Government Performance and Results Act (GPRA) Data Collection and Reporting

1. Government Performance and Results Act (GPRA) Data Collection and Reporting An Overview

2. Agenda • GPRA Overview • Tips for administering the GPRA 3. Review the 10 sections of the GPRA • A. Record Management • B. Drug and Alcohol Use • C. Family and Living conditions • D. Education, Employment, and Income • E. Crime and Criminal Justice Status • F. Mental and Physical Health Problems and Treatment/Recovery • G. Social Connectedness • I. Follow-Up Status • J. Discharge Status; and • K. Services Received • Review how to enter GPRA data into the VMS • Review the process for distributing the Client Satisfaction Survey

3. GPRA Overview • Collecting program data is mandated by GPRA. • GPRA was enacted in 1993 to develop strategic plans, set performance targets, report outcomes, and conduct evaluations. • The purpose of the GPRA is to increase accountability, program reforms, and improve effectiveness. • GPRA target follow-up completion rate is 100%. A completion rate of 80% is required or grant funds may be cut. Good data can help convince Congress to continue funding treatment & recovery programs. • This data is confidential and can not be tied to clients in any way. It is protected by HIPPA & 42 CFR Part 2.

4. New Military Questions • New MilitaryGPRA questions effective 4/1/12 • Sec. A. – 8 new military questions • Questions must be asked by the assessor when other demographic questions are asked during enrollment • Intent of the new military questions: • To collect the client’s military status • To collect whether client has been deployed to a combat zone • To collect whether a client’s family/close friend has military status • To collect the experiences of a client’s family/close friend’s military status

5. New Violence & Trauma Questions • New Violence & TraumaGPRA questions effective 4/1/12 • Sec. F. – 6 new violence & trauma questions • Questions will be asked by the case managers • Intent of the new violence & trauma questions: • To determine whether the client has experienced or witnessed violence & trauma • To determine the client’s experiences related to the violence & trauma • To determine if the client was ever physically hurt

6. How is the GPRA tool Administered? • All GPRA interviews must be administered by Case Managers to each client receiving services at 3 intervals: • Intake (to establish a baseline) • Follow up – 6 month post intake (6 months from intake) • Discharge (when clients complete all Treatment & RSS) • The follow-up GPRA has many names: follow-up GPRA, 6-month GPRA, 6-month follow-up GPRA, & 6-month post intake GPRA. DO NOT BE CONFUSED, these names are for 1 GPRA • Assessors will need to provide information to case managers for portions of the GPRA tool

7. How is the GPRA Tool Administered?(continued) • Questions must be asked as written. • The GPRA interview must be completed in 1 day. • The client cannot fill out the GPRA tool. • The case manager cannot fill out the GPRA tool. • To obtain the GPRA tool responses, the case manager must interview the client.

8. How is the GPRA Tool Administered?(continued) • Case managers cannot use information gathered/entered from the assessment for any of the GPRA interviews. • The assessment process and the orientation and intake process are two separate processes with different purposes.

9. How is the GPRA Tool Administered?(continued) • The assessment process is to determine whether the client is eligible for the CARE program. • The Orientation and intake process is to: • Orient the client to the CARE program, • Go through the CARE Client Handbook with the client, • Give the client the opportunity to choose their service provider, and • Complete the GPRA Intake Interview.

10. How is the GPRA Tool Administered?(continued) • The GPRA interview should be conducted face-to-face with the client, however interviews can be conducted over the phone. • The “Telephone Interview Consent Form” must be signed by the client to conduct phone interviews. • A “written consent” (via a standard form) must be signed by the client in order to release information to the client’s chosen treatment or recovery support provider. • Case managers must submit all GPRA interview data via the VMS within 3 days of the interview.

11. How is the GPRA Tool Administered?(continued) • The following guidelines for protecting clients’ privacy must be strictly adhered to: • Never leave a message that may identify the caller, their title, or their agency as part of an AOD treatment or recovery program. • When speaking to a person other than the client, do not give any more information than a first and last name, and forwarding telephone number. It is okay to state you are conducting a health survey. • When a client is reached, verify their date of birth and whether it is a good time for them to talk prior to conducting the interview. • Never mention AOD or AOD treatment or recovery until the identity of the client has been validated.

12. Instructions • The following GPRA sections must be administered. 1. Intake: Sections A-G 2. Follow up - 6 mo post intake: Sections A-G and I 3. Discharge: Sections A-G, J, and K • Have the client answer all of the questions. • Pay attention to directions within a question asking you to skip a question or to not read certain responses.

13. How to Read Questions to Clients? • You may explain the intent of a question to the client to help them understand, but don’t change the wording of the question. The intent or explanation of each question can be found in the Question by Question (Q by Q) Instruction Guide for the GPRA tool.* • At the beginning of each new section, you should introduce the section of questions, (“Now I’m going to ask you some questions about….”). • If the client does not know the answer to a question, mark DK on the tool. Do not prompt the client to say don’t know if they do not respond. Wait for the response.

14. How to Read Responses to Clients? • Read responses that appear in lower-case lettering. • If the responses are in capital letters, do not read the responses - ask the question open ended. • Many questions ask about activity “during the past 30 days”, you may need to repeat that part of the question when there is a long list of responses.

15. Client Cooperation It may be hard to talk about: sex, drugs, legal and emotional issues. Clients may have religious or have cultural objections. Subjects may be: • Personal • Associated with negative feelings • Taboo • Associated with upsetting events or trauma • Client may not feel well, may be in withdrawal or have other health issues.

16. Interviewer Be sensitive to social and cultural issues: racial identity, gender, ethnicity, socioeconomic status, age, religion, education, and legal issues (may be on probation or have warrants) Watch Your Verbal Communication: • Words or phrase choice • How you say it such as your tone, volume, speed, pauses, laughter • Consider your mood and theirs Interviewer Issues: Boredom, Fear of hostility Subjects too close to home Self doubt Discomfort with questions Interviewers should watch verbal and non-verbal cues

17. Interviewer Tools Interview should be: • Persuasive • Gentle • Warm, respectful, attentive • Non-confrontational • Gently address inaccuracies Interviewer should provide: • Empathetic counseling • Reflective Listening • Affirmations and positive reinforcement

18. Interview Tools (continued) • Roll with Resistance • Rolling with resistance demonstrates respect and empathy • Resistance often means a different point of view • A different approach may be necessary • Promote Awareness • Identify future goals • Identify behaviors that block goals • Increase awareness of consequences of behavior in a nice way

19. Tracking Clients • Health Study Locator form • Frequently update the client’s Health Study Locator form with client and family contact information • Voucher Management System (VMS) Reports • Case Manager Activity List report • Review the client’s voucher billing activity to determine if the client is still receiving services and the last date of paid service • Contact the client and service provider to determine if the client is still receiving services and verify the last date of paid service • Calculate the hours billed on the client’s vouchers • Complete section J & K of the Discharge GPRA • GPRA Due report • Follow-Up GPRA appears at 6 months • Discharge GPRA appears when vouchers expire • Use in conjunction with your internal procedures to track when Follow-Up and Discharge GPRA interviews are due

20. Six Month Follow-Up Window 6-month post intake interview can be conducted: • 30 days prior to 6 mo post intake date or • 60 days after 6 mo post intake date. Example: If intake date is January 1st, 6-month follow up date is July 1st. Interview window would be 30 days prior to July 1st or 60 days after July 1st. Note – If the 6 month interview is completed before or after the interview window, it will not count towards our 100% target follow-up rate. • A compliant six-month follow-up GPRA is: • An interview with the client (face-to-face or by telephone) • Conducted between 5 and 8 months post intake • Submitted in the VMS within 3 days of the interview

21. ATR Follow-Up Interview Window Period • GPRA Intake • Interview Window Period: 1 month before & 2 months after • APRIL • MTWTFSS • 1 • 2 3 4 5 6 7 8 • 9 10 11 12 13 14 15 • 16 17 18 19 20 21 22 • 23 24 25 26 27 28 29 • 30

22. Discharge GPRA • If the client is present on the day of the discharge, the interview should be conducted on the day of the discharge. The discharge date is the last date of paid service, not the interview date. • If client is not present, the case manager will have to find the client to conduct the in-person interview within 14 days after discharge. If the client has not been located to conduct the interview by the 30th day, conduct an administrative discharge. • If the discharge GPRA interview is conducted more than 30 days after the last date of paid service, the interview will not be reimbursed.

23. Discharge GPRA • Discharge & follow-up GPRAs are required for all clients for whom an intake GPRA was submitted if any voucher has been billed in the VMS regardless of whether or not they ever access their Treatment, Early Intervention, Recovery Support Services, Continuing Care, Recovery Coach, or Recovery Management vouchers. • The timeframe of the follow GPRA is not related to the discharge GPRA. The discharge GPRA is due when the client is finished with all CARE paid services, this could occur before or after the follow-up GPRA is due. The follow-up GPRA is due 5 - 8 months after the intake GPRA. • In some cases, the discharge and 6-month follow interviews can be done on the same day.

26. GPRA Tool Let’s move on to the GPRA Tool.

28. Client Satisfaction Survey An Overview

29. New Process for the Client Satisfaction Survey (CSS) • The case manager is responsible for distributing the CSS. • The client must complete the CSS, not the case manager • The importance of the survey should be emphasized to the client at orientation and intake.* • A supply of surveys and self-addressed envelops must be maintained. • The client ID and provider ID must be listed on the survey. • The survey must be distributed to clients at GPRA discharge interview. • Follow-up with all clients who have not returned completed surveys. • A $20 incentive shall be made available to clients for accepting the survey, unless the survey is given to clients during their GPRA follow-up interview.

30. Resources • Motivational Tips • http://www.motivationalinterview.org • Center for Substance Abuse Treatment Improvement Protocol Series No 35. • Toll free 1-800-729-6686 • http://store.samhsa.gov/product/SMA08-4212 • To download English or Spanish copies of the GPRA Tool & the Q by Q go to: • https://www.californiacares4youth.com • To download copies of 42 CFR Part 2 • http://www.access.gpo.gov/nara/cfr/waisidx_02/42cfr2_02.html • To download copies of the HIPAA Rules • http://www.hhs.gov/ocr/privacy

31. Resources (continued) • ADP CARE Staff • Barry Scheel, Treatment Coordinator - bscheel@adp.ca.gov - (916) 445-0136 • Beverly Tukes, Program Coordinator - btukes@adp.ca.gov - (916) 323-7630 • Claire Sallee, Training Coordinator - csallee@adp.ca.gov - (916) 324-6526 • Denise Wallace Warrick, Research Specialist - dwwarrick@adp.ca.gov - (916) 323-2008 • Sue Heavens, Project Director - sheavens@adp.ca.gov - (916) 445-0323 • CARE Call Center: 1-866-350-8773

32. Acknowledgement The Department of Alcohol and Drug Programs (ADP) California Access to Recovery Effort (CARE) Program staff would like to thank the following agencies for their contributions to this presentation. • ADP CARE Staff • Altarum Institute • MAXIMUS • Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT)