1. Block Grant Independent Peer Review 2016 Project Overview February 24, 2016

2. Page 2 Peer Review 2016 Agenda: 45 minutes Overview of the Peer Review project – 5 min Self-Study and Chart Review– 10 min Peer Reviews and Group Discussion – 10 min Focus on Overdose – 5 min NIATx change projects, optional tools – 5 min Online Workspace – 3 min Reimbursement – 2 min Questions and next steps – 5 min

3. Overview Independent Peer Review is a requirement of Federal Substance Abuse Block Grant 5% sample every year Efficacy, Appropriateness, Quality of Service Independent of licensing or evaluation by state Expertise – match by modality NIATx principles used since 2006 – walk-throughs, process mapping, sociograms, Nominal Group Technique Data gathering through Chart Review and Self-Study In-Person Mutual Reviews on May 20th will use all the written material – conversation is key; review form will document Page 3 Peer Review 2016

4. Calendar Now! Kickoff Call February 24 - April 29: Self-paced Chart Review visits and Self-studies April 29 – May 19: sift through material, prepare to do Reviews May 20, 10 am - 2 pm: in-person Reviews, Lunch/Group Discussion Page 4 Peer Review 2016

5. Self-Study and Chart Review Can be done in any order, or in parallel Recommend scheduling the Chart Review visit for when the weather is better – late March/early April? But do the scheduling now while busy calendars are not completely full, and leave time for rescheduling due to the unforeseen In the meantime, Self-Study can be worked on Page 5 Peer Review 2016

6. Self-Study Logistics Answer based on your understanding of your staff’s experience (plus summary points from staff discussion for one section) Flex to meet your needs and fit your program Questions ideally prompt substantive, thoughtful answers that help your partner really know your program when they review your Self-Study Submit via Fillable Word document, send to –Deborah Strod (deborahs@dmahealth.com) AND –Your partner Note: If you will be writing by hand, add extra space before printing. Page 6 Peer Review 2016

7. Self-Study Topics 1.Population Served 2.Assessment, Treatment, Discharge & Follow-up 3.Integrating Overdose Prevention & Response into Treatment 4.Staff Discussion related to Overdose: –What do we do well? –What could we do better? –What change would we like to try? The reviews you provide 5/20 will use almost the same framework as the discussion, but with wider scope – the whole program, not just Overdose Page 7 Peer Review 2016

8. Chart Review Logistics – Ahead of the visit Confidentiality –BSAS Peer Review Confidentiality form - Send a copy to Deborah Strod at DMA Health –Communicate with partner about agency-specific forms at both sites Consider ahead of time whether your Electronic Health Record requires any special permissions or guidance to accommodate a reviewer Orient your peer to your chart, to help them be efficient Page 8 Peer Review 2016

9. Chart Review Logistics – Day of the visit Confidentiality –Sign Agency-specific forms as required –Bring Signed BSAS Peer Review Confidentiality form - Review the questions first so you have them in mind as you read through the charts Consider both the usefulness of the chart, and what each chart shows about the care given Take notes on one copy of the Chart Review - Fillable Word document or Handwritten, as fits your needs Give copies of completed Chart Review to –Your Peer –Deborah Strod –Keep a copy for your use in preparing review of your peer Page 9 Peer Review 2016

10. Chart Review Topics 1.Admission Criteria/Intake Process 2.Assessment 3.Treatment Planning 4.Documentation of Treatment Implementation, Outcomes 5.Discharge and Continuing Care 6.Overdose Prevention 7.Overall Impressions of Chart Page 10 Peer Review 2016

11. Reviewer Feedback Form Read and consider your partner’s Self-Study Go over your observations on the Chart Review form Consider these questions generally for appropriateness, effectiveness and quality of care; and specifically for integrating overdose prevention & response into treatment: 1.What does the program do well? 2.What could the program do better? 3.What recommendations do you make, if any (what should the program keep doing, where could a change improve care)? Page 11 Peer Review 2016

12. Peer Reviews and Group Discussion May 20th Peer reviewer will discuss with the reviewee –Self-Study documentation –Chart Review results –Completed Reviewer Feedback form on reviewed program: What did they do well? What could they do better? What recommendations do you make, if any (keep doing, change)? After about an hour roles switch, and the reviewer becomes the reviewee for the second hour Lunch will follow the reviews Group Discussion about the review: Common issues? Common strengths? What surprised you? What did you learn? Aggregated report summarizing strengths and opportunities, without identifiers, will be prepared for the Block Grant Application, and available to participants Page 12 Peer Review 2016

13. Overdose Focus …more than half of individuals in treatment are likely to use substances while in treatment or shortly thereafter* and…most people need at least three months in treatment to achieve abstinence.** (BSAS Guidance on Drug Screening as Treatment tool) “…treatment providers have recently been encountering a new phenomenon — overdoses occurring in treatment programs’ waiting rooms and in the neighborhoods right outside their doors.” – Boston Globe, 10/22/2015 (not so new, but now making the news) *National Institute on Drug Abuse, (Website updated 2010) Drugs, Brain, Behavior: The Science of Addiction ** National Institute on Drug Abuse, Seeking Drug Abuse Treatment: Know What to Ask. NIH publication 12-7764. Page 13 Peer Review 2016

14. Overdose Prevention Guidance BSAS Practice Guidance Integrating Opioid Overdose Prevention Strategies into Treatment –Education about: »Prevention: Understanding risk factors and harm reduction; »Recognition: Determining whether an overdose is happening; »Response: Responding to overdose, including calling 911, rescue breathing, side-lying recovery position and staying with the person –Training and equipping people likely to witness an overdose with a naloxone rescue kit; and –Engaging individuals in conversation about opioid overdose prevention, recognition and response. BSAS Practice Guidance on Relapse Prevention Page 14 Peer Review 2016

15. Overdose Prevention Guidance BSAS Standards of Care: BSAS vendors are required to be knowledgeable about community prevention efforts and to work with BSAS and its partners to assess need, implement and sustain prevention efforts. PRAXIS trainings available online and in person In March 2015, SAMHSA updated Opioid Treatment Program guidelines, including new guidance on discussing overdose (http://prescribetoprevent.org/prescribers/substance-use-disorder/)Opioid Treatment Program guidelines Overdose prevention, including prescribing or dispensing naloxone, is an essential complement to both detoxification services as well as medically supervised withdrawal. Patients should be advised of the risks of relapse following detoxification and offered a relapse prevention program that includes counseling, naloxone and opioid antagonist therapy. Page 15 Peer Review 2016

16. Overdose Prevention & Response: Resources BSAS Opioid Overdose Prevention webpage BSAS Principles of Care & Practice Guidance on Opioid Overdose Prevention and Response to RelapseBSAS Principles of Care & Practice Guidance Opioid Overdose PreventionResponse to Relapse Massachusetts Opioid Abuse Prevention Collaborative (“MOPC”)Massachusetts Opioid Abuse Prevention Collaborative Praxis – Center for Social Innovation SAMSHSA’s new Overdose Prevention ToolkitSAMSHSA’s new Overdose Prevention Toolkit Incorporating Overdose Prevention and Education into Substance Abuse Treatment (Illinois)Incorporating Overdose Prevention and Education into Substance Abuse Treatment www.prescribetoprevent.org (re: prescribing naloxone)www.prescribetoprevent.org Work with local narcan site Page 16 Peer Review 2016

17. Assess client knowledge and risk –Witnessed/experienced overdose? Responses? –What training have they already had? What current knowledge? –Risky use (e.g. of opioids in combination with alcohol or other drugs) –Access to naloxone –Teaching family and friends how to use naloxone/respond to overdose Open, honest and respectful conversations Overdose Prevention and Response: Main Message Page 17 Peer Review 2016

18. Page 18 Peer Review 2016 NIATx Change Projects 1.Gather a team 2.Pick something that matters 3.Select a small change, with measurable effects 4.Collect baseline data 5.Try it out! Briefly 6.Look at your data 7.If it worked, spread it further; if it didn’t, either modify or just go back to what you were doing. For more info see www.niatx.netwww.niatx.net or talk with Mike Ellis of BSAS

19. Optional Tools Nominal Group Technique – Ensure participation and idea generation (NIATx), can be used for the staff discussion at end of Self-Study Walk-through – Experience your program through the eyes, ears, smells, touches, tastes, and social experiences of your clients (NIATx) Page 19 Peer Review 2016

20. Online Workspace – All Participants Join www.careersofsubstance.org “Peer Review 2016” workspace All forms, including Expense Form Announcements Online discussions Email notifications of new discussions Page 20 Peer Review 2016

21. Reimbursement Reimbursement will be provided for mileage, tolls and parking expenses related to Peer Review 2016. Expense Form is in the online Workspace library Print, complete and mail the form, with any relevant receipts, to AdCare. AdCare mailing address and contact information is at the top of the Form Generally, the Peer Review only involves two trips: –one to your partner to do the Chart Review –one to the group meeting on May 20th. Page 21 Peer Review 2016

22. Next Steps Contact your partner to schedule the Chart Review visits –Your review of their charts –Their review of your charts Begin your own Self-Study Add "info@careersofsubstance.org" to your address book so emails from the online group don't get filtered as spam. Track mileage and parking Join the online group if you have not already! www.careersofsubstance.org www.careersofsubstance.org Page 22 Peer Review 2016

23. Thank you! This Annual Independent Peer Review is an important obligation for the Federal Substance Abuse Block Grant, and your participation helps the Commonwealth continue to receive these critical funds. Most participants find it worthwhile, some find it transformative – as you progress, please keep in touch and let us know how we can help you to get the most out of your activities. Page 23 Peer Review 2016

24. Page 24 Peer Review 2016 Contact If you have questions about the Peer Review, contact For free training & information on overdose prevention for your program, contact Cheryl Gagne PRAXIS 781-247-1753 cgagne@center4si.com Deborah Strod DMA Health Strategies 339-970-0302 deborahs@dmahealth.com Michael A. Ellis Bureau of Substance Abuse Services 617-624-5097 Michael.Ellis@state.ma.us