Presentation is loading. Please wait.

Presentation is loading. Please wait.

Seizing the Quality Opportunity in Addiction Treatment Victor Capoccia Open Society Institute NIATx University of Wisconsin James Harrison Brandywine Counseling.

Similar presentations


Presentation on theme: "Seizing the Quality Opportunity in Addiction Treatment Victor Capoccia Open Society Institute NIATx University of Wisconsin James Harrison Brandywine Counseling."— Presentation transcript:

1 Seizing the Quality Opportunity in Addiction Treatment Victor Capoccia Open Society Institute NIATx University of Wisconsin James Harrison Brandywine Counseling Center September 2007

2 A Simple Truth “Treatment works when the consumer is connected to treatment… treatment doesn’t work when the customer is absent……” Victor Capoccia, 2007

3 Our current reality: System 1 Our customers… –‘wait’ 1-10 weeks –have mountains of paperwork –standardized practices between them and care –are discharged when they show symptoms of illness –are replaced when they fail to come back –are not prescribed medications that are proven to help

4 Our current reality: System 2 Our customers… –are subject to ‘humiliating interventions’, that suggest we believe addiction is a moral condition such as searches, and peer embarrassment –are not actively connected to related health services, or less intense levels of care We prefer customers that can be ‘put on the contract’ over those with insurance public or private

5 At any one time: 110,000 waiting for assessment 42,000 waiting for treatment 32 days from first contact to treatment No show rates about 50% Based on survey conducted by Survey Research Laboratory University of Illinois - Chicago March 2007

6 Why does this situation exist? (Show of hands) Not enough resources? Customer resistance and readiness? Staff training and knowledge? The system we use gives us exactly what it is designed to produce?

7 The Quality Opportunity The Environment is ready –Newsweek, HBO, Time, Baltimore survey The Knowledge is available –NQF, IOM Report The Tools are available –NIATx, ACTION Campaign, Close the Treatment Gap

8 The Work Force Issue Training = lack of knowledge Career Development = investment

9 Baltimore Alliance for Careers in Healthcare Partnership: Employer; Learning Org; WIB; Community Agencies Career ladders and pathways HR and Ed system change Work based Learning Rewards for advancement

10 NIATx: The 5 Principles 1.Understand and involve the customer 2.Focus on key problems 3.Select a powerful change leader 4.Seek ideas from outside the field 5.Use rapid PDSA cycles to test solutions

11 Paths to Recovery STAR State Pilot Project Self-Initiated Members NIATx Participants STAR – State Initiative Advancing Recovery NIATx 200

12 39% decline in days to entry (McCarty et al, 2007)

13 Retention in Care Increased (Session 1 to 2 = 18%; Session 1 to 3 = 17%; 1 to 4 = 11% ns) (McCarty, et al, 2007).

14 The Network for the Improvement of Addiction Treatment (NIATx) Reduce Waiting & No-Shows  Increase Admissions & Continuation James Harrison October 2007 BRANDYWINE COUNSELING INC. Paths to Recovery: Treatment on Demand

15 NIATx Aims Reduce delay: 1st request to 1st Tx Reduce delay: 1st request to 1st Tx Reduce % no-shows Reduce % no-shows Increase continuation rate Increase continuation rate Increase number of admissions Increase number of admissions INCREASING CAPACITY TO IMPROVE INCREASING CAPACITY TO IMPROVE

16 Conducting a Change Exercise PDSA cycles  Plan the change  Do the plan  Study the results  Act on the new knowledge Rapid cycle changes  Changes should be doable in 2 weeks

17 Conducting a Walk-through  Play the role of a client and a client’s family member seeking treatment at your agency  Try to think and feel as the client/family member would, and think about what they would want changed  Ask staff what changes would make the process better for clients and for staff  Compile a list of client and staff needs and possible improvements that could address these needs

18 How P2R Has Made Us Better

19 Organization  Wilmington, Delaware  Outpatient services for adults 18 and over  Seven locations including 3 methadone clinics  1700 clients, 135 staff  Funding: 86% contracts, 14% client fees

20 Population Served  Opiate dependent individuals: 52% of our population. (877)  Modalities: methadone, Revia, buprenorphine  Demographics: mixed  73% male  53% Caucasian, 40% African American, 8% Hispanic

21 Row 2: James Harrison (Change Leader), Joyce Lewis, Dr. Joe Glick, Sally Allshouse (Executive Champion), Mark Lanyon, Lynette Latzko, Denise Purnell. Row 1: Kevin Murphy, Basha Closic, Matt Friedman, Laurie Dyer, Lorina Dryden, Marcia Blancato. Not pictured: Client #811, Ginny L., Michele Smelstoys

22 P2R Goals at the Start  Increase productivity by serving more clients with existing funding  Remove barriers while providing treatment with dignity  Spread improvements throughout the agency  Improve survival of our population

23 Progress So Far  Change 1: Decreased wait for appointments from 4 to 2 weeks  Change 2: Transferred clients from intake to treatment faster  Change 3: Increased intake capacity by 25%.

24 Change Exercise #4 Aim Addressed  Reduce wait from first contact to first unit of service to first unit of serviceWhy?  New clients must wait several days after intake before receiving first dose  Need urinalysis results from lab  Orientation offered only twice a week

25 Changes Made  Eliminated steps: Use instant urines  Reconfigured process: Same day orientation using videotape Measures Used  Average time from intake to first dose

26 Working Out the Bugs  Guest dosing clients admitted to other sites  Show video first so clients don’t have to wait after intake is done  Outreach worker shows video so counselors can prepare intake paperwork

27 Impact Average Time from Intake to First Dose  Pre-Change: 2.3 days  Post-Change: 0.3 days

28 Impact Same day medication Overall Wait for First Unit of Service Add intake slotNurses pre-screen 21 14 8

29 Impact  Recently arrested for heroin possession and has prior conviction of 1 st degree robbery. Stated if he did not get into treatment, he would eventually do something serious to get money for his addiction.  When he came in he was offered same day medication. States this was the reason he stayed for the intake process instead of leaving to get heroin.  Gerald  8 year history of heroin use, has wife and 4 kids

30 Impact  Now he can report he is in treatment. His same day admission may help him avoid reincarceration and the risk of buying street drugs again.  As a result he “will take the opportunity to give [treatment] a good try.”  Orville  In last 15 years, has not been out of prison longer than 6 months. At risk of reincarceration if not clean when reports to probation officer.

31 Unanticipated Successes  Clients receive itinerary that staff signs off on when their part of intake is complete  Word got out on the street that same day medication is available  Videotaping orientation made us aware of unwritten rules. Key to Success  During weekly meetings, the committee evaluated and fine-tuned the change using PDSA

32 Workforce Development Personal Mastery Individual commitment to life-long learning, fine tuning one personal vision Individual commitment to life-long learning, fine tuning one personal vision Skill or talent, passion Skill or talent, passion Recovery focuses on determining values and living life according to those values Recovery focuses on determining values and living life according to those values Find staff talent/skill and encourage it- art, music, numbers, client focused Find staff talent/skill and encourage it- art, music, numbers, client focused

33 Shared Vision Shared picture of the future created out of mission, goals and values Shared picture of the future created out of mission, goals and values Created not dictated Created not dictated Changes through sharing of employees’ personal vision Changes through sharing of employees’ personal vision Match organization and individual’s Match organization and individual’s Recovery “Meeting the client where they are” Recovery “Meeting the client where they are” Different levels of staff participating in program improvement decision making Different levels of staff participating in program improvement decision making

34 Change Exercise #5 Aim Addressed Increase admissions Changes Made  Increase intake slots from 15 to 18 per week Measures Used  Admissions  Wait from first contact to first dose

35 Impact Admissions at an all time high

36 Impact Average wait from first contact to first dose at an all time low

37 Status of the Changes  Successful and left in place.  Future P2R Goals  Alternative program for repeat clients  Special focus on Suboxone patients ACTION Campaign Goal: The ACTION Campaign will take the knowledge gained through the work of NIATx and boil it down into easily adoptable practices. By spreading the knowledge in this way, we can change at least 55,000 lives!

38 ACTION Campaign 3 Themes: 1.Providing rapid access to services 2.Improving client engagement, participation, & retention in treatment 3.Creating a seamless transition between levels of care

39 Rapid Access to Services Engage people the first time you talk with them on the phone or in person Accelerate intake through same-day service Offer express check-in, expanded hours, and group orientation sessions Make sure people seeking help can reach you easily

40 Improve Client Engagement Greet clients warmly to make them feel welcome Involve clients in setting goals and planning for long- term recovery Use confirmation systems that keep clients coming back Celebrate counselor success at retaining clients

41 Create a Seamless Transition between Levels of Care Establish personal connections for internal and external referrals Reduce paperwork to make it easier for clients to take the next steps Introduce clients to ongoing recovery supports before they leave your facility Assess the quality of the transfer, hand-off, or referral

42 What about resources? Closing the Treatment Gap Assure sufficient resources and capacity High quality treatment for drugs and alcohol Available to all who need it

43 Strategies Financing Efficiency Informed by advocacy

44 Recap People who are in treatment get better Our system makes it difficult to get into and stay in treatment We have a unique time in history to change that: environment, knowledge, tools Lets use these tools: BACH, NIATx, ACTION Campaign, Close the Gap

45 More Info NIATx www.niatx.net ACTION Campaign www.actioncampaign.org / Closing the Tx Gap www.soros.org/initiatives/baltimore www.soros.org/initiatives/baltimore Jobs for the Future www.jff.org


Download ppt "Seizing the Quality Opportunity in Addiction Treatment Victor Capoccia Open Society Institute NIATx University of Wisconsin James Harrison Brandywine Counseling."

Similar presentations


Ads by Google