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APNA 29th Annual Conference Session 3026: October 30, 2015 The 2015 IOM Report on Psychosocial Interventions for INSTITUTE OF MEDICINE Mental and Substance Use Disorders: Implications for Education, Practice and Research Susie Adams, PhD,

  1. APNA 29th Annual Conference Session 3026: October 30, 2015 The 2015 IOM Report on Psychosocial Interventions for INSTITUTE OF MEDICINE Mental and Substance Use Disorders: Implications for Education, Practice and Research Susie Adams, PhD, RN, PMHNP , FAANP , FAAN Professor of Nursing Vanderbilt University APNA President 2014-2015 Committee on Developing Evidence-Based Standards for Psychosocial Interventions for Mental Disorders INSTITUTE OF MEDICINE INSTITUTE OF MEDICINE Sponsors Committee Members American Psychiatric Association Mary Jane England, M.D., (Chair) Boston University School of Public Health Susie Adams, Ph.D., R.N. Vanderbilt University School of Nursing American Psychiatric Foundation Patricia Areán, Ph.D. University of Washington American Psychological Association John Brekke, Ph.D., M.S.W. University of Southern California School of Social Work Michelle Craske, Ph.D. University of California, Los Angeles Association for Behavioral Health and Wellness Kermit Crawford, Ph.D. Boston University Medical Center National Association of Social Workers Frank deGruy III, M.D., M.S.F.M. University of Colorado School of Medicine National Institutes of Health Jonathan Delman, Ph.D., J.D. University of Massachusetts Medical School Office of the Assistant Secretary for Planning and Evaluation of the Constance Horgan, Sc.D. Brandeis University Haiden Huskamp, Ph.D. Harvard Medical School U.S. Department of Health and Human Services Harold Pincus, M.D. Columbia University Substance Abuse and Mental Health Services Administration Enola Proctor, Ph.D. Washington University, St. Louis U.S. Department of Veterans Affairs Rhonda Robinson-Beale, M.D. Blue Cross of Idaho Sarah H. Scholle, Dr.P.H., M.P.H. National Committee for Quality Assurance John Walkup, M.D. Weill Cornell Medical College Myrna Weissman, Ph.D. Columbia University INSTITUTE OF MEDICINE INSTITUTE OF MEDICINE Committee Charge Context Mental health and substance use disorders result in significant morbidity The Institute of Medicine will establish an ad hoc committee that will develop a and mortality: framework to establish efficacy standards for psychosocial interventions used to treat mental disorders. The committee will explore strategies that different • Affect approximately 20% of Americans stakeholders might take to help establish these standards for psychosocial treatments. Evidence base for the effectiveness of psychosocial interventions is sizable: Specifically, the committee will: • Thousands of studies on hundreds of interventions 1. Characterize the types of scientific evidence and processes needed to • Findings are not well synthesized establish the effectiveness of psychosocial interventions. • Widespread implementation issues • Define levels of scientific evidence based on their rigor. • Quality chasm • Define the types of studies needed to develop performance measures for monitoring quality of psychosocial therapies and their effectiveness. Health care reform • Define the evidence needed to determine active treatment elements as well • Patient Protection and Affordable Care Act (ACA) as their dose and duration. • Mental Health Parity and Addiction Equity Act (MHPAEA) INSTITUTE OF MEDICINE INSTITUTE OF MEDICINE Adams 1 1

  2. APNA 29th Annual Conference Session 3026: October 30, 2015 Committee Charge (Continued) Committee Process Using the best available evidence, 2. identify the elements of psychosocial 1. Five in-person meetings treatments that are most likely to improve a patient’s mental health and can be tracked using performance measures. 2. Input from consultants: In addition, 3. identify features of health care delivery systems involving • Gary Bond, PhD psychosocial therapies that are most indicative of high quality care that can be practically tracked as part of a system of performance measures. The following • Bruce Chorpita, PhD approaches to performance measurement should be considered: 3. Two public workshops: Measures to determine if providers implement treatment in a manner that is • consistent with evidence-based standards; • Approaches to Quality Measurement • Measures that encourage continuity of treatment; Measures that assess whether providers have the structures and processes in • Approaches to Quality Improvement • place to support effective psychotherapy; • Consumer-reported experiences of evidence-based psychosocial care; and • Consumer-reported outcomes using a measurement-based care approach. INSTITUTE OF MEDICINE INSTITUTE OF MEDICINE Public Workshop Speakers What do the IOM recommendation mean for: Quality Measurement Quality Improvement SAMHSA Criteria for Evaluating Interventions Broad Issues in Quality Measurement • Consumers? Alyson Essex, SAMHSA Helen Burstin, National Quality Forum Shari Ling, CMS • Agencies providing services? Implementation Eric Schneider, RAND Corp. Abe Wandersman, University of South Carolina Gregory Aarons, UCSD • Individual clinicians providing services? Measuring Quality in Behavioral Health Virna Little, Institute for Family Health Tracey Smith, VA Medical Center Gregory McHugo, Dartmouth University • Researchers measuring care provided? Kim Hepner, RAND Corp. Treatment Fidelity Jodie Trafton, Veterans Affairs • Payers? David Clark, Oxford; IAPT Jim Chase, MN Community Measurement Sonja Schoenwald, Medical Univ. of South Carolina Amy Dorin, FEGS • Educators / Training institutions / Measuring Quality in Other Fields Health IT Professional organizations (Cont. Educ)? Matthew Hutter, Harvard University David Mohr, Northwestern University Frank Opelka, LSU Healthcare Network Robert Gibbons, University of Chicago Kurt Stange, Case Western Reserve Univ. Armen Arevian, UCLA Kevin Larsen, ONC Grant Grissom, Polaris Health Directions INSTITUTE OF MEDICINE INSTITUTE OF MEDICINE Committee Approach What do the IOM recommendations • Offer a broad definition of psychosocial intervention mean for psychiatric nurses in: • Focus on evidence-based care – Many interventions may be effective but not yet been established as • Clinical practice? evidence-based. – Long-term goal is for all psychosocial interventions to be grounded in • Education? evidence. • Research? Recommend a framework for establishing and applying efficacy • standards for psychosocial interventions • Administration? • Emphasize framework’s iterative nature – Both of intervention science and the evolving methodologies that will be required to address the psychosocial needs of individuals with MH/SU disorders. INSTITUTE OF MEDICINE INSTITUTE OF MEDICINE Adams 2 2

  3. APNA 29th Annual Conference Session 3026: October 30, 2015 Define Psychosocial Intervention Psychosocial interventions for mental health and substance use disorders are interpersonal or Findings, Conclusions & informational activities, techniques, or strategies Recommendations that target biological, behavioral, cognitive, emotional, interpersonal, social, or environmental factors with the aim of improving health functioning and wellbeing. INSTITUTE OF MEDICINE INSTITUTE OF MEDICINE A Framework to Improve Quality Key Findings Conclusion Mental health and substance use disorders are a serious Broad stakeholder involvement is necessary to develop effective public health problem . psychosocial interventions. A wide variety of psychosocial interventions play a major Recommendations role in the treatment of mental health and substance use conditions. Use the committee’s framework for improving patient outcomes through psychosocial interventions to strengthen the evidence base. Psychosocial interventions that have been demonstrated to The framework should be used guide efforts to support policy, research, and implementation strategies that will promote the use of evidence- be effective in research settings are not used routinely in based psychosocial interventions. clinical practice . Require consumer engagement. Consumers should be active No standard system is in place to ensure that the participants in the development of practice guidelines, quality measures, policies, and implementation strategies for, as well as psychosocial interventions delivered to patients/consumers research on, psychosocial interventions. are effective. INSTITUTE OF MEDICINE INSTITUTE OF MEDICINE A Framework to Improve Quality Elements of Therapeutic Change Conclusion No�one�plays�this� role?? Additional research is needed to validate strategies to apply elements approaches to understanding psychosocial interventions. Recommendation Payers, Govern Conduct research to identify and validate elements of psychosocial NIMH interventions. Public and private organizations should conduct research to ??? identify and validate the elements of psychosocial interventions. Specifically, research is needed to develop a common terminology for elements and evaluating their sequencing, dosing, moderators, mediators, and mechanisms of action. AHRQ Subspecialty� Subspecialty� org org Research Payer� partner INSTITUTE OF MEDICINE INSTITUTE OF MEDICINE Adams 3 3

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