In the previous sections of this report a series of specific best practices have been identified related to child and family services, adult services, and administrative practices. Specific state and local examples have been provided as well, representing best practice models from both Arizona and other jurisdictions. The question that remains is this: Are there states where all the pieces come together? Are there states in which best practices have been implemented throughout all parts and all locations of the administrative and service delivery components that comprise the public behavioral health system in that state?

The answer is: not entirely. Nonetheless, there are several states that exemplify system-wide progress towards a vision of best practice - that have implemented all the necessary capacities and competencies to move the system in the right direction. In these states, although not all best practice standards are met in all local jurisdictions, examples of best practice are the rule rather than the exception. The states that come closest to meeting the vision of best practice in public behavioral health care are Colorado, New Hampshire, Ohio, Rhode Island, Wisconsin, and Vermont.

From among all the various best practice models and examples outlined in this report, what are the essential characteristics that have assisted these states to move towards best practice? The following is a summary of common elements in those states that have moved most successfully towards best practice:

1. There has been strong and consistent leadership that has articulated a vision and has forged consensus and momentum for implementing that vision.

2. The vision articulated by leadership incorporates the concepts of recovery, consumer self-determination and choice, self-sufficiency, community and family-based services; and empowerment of consumers, families and staff to be creative, flexible and also accountable for local service delivery.

3. Information about mental illness and emotional disability is made widely available to the general community; stigma and prejudice are publicly confronted when they become evident; and the vision and mission of the public behavioral health system are espoused constantly in all available forums.

4. Consumers and families are engaged and involved in all aspects of the public behavioral health system, from governance and policy development through planning and program development to quality management and system evaluation. Consumers and families in those states have become the most effective advocates for the vision and mission of the public behavioral health system. They have also provided the motivation and momentum for the change process.

5. Local systems of care have been developed, and these local systems have the requisite clinical and financial authority and accountability to carry out the statewide vision and mission in ways that are reflective of local conditions and needs. These local systems can be non-profit, for profit, quasi- governmental, county-based or multi-county programs.

6. Information gleaned from a variety of data sources is used to drive system planning, budgeting, and quality management and performance evaluation. In the above states, decisions are made at all levels based on consistent analysis and interpretations of accurate and timely data. Included in the information analyzed is literature describing evidence-based best practices from other jurisdictions as well as information generated from within the state's own systems.

7. An organizational culture that fosters and supports constant learning, change, challenging of sacred principles, and trying out new ideas has been created throughout the public behavioral health system.

In the above list of characteristics there is no mention of service types, financing levels or approaches, clinical technologies, or requirements for organizational models. Rather, the list incorporates attributes that move these systems towards excellence and responsiveness as a context for the details of service provision. Specific best practices related to service models and treatment models will continue to evolve and change. Public behavioral health systems that embody the above characteristics will be in the best position to implement specific changes. In fact, it is systems that have the above attributes that most often will generate new and improved ways of meeting consumer and family needs and choices in the most cost effective and accountable manner.

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