

Will there be more focus groups in the future?

Yes. The Raise Your Voice project will have at least four more focus groups in Maricopa County and others throughout the state.  Because of the positive response from the community, ADHS/DBHS intends to use the focus group model as a way of gathering member input in the future.  If there is one thing we have learned thus far, it is that communication between ADHS/DBHS and members is critical and must be a regular and ongoing process within the system.  We cannot design or implement a system having only one point of view.  All voices must be heard to make our system work.

Raise Your Voice Initiative Updates

Click the link below to view the update.

Focus Group Meeting Update- May 6, 2011

Within the next two weeks, the System Transformation Committee will be conducting the final review of the focus group data analysis; once the review is complete, ADHS/DBHS will share the results with peers, family members and the community. The information will be available on this web page and distributed through the Office of Individuals and Family Affairs. As planned, the System Transformation Committee will use the findings of the focus groups when developing recommendations to ADHS/DBHS for the Arnold v. Sarn revised Court Orders. On May 6, 2011, the Committee will discuss a process and structure going forward to assist ADHS/DBHS in the development of the revised Court Orders.

Focus Group Meeting Update – April 13, 2011

Due to due to the high volume of data that was gathered during the focus groups and other demands on staff, the Arizona Department of Health Services, Division of Behavioral Health (ADHS/DBHS) needs additional time for the release of the focus group results. To prevent further delays, ADHS/DBHS and the System Transformation Committee have agreed to establish a Focus Group Data Subcommittee that will be responsible for providing direction to ADHS/DBHS during the data analysis process. This Subcommittee is also responsible to report to the STC the decisions and the reasoning for data grouping and trending. The Focus Group Data Subcommittee is scheduled to meet on April 18, 2011 to review preliminary results. The next STC meeting is April 22.

Focus Group Meeting Update – March 14, 2011

We continue to work on the data analysis. Due to the significance and the large amount of information gathered during the focus groups, the System Transformation Committee decided it would be better to take extra time to conduct a thorough, accurate and complete analysis that will provide useful information that we can share with stakeholders for decision making purposes. Please continue to check this web page for future updates.

Focus Group Meeting Update – February 23, 2011

Thanks to the hard work of peer and family members, the information gathered during the Raise Your Voice focus groups was entered into a data collection template for analysis using SPSS software. The preliminary reports are expected to be ready by February 24. In the meantime, the System Transformation Committee (STC) has been busy drafting the background and methodology as part of the focus group report. Once the data analysis is ready, the STC will review the findings, complete the report and make recommendations on system improvements and how to define the future role of peer and family members within the system.

In addition to these activities, ADHS/DBHS in collaboration with the American Indian Behavioral Health Forum Committee, will be inviting the different tribes to participate in the Tribal Raise Your Voice (TRYV) initiative. Because Tribal Governments require that all external entities gain permission before collecting information on tribal land, the TRYV will be conducted in phases. In the first phase, we will reach out to urban American Indians living in Maricopa County. The Second Phase includes reaching out to TRBHAs, Gila River, White Mountain, Pascua Yaqui and Navajo and third phase will be working with the remaining tribes interested in participating in this initiative.

Focus Group Meeting Update – Tuesday, January 18, 2011

It has been awhile since we posted an update, but we have been busy organizing the information gathered in the focus groups and entering it into a database. As a first step in making sure the process was unbiased and consistent, the Transformation Team developed a data entry protocol. On January 12, ADHS/DBHS provided data entry training to a group of peer and family members who have graciously volunteered to enter the data.

Due to the large amount of data that needs to be entered, ADHS/DBHS is seeking additional volunteers to assist with this project and is planning additional data entry training during the next couple of weeks. If you are interested, please contact Teresita Oaks at 602 542 0411 or at Teresita Oaks.

Focus Group Meeting Update – Wednesday, December 22, 2010

Last week, the focus groups came to an end. Overall, there were 26 focus groups throughout the state (19 in Maricopa County) attended by about 370 persons. We are very grateful for those of you that took the time and effort to attend a focus group. ADHS/DBHS Deputy Director, Dr. Laura Nelson, thanks you as well in a personal note that we intend to post at all focus group sites.

Our attention has now shifted to data entry and analysis. The challenge is to take your feedback, record it into a database, analyze the data and report on the findings. Two weeks ago, members of the System Transformation Team, including a peer member with a background in statistics, took the data from one focus group and conducted a "test run" for data entry. The test allowed us to discover some of the practical problems when dealing with so much data. As a result, the System Transformation Team is developing a data entry protocol, which will be used to make sure all of the data is entered uniformly and consistently.

The System Transformation Team quickly realized that data entry is a big job. Rough estimates are that we will need 50 volunteers to work four hours each to complete the data entry. Earlier this week, the following email was sent by DBHS Project Lead, Teresita Oaks, asking for volunteers:

Hello everyone,
The DBHS System Transformation Team is looking for Peer and Family Members who may be interested in helping DBHS enter the data collected during the Raise Your Voice focus groups into a database so that it can be analyzed and reported.

The data from each of the 26 focus groups will be entered by teams of two, a reader and a typist; therefore, we are specifically looking for individuals who are good at one the following:

  • Reading handwritten notes; some of it difficult to understand
  • Typing the information from handwritten notes as it is read aloud

DBHS will provide training for data entry in early January, 2011. Our goal is to complete the data entry between the third and fourth week of January. If you are interested in participating in this project, please let me know (Teresita Oaks) and I will add you to our list and we will contact you with more information during the first week of January.

The next System Transformation Team meeting is January 14, 2011 so you will not be hearing from us for the next couple of weeks or so. Until then, have a safe and Happy Holiday season.

Focus Group Meeting Update – Tuesday, December 14, 2010

As we mentioned in our last update, the community response to the focus group project-Raise Your Voice-has been outstanding; therefore, this week we will be conducting five more focus group sessions, including one in Casa Grande. To find time and locations of the upcoming focus groups, click here.

As a first step in the data entry process, we met with one of our members with a background in statistics who volunteered to conduct a data entry trial run with the information from one focus group. After conducting the data entry trial, he suggested that we write a data entry protocol and that we train the individuals who will do the data entry to ensure consistency throughout the process. ADHS/DBHS is now in the process of developing a data entry protocol and training materials.

Focus Group Meeting Update – Monday, December 6, 2010

This is Bob Sorce, Assistant Director at ADHS/DBHS. The community response to the focus group project - Raise Your Voice - has been outstanding. Some members, who now learning of this effort have asked if ADHS/DBHS is planning to schedule more focus groups. Because of these requests and our commitment to allowing as many members as possible having their voice be heard, we are in the process of scheduling four more focus groups in Maricopa County. Each Provider Network Organization has agreed to sponsor a focus group to be scheduled sometime within the next two weeks. Stay tuned for the details. In addition two focus groups are scheduled outside of Maricopa County in Cottonwood (view flyer in EnglishPDF, SpanishPDF) on December 8 and Casa Grande (view flyer in EnglishPDF, SpanishPDF) on December 17.

The Raise Your Voice project is designed and managed by the Arnold Court Order Revision Workgroup, which includes several peer and family members. The Workgroup meets twice a month to review current progress and chart the future activities related to System Transformation. ADHS/DBHS strongly believes that any decisions related to System Transformation must include peer and family input. To do otherwise would be contrary to our mission and continue with the "We know what is best for you" system that has failed in the past.

Some of the questions we are hearing are variations of the questions above: What happens with the information collected at the focus groups? When can expect to see changes based on the feedback given at the focus groups? Will there be more focus groups in the future?

Focus Group Meeting Update – Monday, November 29, 2010

Over the past three weeks, 19 focus groups attended by 327 persons have been conducted throughout the State.

Some of the topics that have been discussed repeatedly during the different focus groups are:

  • Active inclusion of members' opinion in their treatment and recovery plan
  • Integration and acceptance by the community at large
  • Stigma reduction
  • Transportation

During the next couple of weeks, ADHS/DBHS will organize the information gathered from the focus groups and enter the data into a database for data analysis. We intend to keep the raw data available for future reference

Focus Group Meeting Update – Monday, November 22, 2010

Some have asked if ADHS/DBHS is conducting focus groups in Maricopa County only because the Arnold vs. Sarn lawsuit is in Maricopa County. The answer is no. ADHS/DBHS is gathering the collective opinion of peers and family members in every part of the state. Focus groups have been held in Sierra Vista, Payson, Casa Grande, Yuma and Tucson. Overall, participation in all of the focus groups both in Maricopa County and in other parts of the state has been consistent with an average of 20 people attending in each meeting. In observance of the Thanksgiving holiday, focus groups are not scheduled during the week beginning November 22, but will resume during the week beginning November 29 with one scheduled in the Flagstaff area.

Overall, members have repeatedly expressed that it is important for the treatment team and service providers to listen to and value their opinion and views when it comes to treatment and service delivery decisions. One member summarized it best by saying, "We know what works better for our own recovery." Expressions of gratitude have been heard many times from members for the opportunity to voice their opinion in a safe and structured environment.

Focus Group Meeting Update – Monday, November 15, 2010

We are pleased to report that four focus groups have been completed at the following clinic sites in Maricopa County: Choices (Townley), Partners in Recovery (East Valley), People of Color (Capitol Center) and Southwest Network (Cave Creek) and two more are scheduled for today. Attendance has been excellent and the discussion has been lively with lots of good ideas being shared. One person asked, "Why did it take thirty years for you to do this?" We don't have a good answer to that question as all of us were not working in the system thirty years ago, but you can be assured it will not take another thirty years for DBHS to reach out and ask members for their opinion.

So far, we have learned that members are most concerned with the way they are treated. Things like listening, respect and having a meaningful role within the clinical team are some of the themes that we are hearing. Check back for more updates and remember the focus groups will continue throughout the week.