Jurisdiction Assessment Process Learning Collaborative Presentation November 14, 2012

1. JurisdictionAssessment ProcessLearning Collaborative PresentationNovember 14, 2012

2. Purpose of Review Process • Identify system strengths and weaknesses • Identify priority initiatives and activities • Target technical assistance and identify system improvement measures • Improve adherence to conditions of award • Improve fiscal efficiency • Steer system transformation

3. Process Develop/Implement Action Plan Assess Progress Assessment Tool Grant Review Grant Review Review @90 days

4. System Assessment Measures • Quality • Access • Integration Quality Access Integration

5. Quality Measures Quality • Linkages • Length of treatment engagement • Relapse risk reduction

6. Access Access • Is there access to a continuum of care? • Are there referral pathways to State Care Coordination for high-risk populations? • Is continuing care accessible and recommended for individuals successfully completing level I treatment? • Are recovery support services available and utilized? (ATR, recovery housing, transportation, recovery community centers, peer mentoring, etc.)

7. Integration Integration • System transformation • Progress towards Healthcare reform • Establishing Health and Wellness measures

8. Measure One 70% of all adult and adolescent patients in ADAA funded treatment programs have a treatment episode of not less than 90 days. _____%

9. Measure Two 56% of adolescent and 66% of adult patients completing/transferred/referred from ADAA funded intensive outpatient (IOP II.1) programs enter another level of treatment within thirty days of discharge. _____% Adults ____%Adolescents

10. Measure Three 90% of patients completing/transferred/referred from ADAA funded Medically – Monitored Intensive Inpatient Treatment with detoxification (III.7 D) programs enter another level of treatment within 30 days of discharge. _____%

11. Measure Four The number of patients using substances at completion/transfer/referral from non-detox treatment will be reduced by 82% among adolescents and adults from the number of patients who were using substances at admission to treatment. Adults ____% Adolescents _____%

12. Measure Five 70% of patients dis-enrolled from a Medically – Monitored Intensive Inpatient Treatment (Level III.7) will enter another level of care within 30 days. _____%

13. Measure Six 70% of patients dis-enrolled from aClinically – Managed, medium / High intensity Residential Treatment (Therapeutic Community) Level III.5 will enter another level of care within 30 days. _____%

14. Measure Seven 70% of patients dis-enrolled from aClinically – Managed, medium intensity Residential Treatment (Extended Care) Level III.3 will enter another level of care within 30 days. _____%

15. Measure Eight Care Coordination – 50% of successful discharges from Medically – Monitored Intensive Inpatient Treatment (Level III.7) receive care coordination. _____%

16. Measures Nine & TEN Level III.7 (Medically – Monitored Intensive Inpatient Treatment) Are there indicators that there is adequate and utilized care Y/N? Level III.1 (Halfway House) Are there indicators that there is adequate and utilized care Y/N?

17. Measures Eleven & Twelve • Level II.1 (Intensive out-patient). Are there indicators that there is adequate and utilized care Y/N • Level I (Outpatient) Are there indicators that there is adequate and utilized care Y/N

18. Measures Thirteen • Continuing Care – Over 5 % of successful discharges from outpatient enroll in continuing care Yes/No _____%

19. Measure fourteen • Medication Assistance Treatment - Services available in the jurisdiction or other established pathways to access treatment. • Access to Methadone Y/N _____ • Access to Outpatient Detox/maintenance (i.e.)Buprenorphine Y/N___

20. Measures Fifteen- Eighteen • ATR Access – Yes/No? • Recovery Housing – Yes/No? • Recovery Coaches – Yes/No? • Recovery Community Center – Yes/No?

21. Measures Nineteen --Twenty-One • Integration of Prevention and Treatment • Shared Programs – Yes/No? • Prevention Coordinator on ROSC Change Team – Yes/No? • Prevention Coordinator on LDAAC – Yes/No?

22. How Are we Measuring Use of Recovery Support Services (RSS) • Yes/No Questions on Jurisdictional Assessment -1st Cut • Do you have it or don’t you? • Recovery Community Centers • Peer Support Specialists • Recovery Housing (purchasing or not) • Through ATR or Block grant $$ • Recovery Housing Association RFP • Monthly RSS Progress Reports • Began in August assessing how Recovery Community Centers were being utilized? • Continued in September by adding questions regarding use of peers to the RSS Report

23. Recovery Community Center Data • Quick Facts • 18 RCC’s funded • 12 presently operational • Of the 12 that are operational, 8 (66%) are merged operations with Wellness and Recovery Centers • On average, 20,000 individuals pass through their doors in a given month (many of them using these services many times in a month) • The quest for unduplicated services provided to = some jurisdictions are able to report in this way (we’ll return to this point)

24. PEER Recovery support specialists • Quick Facts • Presently, 70 peer recovery support specialist operating in the State • Counties have received funding for another 6 that as of last reporting, have not been hired • Primary roles: • Recovery Coach • Peer Navigator • Engagement Specialist • Of the 70 peers who are working, 29 (or 41%) require CCAR training – working with OETAS, trainers, and jurisdictions to ensure that happens soon

25. How are RCC’s and PRSS’ Being utilized? • RCC’s • We have schedules • Some RCC’s are able to offer unduplicated counts • Some are able to offer useful feedback on use of specific services (vocational assistance, types of groups utilized, recovery supports accessed) • PRSS • We have begun to get information on their roles (mostly mixed; some falling into recovery coach or care coordinator roles) • Peer encounters

26. Unanswered Questions • Treatment and RSS: is their a continuum?? • Do RSS meet the needs of clients? • Are clients’ satisfied? • Are the RSS improving outcomes??

27. New RSS Services update • Adolescent Club Houses – Approximately $2M initiative • 6 Sites selected • Montgomery County • BSAS • Prince George’s County • Anne Arundel County • Frederick County • St. Mary’s County • Non-clinical recovery support services for youth 12-17 • Pioneering model/working with national expert • Kick Off Meeting for vendors November 20th

28. New rss services update • Recovery Housing Association (RHA) • Proposals came in yesterday • Selected vendor to initiate start-up January 1, 2013 • Purpose of the RHA • Raising Quality of Housing by • Enforcement of NARR Standards • Cultivation/sharing of best practices • Membership

29. The work ahead • Our data tools are not currently useful enough to gather more nuanced information on RSS • Also we do not provide the necessary data tools that could assist peers in their work • Recovery Planning in SMART (once Peer Encounter is initiated) • Peer Encounter Notes • Supervisory requirements for peers • Recovery Coach Guidelines/Manual • RCC Operational Guidelines • Peer Certification/Medicaid Reimbursement