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The Network for the Improvement of Addiction Treatment: Initial Findings and Future Directions

The Network for the Improvement of Addiction Treatment: Initial Findings and Future Directions. Jennifer P Wisdom, PhD MPH Jay Ford, PhD Jennifer Glover, MS Randy Hayes, MS, LCPC. Reduce Waiting & No-Shows  Increase Admissions & Continuation. Introduction to NIATx and Principles

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The Network for the Improvement of Addiction Treatment: Initial Findings and Future Directions

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  1. The Network for the Improvement of Addiction Treatment: Initial Findings and Future Directions Jennifer P Wisdom, PhD MPH Jay Ford, PhD Jennifer Glover, MS Randy Hayes, MS, LCPC Reduce Waiting & No-Shows  Increase Admissions & Continuation

  2. Introduction to NIATx and Principles of Change Jay Ford, III, PhD NIATx Technical Director and Information Officer Reduce Waiting & No-Shows  Increase Admissions & Continuation

  3. The Network for the Improvement of Addiction Treatment (NIATx) is a collaboration ofThe Center for Substance Abuse Treatment Strengthening Treatment Access and Retention (STAR Program)andThe Robert Wood Johnson FoundationPaths to Recovery Program

  4. The Mission of NIATx… to assist the addiction treatment community in making more efficient use of their treatment capacity and to encourage ongoing improvements in treatment access and retention

  5. Reduce Waiting Times Reduce No-Shows Increase Admissions Increase Continuation Rates Four Project Aims

  6. Customers are served by processes 85% of customer related problems arecaused by organizational processes To better serve customers, organizationsmust improve processes Why Process Improvement?

  7. Five Key Principles Evidence based predictors of change • Understand & Involve the Customer • Focus on Key Problems • Select the Right Change Agent • Seek Ideas from Outside the Field and Organization • Do Rapid Cycle Testing

  8. Nine Key Paths to Recovery • First contact • Intake and assessment • Transitions through levels of care • Paperwork • Scheduling • Engagement • Social supports • Outreach • Maximizing revenue

  9. Rapid Cycle Testingcont’d. Rapid cycle changes • Are quick; do-able in 2 weeks PDSA cycles • Plan the change • Do the plan • Study the results • Act on the new knowledge • Model for ImprovementReference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide, San Francisco, Jossey-Bass Publishers, 1996

  10. A P S D D S P A A P S D A P S D Rapid Cycle ModelReference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide, San Francisco, Jossey-Bass Publishers, 1996 Changes That Result in Improvement DATA Hunches Theories Ideas

  11. RWJF I CSAT STAR RWJF II State Pilot Project How NIATx is changing the landscape of addiction treatment

  12. Reduce Waiting Times:51% reduction (37 change projects in 24 agencies) Reduce No-Shows: 41% reduction (28 change projects in 21 agencies) Increase Admissions: 56% increase (23 change projects in 16 agencies) Increase Continuation: 39% increase (39 change projects in 23 agencies) NIATx Change Cycle Results

  13. Contingency Management Reminder Calls Follow-up Calls Open Access/On Demand Paperwork Reduction Engagement Between Levels of Care Counselor-Specific Feedback Motivational Interviewing (MI)-Like Communication Examples of Successful NIATx Interventions

  14. Impact of Selected Innovations

  15. Reduced payer mandated paperwork Eliminated pre-authorizations Effectively instituted walk-throughs Expanded eligibility criteria for detox aftercare Retrained surveyors to provide PI coaching State Pilot Initial Accomplishments(payer processes improved)

  16. Reduced wait time for: referrals from child welfare services to treatment across county (CO) out patient services for city of Des Moines (IA) outpatient services (OK) Increased admissions across 3 county area (NC) Improved continuation statewide (DE) State Pilot Initial Accomplishments(provider pilots)

  17. Sinnissippi Centers, Inc: A Drug Treatment Agency Improving Services Randy Hayes, MS, LCPC Director of Quality Assurance Sinnissippi Centers, Inc. Reduce Waiting & No-Shows  Increase Admissions & Continuation

  18. Sinnissippi Centers, Inc. Dixon Illinois • Location: Rural Northwest Illinois- • Five Main Service Sites • Four Supported Living Sites; • Two Outpost Sites • 4 County Population Base: 164,421 • Penetration Rate: 6.8% • Outpatient Services For • Serious Mentally Ill • Addiction • Family problems • 24-7 Emergency Services • School Based Prevention programs • Child Welfare Home Based programs. • 2002 Recipient of the JCAHO Codman Award for Behavioral Healthcare • 2003 Recipient of the Am. Psychiatric Association Bronze Psychiatric Services Award

  19. Outpatient Program 40% Court Referral Intensive Outpatient Program 30% Court Referral ----------------------------------------- Prevention Programs School and Community Based Programs Juvenile Justice Program Drug Court FASD Prevention Program Dual Diagnosis (MISA) Program Sinnissippi Addictions Program 50% to 60% have incomes under $6000/year

  20. 39 Change Cycles since November 2003 AIMS 1. Increase Timeliness (Reduce Days - 1st Call to 1st Treatment) 2. Decrease No Show Rate 3. Increase Admissions to IOP program 4. Increase Continuation Primary Method Centralized Scheduling (Clinicians could no longer make their own appointments) Training Intake Staff in use of Motivational Interviewing/Client Engagement Open Second IOP Group for Less Motivated Clients Contingency Management and use of Engagement Measurements (Session Rating Scale)

  21. Days Control Chart Scores AIM # 1: Days to Treatment Intensive Outpatient Q X=13.75 Days

  22. Base Line 58% Quarter avg: 33%

  23. AIM # 3 Increase Admissions Sinnissippi Centers, Inc.

  24. Oklahoma: NIATx Application to State Services Jennifer Glover, MS Clinical Treatment Services Coordinator Oklahoma Department of Mental Health and Substance Abuse Services Reduce Waiting & No-Shows  Increase Admissions & Continuation

  25. Single State Authority for Substance Abuse Prevention and Treatment. Regulate and monitor substance abuse prevention and treatment in the State of Oklahoma. Provide funding and technical assistance to 80+ contracted treatment providers. Who we are and what we do…

  26. Review state processes to remove barriers related to access and retention. Certification rules Contract requirements Myths What is the Project?

  27. ODMHSAS Leadership Change Leader & NIATx Coach Pilot Providers: 2 Residential Providers 3 Outpatient Providers Who is involved?

  28. Elimination of financial eligibility requirement. Results – wait time from 1st contact to admission has been reduced from 30+ days to 3 days. Change Exercise - Access

  29. Identifying and eliminating duplicative paperwork required of treatment providers. Residential treatment providers have reduced their admission process from 8 hours to 2-3 hours. Outpatient treatment providers have reduced their admission time from 4-5 hours to 2-3 hours. Change Exercise - Access

  30. Increased Average Daily Residential Census by 10.3% across two sites Increase assessment conversion rate for 3 Outpatient sites (i.e., number of assessments who are subsequently admitted) by 98.5% from 21 to 41 admissions per 100 assessments. Decrease in time from 1st contact to 1st treatment of 45.3% on average across 3 sites. Increase in residential continuation by 26.8% Decrease in residential AWOL by 46.4% Decrease in residential admission time by 54.5% Results

  31. Forming positive working relationships with treatment providers is vital! Maintaining the relationship is critical! Leadership “buy-in” is essential! Key Lessons Learned…

  32. Diffusion Add 40 more treatment providers to the group. Build an incentive plan to assist the treatment providers to incorporate change and the aims of NIATx into everyday treatment practices. Where do we go from here?…

  33. NIATx Cross Site Evaluation: Initial Findings Jennifer Wisdom, PhD, MPH Research Assistant Professor Department of Public Health and Preventive Medicine Oregon Health & Science University Reduce Waiting & No-Shows  Increase Admissions & Continuation

  34. Methods for Cross-Site Quantitative Analysis • Analysis of combined client level data for agencies submitting at least 12 months of data October 03 to December 04 • Outpatient, Intensive Outpatient, and Residential levels of care • Timeliness to Admission and Continuation

  35. Outpatient: Timeliness

  36. Outpatient: Continuation

  37. Intensive Outpatient: Timeliness

  38. Intensive Outpatient: Continuation

  39. Residential: Timeliness

  40. Sites are making strong gains in timeliness Sites are also making gains in continuation, but these gains more difficult to make and sustain Additional site data will strengthen findings Conclusions

  41. Process improvement valuable in improving drug treatment processes 18-month intervention has had strong positive results Diffusion to other parts of agency Unanticipated consequences of interventions provide a systems perspective Sustainability is important Future Directions

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