Measurement-Based Care for Hawaii Mental Health Teams

CAMHD Performance Standards

Effective 28 December 2024, grounded in CAMHD's Measurement-Based Care procedures

Monthly Youth and Caregiver Reports

Ohio Scales completed monthly by youth aged 10 and older in CAMHD services and their caregivers

Inter-Island Care Without the Flight

Clients answer on their own phone from an email link, so a check-in between visits does not depend on a ferry, a flight or a long drive around the island.

Clinics and Multi-Site Practices

Group practices and agencies with offices on more than one island can bring every site under a Team or Network plan, with role-based access so staff see only the clients their role permits.

Adversity and Trauma Screening

The ACE questionnaire and the PCL-5 sit in the same library as the depression and anxiety scales, for teams that ask about adverse childhood experiences and trauma.

19.8%

of Hawaii adults had any mental illness in the past year (model-based annual average, 2023-2024)

14.8%

of Hawaii residents aged 12 to 17 had a major depressive episode in the past year (annual average, 2023-2024)

Repeated functional measures in youth services

Using longitudinal youth functional impairment scores across 2,807 treatment episodes in Hawaii's public youth mental health system, the study found logarithmic improvement for most levels of care, with time until reliable improvement ranging from 4 to 12 months.

Jackson et al., Administration and Policy in Mental Health, 2017 PMID 26459353

Caregiver Ohio Scales at entry

Latent profile analysis of caregiver Ohio Scales responses for 1,090 youth entering a public mental health system identified four problem profiles (low-risk 63.3%, internalizing 23.2%, delinquency 8.8%, high-risk 4.7%), which were used to predict remission after treatment.

Turner et al., Administration and Policy in Mental Health, 2022 PMID 35697977

PHQ-9 with Hawaii farmers

In PHQ-9 data from 375 Hawaii farmers, a network analysis identified guilt and fatigue as core symptoms, and a two-item screen built on them showed good validity (AUC 0.883).

Liu and Le, Journal of Health Care for the Poor and Underserved, 2025 PMID 40820755

CAMHD Performance Standards

CAMHD's Performance Standards, known as the Pink Book, set the requirements for providers it contracts with. They refer providers to CAMHD's Measurement-Based Care: Values, Vision and Procedures (2023 update), require CAFAS ratings in the general mental health evaluation, and say initial evaluations should use CAMHD's youth and parent versions of the Ohio Scales.

QUEST Integration

The Department of Human Services' Med-QUEST Division runs Hawaii's Medicaid program through QUEST Integration contracts held by five health plans: AlohaCare, HMSA, Kaiser Permanente, Ohana Health Plan and UnitedHealthcare. These plans provide basic behavioural health services to their members.

Community Care Services

Community Care Services (CCS) is a carve-out that provides intensive behavioural health services to adults with a qualifying serious mental illness or serious and persistent mental illness. Once someone is enrolled, CCS provides their behavioural health, substance use and related services, while the QUEST Integration plan continues to provide medical care.

CCBHC Demonstration

Hawaii was selected for the federal Certified Community Behavioral Health Clinic Medicaid demonstration, after a SAMHSA planning grant that ran from December 2024 to June 2026. Two clinics operated by the Adult Mental Health Division on Maui, in Kahului and Lahaina, are expected to be fully certified by 1 January 2027.

Hosted in the United States

HiBoop runs on Google Cloud, and US customers' data is hosted in Google Cloud US regions. These are Google's regions in the United States. Google Cloud locations

Google Cloud regions

• Council Bluffs, Iowa Low CO₂ · 88% carbon-freeus-central1
• Moncks Corner, South Carolina us-east1
• Ashburn, Virginia us-east4
• Columbus, Ohio us-east5
• Dallas, Texas Low CO₂ · 83% carbon-freeus-south1
• The Dalles, Oregon Low CO₂ · 83% carbon-freeus-west1
• Los Angeles, California us-west2
• Salt Lake City, Utah us-west3
• Las Vegas, Nevada us-west4

Low CO₂ is Google's label for a region that ran on carbon-free energy at least 75% of the time in 2025. Google's figures

Why Hawaii Teams Use HiBoop

• Data for US accounts is kept in Google Cloud US regions, encrypted at rest and in transit
• HIPAA compliant with a business associate agreement, and SOC 2 Type II certified
• Access limited by role, with a log of every time client data is viewed or exported
• Care is $25/month, month to month, and you can start without a credit card
• Clients complete scales from an emailed link or a QR code posted in the clinic

USD pricing & support

Transparent pricing in USD with flexible payment options for clinics of every size.

Depression, Anxiety and Suicide Risk

• PHQ-9 (Depression)
• GAD-7 (Anxiety)
• C-SSRS Screener (Suicide Risk)

Youth and Caregiver Reports

• PHQ-A (Adolescent Depression)
• SCARED (Child Anxiety, Youth Report)
• SCARED Parent Version (Child Anxiety, Caregiver Report)

What Hawaii's minor consent law asks

• Under Act 37 of 2020, a minor aged 14 or older may consent to outpatient mental health services without a parent's consent, knowledge or participation, after consultation with and agreement of their licensed therapist; it does not cover inpatient or residential care or medication
• Clarify the limits of confidentiality at the start of treatment and as it continues, and assess and document the minor's maturity, as the Department of Health's guidance on the law recommends
• When billing the family's health plan for minor-initiated services, tell the plan the services are minor-initiated, which bars it from disclosing them to the parents; neither the minor nor the parents can be held liable for payment
• Keep HIPAA safeguards and breach notification in place, with a business associate agreement for each vendor that handles protected health information

What HiBoop provides

• A business associate agreement for HIPAA covered entities
• US-region Google Cloud hosting for US accounts, with encryption at rest and in transit
• Role-based access, so a young client's scores can be limited to the staff who need them
• SOC 2 Type II certification, with the controls described on our trust page

SAMHSA’s CCBHC grants fund detailed behavioral health services including the infrastructure, staffing, and technology required to meet CCBHC standards. Outcome measurement and digital assessment platforms are explicitly eligible as required infrastructure for CCBHC certification.

States receive federal MHBG funds and redistribute them to community mental health organizations. Technology, quality improvement, and workforce development are eligible uses. Contact your state mental health authority to understand how MHBG flows in your state.

SAMHSA’s PIPBHC program funds integration of primary and behavioral health care, including the technology infrastructure needed to coordinate care across disciplines. Outcome measurement platforms and digital assessment tools are eligible as integration infrastructure.

HRSA funds rural health networks to develop shared infrastructure including technology platforms, telehealth systems, and outcome measurement tools. Mental health-focused networks in rural areas can use this to fund shared digital assessment and measurement platforms.

Supports expanding the behavioral health workforce through training, clinical placements, and technology-supported care delivery. Technology platforms that support supervision, measurement, and case management are eligible uses.

The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model includes a Behavioral Health Track for practices treating depression and anxiety. It shifts from fee-for-service to monthly payments tied to outcomes — explicitly requiring technology-enabled care and outcome measurement.

Emergency

For a life-threatening emergency, call emergency services first.

Suicide & Crisis Lifeline (988)

24/7/365

Crisis Text Line

24/7