I've been somewhat bemused by the 'surveillance' film footage of ACORN employees seemingly giving advice on how to evade taxes and conceal criminal activity to conservative activists posing as a pimp and a prostitute.

When I finally saw the entire film footage (on the fabulous "The Daily Show" hosted by Jon Stewart) I was struck with two different thoughts. First, a fleeting thought—I didn't know that people working in the illegal sex trade were concerned about paying taxes. The second, and more substantial thought, is, as an executive of a multi-site organization, how do you know what your front-line team members are doing on most days?

I do feel sorry for the embattled CEO of ACORN. She was making the rounds of the morning talk shows, outraged and threatening to sue because the secret videos broke Maryland law by carrying out an illegal wiretapping operation. But, as many politicians have learned, when the video genie is out of the bottle, no one cares how the video was made. More problematic is that even the most spirited defense of ACORN I've read refers to the organization as "admittedly very poorly managed." Not exactly a glowing endorsement.

So the question is, if your frontline staff were featured in film footage gathered by a hidden camera, what would you see? How do you, as an executive, increase the likelihood that such footage would be benign? There are a few risk management tactics that should be in your organization's plan:

• Updated policies and procedures—with testing of staff knowledge of those policies and procedures
• Routine assessments with compliance—with policies and procedures across all programs
• A consumer 'hotline' (and web site) to report perceived service problems
• Related performance metrics on your organizational and supervisory performance dashboards
• A mystery shopping program to monitor services from the consumer (and hidden camera) perspective
• A robust training and technical assistance program for front-line supervisors

I think the ACORN situation is going to spawn imitators—particularly for health and human services that are perceived as politically unattractive (for any number of reasons). Before your employees are featured on a local news program, be prepared and review your controls for remote staff.

August 28, 2009

There is a thought-provoking article that came out in the August 19 edition of the Schizophrenia Bulletin, “Implementing Evidence-Based Practices for People With Schizophrenia,” by Robert E. Drake; Gary R. Bond; and Susan M. Essock. The article is a great summary of the current sad state of the treatment of serious mental illness at the consumer level. Despite significant research on what works, essentially people with serious mental illness are not getting the treatments they need. While the article is a great state-of-the-nation piece, based on our team's work in the public mental health system I think the recommendations need to be expanded.

Over the last decade, a number of systematic efforts to identify evidence-based interventions for individuals with serious mental illnesses have been made. However, although the interventions have been identified, numerous surveys have shown that consumers are not receiving these interventions. The report states:

Epidemiologic data from the National Comorbidity Study in the early 1990s showed that 60% of persons with serious mental illnesses received no treatment in the past year, 25% received clearly inadequate treatment, and only 15% received minimally adequate (far short of evidence-based) treatment.

The 2005 National Survey on Drug Use and Health found that only 8.5% of adults who reported both serious psychological distress and a substance use disorder received any treatment for both problems in the past year.

In their article, the authors recommend solutions that fall in the domains of information technology, state policy interventions, and federal policy interventions. But, I think these recommended solutions will have a limited effect if there are no changes to fundamentals in system design and financing, needed to assure that consumers with mental illnesses can get the services they need. I know the naysayers will contend that there is not enough money in the system to pay for these changes. I would counter that these are not behavioral health system issues. Rather they are health care issues—and these changes would be budget-neutral if we factor in the costs of emergency room visits and hospital readmissions alone.

To view my proposed solutions, check out: http://www.openminds.com/circlehome/circle/content_schizoebpstudy.htm