WIXLIB

CHILD AND ADOLESCENT MENTAL HEALTH PERFORMANCE STANDARDSSECTION I: GENERAL PERFORMANCE STANDARDSOVERVIEWThe General Performance Standards are requirements for all Child and Adolescent Mental HealthDivision (CAMHD) services, and apply to each of the specific services. They are set forth to guideeffective practices in the delivery of behavioral health supports and services for eligible youth in theState of Hawai’i. In Hawai’i’s integrated system, supports and services are provided in accordancewith all regulations as required by Individuals with Disabilities Educational Improvement Act 2004(IDEA) and Medicaid with active involvement of families and communities in alignment with theHawai’i Child and Adolescent Service System Program (CASSP) principles (See Appendix 1).CAMHD reserves the right to amend this book in the future by adding new services or revisingexisting services as necessary to meet the needs of the youth of Hawai‘i. Any and all changes thatmay occur in the future will be posted on the CAMHD website: html. Additionally, CAMHD will periodically revise its policies and procedures tocomply with department policies, changing laws, regulation and rules as required. All contractorswill be notified of any policy and procedure change that may affect their operations.A. CORE COMPONENTS OF CURRENT CAMHD SYSTEMThese core components underlie the values CAMHD strives to operationalize in its practices. TheCAMHD expects the same commitment from contractors to support these components in theirrespective practices.1. Commitment to the Hawaii CASSP PrinciplesNationally, the CASSP principles (Stroul, B.A. and Friedman, R.M., 1986) were developed inaccordance with the original work of Jane Knitzer in an effort to provide a framework ofprinciples for newly created systems of care. Early in the 1990s, Hawaii communities andstakeholders made minor language revisions to these CASSP principles to effectively addressthe relevant cultural issues as they presented in Hawaii. CAMHD is committed to the CASSPPrinciples (See Appendix 1) and expects the same commitment from contracted providers.2. Commitment to Interagency Collaboration & CoordinationMost of the youth served by CAMHD attend public schools, and may be involved with the childwelfare system, juvenile justice system, or other DOH Divisions, including Alcohol & Drug Abuse(“ADAD”), Developmental Disabilities Division (“DDD”), and Early Intervention Services (“EIS”).A large percentage of the CAMHD population is enrolled in QUEST Healthplan services, whichrequires linkages to the primary healthcare providers. The CAMHD system is committed towork with all other child-serving agencies to integrate services and programs across agencies inthe best interest of youth and their families.3. Commitment to Evidence-Based PracticesMental health services provided within the CAMHD system are expected to be evidence-based.Interventions with youth are meant to incorporate elements of those treatments identified asmost promising based on credible scientific data. The proposed array of services provides amedium through which evidence-based interventions can be applied at high levels of intensityand in a variety of settings, depending on the needs of the youth. The CAMHD regularlyreviews, summarizes, and disseminates relevant research data to support agencies in theirselection and implementation of services. All treatment planning for psychosocial andPage 2General Performance Standards

CHILD AND ADOLESCENT MENTAL HEALTH PERFORMANCE STANDARDSpharmacological intervention should stem from careful consideration of the most currentresearch. In addition, agencies are encouraged to gather and evaluate their own data on childoutcomes and functioning to further inform clinical decisions and the design of appropriateinterventions. See the following links for the (a) CAMHD Biennial d/library/pdf/ebs/ebs013.pdf and (b) the evidencebased child and adolescent psychosocial intervention matrix from the American Academy 0503.pdfa. Definition of Evidence-Based PracticeCAMHD has required contractors to use evidence-based treatment approaches for manyyears, but there is still a lot of confusion about what this really means. In brief, evidencebased practices include all those treatment strategies and interventions for whichobservable, objective data exist demonstrating positive effects. Using evidence-basedtreatment means using interventions that have been shown to work. CAMHD contractedproviders are expected to utilize data about an individual youth’s progress along with thebest available information about “what works” in planning and revising treatment. The data(or evidence-bases) showing the positive effects of mental health treatment practices cantake one of four major forms, listed below in order of their relative strength. Informationabout the evidence base for various practices should be utilized throughout the course oftreatment to make clinical decisions. Higher priority should be given to more reliable orstronger forms of evidence in making treatment decisions.i.General Services ResearchGeneral service research is data typically found in peer-reviewed scientific journals (e.g.,in the form of randomized clinical trial outcomes), and summarized in reports such as theBlue f and Practice Element Profiles in the latest CAMHD Biennial d/library/pdf/ebs/ebs013.pdf. Defined thisway, evidence-based practice can include large brand-named packaged protocols (e.g.,Multisystemic Therapy), broad-based therapeutic approaches (e.g., Cognitive-BehavioralTherapy) and discrete clinical techniques or practice elements (e.g., CaregiverPsychoeducation). When there is limited or weak published research evidence about aparticular approach, but it appears promising, the strategy is often referred to as a “bestpractice.”ii. Case-Specific Historical InformationCase-specific historical information is case-specific data from repeated clinicalinteractions in the form of standardized (e.g., Ohio Scales, CAFAS, BASC, ASEBA) oridiographic (individualized) assessment strategies (e.g., MTPS ratings, mood or SUDSratings, etc.). The usefulness of such data increases as the number of routineassessment points increases over time, and the data can be displayed graphically tohelp demonstrate strategies that are helpful to an individual youth on a case-by-casebasis.iii. Local Aggregate EvidenceLocal aggregate evidence is case-specific data aggregated across numerous youth intomeaningful composite units, such as treatment facilities. Such evidence includes notonly positive clinical outcomes (e.g., a specialty facility may have high rates of successwith youth with severe substance abuse concerns), but also critical incidents (e.g., acertain facility may have higher than average elopement rates, and care should be takenPage 3General Performance Standards

CHILD AND ADOLESCENT MENTAL HEALTH PERFORMANCE STANDARDSbefore youth at risk for elopement are placed there). These types of data are sometimesreferred to as practice-based evidence.iv. Causal Mechanism EvidenceMemory, judgment, and professional knowledge of team members regarding the variouscausal mechanisms associated with the developmental psychopathology and treatmenttrajectory associated with a youth. Many times, such expertise is sought to helpconstruct interventions for youth who have received empirically supported treatments buthave not yet met treatment goals. Say for example, that a team has an agreed-uponcase conceptualization that a youth’s treatment for her trauma is not progressingadequately because the youth has an overall poor sense of control over herenvironment. Therefore, in addition to exposure-based strategies, the team recommendsthat extra care should be taken for cognitive restructuring and parenting strategies thathelp the youth exert personal control over her environment. Given potential informationprocessing biases and other concerns associated with human memory and judgment,care should be taken when relying on this evidence-base and the other forms of dataabove should first be strongly considered.As outlined above, the term “evidence-based practice” extends well beyond brand-namepackaged programs such as Multisystemic Therapy, Functional Family Therapy, andMultidimensional Treatment Foster Care. As outlined in this definition, the term“evidence” can and should take on many forms.4. Commitment to Performance ManagementThe CAMHD is committed to ongoing evaluation of performance and the use of data to continuethe development and management of the system as well as to improve provider development.Its performance management practices involve an extensive system for examining performanceand using findings to make informed decisions about services and needed adjustments toprogram implementation. The CAMHD tracks and analyzes contractor performance data acrossall aspects of service delivery and care. CAMHD uses this information to determine how wellthe system is performing for youth, and how well youth are progressing. It is sensitive enoughto determine if the system is performing better or worse for certain populations, andcomprehensive enough to detect what aspects of care, and in what settings, problems may beoccurring. Services are monitored through tracking of trends and patterns found in utilizationand satisfaction data, and examinations of practice and quality of services.The CAMHD maintains an active quality assurance and improvement program and expects toachieve goals of the program through an annual work plan that maintains improvement activitiesand measures for each quality and assurance program objective. Participants, includingContractors, in the system shall engage in ongoing quality assurance activities to improve theirservices and integration with the system.5. Commitment to Access & Continuity of CareThe CAMHD has the belief that every child/youth is capable of recovery and resiliency. CAMHDseeks to promote individualized care which empowers youth and their families to achieve theirgoals, and maximizes their opportunities to live full lives in their own communities.The CAMHD is committed to the philosophy of providing treatment at the most appropriate andleast restrictive level of care necessary for effective and efficient treatment to meet the youth’sbio-psychosocial needs. We see the continuum of care as a fluid treatment pathway, whereyouth may enter treatment at any level and be transitioned to more or less intensive levels ofcare as their changing clinical needs dictate.

The Child and Adolescent Mental Health Performance Standards (CAMHPS) is a manual developed by the Hawai’i State Department of Health (DOH), Child and Adolescent Mental Health Division (CAMHD) for use in the development and provision of behavioral health services for youth. This manual