Bulletin: BASIS-32 Behavior and Symptom Identification Scale Applications Profile

The BASIS-32 (Behavior and Symptom Identification Scale) was designed to assess outcomes of mental health treatment from the patient's, or client's, perspective. The BASIS-32 is a brief yet comprehensive measure of self-reported symptoms and functional health status that may lead to the need for inpatient psychiatric treatment. It was developed on a psychiatric inpatient hospital population but can be and has been used in outpatient populations as well. The BASIS-32 was admitted to the Trust's library of health status assessment and outcomes instruments in the spring of 1997.

The purpose of this article is to highlight some important state and systems-wide applications in which the BASIS-32 is being used.

ORYX is the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) extensive initiative to integrate performance measures into the accreditation process for a wide range of health care organizations including hospitals, long term care facilities, home health agencies and behavioral health care organizations. To date, the JCAHO has approved well over 200 performance measurement systems for use in ORYX, approximately 60 of which are applicable to behavioral health care organizations. BASIS-32 Plus, accepted as an ORYX approved system in November, 1997, is a performance measurement system that offers a menu of performance indicators including: 1) the BASIS-32 and Perceptions of Care, both patient self-reporting instruments, 2) readmissions within 30 days, and 3) rates for medication errors, restraint and seclusion and patient assaults. Behavioral health organizations must choose a vendor by the end of 1998 and begin submitting data related to the JCAHO-approved performance measurement system by the third quarter of 1999.

The Council of Behavioral Group Practices is a large consortium of independent behavioral health care practices affiliated with the Institute for Behavioral Health Care in Tiburon, California. In 1994, the Council began using the BASIS-32 as part of an effort to evaluate the general health status of its patients. Ultimately, the initiative grew into a comprehensive Outcomes Management Project (OMP), with BASIS-32 serving as the primary measurement tool for mental health care. The OMP currently provides outcomes data analysis and benchmark data to 19 practices in 12 states. To date, baseline data have been collected on more than 15,000 clients including inpatients and outpatients. Preliminary results indicate that the greatest improvements in patient status occur between intake and three-month follow-up.

Greenleaf Health Systems, based in Chattanooga, Tennessee, has been using the BASIS-32 for more than four years to assess adult inpatients and more recently, adult partial hospital patients, in both generic and specialty programs. According to Richard White, Greenleaf's Vice President of Marketing, even with a decline in length-of-stay, patients are still showing statistically and clinically significant behavior improvements following treatment. This is encouraging since the acuity of illness is going up. After four years at Greenleaf, BASIS-32 has become an essential part of the organization's continuous quality improvement efforts. In addition, Greenleaf is using BASIS-32 in developing its managed care business. White says that in the future Greenleaf hopes to add additional instruments to the BASIS-32 and to expand its use beyond the Tennessee. As chairperson of an 11-hospital, statewide Georgia Behavioral Health Coalition, White is optimistic that he will be able to use the BASIS-32 in all hospitals in this provider system.

In September, 1996, the California Department of Mental Health implemented a pilot program using the BASIS-32 in seven of its nine counties. Along with other standardized measures, the BASIS-32 was administered to a population of severely mentally ill adult and older adult outpatients. The instrument was used as part of the assessment and intake process adding clients' perceptions to the clinical assessment and treatment planning process. It was readministered at six-month intervals. Currently, the State is in the process of completing a final report on the pilot program and determining the next steps for the project. Statewide implementation is the likely direction.

The MSPCC provides home and clinic-based mental health services to children and adults throughout Massachusetts. The society's 12 clinic sites across the state handle 10,000 to 12,000 patient visits yearly. In 1996, the Society implemented an outcomes study using the BASIS-32 at intake and two-month follow-up. Fifty-two percent of the study's sample population were people of color (414 adults and adolescents age 14 and over). Preliminary results show the BASIS-32 appears to capture changes between intake and follow-up within each ethnic group.

According to Susan Eisen, Ph.D., assistant director or McLean Mental Health Services Research and primary developer of the BASIS-32, these and other data collected on people of color can be used to assess the validity of outcomes measurement instruments when used with minority groups. This is important because it shows that no matter what the patient's cultural background, BASIS-32 is a useful tool for determining the results of psychiatric care.

According to Paul Youd, MSPCC utilization manager, the Society now incorporates BASIS-32 into every patient assessment and is hoping to use ongoing results in its future quality management plans.

Since April, 1997, the Department of Community Health, Mental Health and Substance Abuse Services of the State of Michigan has required its 49 statewide Community Mental Health Services Programs (CMHSPs) to collect and report standardized demographic information to the State, one element of which is a score on the BASIS-32. The CMHSPs provide mental health services, services for developmentally disabled individuals and some substance abuse services. As part of a larger Quality Management System it is developing, the State requires the CMHSPs to report on a range of demographic information for all adult consumers with a diagnosis of mental illness, excluding those suspected of having dementia. One element of the demographic data is a score on the BASIS-32. It is required that the data be collected at intake and annually or upon discharge whichever occurs first. To date, two rounds of data on consumer function have been collected on approximately 144,140 individuals in April and December, 1997. The Department's intent is to use the data to examine changes in individuals' mental health status over time and to compare the case mix and consumer outcomes of the 49 mental health boards.

The experience of the SCDMH in the development of a performance measurement system began approximately three years ago. As part of a zero-based budgeting system, the South Carolina Legislature's Ways and Means Committee initiated a requirement for program outcomes across state government including a statutory requirement for performance measures as part of annual accountability reports. As part of the evolution of their outcomes program, the Department participated in a five state feasibility study to explore the feasibility of compiling outcomes and other performance indicators from public mental health systems across multiple states.

The South Carolina mental health system is centralized and has a patient-centered database with the potential to with other health care settings. The Department's database includes data from all department hospitals, mental health centers and all public inpatient and outpatient providers. Given these and other factors providing impetus to the development of a system-wide outcome program, the Department sought an approach to outcomes measurement for programs serving adults that would address patients' symptoms and functioning.

After an extensive process of reviewing numerous methodologies to collect outcomes data for the mental health system, the SCDMH Office of Quality Improvement, Outcomes and Advocacy selected the BASIS-32 to measure outcomes for adults in community programs.

Currently, the SCDMH is developing its capacity to automate the collection of the BASIS-32 data. Scanning equipment for the BASIS-32 was purchased from and installed by HCIA Response. Twenty thousand scan forms have been purchased and will be distributed to the 17 community mental health centers. A batch scanner installed centrally will require completed BASIS-32 scan forms to be mailed to the central site for scanning. Ultimately, purchase of a fax-back system will eliminate the mail-in requirement and will allow for faxing of the scan sheets to the scanner with electronic feedback to the site originating the forms. It is expected that baseline data will be collected during the first quarter of the upcoming fiscal year and that by October, 1998, the State will begin to analyze outcome data.

	July 1999 - Volume 4 - Issue 1 A Publication for Members of Medical Outcomes Trust
				Bulletin: BASIS-32 Behavior and Symptom Identification Scale Applications Profile

				The BASIS-32 (Behavior and Symptom Identification Scale) was designed to assess outcomes of mental health treatment from the patient's, or client's, perspective. The BASIS-32 is a brief yet comprehensive measure of self-reported symptoms and functional health status that may lead to the need for inpatient psychiatric treatment. It was developed on a psychiatric inpatient hospital population but can be and has been used in outpatient populations as well. The BASIS-32 was admitted to the Trust's library of health status assessment and outcomes instruments in the spring of 1997. The purpose of this article is to highlight some important state and systems-wide applications in which the BASIS-32 is being used. ORYX ORYX is the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) extensive initiative to integrate performance measures into the accreditation process for a wide range of health care organizations including hospitals, long term care facilities, home health agencies and behavioral health care organizations. To date, the JCAHO has approved well over 200 performance measurement systems for use in ORYX, approximately 60 of which are applicable to behavioral health care organizations. BASIS-32 Plus, accepted as an ORYX approved system in November, 1997, is a performance measurement system that offers a menu of performance indicators including: 1) the BASIS-32 and Perceptions of Care, both patient self-reporting instruments, 2) readmissions within 30 days, and 3) rates for medication errors, restraint and seclusion and patient assaults. Behavioral health organizations must choose a vendor by the end of 1998 and begin submitting data related to the JCAHO-approved performance measurement system by the third quarter of 1999. Council of Behavioral Group Practices The Council of Behavioral Group Practices is a large consortium of independent behavioral health care practices affiliated with the Institute for Behavioral Health Care in Tiburon, California. In 1994, the Council began using the BASIS-32 as part of an effort to evaluate the general health status of its patients. Ultimately, the initiative grew into a comprehensive Outcomes Management Project (OMP), with BASIS-32 serving as the primary measurement tool for mental health care. The OMP currently provides outcomes data analysis and benchmark data to 19 practices in 12 states. To date, baseline data have been collected on more than 15,000 clients including inpatients and outpatients. Preliminary results indicate that the greatest improvements in patient status occur between intake and three-month follow-up. Greenleaf Health Systems Greenleaf Health Systems, based in Chattanooga, Tennessee, has been using the BASIS-32 for more than four years to assess adult inpatients and more recently, adult partial hospital patients, in both generic and specialty programs. According to Richard White, Greenleaf's Vice President of Marketing, even with a decline in length-of-stay, patients are still showing statistically and clinically significant behavior improvements following treatment. This is encouraging since the acuity of illness is going up. After four years at Greenleaf, BASIS-32 has become an essential part of the organization's continuous quality improvement efforts. In addition, Greenleaf is using BASIS-32 in developing its managed care business. White says that in the future Greenleaf hopes to add additional instruments to the BASIS-32 and to expand its use beyond the Tennessee. As chairperson of an 11-hospital, statewide Georgia Behavioral Health Coalition, White is optimistic that he will be able to use the BASIS-32 in all hospitals in this provider system. California Experience: Department of Mental Health Pilot Program In September, 1996, the California Department of Mental Health implemented a pilot program using the BASIS-32 in seven of its nine counties. Along with other standardized measures, the BASIS-32 was administered to a population of severely mentally ill adult and older adult outpatients. The instrument was used as part of the assessment and intake process adding clients' perceptions to the clinical assessment and treatment planning process. It was readministered at six-month intervals. Currently, the State is in the process of completing a final report on the pilot program and determining the next steps for the project. Statewide implementation is the likely direction. Massachusetts Society for the Prevention of Cruelty to Children (MSPCC) The MSPCC provides home and clinic-based mental health services to children and adults throughout Massachusetts. The society's 12 clinic sites across the state handle 10,000 to 12,000 patient visits yearly. In 1996, the Society implemented an outcomes study using the BASIS-32 at intake and two-month follow-up. Fifty-two percent of the study's sample population were people of color (414 adults and adolescents age 14 and over). Preliminary results show the BASIS-32 appears to capture changes between intake and follow-up within each ethnic group. According to Susan Eisen, Ph.D., assistant director or McLean Mental Health Services Research and primary developer of the BASIS-32, these and other data collected on people of color can be used to assess the validity of outcomes measurement instruments when used with minority groups. This is important because it shows that no matter what the patient's cultural background, BASIS-32 is a useful tool for determining the results of psychiatric care. According to Paul Youd, MSPCC utilization manager, the Society now incorporates BASIS-32 into every patient assessment and is hoping to use ongoing results in its future quality management plans. Michigan Department of Community Health, Mental Health and Substance Abuse Services Since April, 1997, the Department of Community Health, Mental Health and Substance Abuse Services of the State of Michigan has required its 49 statewide Community Mental Health Services Programs (CMHSPs) to collect and report standardized demographic information to the State, one element of which is a score on the BASIS-32. The CMHSPs provide mental health services, services for developmentally disabled individuals and some substance abuse services. As part of a larger Quality Management System it is developing, the State requires the CMHSPs to report on a range of demographic information for all adult consumers with a diagnosis of mental illness, excluding those suspected of having dementia. One element of the demographic data is a score on the BASIS-32. It is required that the data be collected at intake and annually or upon discharge whichever occurs first. To date, two rounds of data on consumer function have been collected on approximately 144,140 individuals in April and December, 1997. The Department's intent is to use the data to examine changes in individuals' mental health status over time and to compare the case mix and consumer outcomes of the 49 mental health boards. South Carolina Department of Mental Health (SCDMH) The experience of the SCDMH in the development of a performance measurement system began approximately three years ago. As part of a zero-based budgeting system, the South Carolina Legislature's Ways and Means Committee initiated a requirement for program outcomes across state government including a statutory requirement for performance measures as part of annual accountability reports. As part of the evolution of their outcomes program, the Department participated in a five state feasibility study to explore the feasibility of compiling outcomes and other performance indicators from public mental health systems across multiple states. The South Carolina mental health system is centralized and has a patient-centered database with the potential to with other health care settings. The Department's database includes data from all department hospitals, mental health centers and all public inpatient and outpatient providers. Given these and other factors providing impetus to the development of a system-wide outcome program, the Department sought an approach to outcomes measurement for programs serving adults that would address patients' symptoms and functioning. After an extensive process of reviewing numerous methodologies to collect outcomes data for the mental health system, the SCDMH Office of Quality Improvement, Outcomes and Advocacy selected the BASIS-32 to measure outcomes for adults in community programs. Currently, the SCDMH is developing its capacity to automate the collection of the BASIS-32 data. Scanning equipment for the BASIS-32 was purchased from and installed by HCIA Response. Twenty thousand scan forms have been purchased and will be distributed to the 17 community mental health centers. A batch scanner installed centrally will require completed BASIS-32 scan forms to be mailed to the central site for scanning. Ultimately, purchase of a fax-back system will eliminate the mail-in requirement and will allow for faxing of the scan sheets to the scanner with electronic feedback to the site originating the forms. It is expected that baseline data will be collected during the first quarter of the upcoming fiscal year and that by October, 1998, the State will begin to analyze outcome data. For a more thorough introduction to the BASIS-32, refer to the Medical Outcomes Trust Bulletin, Volume 5, Number 3, May 1997.