1. Partnership for Advancing Recovery in Kentucky Using NIATX Technology for Continuing Care: Opening the Cage Door Will press lever for drugs!

2. Partnership for Advancing Recovery in Kentucky 1/21/08 2 PARK AIM: Increase continuation and decrease dropouts through a statewide system of care that embraces community linkages and collaborative planning.PARK AIM: Increase continuation and decrease dropouts through a statewide system of care that embraces community linkages and collaborative planning. Target evidence based categories: Continuing Care &Wraparound Supports

3. Partnership for Advancing Recovery in Kentucky 1/21/08 3 The majority of those discharged from treatment do not receive the NIDA (1999) recommended 90 days of continuous care (White, in press). 80% of individuals who relapse after treatment do so in the first 90 days (Hubbard et al., 2001). The majority of substance dependent individuals only achieve stable recovery after 3-4 treatment episodes over multiple years (Anglin et al., 1997; Dennis et al., 2005). More about Treatment

4. Partnership for Advancing Recovery in Kentucky 1/21/08 4 Only 17% of individuals who complete treatment in one level of care successfully access the next recommended level of care (OAS, 2005). Linking treatment to recovery supports improves outcomes 20-22% (Dennis, 2007) Only 20% of adults and 36% of adolescents receive any professionally-directed post- discharge continuing care. (Godley et al., 2001; McKay, 2001) Treatment & Recovery

5. Partnership for Advancing Recovery in Kentucky 1/21/08 5 NIATX: Five Principles Understand and involve the customer Fix key problems Pick a powerful Change Leader Get ideas from outside the organization Use rapid-cycle testing

6. Partnership for Advancing Recovery in Kentucky 1/21/08 6 Why a Walk-through? The walk-through… –Helps understand the customer and organizational processes –Provides a new perspective Allows you to feel what it’s like Lets you see the process for what it is –Seeks out and identifies real problems –Generates ideas for improvement –Keeps you asking why?…and why? again

7. Partnership for Advancing Recovery in Kentucky 1/21/08 7 Executive Sponsor Vision –Provides a clear link to a strategic plan –Sets a clear aim for the Change Project Engagement –Supports the change leader –Periodically attends change team meetings –Personally invites change team participants Leadership –Removes barriers to change –Connects the dots –Communicates clearly, concisely, and constantly

8. Partnership for Advancing Recovery in Kentucky 1/21/08 8 Change Team Responsibilities Meet regularly Ensure accountability –Record and distribute minutes –Assign tasks and responsibilities Identify potential solutions –Quickly test one idea –Measure the impact of the change

9. Partnership for Advancing Recovery in Kentucky 1/21/08 9 Making Changes PDSA Cycles –Plan the change –Do the plan –Study the results –Act on the new knowledge Adapt Adopt Abandon Two-week-long cycles

10. Partnership for Advancing Recovery in Kentucky 1/21/08 10 Strategies to Support Recovery Improve the continuity of care Individuals discharged from intensive levels of addiction treatment should be transferred to outpatient treatment before leaving the treatment system (APA, 1995; ASAM, 2001) Use a recovery plan (as opposed to a treatment plan) (White & Kurtz, 2006; Scott, Dennis & Foss, 2005) (Dennis & Scott, 2007)

11. Partnership for Advancing Recovery in Kentucky 1/21/08 11 Emerging Strategies to Support Long-Term Recovery Telephone-based continuing care (McKay et al., 2004) Recovery Management Checkups (Dennis et al., 2003; Scott et al., 2005) Assertive Continuing Care (Godley et al., 2004) Resource Guide access and training for counselors (Carise et al., 2006)

12. Partnership for Advancing Recovery in Kentucky 1/21/08 12 KRCC & Kentucky Technology Strategies Video Meetings between Levels of Care Client & Counselor Counselor KTOS Assessments Using PDA Voicent Auto Reminder Telephone Calls Interactive Video Game Generation Rx for Prevention In House Video Production Caney Digital Media Use of HBO Addictions video clips in treatment groups Telehealth Network for Primary and Medical Specialty Care Use of Physicians Portal for EMR Access & Internet Based Client Tracking Software Regional Video Conferencing for Training & Process Improvement Statewide Video Interest Circles Targeting Evidence Based Practices Use of TRAIN & Essential Learning for Training and Tracking DVD Introduction to Next Level of Care

13. Partnership for Advancing Recovery in Kentucky 1/21/08 13 Video Introduction to Next Level of Care Video created to demystify first visit to outpatient offices Video re-shot to better capture desired messages Video given to Hospital for units Case Managers with portable DVD player

14. Partnership for Advancing Recovery in Kentucky 1/21/08 14

15. Partnership for Advancing Recovery in Kentucky 1/21/08 15 Video Handoffs Clients at Next Step Recovery Center and Bailey Center Crisis Stabilization Units have video meetings with next level of care counselor Clients in the Hospital Have had video handoffs with community counselor- currently discontinued

16. Partnership for Advancing Recovery in Kentucky 1/21/08 16 Resource Guide

17. Partnership for Advancing Recovery in Kentucky 1/21/08 17 Thanks for your attention! For more information contact:  Louise.howell@krccnet.com  David Mathews wdmathews@aol.com  Lou Kurtz louis.kurtz@ky.gov  Wendy Morris wmorris@arh.orgwmorris@arh.org  Jenniferstamper@chrysalishouse.org  Pam Combs Pcombs@arh.org