Implementing EBPs through Systems Change Robert Woods Johnson Foundation (RWJF) Funded

Advancing Recovery $11 million national program of the Robert Wood Johnson Foundation Co-Directed by David Gustafson at NIATx and Tom McLellan at the Treatment Research Institute (TRI) in Philadelphia, PA

Advancing Recovery Focused on implementing EBPs using systems change EBPs of focus: MAT, Continuum of Care, Wrap-around Services, Psychosocial Therapies, Screening & Brief Interventions

Advancing Recovery AR is divided into two 2-year grant rounds Round I: Oct 2006-Sept 2008 Round II: Feb 2008-Jan 2010 Each round consists of up to 6 grantees who are to implement 2 of the 5 EBP

Participants Round 1: Delaware, Florida, Kentucky (KRCC), Maine, Missouri, & Rhode Island (NRI). Round 2: Alabama, Arkansas, City of Baltimore, Colorado, Texas (Homeward Bound), & West Virginia (Prestera)

Round I SiteEBC 1EBC 2 DEPsychosocial: MIContinuing Care FLMATCase Mgmt/Wrap Around KY (KRCC)Continuing CareCase Mgmt/Wrap Around MEMATCase Mgmt/Wrap Around MOMATPsychosocial: MI RI (NRI)Continuing CareMAT

Round II SiteEBC 1EBC 2 ALContinuing CareCase Mgmt/Wrap Around ARContinuing CareCase Mgmt/Wrap Around MD (Baltimore City)MATContinuing Care TX (Homeward Bound)Psychosocial: MIMAT WV (Prestera Center)MATContinuing Care CO (Signal BHN)Continuing CareMAT

Advancing Recovery Currently At the mid-point of the program Focusing on Spread and Sustainability Developing AR’s “legacy”

Practice Improvement Enhancer (PIE)

Purpose Create a framework for whole system’s change

11 Practice Improvement Enhancer (PIE) Increased Use of EBCs Foundation for Change Analytic Tools Recovery OutcomesHealth Understand the Customer Establish Effective Measures Generate Leadership Support Develop Business Case Define Clear Aim Barrier Analysis Financing & Purchasing Plans Inter-Organizational Analysis Methods Learning Collaborative Rapid Cycle Change Partnerships

Missouri Case Example

13 State Walk-Through Understand the Customer –Key executive and administrative support –Fiscal staff –Medical Director –People who know the data system –Provider staff – clinical and administrative Aim = Increase Use of Meds Measures = Med Screenings, Referrals & New Business Case = Less “cycling” Missouri's State and Provider Partnership

System Changes for MAT Financial & Purchasing Changes Providers able to bill for physician to evaluate and prescribe naltrexone or acamprosate Providers able to bill for laboratory services Providers able to purchase naltrexone and acamprosate at reduced cost with central purchasing procedure 14 Missouri's State and Provider Partnership

15 Learning Collaborative Site visit facilitated discussion of provider walk-through results Face-to-face partnership meetings with coaches Conference calls –Regular schedule –Distribute Agenda in advance of calls –Distribute Minutes after calls Web site –Great resource, people have been slow to use Missouri's State and Provider Partnership

16 Rapid Cycle Changes for MAT Providers screening –Developed screening protocol –Screening began at intake and continued during treatment episode Client education groups –Creating groups of individuals using MAT and their families –Helps individuals provide mutual support and allows for targeted staff assistance Missouri's State and Provider Partnership

17 Missouri's State and Provider Partnership Individuals Affected by MAT (cumulative)