- Transformational: Our work is focused on personal change.
- Collaborative: We must develop a shared understanding and vision.
- Outcomes: What we measure is relevant to the decisions we make about the strategies and interventions we use.
- Management: Information gathered is used in all aspects of managing the system from planning for individuals and families, to supervision, and program and system operations.
Human services, including health care, are often complex because of the number of different people involved in the process of care. In complex systems, participants always have different perspectives and often have competing responsibilities and objectives. Transformational Collaborative Outcomes Management is a conceptual framework for managing complex systems. Within this framework there is a philosophy, a strategy and a set of tactics all designed to facilitate an effective and integrated approach to addressing the needs of people.
The TCOM approach is grounded in the concept that the various perspectives in a complex service system creates conflicts. The tensions that results from these conflicts are best managed by keeping a focus on common objectives—a shared vision. In human service enterprises, the shared vision is the person (or people) served. In health care, the shared vision is the individual in services; in the child serving system, it is the child and family. By creating systems that all return to this shared vision, it is easier to create and manage effective and equitable systems.
TCOM consists of a set of principles that guided the development and implementation of a set of assessment tools. The CANS, ANSA, Family Advocacy and Support Tool, and Childhood Severity of Psychiatric Illness Crisis Assessment Tool are a customizable suite of tools that are used as a strategy to use data from the uniform assessment for:
- Organizing information
- Improving communication
- Building consensus in an integrated, collaborative and transparent service context
Background and Implementation
The state began using the CANS and ANSA as part of the Uniform Assessment during the implementation of Texas Resiliency and Recovery. The initial CANS/ANSA implementation and training focused on systemwide adoption of the tools as an assessment for determining needs and strengths correlating to a level of care. Every provider of mental health targeted case management and rehabilitative services follows the TRR Utilization Management Guidelines and requests service authorization through use of the TRR UA. This broad implementation of the CANS/ANSA provides an opportunity for oversight of the mental health system of care including local mental health authorities, local behavioral health authorities, private comprehensive provider agencies, and managed care organizations. The assessments have the potential to serve as a touch point for the coordination and fiscally conscious management of services and resources.
The Texas TCOM Implementation Project will focus on demonstrating the potential of a full implementation of TCOM and training staff individuals involved at all levels of the system on how to effectively use the tool to engage clients, enhance collaboration within the system of care, and the meaningful use of the resulting data to inform decision making.
Expected Outcomes from TCOM Implementation Project
- Improved health outcomes for recipients of mental health services in Texas
- Expanded training for certified users in the use of CANS/ANSA as a care planning tool
- Training will be developed in partnership with Chapin Hall, a research policy center at the University of Chicago that focuses on improving the well-being of youth, families and their communities, which includes the interaction between CANS/ANSA and evidence based practices, and best practices for recovery treatment planning such as wraparound process planning.
- Staff using new scripts to communicate the role of the CANS/ANSA in recovery treatment planning and ongoing monitoring of progress.
- Direct connection between CANS/ANSA scoring and recovery treatment plan development.
- All levels of the organization view CANS/ANSA as a tool for measuring change in client needs and strengths over time.
- TCOM Reports available and in use at all levels of the organization and state.
- Improved engagement between LMHAs/LBHAs and other service providers and agencies around the shared vision of individual or child and family and improved communication between service providers and agencies.
TCOM Data and Reports
Links to additional reports will be made available as they are developed.
The Evidence-Based Practice Reports
- Identify people who have an assessed need.
- Identify the implementation and use of interventions identified as having the potential to improve one's mental health based on assessed need.
Actionable items suggest an area must be addressed in the recovery treatment plan and that an appropriate evidence-based report should be used in the provision of skills training, mental health rehabilitative services or counseling. Conversely, a non-actionable item indicates a person doesn't have an identified need but is receiving service encounters associated in the provision of skills training, mental health rehabilitative services, or counseling. In this case, the person's assessed need and recovery treatment plan should be amended.
These reports can be used to help monitor outcomes and inform the use of evidence-based practices to address a person's needs, helping to support their recovery. In addition, these reports can be helpful when providing clinical supervision to staff providing services.
How to get to Evidence Based Practice Reports on MBOW
- Sign in to MBOW (https://hhsc4svpop1.hhsc.txnet.state.tx.us/DataWarehousePage/)
- "CA Utilization Management"
- "UM Service Delivery"
- "Evidence Based Practices" (folder)
- Select "AMH" or "CMH"
- Select which evidence-based practice report you're interested in
How is this rollout different than what we've already been doing with the CANS/ANSA?
The first stage of successfully implementing Transformational Collaborative Outcomes Management is to help everyone in a system obtain certification in the ANSA and the CANS so the infrastructure is in place to support person-centered care. Once everyone in the system is routinely completing the assessments, it becomes possible to help them learn how to use the information from these flexible tools in meaningful ways with clients and families, in supervision, with programs and at the system level. This meaningful use of person centered information at all levels of the system is the essential element of TCOM.
HHS' behavioral health system has successfully implemented the ANSA and the CANS. Therefore, now is the chance to help the system shift to meaningful use of this information.
What's the difference between using CANS/ANSA as assessment tools and implementing TCOM?
The assessments are two of many tools that exist in the TCOM framework.
Communimetrics is a communication theory of measurement. TCOM is the framework used to help manage human-serving systems including all steps of implementation, training, action planning, etc. Within this framework are separate tools (CANS, ANSA, FAST, etc.) that support the effective communication of actionable needs and strengths of the child, youth, family receiving services.
It is one thing to complete the assessments; it is another thing to do it in an openly collaborative manner, to develop a recovery treatment plan, guide professional development, and understand and reward program performance and system gaps.
If I'm doing the ANSA/CANS am I doing TCOM already?
Not necessarily. Completing a CANS or ANSA is only one part of "doing" TCOM. TCOM is about the entire cycle of care, which is also identified in the Key Decision Points. If you are engaged in a fully collaborative assessment process, embedding the assessments into the recovery treatment plan in a meaningful way, using the ANSA and CANS to assess progress and performance of clients and direct care staff and re-engineering programs, then you are doing TCOM. If you are just completing the ANSA and CANS you are not fully using the opportunities and responsibilities identified with these assessment strategies.
Is TCOM simply taking the data from the ANSA/CANS and using it to inform system goals and direction?
No, TCOM is a comprehensive approach to using person-centered assessment information at all levels of the system consistently and simultaneously to inform all important decisions about access, engagement, appropriateness, effectiveness and transitions and links.
What will following the TCOM framework do for Texas?
TCOM will assist Texas to better serve all people with behavioral health needs. Full use of TCOM will support improved access, engagement, appropriateness, effectiveness and transitions in HHS' behavioral health system.
Can ANSA/CANS = TCOM?
The CANS and ANSA are strategies within the TCOM framework. The TCOM philosophy is to always return to the common (shared) vision of making decisions based on the best interests of the people we serve. By completing the CANS and ANSA in a collaborative fashion, we can begin to realize this philosophy. Then by meaningfully applying this information to all decisions, it becomes possible to create a system that cares.
What do I need to do, and how do I use the ANSA/CANS to TCOM?
The CANS and ANSA are best thought of as a common language by which we communicate about the people we serve. As such, certification is just learning the vocabulary and grammar. First, you must get certified in the use of the tools. Certification with a reliability of .70 or more ensures you understand the core of what is being communicated through the use of the tools. The ratings of 0-3 are reflective of action levels. These actions then guide action planning that address a client's needs and build upon their strengths. Additionally, understanding the contextualization principles is the essence of learning the structure of this common language approach. Once you complete the ANSA and CANS, the larger questions is — what are you going to do with what you now know about the person or family in care?