Block Grant Independent Peer Review 2017

1. Block GrantIndependent Peer Review 2017 Project Overview March 1, 2017

2. Agenda: 45 minutes • Overview of the Peer Review project – 5 min • Self-Study and Chart Review– 10 min • Peer Reviews and Group Discussion – 10 min • Focus on MAT & Medications – 5 min • NIATx change projects, optional tools – 5 min • Online Workspace – 3 min • Reimbursement – 2 min • Questions and next steps – 5 min

3. Overview • Independent Peer Review is a requirement of Federal Substance Abuse Block Grant • 5% sample every year • Efficacy, Appropriateness, Quality of Service • Independent of licensing or evaluation by state • Expertise – match by Level of Care • NIATx principles used since 2006 – walk-throughs, process mapping, sociograms, Nominal Group Technique • Data gathering through Chart Review and Self-Study • In-Person Mutual Reviews on May 19th will use all the written material – conversation is key; review form will document

4. Calendar • Now! Kickoff Call • March 1 - April 29: Self-paced Chart Review visits and Self-studies • Self-Studies due March 31 to Deborah Strod & your partner • Chart Reviews due April 30 to Deborah Strod & your partner • April 29 – May 19: Sift through material, prepare to do Reviews (3-question draft Review Form will guide) • May 19, 10 am - 2 pm: • In-person Reviews • Group discussions by LOC • Whole group exchange over lunch • Location: West Boylston DPH Regional Office

5. Self-Study and Chart Review Scheduling • Contact your partner to schedule your visits now while calendars are not completely full • Pick a date sooner rather than later - leave time for rescheduling due to the unforeseen • Chart Review can be done in March along with the Self-Study. The order is less important than making the due dates. If a Chart Review visit in March works better for you, go for it and get both done in the first month! By March 15th , please report to Deborah Strod the dates you have chosen.

6. Self-Study Logistics • Answer based on your understanding of your staff’s experience (plus summary points from staff discussion for one section) • Flex to meet your needs and fit your program • Questions ideally prompt substantive, thoughtful answers that help your partner really know your program when they review your Self-Study • Submit via Fillable Word document, email to • Deborah Strod (deborahs@dmahealth.com) AND • Your partner Note: If you will be writing by hand, add extra space before printing.

7. Self-Study Topics • Population Served • Assessment, Treatment, Discharge & Follow-up • Medications & MAT • Staff Discussion related to Medications & MAT: • What do we do well? • What could we do better? • What change would we like to try? The reviews you provide 5/19 will use almost the same framework for the discussion, with wider scope – the whole program, not just Medications & MAT

8. Chart Review Logistics – Ahead of the visit • Confidentiality • BSAS Peer Review Confidentiality form - Send a copy to Deborah Strod at DMA Health • Communicate with partner about agency-specific forms at both sites • Consider ahead of time whether your Electronic Health Record requires any special permissions or guidance to accommodate a reviewer • Orient your peer to your chart, to help them be efficient

9. Chart Review Logistics – Day of the visit • Confidentiality • Sign Agency-specific forms as required • Bring Signed BSAS Peer Review Confidentiality form • Looking at Charts • Chart selection process is on first page of Chart Review • Go over the questions first so you have them in mind as you read through the charts • Consider both the usefulness of the chart itself, and what each chart shows about the caregiven • Take notes - Fillable Word document or Handwritten • Copies of completed Chart Review go to: • Your Peer • Deborah Strod • Yourself - to use in preparing comments for your peer

10. Chart Review Topics • Admission Criteria/Intake Process • Assessment • Treatment Planning • Documentation of Treatment Implementation, Outcomes • Discharge and Continuing Care • Medications & MAT • Overall Impressions of Chart

11. Reviewer Feedback Form • Read and consider your partner’s Self-Study • Go over your observations on the Chart Review form • Consider these questions generally for appropriateness, effectiveness and quality of care; and specifically for Medications & MAT: • What does the program do well? • What could the program do better? • What recommendations do you make, if any (what should the program keep doing, where could a change improve care)?

12. Peer Reviews and Group Discussion May 19th • Peer reviewer will discuss with the reviewee • Self-Study documentation • Chart Review results • Completed Reviewer Feedback form on reviewed program: What did they do well? What could they do better? What recommendations do you make, if any (keep doing, change)? • After about 45 minutes roles switch, and the reviewer becomes the reviewee • Level-of-Care discussions for a half-hour (new this year!) • Lunch & Whole Group Discussion: Common issues? Common strengths? What surprised you? What did you learn? • Aggregated report summarizing strengths and opportunities, without individual identifiers, will be prepared for the Block Grant Application, and available to participants

13. Focus on Medications & MAT • Portions of the Peer Review address a specific focus: The 2017 Peer Review will provide an opportunity to share the ways programs • Address all medications in the admissions and discharge processes • Manage medication security, distribution and clinical care during treatment • Integrate people receiving medication-assisted substance use treatment into other levels of care. OTPs: some questions relate to what you already do; but consider how you address medications for other substances/conditions, along with MAT. • Resource: BSAS Practice Guidance Integrating Medication in Behavioral Health Treatment

14. Medications & MAT • BSAS guidance refers to medications for opioids and for MH conditions; many co-morbid physical conditions also require medication. • In addition a high percentage of BSAS clients use nicotine and are interested in quitting, which can involve medications also. • From the Practice Guidance: • Policies recognize that medications can promote recovery. • Policies prohibit denial of service on the solely because an individual takes a prescribed medication. • Policy clearly identifies criteria and process for safeguarding against abuse of medications.

15. Medications & MAT • Given the high level of co-occurring MH & SUD, and co-morbid physical health conditions, many people have multiple medications. • How to you make it clear that people who are on MAT, MH and other medications are welcome? • Do your staff feel comfortable and capable of working with MAT, MH and other medications? Are there certain medications that cause you to be concerned about people’s recovery (e.g. gabapentin and Neurontin)? • Do you have medical personnel on-site or active relationships with prescribers offsite and/or OTPs/OBOTs? • What issues does this cause in care transitions? • How does your agency help you ensure that your program is able to manage medications and prevent diversion?

16. Medications & MAT • High proportion of people receiving SUD services use tobacco/nicotine, which can interfere with medication absorption and action. Doses may need adjustment as people quit smoking. • How do you support quit attempts? Consult on dosing? • How do you support staff in quitting? • Are you up to date on new vaping technology & perceptions?

17. Medications & MAT additional Resources • SAMSHA’s MAT page • SAMHSA’s Decisions in Recovery: Treatment for Opioid Use Disorders • NIATx’sGetting Started with MAT (2010) • TIP 43 Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs • TAP 30 Buprenorphine: A Guide for Nurses Any suggestions from the group to add? Say now or share on the online Workspace…

18. NIATx Change Projects • Gather a team • Pick something that matters • Select a small change, with measurable effects • Collect baseline data • Try it out! Briefly • Look at your data • If it worked, spread it further; if it didn’t, either modify or just go back to what you were doing. For more info see www.niatx.net or talk with Mike Ellis of BSAS

19. Optional Tools • Nominal Group Technique – Ensure participation and idea generation (NIATx), can be used for the staff discussion at end of Self-Study • Walk-through – Experience your program through the eyes, ears, smells, touches, tastes, and social experiences of your clients (NIATx)

20. Online Workspace – All Participants Join Peer Review 2017 online workspace at www.careersofsubstance.org It has: • All forms, including Expense Form • Announcements • Online discussions • Email notifications of new discussions (opt-out) • These slides and other references

21. Reimbursement • Reimbursement will be provided for mileage, tolls and parking expenses related to Peer Review 2017. • Expense Form is in the online Workspace library • Print, complete and mail the form, with any relevant receipts, to AdCare. • AdCare mailing address and contact information is at the top of the Form • Generally, the Peer Review only involves two trips: • one to your partner to do the Chart Review • one to the group meeting on May 19th.

22. Next Steps • Contact your partner to schedule the Chart Review visits • Your review of their charts • Their review of your charts • Begin your own Self-Study • Add "info@careersofsubstance.org" to your address book so emails from the online group don't get filtered as spam. • Track mileage and parking • Join the online group if you have not already! www.careersofsubstance.org

23. Thank you! This Annual Independent Peer Review is an important obligation for the Federal Substance Abuse Block Grant, and your participation helps the Commonwealth continue to receive these critical funds. Most participants find it worthwhile, some find it transformative – as you progress, please keep in touch and let us know how we can help you to get the most out of your activities.

24. Contact If you have questions about the Peer Review, contact For free training & information on overdose prevention for your program, contact Cheryl Gagne PRAXIS 781-247-1753 cgagne@center4si.com