State of California Department of Alcohol and Drug Programs The Substance Abuse Research Consortium Semi Annual Meeting Improving the Quality, and Effectiveness of Addiction Treatment Through Re-Engineering Our System of Services September 2009 Michael Cunningham Chief Deputy Director Millicent Gomes Deputy Director – Office of Criminal Justice Collaboration

State of California Department of Alcohol and Drug Programs IOM Quality Chasm Recommendation “Substance use disorder treatment should move toward building its standards of care, performance measurement and quality, information and cost measures upon a chronic illness model rather than the current, acute illness-based, fragmented and deficient system of health care.”

State of California Department of Alcohol and Drug Programs National Leadership Group Recommendations for Prevention, Treatment, & Recovery “The overarching principle is the individual (family and community) receiving the right prevention, intervention, and/or treatment and support, at the right level, for the right period of time by the right practitioner, agency or sponsor, every time….In this principle will be the assurance of quality, efficiency and accountability to all stakeholders and the assurance that every individual has the best opportunity to achieve wellness and recovery.”

State of California Department of Alcohol and Drug Programs GOAL Guide the development and implementation of a comprehensive and integrated continuum of alcohol and other drug services (COS). Is dynamic and responsive to changes; Considers the needs of all people and communities served by the system and addresses their multiple needs; Anticipates new groups and new issues; Is data driven and outcome oriented; and Provides for continuous quality improvement.

State of California Department of Alcohol and Drug Programs AOD Services Re-Engineering Gaps & Needs Principles Recommendations

State of California Department of Alcohol and Drug Programs COSSR Phase I Report Purpose of Re-Engineering Goal of Re-Engineering the California Continuum of Services System Phase I Methodology: Designing the Continuum Core Principles Gaps and Needs - Overall, Prevention, Treatment, Recovery Recommendations

State of California Department of Alcohol and Drug Programs Core Principles Services must be comprehensive, integrated, and high quality, with demonstrated effectiveness. Services must be accessible, affordable, individual and community-centered, and responsive to individual and family needs and differences. Delivering quality and effective care requires outcome and data-based planning for the entire system.

State of California Department of Alcohol and Drug Programs Core Principles (continued) Potential problems can be prevented by reducing risk factors and increasing protective factors in both communities and individuals. Transient or non-dependent alcohol or other drug problems can be resolved through acute care, including brief intervention and brief treatment services. Recovery from severe and persistent (chronic) problems can be achieved through continuing and comprehensive alcohol and other drug treatment and recovery services.

State of California Department of Alcohol and Drug Programs Universal Maintenance Tx Modalities Indicated Assessment Selective Monitoring CLIENT COMMUNITY CENTERED Continuum of Services

State of California Department of Alcohol and Drug Programs AOD Services Re-Engineering Gaps & Needs Principles Recommendations Who, What, When, Where & How Communication Plan Logic Model Goals, Objectives, Outcomes

State of California Department of Alcohol and Drug Programs COSSR Phase II Report Conceptual Framework for Re-Engineering in CA Continuum of System Re-Engineering in Four Phases Re-Engineering AOD System of Services – Phase I Re-Engineering AOD System of Services – Phase II System Improvement Model Committee Descriptions & Objectives Next Steps: Phase III

State of California Department of Alcohol and Drug Programs Programs and Services Improvement Model * Adapted from the Chronic Care Model, Improving Chronic Illness Care Program AOD Use Abuse Dependency &

State of California Department of Alcohol and Drug Programs Implementation Plan Objectives There were 18 objectives identified for the Implementation Plan Of these, were 5 objectives that directly relate to improving the quality and efficiency of treatment services

State of California Department of Alcohol and Drug Programs Quality Improvement Related Objectives Develop useful data information systems and standards for prevention, treatment, and recovery support services that include families and communities, in order to document outcomes and improve client/patient management leading to timely, safe, effective, and person centered services. Identify and apply evidence-based practices for AOD prevention, treatment, and recovery from AOD problems in a variety of populations, communities, and settings.

State of California Department of Alcohol and Drug Programs Quality Improvement Related Objectives (continued) Develop and implement new regulations governing Drug-MediCal certification, as well as outpatient treatment program certification and residential treatment program licensure (Title 9 and Title 22). Establish the framework for performance management and improvement systems in ADP publicly-funded licensed and/or certified programs, incorporating data and outcome-driven Continuous Quality Improvement (CQI) activities in these ADP licensed and certified programs.

State of California Department of Alcohol and Drug Programs Quality Improvement Related Objectives (continued) Establish and implement a community and client data- driven, outcome-based framework for State and local planning for the COS that incorporates a process for evaluation and improvement of products and services, including the capacity to prevent and treat co- occurring disorders (COD).

State of California Department of Alcohol and Drug Programs AOD Services Re-Engineering Gaps & Needs Principles Recommendations Assess Readiness Establish Relationships Pilots & Demonstrations TA & Training Revise Policies & Procedures Institute Changes Monitor & Refine Who, What, When, Where & How Communication Plan Logic Model Goals, Objectives, Outcomes

State of California Department of Alcohol and Drug Programs SUMMARY The chronicity of AOD problems necessitates a comprehensive continuum of services Delivering quality and effective care requires outcome and data based planning of our prevention, treatment and recovery system The adoption of evidence based practice is crucial to achieving outcomes The continuous improvement of the AOD system of services is essential to achieving positive outcomes Performance measurement and management are critical elements of a high quality, effective system of services

State of California Department of Alcohol and Drug Programs Contact Information THANK YOU!!! Materials Available at: Department of Alcohol and Drug Programs 1700 K Street Sacramento, CA