adolescent continuing care alabama partnership robert wood johnson foundation – advancing recovery
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Adolescent Continuing Adolescent Continuing CareCare
Alabama PartnershipAlabama Partnership
Robert Wood Johnson Foundation – Robert Wood Johnson Foundation – Advancing RecoveryAdvancing Recovery
Alabama AR PartnersAlabama AR Partners Alabama Department of Mental Health & Mental Retardation – Substance Alabama Department of Mental Health & Mental Retardation – Substance
Abuse Service DivisionAbuse Service Division• Sarah HarklessSarah Harkless• Bob WynnBob Wynn• Tammy PeacockTammy Peacock
CoachesCoaches• Carolyn Castro-DonlanCarolyn Castro-Donlan• Neil KalteneckerNeil Kaltenecker
FORMLLFORMLL• Mike McLemoreMike McLemore
Nova Center for Youth & FamiliesNova Center for Youth & Families• Gina KogerGina Koger• Susan SmithSusan Smith
Northwest Alabama Mental Health CenterNorthwest Alabama Mental Health Center• Gwen Thomas-LeBlancGwen Thomas-LeBlanc
The Bridge, Inc.The Bridge, Inc.• Jeremy BlairJeremy Blair
Where we have beenWhere we have been Lack of Availability of Adolescent ServicesLack of Availability of Adolescent Services One-size fits all approach in terms of outpatient One-size fits all approach in terms of outpatient
treatmenttreatment Wrap-around services were viewed as Wrap-around services were viewed as
peripheral and not necessarily as a value-added peripheral and not necessarily as a value-added service essential for treatment of adolescentsservice essential for treatment of adolescents
Client engagement and retention was not Client engagement and retention was not measured or trackedmeasured or tracked
Minimal focus on the consumer’s point of viewMinimal focus on the consumer’s point of view
Enter Advancing RecoveryEnter Advancing Recovery
Began a process of collaboration with Began a process of collaboration with three adolescent providers and the SASDthree adolescent providers and the SASD
Opened up dialogue among participants Opened up dialogue among participants about treatment protocols and best about treatment protocols and best practices.practices.
Introduced the NIATX processes of walk-Introduced the NIATX processes of walk-through and PDSA cycles.through and PDSA cycles.
State-wide AimsState-wide Aims
Aim 1. Engage and retain youth in Aim 1. Engage and retain youth in treatment and recovery process.treatment and recovery process.
Aim 2. Effect salutary change on Aim 2. Effect salutary change on substance use related functioning.substance use related functioning.
Expected OutcomesExpected Outcomes Increase adolescent access to and retention Increase adolescent access to and retention
in continuing care following residential in continuing care following residential treatmenttreatment
Improve outcomes for adolescents following Improve outcomes for adolescents following residential treatmentresidential treatment
Increase utilization of clinically appropriate Increase utilization of clinically appropriate levels of carelevels of care
Utilize advocates to enhance programmatic Utilize advocates to enhance programmatic design to be more consumer orienteddesign to be more consumer oriented
Increase the youth’s protective factors and Increase the youth’s protective factors and decrease their risk factors from admission to decrease their risk factors from admission to residential treatment to discharge from residential treatment to discharge from continuing care.continuing care.
Provider System ChangesProvider System Changes Streamlining of admission process to remove Streamlining of admission process to remove
barriers and increase engagementbarriers and increase engagement Instituted referral and tracking system for youth Instituted referral and tracking system for youth
following discharge from residential treatment following discharge from residential treatment and input on program designand input on program design
Use of ASAM PPC-2R criteria to determine Use of ASAM PPC-2R criteria to determine levels of care following discharge from levels of care following discharge from residential treatmentresidential treatment
Increased communication among residential Increased communication among residential treatment providers and outpatient providerstreatment providers and outpatient providers
Developed a framework for partnershipsDeveloped a framework for partnerships
SASD System ChangesSASD System Changes Development of new certification standards based on Development of new certification standards based on
ASAM PPC2 criteriaASAM PPC2 criteria Preparation for statewide training on ASAM PPC2Preparation for statewide training on ASAM PPC2 Development of a standardized adolescent placement Development of a standardized adolescent placement
assessment to determine appropriate levels of careassessment to determine appropriate levels of care Included continuing care as a component in all newly Included continuing care as a component in all newly
funded programs through the RFP process funded programs through the RFP process Expansion of SASD funded adolescent treatment Expansion of SASD funded adolescent treatment
programsprograms Support for new adolescent treatment programs that are Support for new adolescent treatment programs that are
not state fundednot state funded Encourage interagency communication between Encourage interagency communication between
adolescent providers and the SASD through the adolescent providers and the SASD through the Organizational Readiness Workgroup and later the Organizational Readiness Workgroup and later the Adolescent Treatment Providers GroupAdolescent Treatment Providers Group
The DataThe Data
Total number of clients admitted to Total number of clients admitted to continuing care increased from 40% in continuing care increased from 40% in April/May 08 to 56% in April/May 09.April/May 08 to 56% in April/May 09.
The average days to admission from The average days to admission from residential discharge to continuing care residential discharge to continuing care decreased from 19 days in April 08 to 5 decreased from 19 days in April 08 to 5 days in April 09.days in April 09.
A baseline was established in the first year A baseline was established in the first year consisting of an average of 22.4 case consisting of an average of 22.4 case management referrals per month.management referrals per month.
Clients Referred to CC Compared Clients Referred to CC Compared to Admitted to CCto Admitted to CC
Average Days to Admission to CCAverage Days to Admission to CC
Average Number of Case Average Number of Case Management ReferralsManagement Referrals
Intra-Organizational AnalysisIntra-Organizational Analysis Identifying and referring to appropriate levels Identifying and referring to appropriate levels
of careof care Developing alternative levels of care Developing alternative levels of care
(Outpatient, Continuing Care group)(Outpatient, Continuing Care group) Utilization of the Walk Through:Utilization of the Walk Through:
Provider Improvements:Provider Improvements:• Consumer focused improvements (expanded locations, Consumer focused improvements (expanded locations,
privacy, comfort, schedules)privacy, comfort, schedules)• Paperwork reduction (intake and assessment)Paperwork reduction (intake and assessment)• Buy-in of staff in 11 locationsBuy-in of staff in 11 locations• Follow up by residential staff post dischargeFollow up by residential staff post discharge
Identification of areas for improvement in the Identification of areas for improvement in the SASD: SASD:
• Certification processCertification process• Billing Billing • CommunicationCommunication
Inter-Organizational AnalysisInter-Organizational Analysis Network of communication has opened up between the partners Network of communication has opened up between the partners
and with other adolescent providers which has facilitated:and with other adolescent providers which has facilitated: the referral process for continuing care the referral process for continuing care new referralsnew referrals networking and relationships among providersnetworking and relationships among providers
Building Relationships – Building Relationships – Awareness and buy in for continuing care by the Department of Youth Awareness and buy in for continuing care by the Department of Youth
Services, the Administrative Office of Courts, judges, juvenile Services, the Administrative Office of Courts, judges, juvenile probation officersprobation officers
Statewide spread – developing working relationships and establishing Statewide spread – developing working relationships and establishing a referral process with adolescent providers outside the AR project a referral process with adolescent providers outside the AR project
Ongoing discussions with judges educating them on adolescent Ongoing discussions with judges educating them on adolescent substance abuse treatment and the benefits of continuing caresubstance abuse treatment and the benefits of continuing care
Presentations on the benefits of continuing care at statewide Presentations on the benefits of continuing care at statewide conferencesconferences
Utilization of consumer advocacy to provide support for youth Utilization of consumer advocacy to provide support for youth transitioning from residential treatment and input on program transitioning from residential treatment and input on program design design
Ongoing review of the hand off of the client in the referral processOngoing review of the hand off of the client in the referral process
Lessons Learned to DateLessons Learned to Date
It is about communication and relationshipsIt is about communication and relationships Regular electronic and face-to-face meetingsRegular electronic and face-to-face meetings Value of all participants conference calls Value of all participants conference calls
Value of planning then planning some more and Value of planning then planning some more and then planning a little bit morethen planning a little bit more
““You can observe a lot by watching” – Yogi BerraYou can observe a lot by watching” – Yogi Berra Changing or improving processes take time and Changing or improving processes take time and
repetitive learning. Be patient and take the time to repetitive learning. Be patient and take the time to observe employees and clients during the observe employees and clients during the implementation process.implementation process.
Lessons Learned to Date – Cont’dLessons Learned to Date – Cont’d
Use the available technology to aid in the Use the available technology to aid in the implementation. Be creative in using your implementation. Be creative in using your tools in ways previously unimagined.tools in ways previously unimagined.
Understand the usual operating or Understand the usual operating or business practices can benefit from review business practices can benefit from review and improvement.and improvement.
Coaches have a wealth of knowledge and Coaches have a wealth of knowledge and experience…..be open to their feedback experience…..be open to their feedback and suggestions.and suggestions.
Eureka Moments!Eureka Moments!
Implement, Spread and DiffuseImplement, Spread and Diffuse
Financial AnalysisFinancial Analysis Review funding and service array of case Review funding and service array of case
management.management. The base rate for these services was established in The base rate for these services was established in
the previous decade.the previous decade.
Inter-organizationalInter-organizational Through established provider network, continue Through established provider network, continue
to build effective relationships that removes to build effective relationships that removes barriers and opens up communication among barriers and opens up communication among adolescent providers.adolescent providers.
SustainabilitySustainability Develop a sense of shared ownership for Develop a sense of shared ownership for
adolescent care with other providers adolescent care with other providers through regular meetings with the through regular meetings with the Adolescent Treatment Providers GroupAdolescent Treatment Providers Group
One day workshop on systems change & One day workshop on systems change & collaboration at the Alabama School of collaboration at the Alabama School of Alcohol & Drug StudiesAlcohol & Drug Studies
Where we are goingWhere we are going
Continue improving client retention and Continue improving client retention and engagementengagement Use of video conferencing technology to Use of video conferencing technology to
facilitate transition to continuing carefacilitate transition to continuing care Establish case management to provide Establish case management to provide
wrap-around services as an integral part of wrap-around services as an integral part of substance abuse treatment for youth in substance abuse treatment for youth in outpatient and residential treatmentoutpatient and residential treatment
Contact InformationContact Information Jeremy Blair Jeremy Blair
Gina Koger Gina Koger [email protected]
Gwen Thomas-LeBlancGwen Thomas-LeBlanc [email protected]
Tammy PeacockTammy Peacock [email protected]