State Directors’ Role in CTN Dissemination September 7, 2003 Janet Wood, M.B.A., M.Ed. SSA in Colorado

Armenakis and Colleagues (1993) Most organizations can sustain a maximum of 3 major types of change at any 1 time Could explain why most SSA Directors are not involved in CTN (1) Restructuring (2) Funding Cuts (3) Adjusting to a New Boss

SSA Directors Getting our attention is something akin to “braiding a dog’s tail while he’s chasing a Frisbee”…

SSA Directors are Ideal Partners Good understanding Political, legislative, and funding environment Key role in financing and management of addiction services Regulatory bodies that influence quality of treatment TA and training resources Can provide incentives or disincentives Contractual relationships with providers/managed care companies Used to tackling system issues

NIDA Welcomes SSA Involvement Selling NIDA on SSA Director involvement was not difficult Consider NIDA’s support in hosting this meeting

Common Goal: Improved Treatment Outcomes The goal of the CTN Dissemination Sub- committee is to increase the adoption of CTN research- based practices that result in improved drug abuse treatment outcomes (utilization)

Dissemination Mechanical distribution of information does not result in adoption of effective treatment Technical assistance and other resources are needed Attention and resources must be directed towards a complex change process

Matrix of Influence Provider credentialing Provider Assn TrainingATTC Counselor Cert/licensing Professional organizations Medicaid Authority PICs Rulemaking Authority GovernorResearchersRecovery community Managed Care Legislative environment University programs Other?

Each State is Uniquely Challenged Montana SSA (Fully Staffed with 5 FTE) Geography of MT (NW to SE corner of state) same distance as Wash. DC to Chicago New York and California-complexities not unlike overseeing multiple state systems

Should We Wait for the Right Conditions? No. There may never be enough time, money, or political will. There are multiple strategies: No cost Low cost Some cost High cost

“No Cost” Strategies for Dissemination Stop doing some things Discontinue funding for some programs Extended contracts (multi-year) for providers Used our training funds differently Created a different billing mechanism

“Low Cost” Strategies for Dissemination Kansas SSA had contests at meetings with addiction counselors Open training to additional staff Recognize providers who deliver EBT Allocate new funding for EBT

“Some Cost” Strategies for Dissemination Make an investment over a period of time 5 years to build infrastructure for prevention providers Increase available training and TA Loan staff to “jump start” projects

“High Cost” Strategies for Dissemination Some States have made a large investment Connecticut and Iowa have well established academic partnerships and researcher in residence programs Money’s not sufficient, but it sure helps!

CTN Benefits to Colorado Learning the language of research Access to the world’s leading addiction researchers Having someone other than the SSA “harping” about quality treatment

CTN Benefits to Colorado, continued Availability of training Ability to influence the national research agenda Diffusion possibilities among CTN and non- CTN providers Links with a national network of CTPs

CTN Benefits to Colorado, continued Increasing scale Closer working relationship with the university Access to ATTC resources Opportunity to align providers to move forward

Broadening SSA Involvement in the CTN How do we build on the existing infrastructure in states to make this happen over the long haul? Or, if there isn’t much infrastructure, how can it be built over time?

Ideas in the Making NIDA and NASADAD planning for the June 2004 NASADAD meeting NIDA funded CSAT and ATTCs Potential for NTN to serve as a link

Your Thoughts and Reactions? How would this be done in your state? What opportunities do you see? What barriers exist?