For more information contact Arlene Stanton, Ph.D., N.C.C., Government Task Order Officer

1. American Association for the Treatment of Opioid Dependence, Inc. 2006 National Conference, AtlantaApril 25, 2006Evaluation of the Impact of Opioid Treatment Program (OTP) AccreditationArlene Stanton, PhDGovernment Project OfficerSubstance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment (SAMHSA/CSAT)Under Contract # RFP 277-00-6507 with Northrop Grumman Information Technology For more information contact Arlene Stanton, Ph.D., N.C.C., Government Task Order Officer Division for Pharmacologic Therapies Center for Substance Abuse Treatment Substance Abuse & Mental Health Services Administration Rockville, Maryland 20857 Phone:  240-276-2718 Fax: 240-276-2710 Email:   arlene.stanton@samhsa.hhs.gov

2. Design • 478 Post-Accreditation Questionnaires • 82% First Accreditation • 171 6-Month Follow-up Questionnaires • 590 Patient Interviews • Key Policy Variables for Analysis • Accrediting Body (CARF, JCAHO, Other) • OTP size (0-100, 101-200, 201-300, 400+) • Financial Structure (For profit, Non profit, Gov) • Organizational Setting (Hospital, Other) • Treatment Type (Detox, Maintenance, Both)

3. A. Study Population • What are the descriptive characteristics of the participating OTPs along selected relevant dimensions?

4. Treatment Setting by Type of Treatment OTP Clinic Setting

5. Treatment Setting by Financial Structure OTP Clinic Setting

6. Treatment Setting by Accreditation Source (N=467) OTP Clinic Setting

7. Descriptive Characteristics of Patient Population Site visits conducted to 22 OTPs/590 patients interviewed • Average Number of Months in Current Program: 26 months • Average Total Number of Years in Treatment: 6 years • Average Age of Patients: 35 years old • % in Opioid Treatment Prior to Current Episode: 64% • Drug Being Treated For: • 69% heroin only • 12% heroin and pain medication • 19% pain medication only

8. B. Administrative Evaluation Questions • What are OTP staff perceptions of accreditation's impact on the OTP?

9. Perceived Areas of Impact of the Accreditation Process (N=468) % % % Great Impact Area None Some Extent Require more document of pt. progress 21 64 15 Enhance efficiency of treatment 28 53 18 Improve coordination of care 26 59 14 Improve treatment practices 27 58 15 Require new QA procedures 20 53 27 Hinder staff from daily tasks 59 33 8 Lead to purchasing computer equip. 71 23 7 Increase monitoring of pt. outcomes 24 53 24 Require doing more with less 42 35 24 Improve ability to monitor pt. progress 32 56 11 Improve links w/ community resources 47 44 9 Improve safety 37 51 12 Increase pt. participation in OTP planning 37 53 10 Increase pt. participation in indiv. tx plan 43 45 12

10. OTP Providers’ Perceived Impact of Accreditation on Their Program (N=445)

11. Which OTPs Are More Likely to Rate the Impact of Accreditation on Their Program as Being Positive? • Larger programs (over 100 clients) were significantly more likely than smaller programs (< 100 clients)(Odds Ratio=2.71) • Maintenance/Other programs were more likely than Detox-only programs • (Odds Ratio=3.35)

12. C. Clinical Evaluation Questions • What are the effects on patients associated with operating as an accredited OTP with regard to various patient factors?

13. Methadone Dose (N=468) Note that variability in range may be the result of patient status (e.g., transfer versus 1st admission)

14. Who Determines Max Dose and Length of Treatment (N=475)

15. Methadone Dose: Patient Influence & Take-Home Privileges(N=469) Dose Take Home Privileges

16. % Offering Service Baseline Follow-Up General medical care 39 43 HIV/AIDS-related medical care 29 38 Psychological testing 57 66 Psychiatric services 52 50 Educational assistance 35 42 Vocational assistance 43 46 Financial assistance 28 27 Legal assistance 9 15 Counseling 98 99 Housing/shelter assistance 40 39 Post-treatment follow-up 76 79 Acupuncture 13 15 Detox from a substance other than heroin 42 45 Treatment for alcohol abuse 72 72 Treatment for cocaine abuse 71 71 Individual/group therapy for opiate addiction 95 99 Nutritional counseling 50 58 12-Step program 45 53 Smoking cessation 29 32 Case management 71 77 Childcare 6 6 Aftercare 36 55 Transportation 25 25 Changes in OTP Services Offered (N=171)

17. Patient Perceptions of Care 92% of patients reported that they were treated with as much respect as they would like. Asked the extent to their treatment plan met all of their treatment needs, patients said: • Completely: 66% • To some extent: 33% Patients rated their overall treatment during the past 3 months as: • Very good/Excellent: 77% • Good: 17% • Poor/Fair: 6%

18. Effects on Patient Outcomes Extent that patient is involved in dosing decisions: • Most/All of the time: 57% • Often/Sometimes: 28% • Never/Rarely: 15% Self-reporting of dosage levels: • Too high: 7% • Just right: 76% • Too low: 16% Extent that patient is satisfied with take home schedule: • Very satisfied: 57% • Somewhat satisfied: 31% • Not satisfied: 12%

19. Patient Self-Reported Effects on Treatment Outcomes Employment: • 33% are employed Health Status • Very Good/Excellent: 34% • Good: 32% • Poor/Fair: 34% Drug Use in Last 30 Days: • 69% report using a drug (including alcohol-most common drug/stimulants-least common) • 32% report using one drug • 20% report using two different drugs • 11% report using three different drugs • 6% report using between 4-7 different drugs

20. Preparing for Accreditation: Staff Level of Effort* 1st Accreditation 2nd + Accreditation Hrs per Mo. (N=395) Hrs per Mo. (N=83) Staff meetings 57 31 Staff training 36 23 Review/update of records keeping 57 40 Review/update of treatment & continuing care plans 46 33 Development of quality assurance plan 19 11 Preparation of accreditation application 11 6 Preparation of OTP documentation 38 22 Interaction with external consultant 12 7 Accreditation survey 25 16 *Denotes mean number of hours spent by all staff in an average month since OTP started preparing for first or subsequent accreditation.

21. Conclusions • Overall, OTP providers report that the accreditation process significantly improved their programs. • Overall, patients reported that their treatment needs were being met and that they were satisfied with treatment. • Programs with an enrollment of over 100 clients, and programs that provided maintenance rated the accreditation process more favorably than their counterparts. • Consistent with the goals of accreditation, patients reported having a major influence on dosing levels. • Less staff time per month was spent preparing for a subsequent accreditation.