Chapter 1
The Planning Foundation

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The Strategic Plan Framework

This document marks a fundamental milestone in the New York State Office of Mental Health’s (OMH) strategic planning process. Over the last several years, the agency has developed a strong planning infrastructure, with substantive stakeholder input at all levels of the process. The process has included development and refinement of the strategic framework, systematically scanning the environment through a review of the literature and soliciting County and stakeholder perspectives. It has laid the foundation for identifying programmatic and financial priorities, and the continued expansion and strengthening of the agency’s performance management capacity and capabilities.

Having reached this milestone, OMH is now entering a new phase for issuing its Statewide Comprehensive Plan for Mental Health Services. A major release of the Plan will occur every five years, with annual updates in the interim. Such an approach has been used successfully by OMH in the past when a comprehensive planning process was well established. It is consistent with the intent of the New York State Mental Hygiene Law. This year, therefore, represents the first annual update to the 2006-2010 edition of the Statewide Comprehensive Plan.

Moreover, this document has been designed to incorporate a description of the actions taken to fulfill the planning requirements of the Mental Hygiene Law and modifications in the plan of services being required. It also serves, therefore, as the 2007 Statewide Comprehensive Plan Interim Report. Going forward, OMH intends to re-establish the scheduled release of planning documents consistent with the time frames specified in the Mental Hygiene Law.

What follows is a brief summary of progress over the last several years. New readers of this plan are referred to the three previous Statewide Comprehensive Plans for greater detail. They can be found online at http://www.omh.state.ny.us/omhweb/about/ under the heading "Office of Mental Health Strategic Planning Documents."

In particular, this chapter highlights planning advances, elements of the Strategic Plan Framework, major functions of OMH, and the balanced scorecard approach for bringing about positive change in the public mental health system. As you read, you will see that OMH has made great strides in honoring its commitment to create strengthened and viable planning and performance measurement processes that promote forward momentum. The agency remains committed to a transparent performance and accountability structure and has created a robust platform for the new administration to advance the agency’s goals and vision.

Movement toward Positive Change

A central role of government is to develop policies and provide services and programs that enable all citizens to live full, productive and meaningful lives. In relying upon government institutions to provide an array of vital programs and services to protect and enhance our health and mental well-being, we expect the best value for our investment of public funds. To this end, OMH continually strives to ensure the most effective and efficient use of public monies. It does this through actions aimed at promoting accountability, improving performance management, and improving operations through structural and service enhancements, including the use of technology. A significant contributor to these efforts has been the agency’s formal strategic planning and performance measurement processes, which play an integral part in defining strategic direction and priorities in relation to financial decision making and expected outcomes.

A discussion of the national and State focus on quality and performance can be found in Chapter 1 of the 2006-2010 Plan. This focus is at the heart of OMH’s role in encouraging and sustaining services and supports informed by scientific inquiry, focused on facilitating recovery, and designed to enhance the resilience of all New Yorkers, particularly children with serious emotional disturbance and adults with serious mental illnesses. Balancing the imperative for quality with the need for cost-effective and efficient services is in part why OMH is committed to relying upon best practices, such as the Balanced Scorecard approach, as well as other performance management and quality improvements for strategic management.

Driving OMH toward positive change are several elements seen as foundational to a system of care that places the people it serves at its center. These include having:

• A clear and compelling vision of desirable outcomes
• The leaders and capacity to communicate the vision
• An environment that is open and amenable to change
• Strategies that reflect the context and the roles, capabilities, and interests of stakeholders
• Individuals that serve as catalysts or “champions” to facilitate the change necessary to achieve desired outcomes
• Systematic processes in place not only to take advantage of opportunities, but also to overcome barriers
• Tools to monitor progress and adjust processes based on experience.¹

The building blocks for facilitating positive change within New York’s public mental health system are found in its Strategic Plan Framework.

The Strategic Planning Infrastructure

The precise description of OMH’s purpose, what it strives to be, and the inherent characteristics and qualities considered important to OMH are reflected in its mission, vision and values.

Mission
The mission of the New York State Office of Mental Health is to promote the mental health of all New Yorkers, with a particular focus on providing hope and recovery for adults with serious mental illness and children with serious emotional disturbances.

Vision
The New York State Office of Mental Health envisions a future when everyone with a mental illness will recover, when all mental illnesses can be prevented or cured, when everyone with a mental illness at any stage of life has access to effective treatment and supports essential for living, working, learning, and participating fully in the community.

Values

• Recovery is the process of gaining control over one’s life in the context of the personal, social and economic losses that may result from the experience of psychiatric disability. It is a continuing, nonlinear, highly individual process based on hope and it leads to healing and growth.
• Hope is the belief that one has both the ability and the opportunity to engage in the recovery process.
• Excellence is the state of possessing superior merit in the design, delivery and evaluation of mental health services.
• Respect is esteem for the worth of a person including recognition of dignity, diversity and cultural differences.
• Safety is an environment free from hurt, injury or danger.

Recovery, hope, excellence, respect and safety reflect the values that govern behavior, foster responsible decision making, and set the course for the agency’s strategic direction and success. These values help to define the conduct by which OMH carries out its day-to-day operations and they enable a culture in which partnerships, trust and hope are accorded respect and appreciation.

The mission, vision and values were all reviewed carefully in 2005 as part of a public input process, to ensure that the Framework was relevant to the needs of individuals and communities served by the public mental health system. Refinements to these foundational components are described fully in the 2006-2010 Statewide Comprehensive Plan for Mental Health Services. Stakeholder input over the last year indicated no substantial changes to these elements were required at this time.

Principles, Goals and Objectives

Principles
The mission, vision and values are supported by four principles – accountability, best practices, coordination of care and disparities elimination – which serve to reinforce the agency’s strategic direction. Known as the “ABCD’s of Mental Health Care,” these fundamental concepts include:

• Accountability for Results, whereby a clearly defined entity or individual is responsible for the effectiveness of services delivered. Services are designed and delivered to achieve specific outcomes, which are measured by performance indicators.
• Best Practices, whereby service design and delivery are based on the best research and evidence available and best practice guidelines are incorporated into treatment practices. Adherence to these guidelines is measured as part of the accountability process.
• Coordination of Care, whereby coordinated, comprehensive networks of providers deliver a balanced array of medical, self-help, social, supportive and rehabilitative services and programs. These services are focused on rehabilitation and recovery, and the development of individualized service plans designed around the needs and desires of the individual.
• Disparities Elimination and Cultural Competence, whereby all service components are held accountable to address disparities in access to and participation in services, differences are managed skillfully, cultural knowledge is absorbed organizationally, language assistance services are provided routinely, and service modifications are made to take into account the diversity of individuals, families and communities.

Goals and objectives
With the 2005-2009 Statewide Comprehensive Plan, OMH demonstrated a major step forward in operationalizing the agency’s strategy into a set of goals and objectives. These goals and objectives also received careful scrutiny in 2005, were further refined based on extensive stakeholder input, and outlined in the 2006-2010 Plan.

Goals and objectives for the public mental health system, by domain, are described in Table 1.1.

Based on feedback received during a series of public informational and formal hearing sessions held across the State in the spring of 2006, stakeholders endorsed the Strategic Plan Framework and indicated that it provides a reliable basis for communications and continued planning efforts among counties and all stakeholders of the public mental health system.

A compilation of the Strategic Plan Framework elements appears in Appendix 1 to this Plan Update and Interim Report.

Primary Functions of the Office of Mental Health

As the State mental health authority, OMH has two main strategic directions: assuring access to services of the highest quality for children with serious emotional disturbance and adults with severe mental illnesses and promoting the mental health of all New Yorkers through a public health approach of education and advocacy. To effectively meet its responsibilities, OMH organizes daily operations along four functional, administrative lines:

Regulating, certifying and overseeing New York’s public mental health system
OMH regulates and licenses all mental health facilities and programs in the State, with the exception of private practices and Federal facilities. The agency oversees 58 Local governmental units, one of which covers New York City in its entirety. Within the five regions of the State, more than 2,500 mental health programs are operated by local governments and private agencies. The services offered by these programs include inpatient, outpatient, emergency, residential, and community support. While certain policy, funding, regulatory, and management functions are centrally administered, actual program administration takes place on the Local government level. Each year approximately 588,000 individuals receive services in County-operated or nonprofit mental health programs.

Providing State-operated inpatient and outpatient mental health services
OMH is a major provider of intermediate and long-term inpatient as well as outpatient treatment services. It operates 25 psychiatric centers, including six serving children with serious emotional disturbance and 16 serving adults with serious mental illnesses, and three serving adults with mental illness who have contact with the criminal justice system. State-operated outpatient services are designed to serve children and adults who use State-operated inpatient services. Additionally, OMH provides mental health services in 23 sites around the State to inmates incarcerated in Department of Correctional Services’ facilities.

Conducting mental health research to advance prevention, treatment, and recovery
Scientific research conducted by OMH is critical in identifying treatment and clinical practices that are effective in improving the outcomes of services and integrating these practices into the public mental health system. Researchers from the Nathan S. Kline Institute (NKI) in Orangeburg and the New York State Psychiatric Institute (NYSPI) in New York City conduct clinical trials to develop and evaluate new treatments and services and basic research to better understand the molecular, biochemical, neurological and genetic mechanisms underlying mental illness. These researchers participate in consortia and other scientific collaborations that are leading to the development of new medications to treat schizophrenia, bipolar disorder, depression, anxiety disorder, and Alzheimer’s disease. OMH research and evaluation staff members also examine service outcomes, conduct data-driven analyses of pressing mental health issues, and develop sound recommendations and approaches for improving service quality and access.

Promoting mental health through public education
OMH promotes mental health through education and advocacy for all New Yorkers. Mental health promotion activities are targeted toward expanding public awareness and knowledge of mental health, particularly for persons at risk for, or living with, mental health problems. Specifically, mental health promotion focuses on enhancing individual resiliency, making communities stronger, and diminishing structural barriers that impede access to housing and gainful employment. Through OMH, many New Yorkers are being educated and given information on the nature and impact of mental health and mental illness, effective treatments and services, preventive and coping strategies, and how to get help when needed.

The Balanced Scorecard Approach

Strategic planning by OMH is premised on a number of elements incorporated into the agency’s performance measurement and management structures over the last 10 years and strengthened recently with the introduction of the balanced scorecard approach. The elements include:

• Keeping the focus on the agency’s mission, vision and values
• Aligning performance measures, standards and targets with the agency’s goals and objectives
• Promoting ownership of and accountability for results at all levels of the organization
• Enhancing organizational efficiency by encouraging attention to the issues of greatest importance
• Creating an organizational structure and culture from one defined by specialized functions to one concerned with service outcomes
• Ensuring data-driven decision making
• Systematically identifying issues that would likely become problematic without proactive change
• Promoting effective communications that foster full participation in meeting short- and long-term goals

Introduced in 1992 by Kaplan and Norton² of the Harvard Business School, the balanced scorecard approach enables better performance and outcomes through the systematic integration of stakeholder, internal business processes, employee and organizational knowledge and growth, and financial data. Organizations that have been effective in using this approach consistently make clear their strategy in operational terms, align organizational activities to strategy, make strategy a part of every person’s daily work, ensure continual attention to strategy, and inspire change with strong and committed leadership at the executive level.

Figure 1.1
Basic Design of the Balanced Scorecard Approach for the Public Mental Health System
⁴

Initially developed for use in business, the balanced scorecard approach has been adapted over time for the public sector. It has been embraced by several agencies at the Federal level (e.g., Department of Energy, Office of Personnel Management) as well as within the fields of public health and mental health. As noted in last year’s Plan, the literature is replete with case studies and reports of improved outcomes and performance resulting from the use of the balanced scorecard approach.

Processes for Promoting Positive Change
The balanced scorecard approach represents a dynamic, continual and comprehensive strategic performance management system that encompasses mission, strategy and perspectives.³ Figure 1.1 depicts the basic design of the Balanced Scorecard, which has been adapted to the OMH public mental health system.

The mission is at the top of the model, signifying its importance as the main driver of activities in a public sector organization. At the core of the approach is the business strategy, which is the means to accomplish the mission and nurture advancement of the organization’s vision through a focus on goals and objectives. Connected to these two components are the major organizational perspectives: customer, financial, internal processes, and learning and growth.

In adopting the balanced scorecard approach, organizational leaders embrace a “vision for change” and nurture collaboration and dedication to strategy as part of the organization’s day-to-day work. Under this framework, the goals and objectives serve as the means to accomplish the mission within the context of the agency’s vision and values. Moreover, measurement serves as the method to check progress, ensuring that each part of the organization aligns its initiatives and programs to the strategic plan. Thus, the balanced scorecard framework fosters a culture that promotes positive change, integrates key organizational perspectives, aligns the mission with strategies to attain goals, and underscores attention to performance and outcomes.⁵

Implementation of the balanced scorecard approach within OMH draws upon a set of integrated processes OMH has been using to improve service quality: gathering input from stakeholders on relevant areas of performance, collecting and analyzing performance data, reporting results, and using the data to refine programs and services. As depicted in Figure 1.2, these processes together have formed a continuous quality improvement cycle.⁶

As depicted in the model, measuring the performance of the State public mental health system is critical to facilitating change and improvements in the quality and effectiveness of public mental health services. Performance measurement promotes accountability and reflects progress toward attaining the shared goals of the State mental health authority, providers, individuals and families served within the system, and other stakeholders.

Combining this model with the strengths of the balanced scorecard approach, OMH has capitalized on the benefits of each. The balanced scorecard approach being utilized by OMH gives priority to the needs of consumers, families and stakeholders. The approach is dynamic and living rather than one that relies upon static planning guidelines. It incorporates regular and systematic tracking of performance and focuses on achieving positive outcomes. By facilitating proactive change, the balanced scorecard approach also reveals issues before they can become problematic and emphasizes strategic thinking to resolve such issues. Finally, the balanced scorecard approach stresses cross-functional collaborations and teamwork, both important ingredients in addressing opportunities for improved care.

Managing Performance

As part of the balanced scorecard approach, OMH critically reviews organizational perspectives through a scan of environmental trends, challenges and opportunities facing the national and State public mental health systems.

For the purposes of this discussion, environmental trends include developments unfolding within the national and New York State public mental health systems as well as the broader societal issues that affect these systems of care. Challenges, on the other hand, relate to the pressures exerted on an organization based on consumer needs or expectations, service needs, or financial, societal or other needs as well as an organization’s capabilities, including human and other resources.⁷ Opportunities are the circumstances or events that serve to move an organization forward in line with its strategic plans. Last year’s Plan provides detail on OMH’s operating environment and this year’s Plan offers additional detail on emerging trends, challenges, and opportunities.

Figure 1.3 provides another way of viewing the balanced scorecard process and outlines the approach OMH is taking in planning for the provision of effective and efficient mental health care and mental health promotion in New York State. Each year, the agency conducts a comprehensive assessment of the public mental health system and the broader environment in which it operates. There are four major sources of information: an extensive review of the literature highlighting international, national and State developments and advances in the base of knowledge; far-ranging and inclusive stakeholder input, including annual regional briefings and hearings on the Statewide Comprehensive Plan, the work of the Commissioner’s advisory bodies, and many other forums, events and activities; County perspectives, including Mental Hygiene Directors, Community Service Boards, and other stakeholders; and internal analyses conducted by OMH.

Figure 1.3
Processes for Promoting Performance Management and Continuous Quality Improvement

At essentially the same time, the Strategic Plan Framework is reviewed and modified as indicated. Information from the environmental assessment and review of the Planning Framework is then brought together and organized into a set of environment trends and challenges faced by the New York State public mental health system.

The second level of Figure 1.3 shows the selection of strategic priorities, priorities that evolve from an examination of where we want things to go (the Strategic Plan Framework) and where things are going (environmental trends and challenges). Specifically, we look for areas of divergence between these two and identify the priorities and actions to put us back on the path to successful outcomes.

Detailed initiatives are then identified to advance the strategic priorities and to narrow the divergence between the direction indicated in the Plan and the trends and challenges. The initiatives that required Executive Budget recommendations last year were addressed by Chapter 6 of the 2006-2010 Comprehensive Plan. The 2007-2008 Executive Budget recommendations in support of these priorities are delineated in Chapter 4 of this Plan Update and Interim Report.

As part of the agency’s commitment to move forward an agenda of continuous quality improvement and accountability, OMH establishes performance measures for the initiatives, which are constructed to quantify progress, work toward a target, and to do so within a specified period. The Balanced Scorecard is one of a number of performance management tools OMH uses to keep abreast of progress related to its strategic priorities and initiatives supporting them. It has been designed to be easily understandable and to provide visual cues of progress. To be included in the Balanced Scorecard, each performance measure must be related to a strategic priority, be connected to an active initiative designed to provide forward direction, and be measurable.

Complementing the balanced scorecard approach and the Balanced Scorecard, OMH has introduced a Statistics and Reports portal on the agency web site

to provide not only data that indicate progress toward addressing strategic priorities, but also data that focus on effectiveness and quality. These resources are described further in Chapter 5, which provides an overview of new internet-based reporting systems that increase the utility of OMH’s data collection and analysis infrastructure.

What is important about each and every one of these components of the Strategic Plan Framework is that taken together they represent a comprehensive, integrated and transparent strategic planning and performance management infrastructure. This planning framework is far beyond the scope of previous approaches and capabilities, enabling the agency to move ahead with an agenda focused on wellness and recovery for all New Yorkers.

Before reading about and considering the agency’s new web-based reporting tools, however, you will be provided with an overview of activities and initiatives in progress by OMH in Chapter 2; of trends, challenges and opportunities for improvement during the coming Fiscal Year in Chapter 3; and of strategic priorities for 2007-2008.

1. Mazade NA. (2005, January). Concepts of “transformation.” Alexandria, VA: National Association of State Mental Health Program Directors Research Institute.
2. Kaplan RS & Norton DP. (1992, January-February). The balanced scorecard: Measures that drive performance. Harvard Business Review, 71-79.
3. Rohm H. Improve public sector results with a balanced scorecard: Nine steps to success. Raleigh, NC: U.S. Foundation for Performance Measurement
4. Adapted from Developing and Using Balanced Scorecard Performance Systems, the Balanced Scorecard Institute, and Improve Public Sector Results with a Balanced Scorecard: Nine Steps to Success, U.S. Foundation for Performance Measurement.
5. See the primer offered by the University of Minnesota. (2004). Measurement model: The balanced scorecard. Author: Center for Human Resource Development Service Improvement Program. Available online at http://training.finop.umn.edu/sip/GRAPHICS/MeasModBalScrd.pdf  (PDF).
6. New York State Office of Mental Health. (2005, January). 2005-2009 statewide comprehensive plan for mental health services. Albany, NY: Author.
7. See Baldrige actionable glossary. Accessed online at http://www.baldrige21.com/Baldrige%20Glossary.html

Comments or questions about the information on this page can be directed to the Office of Planning.