IX. Conclusion

As noted in the introduction to this document, the purpose of this volume is to provide greater detail and information about recommended best practice approaches for the public behavioral health system. Most of the best practice models described in this report would be applicable in any public behavioral health system. The challenge is to pick which among the best practices are the highest priorities for implementation, and then to tailor the selected best practice models to local conditions and resources. By providing greater detail about best practice models and examples, the intent has been to address two fundamental questions. The first is: How will we know when we have actually attained implementation of a given best practice? The second is: What can we expect will be the long-term effects of making the changes necessary to implement best practice models. Thus, this volume is intended to serve as a menu from which best practice approaches may be selected and adapted. It can also serve as a series of guideposts to support the implementation process and to assist system managers to anticipate the effects of the changes.

In Volume I, a number of recommendations for immediate action to improve the Arizona public behavioral health system have been made. These are based on immediate needs for system improvements identified through the strengths-based assessment of the Arizona public behavioral health system. They were also recommended because, once implemented, they would create both a track record of success and additional motivation for further changes and improvements. These are important elements of any change process: (a) starting with a limited but important agenda and gaining some immediate successes; and (b) leveraging early successes into an on-going and highly motivated change process.

Change is always difficult, even when all parties have the best intentions. It typically takes a huge amount of effort to make changes, and only a small amount of effort to stop or delay the change process. It is hoped that the information and examples in this volume can both stimulate positive change, and also assist the change agents to overcome inertia and resistance to change.

The best practices discussed in this volume represent the state-of-the-art, as it is known today. However, the state-of-the-art is developing and changing very rapidly. One of the most exciting aspects of public (and private) behavioral health today is the pace of new knowledge development. There continues to be an explosion of new clinical trials and studies that introduce new medications and related practices. There is also an explosion in good services research, leading to greater confidence with many of the best practice models contained in this report. The new services research is also challenging some commonly held opinions about the efficacy of certain program models and approaches.

Thus, this volume must be viewed as a work in progress. It has been noted throughout this report that a willingness to learn and to challenge traditional approaches is a best practice itself. Thus, it is hoped that all participants in the public behavioral health arena will challenge the contents of this volume, and will contribute to the knowledge and skill of the public behavioral health system in meeting the needs and choices of priority consumers.

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