Achievements & Lessons Learned-M: Missouri Department of Health

Knowledge Item: CA-Initiative Impact-99M
Major Achievements and Lessons Learned: 1994-1998

Missouri Department of Health

This statewide program created, implemented, and evaluated the effectiveness of a coordinated system of care through a collaborative effort of the Departments of Health and Mental Health.

In 1999, the Evaluation and Dissemination Center asked each project to state its major achievements and the lessons it had learned from conducting the project. Those stated achievements and lessons learned are reproduced here (with minor editing) as reported to the Evaluation and Dissemination Center. The summary statements given here are those aspects of the program's experiences that the Project Director wished to emphasize.

*Achievement 1:* Developed a set of customized, regional models of integrated, coordinated care for persons multiply diagnosed with HIV, substance abuse, and mental illness.
Key Elements for Success: a) Customized models to meet local needs. b) Ensured local control.	Factors that Limited Success: a) Conflicting agendas of participating agencies. b) Changes in CARE Act financing mechanisms delayed project implementation.	Factors that Ensured Success: a) Opportunity to develop positive working relationships. b) Availability of cross-training for providers.

Achievement 2: A model for treating multiply diagnosed individuals was implemented in the greater Kansas City using a centralized provider of medical and behavioral health care services.
Key Elements for Success: a) Early delays actually allowed the project to conduct an enhanced planning and implementation phase. b) Staff developed positive working relationships with collaborating agencies in the service network. c) Provider cross-training increased awareness of issues concerning multiple diagnosis.	Factors that Limited Success: a) Differing agendas of participating contracted providers. b) Service utilization rates by multiply-diagnosed patients was lower than expected.	Factors that Ensured Success: a) Coordination of care was ensured through active case management. b) Collaboration among different local and state agencies helped to link clients to needed care and to decrease duplication of services.

*Achievement 3:* A model of collaborative care for triply-diagnosed persons was implemented in the St. Louis metropolitan area by linking distinct service systems for HIV, substance abuse, and mental illness.
Key Elements for Success: Two case review teams served to screen cases at the outset and then review for continuing care issues	Factors that Limited Success: a) Competing agendas among participating agencies b) Staff turnover and burnout c) Restrictive diagnostic criteria for mental illness created barriers to accessing mental health services	Factors that Ensured Success: a) Allowing for local control of the service delivery model b) Staff training provided practical, hands-on experience c) Two complementary case review teams permitted systematic monitoring of client care and treatment plans d) Active case management component freed direct service providers from additional administrative duties

Achievement 4: A model for treating persons with co-occurring diagnosis of HIV disease, substance abuse, and mental illness in rural Missouri was implemented through coordination by a centralized comprehensive mental health facility.

Key Elements for
Success:

a) Created a one-stop-shopping model to facilitate access to care.

b) Conducted early education and outreach to the community about the program’s services, eligibility criteria, and ways to access care.

Factors that Limited
Success:

a) Stigma and limited knowledge about HIV in rural areas created barriers to accessing care.

b) Large travel distances to services, as well as for program staff to attend meetings and trainings in metropolitan areas.

c) Staff turnover affected continuity of care.

Factors that Ensured
Success:

a) Allowing for local control of the service delivery model.

b) In-home case management visits increased access in rural communities.

c) Establishing good working relationships with service providers.

1. Lesson Learned: Local control in a statewide project to change service infrastructure is critical.

How related to achievements: In each of the three models, local control was mentioned by key stakeholders as a key factor to ensuring success. Local strategies are needed to tailor ways for fractious service systems to collaborate more effectively.

2. Lesson Learned: Training is a critical component in implementing strategies for collaboration across different care systems.

How related to achievements: Providers across medical, substance abuse, and mental health care systems need a common language to communicate effectively. Permits expansion of the knowledge base so that appropriate care and referrals can be made for individuals triply-diagnosed with HIV/AIDS, substance abuse, and mental illness.

3. Lesson Learned: Case management is a key element in the coordination of care across HIV/AIDS, substance abuse, and mental health service systems.

How related to achievements: All three models used case management effectively to streamline the care of multiply-diagnosed individuals.

Project Resource Page

Missouri Department of Health

Last Updated: August 02, 2001; data through June 15, 1999; analyses conducted January 2000.

Knowledge Base Citation: The Knowledge Base and this Knowledge Item were designed and authored by G. J. Huba, Ph.D.; in collaboration with Lisa A. Melchior, Ph.D.; A. T. Panter, Ph.D.; and the staff of The Measurement Group. Cite this work as "Huba, G. J., Melchior, L. A., and Panter, A. T. (1998 - 2001). The Measurement Group Knowledge Base on HIV/AIDS Care. On the World Wide Web: http://www.TheMeasurementGroup.com."

Questions or Comments: Contact The Measurement Group.

Use of Knowledge Base Information: Acceptable Uses and Limitations.

Collaborators from Participating Projects: Cooperative Agreement Steering Committee 1999.

Participating Projects: This Knowledge Base is based on the service delivery experiences of 27 Cooperative Agreement Projects on Innovative Models of HIV/AIDS Care. These projects and the Evaluation and Dissemination Center which produced this Knowledge Base were funded by the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB) as Special Projects of National Significance (SPNS) between 1994 and 1999.

Why This Evaluation was Conducted: Editorial.

More Information: Design of this Knowledge Base.

Recommended Citation Format for Web Materials: American Psychological Association Publication Manual Section, Revised 2001.

Work on the Knowledge Base and the cross-cutting evaluation was supported in part by Grant Number 5 U90 HA 00030-05 from the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau's (HAB) Special Projects of National Significance (SPNS). The contents of this Knowledge Base are solely the responsibility of The Measurement Group and do not necessarily represent the official views of HRSA or HRSA/HAB's Special Projects of National Significance nor may they represent the positions of the individual grantees whose projects are included in the cross-cutting evaluation.