• The mission and vision of each component of the system is driven by and focused on consumers and families.
• Each component of the system is an effective advocate for the mission of the organization and for the larger public behavioral health system.
• Each component of the system is a learning organization - one that remains open to change, willing to learn, anxious to improve, and able to take risks.
• There is an emphasis on integration, collaboration and coordination throughout the system.
• There is a system-wide emphasis on outcomes and performance versus process and regulation.
• There is a system-wide emphasis on the content as opposed to the structure of the system. This includes allowing and supporting creative and flexible use of resources.
• Each component of the system is accountable to its constituents and the general public.
• Each component of the system is efficient and effective in its use of public resources.
• Organizational and procedural barriers to flexible and creative service design and delivery will be minimized. These include categorical funding limitations, competing organizational imperatives, discipline-based or disability-based service compartments, and excessive monitoring of compliance with process requirements.
• The quality, performance, and cost-effectiveness of all components of the system are constantly and consistently evaluated, and the results of these evaluations are published and circulated widely on a regular basis.
• The costs for administrative and compliance functions versus service delivery and quality functions will be minimized. Each component of the system will have effective information technology for performance evaluation and decision support, and each component of the system will sufficient and highly qualified staff resources.

• Every staff member in the public behavioral will be able to articulate what role and responsibility s/he has with regard to producing positive outcomes for consumers. Each staff member will also be able to articulate positive understanding of the strengths, capabilities, rights, and dignity of consumers of public behavioral health services.
• Over time the public, the media, and policy makers and elected officials will come to understand mental illness and substance abuse, the rights and abilities of public behavioral health consumers to live and work in communities of their choice, and the need to substantial community resources to assure that this vision for consumers is attained.
• Each component of the public behavioral health system will learn and adopt best practices from other jurisdictions, and also will contribute best practice knowledge and experience to other jurisdictions.
• Consumers and their families will be able to access resources and services from non-behavioral health organizations as equitably as all other groups in the general population. Consumers of other systems will also enjoy facilitated access to behavioral health services when needed and chosen. Primary health care and behavioral health care will be integrated and coordinated at the level of delivery systems and at the level of each individual consumer.
• Outcomes important for consumers and their families (i.e., independent housing, competitive employment, successful school and family functioning, increased perception of quality of life, etc.) will be measured and rewarded throughout the system, which in turn will drive the system towards ever-greater competence and success in assisting consumers and their families to attain these outcomes.

Implementation of consistent and comprehensive continuous quality improvement (CQI) practices grounded in consumer-based outcomes, satisfaction, and performance measures in each major component of the system

CQI assures that, long after the current crop of experts is gone, the organizations and the system continues to learn, grow, change, and find new and better ways to carry out their mission in the public behavioral health sector.

CQI becomes the organizational force to:

• assure that evidence-based best practices are implemented as intended;
• assure that the implementation of such best practices has the desired effect in terms of beneficial outcomes for consumers and families in a cost effective manner;
• identify and overcome organizational barriers to quality and effectiveness in working with primary and secondary customers of services; and
• assure constant learning and consequent re-shaping and re- vitalization of best practices within the organization.

• There is an equal commitment from both top leadership and line staff to constant improvements to the quality and effectiveness of the organization and its services.
• Responsibility for CQI is assigned to a single point of accountability within the organization with the resources and the authority to make sure the process is implemented and that there is follow-through on CQI activities.
• Consumers and families are consistently and substantively engaged in all aspects of the CQI process.
• CQI activities and strategies are based on empirical data that include information on consumer outcomes and satisfaction.
• There is an annual evaluation of the CQI process to document: (a) specific improvements implemented; (b) benefits derived by consumers and families from the improvements; and (c) identification of priority CQI activities for the coming year.

• Every participant in the public behavioral health system will understand her/his role in contributing to the over-all quality and effectiveness of the organization. There also will be no doubt about the commitment of the public behavioral health system to quality and effectiveness.
• Accountability for quality and effectiveness will not be diffused throughout public behavioral health organizations, and quality- related activities will not be discarded when other crises or priorities arise.
• The CQI process will be converted from one that solely focuses on clinical practice issues to one that focuses on the over-all effectiveness of the organizations in meeting consumer needs and choices in a timely and responsive manner that is respectful of consumer and family rights and dignity.
• Quantitative data on consumer level of functioning, service utilization patterns, outcomes, and satisfaction will inform the development and continued refinement of best practices throughout the public behavioral health system.
• The CQI process itself will be regularly and consistently scrutinized to assure its true effectiveness in producing quality and effectiveness strategies of ultimate benefit to consumers and families.

Assurance of cultural and linguistic competence throughout the system

Given the cultural and linguistic diversity of Arizona, it is not surprising that positive efforts have been made to attain cultural and linguistic competence and relevance in the public behavioral health system.

• Culturally and linguistically competent practices are incorporated as part of all best practices. For example, clinical guidelines for treating oppositional-defiant behaviors in children address varying cultural approaches to intervening with such behaviors.
• Consumers and families from diverse cultural and linguistic backgrounds are engaged to assist in developing cultural and linguistic competency strategies, and to train program staff on relevant cultural/linguistic factors affecting access to and utilization of public behavioral health services.
• Policies and strategies for attaining cultural and linguistic competence will address the important roles of family, including extended family, in varying cultures.
• Reference groups, including civic, religious, and cultural institutions outside the mental health community are included and employed in efforts to increase cultural and linguistic competence.
• The system assures access to clinicians, program staff, and/or interpreters for all languages commonly spoken in Arizona

• Consumers and family members from all applicable cultural and linguistic backgrounds and traditions will enjoy easy access to culturally and linguistically appropriate and competent services throughout the public behavioral health system.
• Consumers from culturally and linguistically diverse backgrounds will attain the same levels of positive outcomes and satisfaction as do all other consumers and families in the system.
• The administrative and clinical/program service staff of all components of the public behavioral health system will reflect the cultural and linguistic diversity of the consumer population and the population of the wider community.
• Program content and clinical practice that reflects and is respectful of cultural and linguistic diversity will be as cost effective and other program approaches and modalities.

Consistent implementation of utilization management criteria and evidence- based clinical protocols and clinical pathways

• Utilization management criteria based on evidence-based clinical protocols are implemented as a guide to service planning and service resource allocation decision- making.
• These utilization management and service access guidelines are not established to create a barrier to service access and choice, but rather to assure that services are directly linked to clinical needs, and are predictably most appropriate in terms of producing positive outcomes.
• Actual utilization of services is monitored to assure minimal over- or under-utilization of services.
• Utilization management criteria are used to identify heavy users of service, to trigger service planning process or new service development to better address the needs of heavy service users.
• Training on current and new utilization management criteria and protocols is provided on a routine basis, and staff competencies in utilization criteria and treatment planning is routinely monitored.
• The quality improvement process assures that (a) utilization management criteria are properly implemented and applied, and (b) that application of the utilization management criteria have the desired result for consumers and their families.

• Consumers and their families will attain the best possible outcomes and the highest possible satisfaction as a result of receiving the most clinically appropriate amount, duration, and scope of services.
• The public behavioral health system will use its scarce resources most efficiently to produce the best outcomes with the least clinically appropriate amount of services.
• Utilization management criteria will assist managers in the system to plan for the amount and types of services needed, and the competencies of staff in the system, based on the predictable needs of individuals presenting for services.
• Consumers for whom the available mix of services is not producing positive outcomes and reasonable utilization patterns will be routinely identified and will have their needs reassessed for improved service planning.

Meaningful inclusion of consumers and family members at all levels and in all functions within the public behavioral health system

• Consumers and families are actively engaged in the overall governance and policy development functions of public and private behavioral health organizations in the system.
• Consumers and families are directly involved in program planning and development, quality improvement, and program evaluation functions.
• Consumers and families are hired and paid to train managers and practitioners throughout the system.
• Consumers and family members are hired to be employees of the system - to function as real employees in real jobs, not limited to performing "consumer representative" functions.

• The public behavioral health system will become capable of being truly consumer and family driven.
• Input from consumers and family members will provide the motivation and driving force for continuing improvements in the system.
• All participants in the system will become better trained and better able to listen to the voice of consumers and family members.
• The recovery process for many consumers will be enhanced through participation in the system, self-advocacy, and advocacy for others.