Ongoing quantitative indicators include weekly attendance, scores on a pre/post-knowledge test, BASIS-32 (a behavioral health assessment tool), and a consumer satisfaction survey. Data on days spent in psychiatric hospitals and psychiatric residential programs requiring an intensive day/night level of service, collected through our administrative claims system, are combined to measure incidents of relapse. Qualitative data, and perhaps the richest source of input received, come from consumer and clinician feedback gathered after each class, focus groups held during and after the pilot, and bimonthly meetings in which facilitators share their experiences and concerns about BEST.
After completing BEST, consumers' quantitative indicators show statistically significant improvements. Consumers who attend BEST experience significant improvement in BASIS-32 scores and satisfaction with treatment. Hospital and residential days were reduced for the group overall one year after completing BEST as compared to the year prior to starting the program. Outliers and dropouts are analyzed individually, with a majority of them having schedule changes due to job, school, or family obligations, or not being stable enough to enter a group setting. We addressed this by adding an introductory class to prepare consumers for the time commitment the program requires.
Consumers report that most are using the coping skills BEST teaches. Disease management skills learned and practiced include recognizing personal warning signs and triggers of mood episodes, stabilizing daily rhythms, identifying and addressing sources of stress, identifying core beliefs and negative thinking patterns that affect mood, building communication skills, and building a support system. Consumers feel that BEST presents an overall view of stress management, and that they are able to say “I am like you, and that's OK” when referring to others with bipolar disorder.
Some consumers do not like BEST's meditation component, since some find it hard to quiet their mind. In early sessions, the suggestion that came up most often was to address “what is normal mood” earlier in the program. Some have suggested augmenting elements of the program that address healthy risk taking and phobias such as claustrophobia, fears of crowds and being touched by others, and social anxieties, and how to cope with and understand them.
Consumers' qualitative input helps enhance the program and manual. A discussion during one of the pilot's focus groups inspired the development of a new tool: the “spectrometer,” a mood gauge that helps individuals describe their unique symptoms and associate them with the possible interventions for every mood level, including normal mood.
After completing BEST, consumers say they are more prepared to talk about bipolar disorder to other people, and that their families are more understanding of their disorder and accept their limitations more readily. Consumers believe their moods are more regulated and normal, and that it is now easier to accept and understand what their normal mood is like. They appreciate that they now can “label” their signs, symptoms, triggers, illness, etc., to better explain and communicate to their prescribers and clinicians what they are experiencing.
Developing programs to deliver evidence-based practices is an excellent role for a managed behavioral healthcare organization. MBHOs are interested in health maintenance, wellness, and prevention as part of a strategy to control healthcare costs. MBHO staff members have resources to develop guidelines and materials, as well as offer research support such as data collection and analysis through administrative claims systems. By combining the wisdom of consumers dealing with illness, the expertise of multiple providers who know what works in the real world, and the latest research in treatment, MBHOs can create rich, effective programs that help their members develop resiliency and resistance to the ravages of their disease.
The authors are with Behavioral HealthCare, Inc., in Centennial, Colorado: Mary Hajner is Research Coordinator; Alicia Nix is Project Support Coordinator; and Ann Terrill-Torrez is Director of Quality Improvement. The authors are in the process of generating more outcomes and preparing submissions to peer-reviewed journals, and they are willing to discuss the program further. Contact Mary Hajner at
For more details about their work with bipolar disorder, visit http://www.bhicares.org/bipolarguidelines.shtml.