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

• Information about mental illness, emotional disability, and substance abuse is made widely available to the general community.
• The vision and mission of the public behavioral health system is espoused constantly in all available forums.
• The public behavioral health system has a positive image among policy-makers, elected officials, the media, and the general public.
• State and local officials understand the operation of the system and are willing to support allocation of the resources necessary to meet the needs of citizens with behavioral health needs.
• Stigmatizing actions affecting people with mental illness or substance abuse are routinely and publicly confronted
• Public officials, the media, and the public trust system leadership to be honest, responsive, and to follow through on commitments.

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.

• Services for children and adults and their families are flexible and individualized, and are geared towards recovery and maximum community integration and participation.
• The service system focuses on and measures performance with regard to consumer and family preferences and priorities such as independent housing and employment, home and school performance, and quality of life.
• Over time the system converts from services delivered in facilities and congregate setting to services delivered in integrated community settings.

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 the named 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.

• Consumers and families are actively involved at every level of the system.
• Consumers and families are effective and visible spokespeople and advocates for the public behavioral health system and its priority consumers.
• Public officials and the media listen to consumers and families and take their advice about necessary improvements in the system.
• The tendency for public dissonance among providers, professionals, and program managers is overcome by a primary focus on the part of these stakeholders on consumer and family priorities.

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.

• All participants in the system, and the general public, can identify and understand the local systems of care, and know to who they should turn for information and advice or to lodge a complaint with regard to public behavioral health.
• There is no diffusion or confusion of accountability for individuals with serious emotional disorders, serious mental illness, and serious substance abuse disorders.
• Local service planners and managers have the flexibility and authority to tailor resources to the unique needs and choices of their priority consumers.

Information gleaned from a variety of data sources is used to drive system planning, budgeting, and quality management and performance evaluation. In the named states, decisions are made at all levels based on consistent analyses 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.

• All managers at all levels have access to consumer demographic, service utilization, cost, outcome, performance and satisfaction data to make informed decisions and to hold themselves accountable for achieving their system performance objectives.
• Information collected and analyzed at one location in the system is routinely shared with other components of the system.
• Comparative information collected and analyzed at the state level is routinely shared with the sources of such information in the field.
• Consumers and families are included in the process of analyzing and interpreting information.
• Information about best practices is routinely generated from the local systems of care, and is reviewed in the context of evidence-based best practices from other jurisdictions.
• The system welcomes outside evaluation and research, and is eager to use and adopt the information gleaned from these studies.

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.

• Participants at all levels of the system express a willingness to learn and try new ways to deliver services.
• All participants in the system feel free to challenge the status quo with no fear of retribution.
• Communication within the system and between the system and other systems and the general public is open, honest, and non-defensive.