JURISDICTION ASSESSMENT PROCESS LEARNING COLLABORATIVE PRESENTATION NOVEMBER 14, 2012

PURPOSE OF REVIEW PROCESS Identify system strengths and weaknesses Identify priority initiatives and activities Target technical assistance and identify system improvement measures Improve adherence to conditions of award Improve fiscal efficiency Steer system transformation

Grant Review PROCESS What are the strengths and weaknesses? What are the priorities? Analyze Define the problem. Define the goal. Feedback What resources are needed? Collaborate/ Develop How is it going? what else is needed? Implement What was the impact? What are the next steps? Evaluate Grant Review days Assessment Tool Develop/Implement Action Plan Assess Progress

SYSTEM ASSESSMENT MEASURES Quality Access Integration Quality Access Integration

QUALITY MEASURES Quality Linkages Length of treatment engagement Relapse risk reduction

ACCESS Is there access to a continuum of care? Are there referral pathways to State Care Coordination for high-risk populations? Is continuing care accessible and recommended for individuals successfully completing level I treatment? Are recovery support services available and utilized? (ATR, recovery housing, transportation, recovery community centers, peer mentoring, etc.) Access

INTEGRATION System transformation Progress towards Healthcare reform Establishing Health and Wellness measures Integration

MEASURE ONE 70% of all adult and adolescent patients in ADAA funded treatment programs have a treatment episode of not less than 90 days. _____% Type of Measure ADAA Requirements Data ElementsComment Quality MFR Condition of Award: four, 26(a) and 27(d)  By County of Residence  Any ADAA funded program in episode  Discharged Excludes OMT and Jail-based

MEASURE TWO 56% of adolescent and 66% of adult patients completing/transferred/referred from ADAA funded intensive outpatient (IOP II.1) programs enter another level of treatment within thirty days of discharge. _____% Adults ____%Adolescents Type of Measure ADAA Requirements Data ElementsComment Quality Measure MFR Condition of Award: four and 26(b)  By County of Residence  ADAA funded  Dis-enrolled II.1  Enrolled in > loc within 30 days Excludes jail-based

MEASURE THREE 90% of patients completing/transferred/referred from ADAA funded Medically – Monitored Intensive Inpatient Treatment with detoxification (III.7 D) programs enter another level of treatment within 30 days of discharge. _____% Type of Measure ADAA Requirements Data ElementsComment Quality Measure MFR Condition of Award 26(c) By County of Residence ADAA funded Dis-enrolled III.7D Enrolled in>loc within 30 days Excludes jail- based

MEASURE FOUR The number of patients using substances at completion/transfer/referral from non-detox treatment will be reduced by 82% among adolescents and adults from the number of patients who were using substances at admission to treatment. Adults ____% Adolescents _____% Type of Measure ADAA Requirements Data ElementsComment Quality Measure MFR Condition of Award 26(d) By County of Residence ADAA funded Disenrollment Excludes jail- based

MEASURE FIVE 70% of patients dis-enrolled from a Medically – Monitored Intensive Inpatient Treatment (Level III.7) will enter another level of care within 30 days. _____% Type of Measure ADAA Requirements Data ElementsComment Quality Measure MFR Condition of Award 27(a) By County of Residence Dis-enrolled III.7 ADAA funded Enrolled in >loc within 30 days Excludes jail- based

MEASURE SIX 70% of patients dis-enrolled from a Clinically – Managed, medium / High intensity Residential Treatment (Therapeutic Community) Level III.5 will enter another level of care within 30 days. _____% Type of Measure ADAA Requirements Data ElementsComment Quality Measure MFR Condition of Award 27(b) By County of Residence Dis-enrolled III.5 ADAA funded Enrolled in >loc within 30 days Excludes jail- based

MEASURE SEVEN 70% of patients dis-enrolled from a Clinically – Managed, medium intensity Residential Treatment (Extended Care) Level III.3 will enter another level of care within 30 days. _____% Type of Measure ADAA Requirements Data Elements Comment Quality Measure MFR Condition of Award 27(c) By County of Residence DisenrolledIII.3 By County of Residence ADAA funded Enrolled in >loc within 30 days Excludes jail-based

MEASURE EIGHT Care Coordination – 50% of successful discharges from Medically – Monitored Intensive Inpatient Treatment (Level III.7) receive care coordination. _____% Type of Measure ADAA Requirements Data ElementsComment Quality & ACCESS Condition of Award 22 By County of Residence Disenrollment from III.3, III.5or III.7 ADAA funded Enrollments in Care coordination

MEASURES NINE & TEN Level III.7 (Medically – Monitored Intensive Inpatient Treatment) Are there indicators that there is adequate and utilized care Y/N? Level III.1 (Halfway House) Are there indicators that there is adequate and utilized care Y/N? Type of Measure ADAA Requirements Data Elements Comment ACCESSCondition of Award 31 & 32 TX Matrix Grant Narrative

MEASURES ELEVEN & TWELVE Level II.1 (Intensive out-patient). Are there indicators that there is adequate and utilized care Y/N Level I (Outpatient) Are there indicators that there is adequate and utilized care Y/N Type of Measure ADAA Requirements Data Elements Comment ACCESSConditions 31 & 32TX Matrix, Grant Narrative

MEASURES THIRTEEN Continuing Care – Over 5 % of successful discharges from outpatient enroll in continuing care Yes/No _____% Type of Measure ADAA Requirements Data ElementsComment ACCESSCondition of Award 31 & 32 By Level 1 Program # successful completions discharged Enrollments in Continuing Care

MEASURE FOURTEEN Medication Assistance Treatment - Services available in the jurisdiction or other established pathways to access treatment. Access to Methadone Y/N _____ Access to Outpatient Detox/maintenance (i.e.)Buprenorphine Y/N___ Type of Measure ADAA Requirements Data ElementsComment ACCESSCondition of Award 34 &35 Grant Narrative Treatment Matrix

MEASURES FIFTEEN- EIGHTEEN ATR Access – Yes/No? Recovery Housing – Yes/No? Recovery Coaches – Yes/No? Recovery Community Center – Yes/No? Type of Measure ADAA Requirements Data ElementsComment ACCESSCondition of Award 21 (ATR only) Grant Narrative Jurisdiction reporting Supplemental Funding Conditions

MEASURES NINETEEN -- TWENTY-ONE Integration of Prevention and Treatment Shared Programs – Yes/No? Prevention Coordinator on ROSC Change Team – Yes/No? Prevention Coordinator on LDAAC – Yes/No? Type of Measure ADAA Requirements Data Elements Comment INTEGRATIONGrant Narrative

HOW ARE WE MEASURING USE OF RECOVERY SUPPORT SERVICES (RSS) Yes/No Questions on Jurisdictional Assessment -1 st Cut Do you have it or don’t you? Recovery Community Centers Peer Support Specialists Recovery Housing (purchasing or not) Through ATR or Block grant $$ Recovery Housing Association RFP Monthly RSS Progress Reports Began in August assessing how Recovery Community Centers were being utilized? Continued in September by adding questions regarding use of peers to the RSS Report

RECOVERY COMMUNITY CENTER DATA Quick Facts 18 RCC’s funded 12 presently operational Of the 12 that are operational, 8 (66%) are merged operations with Wellness and Recovery Centers On average, 20,000 individuals pass through their doors in a given month (many of them using these services many times in a month) The quest for unduplicated services provided to = some jurisdictions are able to report in this way (we’ll return to this point)

PEER RECOVERY SUPPORT SPECIALISTS Quick Facts Presently, 70 peer recovery support specialist operating in the State Counties have received funding for another 6 that as of last reporting, have not been hired Primary roles: Recovery Coach Peer Navigator Engagement Specialist Of the 70 peers who are working, 29 (or 41%) require CCAR training – working with OETAS, trainers, and jurisdictions to ensure that happens soon

HOW ARE RCC’S AND PRSS’ BEING UTILIZED? RCC’s We have schedules Some RCC’s are able to offer unduplicated counts Some are able to offer useful feedback on use of specific services (vocational assistance, types of groups utilized, recovery supports accessed) PRSS We have begun to get information on their roles (mostly mixed; some falling into recovery coach or care coordinator roles) Peer encounters

UNANSWERED QUESTIONS Treatment and RSS: is their a continuum?? Do RSS meet the needs of clients? Are clients’ satisfied? Are the RSS improving outcomes??

NEW RSS SERVICES UPDATE Adolescent Club Houses – Approximately $2M initiative 6 Sites selected Montgomery County BSAS Prince George’s County Anne Arundel County Frederick County St. Mary’s County Non-clinical recovery support services for youth Pioneering model/working with national expert Kick Off Meeting for vendors November 20th

NEW RSS SERVICES UPDATE Recovery Housing Association (RHA) Proposals came in yesterday Selected vendor to initiate start-up January 1, 2013 Purpose of the RHA Raising Quality of Housing by Enforcement of NARR Standards Cultivation/sharing of best practices Membership

THE WORK AHEAD Our data tools are not currently useful enough to gather more nuanced information on RSS Also we do not provide the necessary data tools that could assist peers in their work Recovery Planning in SMART (once Peer Encounter is initiated) Peer Encounter Notes Supervisory requirements for peers Recovery Coach Guidelines/Manual RCC Operational Guidelines Peer Certification/Medicaid Reimbursement