II. Discussion of Best Practice
Elements and Criteria

Volume I contains a brief discussion of the criteria used to identify and select best practice approaches and models relevant to Arizona. In this Volume many of the criteria for best practice selection are used to define performance standards and criteria that can be used to continuously assess the degree to which Arizona is moving towards best practice models.

Best practices in public behavioral health are recognized to be multi-dimensional. That is, best practices are defined by several different domains, including vision and values, systemic implementation, and point-of-service excellence in clinical and program delivery. The first domain reflects characteristics of any public sector human services, health care, or behavioral health care system in any jurisdiction. These characteristics include:

  • Customer orientation - respect for and responsiveness to the individual needs and choices of consumers and their families at all levels of the system.
  • Clinical excellence - implementation of evidence-based clinical treatment practices consistently throughout the public behavioral health system.
  • Continuity - assurance that every individual and family will have a single point within the system with the accountability and responsibility to be there when needed, and to respond to individual and family needs as they change over time;
  • Integration - assurance of uninterrupted movement among the components of the public behavioral health system as well as full and coordinated access to, and integration with, other important services and supports, including primary health care, housing and vocational services; and
  • Stewardship of public funds - clearly identified single points of public accountability for the quality, effectiveness and efficiency of the public behavioral health system, and consistent evaluations of the quality and performance of the system.

More detailed examples of these criteria are contained in Appendix A of this volume.

The second domain reflects the practical elements of implementing specific program model and clinical treatment best practices within the preferred public behavioral health system. These are elements without which the first set of criteria cannot effectively be met, and include:

  • Vision - clearly articulated and understood mission, values, and strategic direction for the public behavioral health system as a whole;
  • Strategy - feasible and proven approaches to structuring, organizing, financing, and operating the public behavioral health system:
  • Technology - the actual practice and delivery of services to priority consumers and their families;
  • Human Resources - the supply of trained, competent, and culturally appropriate staff necessary to deliver best practice service models; and
  • Culture - the expectations and beliefs by all participants in the system in the value and potential of all consumers and the value of a high quality, customer- oriented, efficient and effective public behavioral health

The third domain reflects the combination of empirical research, professional judgement, feasibility of implementation, and relevance to Arizona. The practical criteria are used for those many elements of the public behavioral health system that are not sufficiently evaluated to assure implementation of evidence-based best practice. They also provide a reality check on the application and prioritization of best practice models throughout Arizona. These practical criteria include:

  • There have been sufficient studies and evaluations to indicate that the practice is promising and is most likely beneficial for consumers and families;
  • The practice or approach has become a nationally accepted best practice and has been widely used as a standard and guideline for program implementation and service delivery for a substantial period of time;
  • There are examples of successful and beneficial implementation of the practice or approach in other jurisdictions;
  • The practice or approach is relevant to Arizona local conditions and resources. It addresses gaps or needs in the current service system; and/or
  • The implementation of the practice or approach is feasible within the current Arizona public behavioral health system.

Each of the above domains of best practice criteria has been applied to the models and approaches selected for inclusion in this report. They have also been used as guideposts for the strategic recommendations and for recommended implementation strategies. In fact, the above domains of best practice criteria represent best practice in and of themselves. If a state such as Arizona were to apply these criteria to the planning, design, implementation, management, monitoring, and evaluation of public behavioral health systems, the system would be driven towards constant improvements in quality and effectiveness as well as towards newly emerging best practice models.

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