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CalOMS Summit

CalOMS Summit. science. TRI. addiction. “Friends of Mady” Meeting. Performance Improvement Strategies: Addressing Paperwork Burden Concurrent Recovery Monitoring Deni Carise, Ph.D. Treatment Research Institute. science. TRI. addiction. The Treatment System. Modality 1975 1990 2006.

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CalOMS Summit

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  1. CalOMS Summit science TRI addiction “Friends of Mady” Meeting Performance Improvement Strategies: Addressing Paperwork Burden Concurrent Recovery Monitoring Deni Carise, Ph.D. Treatment Research Institute

  2. science TRI addiction The Treatment System Modality 1975 1990 2006 Residential 64% 39% 8% Outpatient 27% 59% 81% Methadone 9% 10% 11%

  3. A Typical Counselors Day? Who are the Counselors? science TRI addiction 2 - 3 Hours – Group Counseling 2 - 3 Hours – Intakes 2 - 3 Hours – “Paperwork”

  4. Addressing “Paperwork” Who are the Counselors? science TRI addiction The Delaware Concurrent Recovery Monitoring Grant

  5. science TRI addiction Delaware CRM Project 4 Phases: • Paperwork Burden Evaluation • Collaboratively select CRM items 3) Pilot collection & reporting of CRM items 4) Expand to all 11 state adult OP SA programs and monitor progress

  6. Phase 1 The Paperwork Burden Review Evaluate current data collection in an effort to minimize paperwork burden “A good faith effort”

  7. science TRI addiction Goal: PB Review • Diminish unnecessary or burdensome paperwork • Develop more efficient system - consolidate & streamline paperwork • Facilitate programs’ ability to participate in expanded CRM effort in Phases 2-4

  8. science TRI addiction Paperwork Burden Step 1 Conducted site visits with clinical and administrative staff from 11 OP Tx Programs in DE.

  9. Paperwork Burden Step 2 Reviewed paperwork completed thru continuum of care: Screening Intake Assessment During treatment Discharge or transfer Follow-up

  10. Organizing Forms • Intake Log/Schedule Book – Time 1-2 minutes • Client Service Record – Document services. Time 3-5 minutes. • Checklist of Required Forms – Assures inclusion of all required clinical forms. Time required: 10-20 minutes during Tx. or 60 minutes @ D/C

  11. Organizing Forms Suggestions Keep: Intake Log/Schedule Book Client Service Record Modify: Checklist of Req. Forms – Do it during! Time taken for Organizing Forms: Then: 14 - 67 minutes. Now: 14 - 27 minutes Decrease: 0 - 40 minutes “Depending on the current practice at the site.”

  12. Client Admin Intake Forms 1) Protection & rights forms (confidentiality and HIPAA) – Time: 10-20 minutes 2) Consent for treatment & Release of information – Time: 5-10 minutes 3) Program description, rules, fee agreement, grievance policy – Time: 5 minutes

  13. Intake Forms - Suggestions Modify: HIPAA – upgraded HIPAA form across sites Consent & Release of info – Combine Program Description, Rules, Fee forms: Combine in Client Handbook, Consolidate Time taken for : Client Administrative Forms: Then: 20 – 35 Minutes Now: 15 – 30 Minutes Decrease: 5 Minutes, but  quality

  14. Intake Assessment • DE Consumer Form (CRF) – Time: 10-15 Min • Addiction Severity Index – Time: 45 – 60 Min • ASAM Patient Placement – Time: 30 Minutes • Gambling Screen (SOGS) – Time: 10 Minutes • Alcohol Screening (MAST) – Time: 7–10 Min • “Interpretive Summary” – Time: 30 – 45 Min • “Assessment summary” – Time: 30 – 45 Min • Misc Forms – Time: 15 – 30 Minutes

  15. Intake Assessment Suggestions Keep: CRF & ASI Delete: ASAM & MAST “Interpretive” & “Assessment Summary” Modify: SOGS – 2 Question Screener Misc Forms - Consolidate Time taken for : Then: 3 – 4 Hours (177 – 245 minutes) Now: 1 to 1 ¾ hours (67-105 minutes) Decrease: 1.8 - 2.3 hours (110-140 minutes) “Depending on the current practice at the site.”

  16. During Treatment Forms • ASI every 90 Days – Time: 30 – 45 Min • ASAM every 90 Days – Time: 10 – 15 Min

  17. During Tx. Suggestions: Delete: ASI every 90 Days – Time: 30 – 45 Min ASAM every 90 Days – Time: 10 – 15 Min Time taken (over 6 month treatment episode): Then: 1 ¼ - 2 Hours (80-120 Minutes) Now: 0 Minutes Decrease: 1 ¼ - 2 Hours (80-120 Minutes) “Depending on the current practice at the site.”

  18. Discharge Forms • DE Consumer Form (CRF) – Time: 5-10 Min • Addiction Severity Index – Time: 30–40 Min • ASAM Patient Placement – Time: 10-20 Min

  19. Discharge Form Suggestions Keep: DE Consumer Form (CRF) – 5-10 Min Delete: Addiction Severity Index – 30–40 Min ASAM Patient Placement – 10 - 20 Min Time taken for : Discharge Forms Then: 45 – 70 Minutes Now: 5 – 10 Minutes Decrease: 40 – 60 Minutes “Depending on the current practice at the site.”

  20. Overall Changes Burden Decreases – (per patient): Assessment: 2 - 3 Hours During Treatment: 1½ - 2 Hours Discharge: ¾ - 1 Hour Total: 4 - 6 Hours PER PATIENT

  21. Burden Decreases Total: 4 - 6 Hours PER CLIENT Approx 1,500 clients/year Total reduction: 6,000 – 9,000 hours per year or 750 - 1,125 counselor days per year “Depending on the current practice at the site.”

  22. What made this successful? Extensive commitment and ongoing involvement by State Director Dedicated, patient, “PB” staff Collaborative nature of work between researchers, state, licensing and treatment program staffs.

  23. How might this be done in your state? Notice I didn’t pick California or Texas… But – there are many options!

  24. science TRI addiction Delaware CRM Project 4 Phases: • Paperwork Burden Evaluation - Done Concurrent Recovery Monitoring: • Collaboratively select CRM items 3) Pilot collection & reporting of CRM items 4) Expand to all 11 state adult OP SA programs and monitor progress

  25. Concurrent Recovery Monitoring Phase 2 Phase 2 Collaboratively develop, select and test CRM items Why do CRM?

  26. Providers: Do you know.. How many clients in your group: Used drugs last week? Drank last week? Feel confident about staying sober? Had family problems? Hint – the Answer is No! On to: Developing CRM

  27. How collected – Options: • Paper-pencil at entry to individual or group sessions? • Computer assisted collection? • Web-based? • Teleform?

  28. When collected: • Prior to group for use in group • Prior to individual for use in session (self administered)? • In individual sessions? • After individual or group sessions?

  29. How often collected: • At every session • Weekly • Bi-weekly (2, 4, 6, 8 weeks, etc.) • Monthly (end of month for everyone) • Varies with level of treatment

  30. Deciding on Items Collected: Clinical Value – This is an intervention in itself Value to State in: Performance based contracting NOMS

  31. Items Collected: Items Collected Final decisions on item content

  32. Items Collected: CRM Form Example Drug & Alcohol Abstinence • How many days in the past 7 have you used any drugs or alcohol? • How many days in the past 7 did you attend any AA, NA or CA meetings?

  33. Items Collected: CRM Form Example Psychiatric 3. How many days in the past 7 have you had psychological or emotional problems? Family 4. How many days in the past 7 have you had family problems or conflicts with your family? Employment 5. How many days in the past 7 have you missed work, were late for work, or left work early?

  34. Phase 3 Pilot the collection and reporting of these items in 4 state adult OP SA programs

  35. Phase 3: • Trained 4 sites on CRM Procedures • Conduct Focus Groups at months 1, 3 & 6 • Updated CRM Items & procedures

  36. Counselor Use of CRM Data • Document attendance at recovery group meetings • Treatment planning & updates • Assess relapse potential • Progress notes • “Icebreaker” to start session • Monitor progress

  37. Director Use of CRM Data • Some sites have added CRM to progress notes • Others use it for clinical supervision & treatment planning

  38. Impressions Impressions • CRM is: • Feasible • Useful • Not very efficient in current form • Counselors & directors like the idea of a computer application allowing them to efficiently collect and manipulate collected CRM data for clinical and planning purposes.

  39. Phase 4 Reports Anyone? New Questions?

  40. Directors would use reports for… • Clinical Supervision • Training tool • Justify implementation of new groups • Compare performance by counselor • Get aggregate data

  41. Counselors would like… • Directors to see reports on # of sessions patients attend and hours/effort put into CRM work Clinical Reports • Individual – 1 Clients Over Time • Use and Meetings • Non SA Problems • Group – All clients prior to group

  42. Phase 4: Updated CRM Items In the past __ days, how many days have you • had any alcohol at all, including beer, wine, or liquor? • had at least (5-men, 4-women) drinks in a day? • used any illegal/street drugs or abused any prescription medications?

  43. Phase 4: Updated CRM Items In the past __ days, how many days have you: • been in any situations or with any people that might put you at increased risk for using alcohol or drugs (around risky “people, places, things)? • How much have you been bothered by urges or cravings to drink alcohol or use drugs?

  44. Phase 4: Updated CRM Items • In the past __ days, how many days have you: attended self-help meetings (such as, AA, NA, SMART Recovery, etc) to support your recovery? • How confident are you in your ability to be completely abstinent from alcohol and drugs in the next __ days?

  45. science TRI addiction

  46. science TRI addiction

  47. science TRI addiction

  48. Counselor – Jane Brown

  49. Director Report Example

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