Implementing EBPs through Systems Change

1. Implementing EBPs through Systems Change Robert Woods Johnson Foundation (RWJF) Funded

2. Advancing Recovery • $11 million national program of the Robert Wood Johnson Foundation • Co-Directed by David Gustafson at NIATx and Tom McLellan at the Treatment Research Institute (TRI) in Philadelphia, PA

3. Advancing Recovery • Focused on implementing EBPs using systems change • EBPs of focus: MAT, Continuum of Care, Wrap-around Services, Psychosocial Therapies, Screening & Brief Interventions

4. Advancing Recovery • AR is divided into two 2-year grant rounds • Round I: Oct 2006-Sept 2008 • Round II: Feb 2008-Jan 2010 • Each round consists of up to 6 grantees who are to implement 2 of the 5 EBP

5. Participants • Round 1: Delaware, Florida, Kentucky (KRCC), Maine, Missouri, & Rhode Island (NRI). • Round 2: Alabama, Arkansas, City of Baltimore, Colorado, Texas (Homeward Bound), & West Virginia (Prestera)

6. Round I

7. Round II

8. Advancing Recovery Currently • At the mid-point of the program • Focusing on Spread and Sustainability • Developing AR’s “legacy”

9. Practice Improvement Enhancer (PIE)

10. Purpose • Create a framework for whole system’s change

11. Practice Improvement Enhancer (PIE) Recovery Analytic Tools Rapid Cycle Change Inter-Organizational Analysis Foundation for Change Partnerships Barrier Analysis Understand the Customer Generate Leadership Support Increased Use of EBCs Develop Business Case Define Clear Aim Establish Effective Measures Financing & Purchasing Plans Outcomes Health Learning Collaborative Methods 11

12. Missouri Case Example

13. State Walk-Through Understand the Customer Key executive and administrative support Fiscal staff Medical Director People who know the data system Provider staff – clinical and administrative Aim = Increase Use of Meds Measures = Med Screenings, Referrals & New Business Case = Less “cycling” Missouri's State and Provider Partnership 13

14. System Changes for MAT Financial & Purchasing Changes Providers able to bill for physician to evaluate and prescribe naltrexone or acamprosate Providers able to bill for laboratory services Providers able to purchase naltrexone and acamprosate at reduced cost with central purchasing procedure Missouri's State and Provider Partnership 14

15. Learning Collaborative Site visit facilitated discussion of provider walk-through results Face-to-face partnership meetings with coaches Conference calls Regular schedule Distribute Agenda in advance of calls Distribute Minutes after calls Web site Great resource, people have been slow to use Missouri's State and Provider Partnership 15

16. Rapid Cycle Changes for MAT Providers screening Developed screening protocol Screening began at intake and continued during treatment episode Client education groups Creating groups of individuals using MAT and their families Helps individuals provide mutual support and allows for targeted staff assistance Missouri's State and Provider Partnership 16

17. Individuals Affected by MAT (cumulative) Missouri's State and Provider Partnership 17