Florida Alcohol Drug Abuse Association Mary Booker Joan Helms NIATx Conference June 2013

Learn to engage and identify stakeholders Identify tools and benchmark process Develop and expand collaboratives Initiate and grow peer mentor networks Present outcomes to stakeholders Integrate and replicate outcomes

Current Budget Substance Abuse: $215,672,421 Mental Health: $760,060,545 Sources of Funding Substance Abuse State: 40%Federal: 60% Mental Health (including State MH Facilities) State: 81%Federal: 19%

Operational Structure Central Office: Guides State System of Care, Monitors progress Regional Offices (6): Manage regional systems of care Percent Funds in Contracted Services Mental Health: Civil Facilities – 1 of 3 privatized Forensic Facilities – 2 of 4 privatized SVPP – privatized Substance Abuse: privatized

Managing Entities (Includes SA and Community MH) Current contracts: 7

FADAA, incorporated in 1981, is a non-profit membership association representing over 100 of Floridas premiere community- based substance abuse and co-occurring treatment and prevention agencies, managing entities, community anti-drug coalitions and approximately 3,500 individual members. Throughout its history, FADAA has been involved in leading industry change to better serve consumers and communities and has been at the forefront in creating responsive systems and tools to facilitate the transfer of evidence-based practices to the field and to initiate and expand continuous quality improvement activities. FADAA is perceived as the lead voice by national, state and local policy makers, providers and the recovery community on substance abuse policy and related practice improvement.

The State and FADAA aggressively pursued grants to build the capacity for system improvements while removing regulatory and administrative barriers to client access to service: Robert Wood Johnson – Resources for Recovery Strengthening Treatment Access and Retention - State Implementation Robert Wood Johnson – Advancing Recovery Partnership for Quality Performance State Contract

In 2005, FADAA and DCF collaborated to establish new state Medicaid codes for substance abuse services and legislative authorization for a local match program to maximize reimbursement for substance abuse services.

In 2006, FADAA, DCF and 6 (initial) substance abuse provider agencies received a 3-year STAR-SI grant to improve client access and retention. Reduce average time between an individuals first contact for OP treatment and an initial screening/assessment by 25%. Reduce average time between initial screening/assessment and delivery of first OP treatment service by 25%. Increase the number of persons who complete detoxification and then enter OP treatment by 50%.

By the end of the 3-year project, the team included: 21 individual provider agencies Two managing entities Staff from the State Substance Abuse Mental Health Program Offices and the Florida Alcohol & Drug Abuse Association (FADAA) Other accomplishments: Implemented more than 50 improvement projects Provided staff training in the use of change teams and rapid cycle process improvements 30+ participants have been trained throughout Florida as Change Team Leaders Established 19 Peer Mentors and 5 Coaches within Florida

Year 1Year 2Year 3Year 4FIS DACCOACTSBayview Mental Health BridgewayCenter for Drug Free Living LakeviewFamily Resource Center Centre for WomenDATACDAC Manatee GlensGatewayCoastalEPICClay County MeridianJackson NorthRiver RegionLifestreamDISC Village Stewart MarchmanLifestreamSutton PlaceRiver RegionGateway The VillageThe HarborTri-County Human Services Human Services Associates The VillageMeridian River Region Tri-County

Cadre of Peer Mentors (NIATx trained) NIATx Process Improvement Training & Coaching Florida Learning System Established System of Care - Client Access & Retention Improved NIATx Training for Family Intervention Specialists

Two year funding - $180,000 per year Three providers (Operation PAR, Spectrum-Miami Behavioral Healthcare, River Region Human Services) Focus on the use of medication (Nalotrexone), case management and support services for improved client outcomes

The State and its partners agreed to implement the evidenced based practice of providing Vivitrol to patients with alcohol addictions. Vivitrol is only administered in conjunction with psychosocial interventions Partner agencies: Identified and implemented client screening and selection criteria Developed a medication protocol; Provided educational training regarding Vivitrol to over 130 staff; Initially provided Vivitrol to 10 clients; Tracked client progression.

The State reviewed and selected evidenced based practice to enhance case management services to substance abuse clients.

Partners reported experiencing the following barriers to implementing the program: Obtaining the medication Prohibitive costs Getting Vivitrol on the Medicaid formulary Partners reported that staff were fully supportive of the program due to the information received from the medication representatives and staff comfort with administering medication in conjunction with counseling.

NATIONAL INITIATIVES SAMSHA Paths to Recovery RWJ/NIATx FADAA RWJ Resources to Recovery, Advancing Recovery, STAR-SI Florida Learning System Florida DCF Collaborative Partners

Provided guidance on the progress of the grant as appropriate Monitored data collection and reporting Assisted with the revision of regulations and policies that impede service delivery and process improvements Supported the peer learning network Disseminated project results

Florida Learning System

NIATx SAAS SAMHSA The National Council for Behavioral Health Florida Department of Children & Families Florida National Guard Florida Certification Board Florida State University Local Level Partners SA, MH and Prevention Providers Managing Entities Community Anti-Drug Coalitions

Partnership for Quality Performance State Contractual Work Plan State and National Level Partners Provider Commitment

ProsCons Fluid, flexible – meets on the ground technical service needs Like a contract Easy to make changes No formal contract amendment required Amount of detail Tracking Monitoring partners Organizational system changes

Data system refinements Improve client engagement and retention Increase use of evidence-based practices and assessment Contract linkages NIATx resources

Buy-in Trust building Elimination of turf issues Time-consuming Resistance Communication History with individuals, organizations Risk taking Sharing information

Research based grants Transformation Creativity Flexibility Acknowledgement & recognition of what issues partners are dealing with Group dynamics Drawing on talent of providers

Three Key Roles: Use their experience and expertise during site visits, telephone and online technical assistance to the providers Identify promising process improvement strategies, tools, and products to be disseminated through the repository Continue to participate in and expand the peer learning network

Provide Technical Assistance Provider Sites State Tiered approach with increasing levels of expertise Knowledge Experience Strengths Standardize approach Develop network – on-line data base

Adjust States data Create financial incentives Use evidence-based practices Use uniform, evidence-based assessment Address regulatory and policy barriers Implement system performance management/CQI

Sustaining successes Implementing rapid change cycles in interagency matters Diffusing lessons learned and new processes across provider sites

State/Districts Integrate successful changes DCF SAMHPO District Office Provide leadership for Florida Learning System FADAA/Providers Active participant in Florida Learning System Integrate changes in provider infrastructure Managing Entities Integrate changes into Association and agency infrastructure

Core competencies (PI, Peer Mentors) Define role of managing entities o Dissemination of education o Replicating projects o Mentoring Integrated QI approach within and across managing entities

Engage networks Increase participation of provider agencies Recruit and train additional peer mentors Increase staff competencies in performance improvement Participation by all provider networks Capacity to implement process improvements at state and local areas Systems integration

Tremendous talent and leadership exists at the provider level. Improvements are demonstrated quickly at the provider level. State level change is slower - but not impossible. State budget and procurement practices can be difficult but leveraging resources are critical. National partners are essential (e.g., NIATx).

Mary Booker, Assistant Director , ext. 115 Joan Helms, Director of Research & Practice Improvement , ext. 107 NIATx Conference PowerPoint Presentation