UCLA Integrated Substance Abuse Programs Richard Rawson, Ph.D. Rachel Gonzales, Ph.D. Funded by: California Alcohol and Drug Programs CalOMS Training for Counties

Learning Objectives Goals of the CA Data System Importance of using data to improve treatment Basic models for disseminating CalOMS data

Goals of CA Data System Provide a comprehensive data collection and management system To establish greater accountability of the treatment system for providing quality services Ensure efforts are in accordance with SAMHSA’s National Outcome Measurement System – NOMS – essential Indicators used to evaluate the quality of substance abuse treatment

Importance of CalOMS Data CalOMS data are standardized –same data are collected across programs/counties at admission (t1) and discharge (t2) CalOMS data are comprehensive - allows for understanding: –Client’s in treatment (Demographic data) –Treatment patterns (Service data) –How programs are performing (Performance data) –Impact of treatment on client outcomes (Outcome data) CalOMS data helps us keep up to date with treatment improvement initiatives: Use data to improve treatment

Step 1: What do you want to know: Tx Priority Step 2: Identify CalOMS Data Needed (demographic, service, performance, outcome) Step 3: Request Data/Run Data Report Step 4: Examine & Analyze Results Step 5: Determine, what, if any, changes should be made to improve service delivery Steps: Using CalOMS Data

Exercise: CalOMS Demographic Data Who’s in treatment? –Primary substance problem (e.g., alcohol, marijuana, cocaine, opiates, prescription, meth) –Special needs: Pregnant (e.g., injectors, homeless, youth, disabled, veterans, criminal offenders, mentally ill) Apply CalOMS demographic data to treatment improvement initiatives

Primary Substance Problem CalOMS Treatment Admission Report

Clients with Special Needs 6% of admissions were pregnant women Meth most commonly reported among pregnant women

Exercise: CalOMS Service Data What are treatment trends? –Service utilization (e.g., detox, outpatient, residential, NTP) –Treatment referral sources (e.g., SACPA, Self, DMC) Apply CalOMS service data to improve treatment

Service Utilization & Referral Most admissions are to outpatient programs ½ of referrals are from criminal justice system CalOMS Assessing Services Report

What is Performance Data? Desired Outcomes Access Retention/Completion Continuity of Care Treatment Performance indicators measure the treatment process at the program level

Exercise: CalOMS Performance Data  Access  Retention  Continuity of Care Applying CalOMS performance data to improve treatment

Access (Wait time) Research supports: reduced wait time is associated with improved engagement and retention in treatment… CalOMS Assessing Services Report

Access for Priority Populations

Retention (Length of stay) Research supports: without an adequate amount of time in treatment, few improvements are observed….

<30 days <90 days >90 days CalOMS Service Utilization Report

What do the data indicate? Outpatient Treatment Sub-optimal < ½ Optimal Dose

< 1% are staying 365 days or more 40% not retaining during initial 30 days

Continuity of Care Measure  Do individuals who enter treatment proceed through appropriate levels of care?  Per CalOMS: matched admission-discharge treatment service sets that occur within 30 days of a prior discharge (via client unique client ID)

Treatment Episode Continuing Care/Aftercare Programs Detox/ Inpatient Long-term Residential Treatment Intensive Outpatient/Psychosocial Behavioral Treatment Sober Living Residence

Continuity of Care Patterns Majority of clients only receive 1 service (level of care) 75% of clients in detox do not go to another level of care

What is Outcome Data? Desired Outcomes Substance use Employment/Education Criminal Activity Housing Stability Social Connectedness Treatment Outcome indicators measure client status at the client level

Exercise: CalOMS Outcome Measures Interested in treatment impact Stopping or Reducing –Substance use –Unemployment –Crime –Homelessness –Family conflict Applying CalOMS Outcome data to improve treatment

Reductions in Criminal involvement and crime Changes During Treatment Reports

Improvements in Client Outcomes

Step 5: Using Data to Improve Treatment Desired Program/Policies/Services Data What’s being done What NEEDS to be done

What To Look At? Start at the… Program and Provider Level ACTIVITIES: Use of evidence based practices FACTORS: Staff, license/training, resources, tx environment PERFORMANCE MEASURES Access, retention, continuity of care

Tx Improvement: What changes are needed? What program elements can affect performance measures? –Improved screening and placement –Timeliness & rapid response –Comfortable, friendly environments –Flexibility –Case management

Strategies for Enhancing Service Linkages Active referral/transfer Case management processes Integrating staff at different tx levels Creating personal linkages Arranging transportation Referring to appropriate geographical location

Illustration: NIATX Strategies Improve Access & Retention Screening/PlacementTimeliness/ Rapid Response Enhanced Tx Enhanced TxResponse Contact your ATTC Representative

Summary: Utility of CalOMS Data  Provides Evidence  Establish Priorities  Decision-Making  Improvement and …

.... increase and sustain Community & Financial Support $$$ For Services & Programs

Remember Data in a system is only as good as how the data is collected… Data quality efforts are essestial Data Validity is Essential

Goal: Improved Measures More work is needed to improve upon CalOMS performance and outcome measurement Standard data collection of discharge is necessary for valid data and assessing treatment quality & effectiveness Continued Training is Critical

Disseminate the Data Demonstrates utility Gives feedback on services and outcomes Increases buy-in & engagement Improves data collection Greater data quality & valid data

Effective Dissemination Models Using CalOMS data you can create: Program Site Reports (report card) Brief Treatment Updates Fact Sheets on specific topics State CalOMS Reports

Program Site Reports Report Style Executive Summary Highlight Program Performance Tables/Graphs with Outcomes Engaging

Treatment Updates Specific data topic Newsletter Style One-page Format Graphs/Tables Short Summary

Treatment Updates Innovative Quick Reference Targeted Subject Concise

Fact Sheets Comprehensive Visual Summary of major trends Downloadable

State CalOMS Reports

CalOMS Resources Data Dictionary Data Collection Guide Reports User Guide & Instructions Data Quality Standards

Contact Information Richard Rawson Rachel Gonzales