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Behavioral Health Quality: Framework & Measurement

Instructor: Anthony Santillanes

I'm Anthony with a Bachelor's in Health and Wellness, a Master's in I/O Psychology, and have led multiple adult training events.

This lesson provides an overview of the framework and measurement of behavioral health quality as well as introduces the Substance Abuse and Mental Health Services Administration's role.

Behavioral Health Quality

Have you ever bought something that you had to return because it was broken or didn't perform the way it should have? Or have you ever visited a restaurant or hotel where you gave it a one- or two-star rating due to a poorly prepared steak or less than amicable room conditions?

Have you or a family member ever been hospitalized or sought treatment from a therapist? Maybe you had to go back to your health professional for the same issue multiple times or had to go to multiple professionals for the same issue, and the costs were substantially different. Enter the national behavioral health quality framework (NBHQF).

The NBHQF is an initiative established by the Substance Abuse and Mental Health Services Administration (SAMHSA) under the Affordable Care Act to promote the quality of health among Americans and reduce costs of care. Major components of the framework include the patient, population, payer, system, plan, provider, and practitioner.

The Framework for Behavioral Health Quality

SAMHSA has built the framework for this endeavor, which can be surmised as the goals to promote the physical and mental health of Americans as well as reduce costs of medical care. SAMHSA provides general oversight and guidance related to the evaluation of various treatments' effectiveness and sharing of best practices.

Imagine a football team, and think of SAMHSA as the coach. Everyone on the team plays a different position and each one must contribute a unique set of skills and abilities for the team to succeed. Just like a quarterback and receiver need to be in sync, so too does the provider and patient, and just as the training program needs to support the development of the team, so too does the care system need to support the population.

SAMHSA is also responsible for determining appropriate data gathering techniques from various treatment agencies, gathering and analyzing said data, and then determining and sharing best practices to increase the likelihood for treatment success as well as cost effectiveness. While doctors and therapists review their individual patients and treatments, SAMHSA evaluates all of the individuals and organizations providing care in order to find the best quality.

Behaviors and Outcomes

Now that we've reviewed the NBHQF, let's take a look at the patient/population level to understand unhealthy behaviors and how these are assessed. Unhealthy behaviors are those behaviors that don't contribute to one's wellness. These behaviors can include alcohol and drug abuse and lack of exercise as well as any other activity that compromises the body and mind's well-being. Measurement of these behaviors can be achieved through a survey or assessment completed by the individual being evaluated.

Evaluating a person's behavioral health quality can help identify behaviors that are related to various outcomes. For instance, a person who regularly abuses alcohol might have more attendance issues at work and in their personal life than someone who does not. If a person decreases physical activity, he or she might be more likely to suffer from a number of physical and mental difficulties. These examples highlight a couple of the potential outcomes that are associated with behavior. So who writes these measurement devices or assessments?

Evaluating Behavioral Health Quality of the Individual

Behavioral health quality (BHQ) assessments are usually developed by teams of professionals with experience in test development and who have either a master's or post-graduate degree. (This may not apply to assessments found on social media sites, but to be clear, those usually are not legitimate assessments either.) These teams can be comprised of a mix of medical, health, and psychology professionals. They will need to be experts in their fields and either possess a strong statistics background or have someone on the team specifically assigned to the statistical evaluation of the assessment to verify assessment responses are related to health outcomes.

Intervention Quality

Another keystone to SAMHSA's NHBQF is to evaluate intervention quality. There are a few questions that SAMHSA will use when evaluating intervention quality provided by a practitioner(s):

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