The role of monitoring outcomes in initiating implementation of evidence-based treatments at the state level.

This article describes a six-year statewide initiative to help mental health service providers in continuously monitoring the outcomes of youths with serious emotional disturbances who are treated in the public-sector managed behavioral health care system. Participating providers submit outcome data to a state-sponsored evaluator, using the Child and Adolescent Functional Assessment Scale (CAFAS), and receive monthly feedback that identifies youths who are making poor progress in treatment. Additional reports are used to ensure record compliance, monitor at-risk youths, and assist in reviewing the adequacy of treatment plans. In addition, outcome data for closed cases are generated for various types of clients. The consistently poor outcomes for some types of clients have generated a genuine interest among clinical staff in learning and implementing evidence-based treatments. The data for all participating providers were pooled to generate state averages for various indicators so that each provider can compare their site to these benchmarks. State administrators consider the data in generating policy and identifying systemwide needs. The processes that shaped this initiative and that created the providers' investment in continuous quality improvement activities are described.