2010 SAAS National Conference and NIATx Annual Summit

1. 2010SAAS National Conference and NIATx Annual Summit NIATx as a Springboard to Excellence: Quality Efforts, EBPs,and Outcomes

4. NIATx & Evidence Based Practice World Class Systems

5. NIATx & Evidence Based Practice For NIATx as Springboard: NIATx as support for Quality Assurance & Regulatory Response NIATx as Performance Improvement and EBPs NIATx as a method to use Outcomes

6. NIATx & Evidence Based Practice

9. NIATx Break Thru Performance Dimensions Use & Dissemination of the �Walk Through� as an accepted and powerful methodology Real Use of the Rapid Cycle Performance Improvement -Real people, Real data, Real improvement, Real fast The development and creation of the Business Case- first combinations of Quality, Cost, Improvement and Impact Creation and accelerated use of �Learning Collaborative (s) & Communities� Continued Development of Promising and emerging best practices

10. NIATx & Evidence Based Practice Some Definitions: EBM/EBP: �the integration of best research evidence with clinical expertise and patient values����the integration of the best available research with clinical expertise in the context of patient characteristics,culture and preferences��Empirically Supported Treatments

14. NIATx & Evidence Based Practice EBP Definitions-3 Components: Best Existing Research Clinical Expertise Patient Characteristics,Culture & Preferences

15. NIATx & Evidence Based Practice

16. NIATx & Evidence Based Practice Definitions-3 Components: �First, do it right-then (explore) doing it differently� Gordon Paul�s now-famous ultimate clinical question, �What treatment, by whom, is most effective for this individual, with that specific problem, under which set of circumstances, and how does it come about?� (Paul, 1967, 1969, p. 44)

17. NIATx & Evidence Based Practice

19. Working in Teams, Design a PDSA using a Quality Assurance Measure as a trigger for a PDSA or sustainability trigger 15 minutes-HAVE SOME FUN!- Advanced Q&A to Follow

21. Client care EvaluationBy the time the client arrives for initial evaluation, a single clinician should be designated as responsible for ensuring that a comprehensive evaluation is completed in a timely manner. With the client's permission, the clinician should pursue information from other available sources, particularly family members, significant others and current and past providers of services. The evaluation should include: A thorough exploration of current concerns, goals and symptoms A review of mental health history including past successes and difficulties, prior interaction with mental health care professionals and past treatments, including medications, adherence and preferences Current or past use, abuse or dependence on alcohol or other substances A thorough understanding of the client's social circumstances, support network, and ongoing life-stressors, including family issues, housing stability and past traumas An initial risk assessment, including risk to self and others Medical history and treatments

22. BONUS SLIDE NIATx for QA can be (1) used as a trigger for performance improvement (2) as part of a sustainability plan, and (3) as a response to a required action mandated by regulators and accrediting systems

23. Questions, Comments, -On to the Work-SESSION�.

24. Working in Teams, Design a PDSA using a Evidence Based Practice or Promising Practice 15 minutes-HAVE SOME FUN!- Advanced Q&A to Follow

25. NY State Project Contingency Management OASAS announced Star-SI training in Contingency Management by Dr. Petry FACTS hosted training as well as sent staff for training Change Team Leader selected to go to training as well as 2 other staff members

26. NY State Project Contingency Management Alcohol and Chemical Dependency Education Group Data from current group assessed CM group run for the 12 week session with 3 staff members following CM protocol

27. EXPERT & FIDELITY Support Bi-monthly meeting with other CM groups by OASAS and Dr Petry  Problem solve Monitor progress Address problems in implementation Share ideas Assist with logistics/paperwork Blend with NIATx PDSA

28. Results The number of visits increased from 94 to 146 ( + 52) The average attendance increased by 18% Individual consistency increased by 14% Revenue increased by $3640. Secondary Impact(staff morale, excitement of doing something new, recognition)

31. Results CM improved attendance with adolescents More youth willing to sign up for the group Once involved, youth attendance more consistent

33. Additional Impact Three major outcomes An average increase of 15% of intake show rate, (2007-57%, 2008-62% and 2009-72%) An increase in retention in treatment based on data collected from CM An 8% increase of intakes coming from our inpatient unit

34. Motivational InterviewingImplementation & Monitoring NYS The possibility discussed with Outpatient Methadone Maintenance Clinics. Agreed to a ten- week program: Five two- hour training sessions followed by a week for application discussion evaluation of progress during clinical supervision. Training sessions were interactive and practical rather than in lecture format. Continuing post- course discussion during clinical supervision. Course laid a foundation for staff who attended other training that applied MI in the training. Results About 106 training hours and 53 supervisory were devoted to the project.

35. MI Course Outline Spirit of MI Application, Evaluation and supervision. Change Talk and Sustain Talk Application, Evaluation and supervision. Eliciting and strengthening Change Talk Application, Evaluation and supervision. Rolling with Resistance & Sustain Talk -- Application, Evaluation and supervision. Developing a Change Plan & Consolidating Commitment. Blending with other approaches. -- Application, Evaluation and supervision. Clinical Supervisory support and organizational integration: ongoing.

36. BONUS SLIDE When using NIATx for EBPs recognize that you will need an EBP expert on the team-Think both NIATx and EBP fidelity

37. Motivational Interviewing We will begin to track and monitor this process using tape recorders to track use of OARS Open ended questions Affirmations Reflective listening Summaries

38. Questions, Comments, -On to the Work-SESSION�.

39. Working in Teams, Design a PDSA using an Outcome Measure 15 minutes-HAVE SOME FUN!- Advanced Q&A to Follow

40. Using an Outcome Measure to Enhance Access and Retention in TreatmentScott O. Farnum, MS, MPAHill Health Center, New Haven, CTLynn Madden, MPAAPT Foundation, New Haven, CTDavid Prescott, Ph.D.The Acadia Hospital, Bangor, MENIATx National Summit April, 2007

41. IOP Open Access Results Open access has resulted in continued growth in the number of admissions (project implemented in March 2003)

42. How do we know if we are doing any good? As the number of clients in our IOP program increased and the program became busier clinicians expressed concerns about program quality. We chose the BASIS-32, an existing outcome measurement tool that is based on client self report, to measure the impact of treatment outcomes.

43. BASIS-32 Outcome Measurement 32 items Client Self-Report Likert Scale (0-4) 0 = No Difficulty 4 = Extreme Difficulty Scoring yields 5 subscales and 1 overall scale

44. BASIS-32 Scale Scores Total (Average of 32 items) Relationship with Self/Others Daily Living Skills Depression/Anxiety Impulsivity/Addiction Psychosis

45. BASIS-32 Admission Scores

46. Substance Abuse Programs BASIS -32 Admissions Data � What we learned Admission Triage Process Appears to Make Sense in terms of Placement Severity of Addiction in Outpatient programs is similar to Inpatient programs Daily Living Skills rated by clients as area of most significant impairment

47. BASIS-32 Total ScoreChange: Admission vs. Mid Treatment

48. BONUS SLIDE NIATx and outcome can translate into 3 Dimensions and strategies (1) outcome measures that directly link to the chart & discharge summaries, (2) Point of services measures that help inform you of client attachment & bonding, and (3) aggregate outcome profiles for therapist,service and organization

49. BASIS-32 Change ScoresImpulsivity/Addiction

50. Using outcome data to plan program changes Builds upon data suggesting that Daily Living Skills is perceived by clients as most significant problem We developed a group curriculum specifically designed to improve this set of issues

51. Improving Skills in Daily Living

52. SUMMARY Using an outcome measure allowed us to tailor treatment more closely to client needs � improving access and retention can be enhanced by correlating treatment outcomes with process change.

53. NIATx & Evidence Based Practice

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56. Questions, Comments, -On to the Work-SESSION�.

57. NIATx & Evidence Based Practice For NIATx: The building of NIATx Learning Collaborative(s) provides the vehicle for local and national practice consensus The PDSA and rapid cycle approach is a natural and powerful laboratory for assessing the value of evidence based practice in specific communities and populations The spread(practice) and diffusion(culture) strategies for NIATx provide essential elements of the infra-structure for implementing consistent clinical treatments & EBPs The national and local NIATx communities continues to develop and collect a wide ranging set of practices that serve as �promising practices� for improvement The embracement of patient preferences as part of the EBP platform fits well with the NIATx focus on customer NIATx continues to contribute to �best available research� in formal publications and national presentations addressing access,retention,and innovative treatment.

58. SUMMARY Acknowledge The Complexity Of The Effort Recognize the Importance Of A Multi Pronged Longitudinal Strategy Across The Continuum Of Care Consider Partnerships That Span Regulatory Agencies, Government, And Community Plan For Sustainability, & Anticipate The Spread Of Innovative Ideas Make Accessible Tools, Techniques, & Methods In A User Friendly Way

59. SUMMARY Remember Clinicians Are At The �Heart Of The Matter� And Need To Be At The Design Table Leadership Is Vital To The Process-Planning And Support Support Staff Motivation, Ownership And Customization Information Is Vital, Communication Is Crucial Tailor Existing Measurement And Emerging Measurement Systems To The EBPs To Track Use And Document ROI-the Business Case

60. EndNote Many of the above components and processes comprise part of the essence of the NIATx approach-to achieve maximal success they should be employed according to established guidelines ,with scientific fidelity, and completely within an organization.