1. Block Grant Independent Peer Review 2017
Project Overview
March 1, 2017

2. 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 MAT & Medications – 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 Level of Care
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 19th will use all the written material – conversation is key; review form will document

4. Calendar Now! Kickoff Call
March 1 - April 29: Self-paced Chart Review visits and Self-studies
Self-Studies due March 31 to Deborah Strod & your partner
Chart Reviews due April 30 to Deborah Strod & your partner
April 29 – May 19: Sift through material, prepare to do Reviews (3-question draft Review Form will guide)
May 19, 10 am - 2 pm:
In-person Reviews
Group discussions by LOC
Whole group exchange over lunch
Location: West Boylston DPH Regional Office
We want your self-studies to be exchanged when you go to do the Chart Review if possible. Some people use the Chart Review visit to have a real site visit, observing interactions in the waiting room, taking a tour. This is not required, but we have found many partners just do it spontaneously, and it can feed into the reviews you give at the end of the process.
In the past we have let people self-schedule for the whole period, but found that in recent years as people get busier, there has been a last minute crunch.
Meeting will be in West Boylston

5. Self-Study and Chart Review Scheduling
Contact your partner to schedule your visits now while calendars are not completely full
Pick a date sooner rather than later - leave time for rescheduling due to the unforeseen
Chart Review can be done in March along with the Self-Study. The order is less important than making the due dates. If a Chart Review visit in March works better for you, go for it and get both done in the first month!
By March 15th , please report to Deborah Strod the dates you have chosen.
I don’t mind if you start the right now. Partner lists have been sent out. Getting ahead is fine!

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, to
Deborah Strod
AND
Your partner
Note: If you will be writing by hand, add extra space before printing.

7. Self-Study Topics Population Served
Assessment, Treatment, Discharge & Follow-up
Medications & MAT
Staff Discussion related to Medications & MAT:
What do we do well?
What could we do better?
What change would we like to try?
The reviews you provide 5/19 will use almost the same framework for the discussion, with wider scope – the whole program, not just Medications & MAT
Go through Self Study. Question 1d: For example, if a client is told that they can’t go to a community NA group because they are on medication, do you help them to have a conversation with the group about it?

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

9. Chart Review Logistics – Day of the visit
Confidentiality
Sign Agency-specific forms as required
Bring Signed BSAS Peer Review Confidentiality form
Looking at Charts
Chart selection process is on first page of Chart Review
Go over the questions first so you have them in mind as you read through the charts
Consider both the usefulness of the chart itself, and what each chart shows about the care given
Take notes - Fillable Word document or Handwritten
Copies of completed Chart Review go to:
Your Peer
Deborah Strod
Yourself - to use in preparing comments for your peer
Like I said, some people make a real site visit out of it. Some people last year wished that they could have spoken to patients or talked with staff as part of it to really see more about their partner program. We are not asking you to do that as a formal part of this process, but if you want to, go for it! We used to do a Walk-through, but given the Chart Review is required, the two together just took too much time.

10. Chart Review Topics Admission Criteria/Intake Process Assessment
Treatment Planning
Documentation of Treatment Implementation, Outcomes
Discharge and Continuing Care
Medications & MAT
Overall Impressions of Chart

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 Medications & MAT:
What does the program do well?
What could the program do better?
What recommendations do you make, if any (what should the program keep doing, where could a change improve care)?

12. Peer Reviews and Group Discussion May 19th
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 45 minutes roles switch, and the reviewer becomes the reviewee
Level-of-Care discussions for a half-hour (new this year!)
Lunch & Whole Group Discussion: Common issues? Common strengths? What surprised you? What did you learn?
Aggregated report summarizing strengths and opportunities, without individual identifiers, will be prepared for the Block Grant Application, and available to participants

13. Focus on Medications & MAT
Portions of the Peer Review address a specific focus:
The 2017 Peer Review will provide an opportunity to share the ways programs
Address all medications in the admissions and discharge processes
Manage medication security, distribution and clinical care during treatment
Integrate people receiving medication-assisted substance use treatment into other levels of care.
OTPs: some questions relate to what you already do; but consider how you address medications for other substances/conditions, along with MAT.
Resource: BSAS Practice Guidance
Integrating Medication in Behavioral Health Treatment
New SOTA (State Opioid Treatment Authority) Tracy Nicolosi at BSAS

14. Medications & MAT
BSAS guidance refers to medications for opioids and for MH conditions; many co-morbid physical conditions also require medication.
In addition a high percentage of BSAS clients use nicotine and are interested in quitting, which can involve medications also.
From the Practice Guidance:
Policies recognize that medications can promote recovery.
Policies prohibit denial of service on the solely because an individual takes a prescribed medication.
Policy clearly identifies criteria and process for safeguarding against abuse of medications.
NIDA’s Principles of Drug Addiction Treatment state that medications are an important element of treatment for many individuals, a conclusion echoed in William White’s comprehensive study, Recovery Management and Recovery Oriented Systems of Care: Scientific Rationale and Promising Practices. However, White reports, public and professional attitudes continue to limit access to medications proven effective in treating addictions and co-occurring disorders. These attitudes contribute to individuals’ ambivalence about accepting pharmacotherapy in the treatment of addiction.
Yet the perception remains that programs won’t accept people on MAT in particular, and anecdotes about difficulties establishing relationships with prescribers, particularly during transitions, persist.

15. Medications & MAT
Given the high level of co-occurring MH & SUD, and co-morbid physical health conditions, many people have multiple medications.
How to you make it clear that people who are on MAT, MH and other medications are welcome?
Do your staff feel comfortable and capable of working with MAT, MH and other medications? Are there certain medications that cause you to be concerned about people’s recovery (e.g. gabapentin and Neurontin)?
Do you have medical personnel on-site or active relationships with prescribers offsite and/or OTPs/OBOTs?
What issues does this cause in care transitions?
How does your agency help you ensure that your program is able to manage medications and prevent diversion?
Hear from detoxes that won’t put on methadone unless there is a place for them to go (methadone or buprenorphine program), they will put on buprenphrophine or detox and no MAT and discharge…. Not all benzos, types: Seroquel, gabapentin, Neurontin… complaints relate to programs not taking.
All body systems are affected by addiction, and can have consequences not only of use but of poor nutrition and basic wellness practices as well. Liver cirrhosis, diabetes, neurological consequences from falls, etc. can result in need for medications either temporarily or chronically.
Transitions within BSAS system, provider, to/from community provider, to/from criminal justice settings…

16. Medications & MAT
High proportion of people receiving SUD services use tobacco/nicotine, which can interfere with medication absorption and action. Doses may need adjustment as people quit smoking.
How do you support quit attempts? Consult on dosing?
How do you support staff in quitting?
Are you up to date on new vaping technology & perceptions?
More than 460 Brands, Thousands of flavors, some. When people quit smoking they are going through withdrawal.

17. Medications & MAT additional Resources
SAMSHA’s MAT page
SAMHSA’s Decisions in Recovery: Treatment for Opioid Use Disorders
NIATx’s Getting Started with MAT (2010)
TIP 43 Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs
TAP 30 Buprenorphine: A Guide for Nurses
Any suggestions from the group to add? Say now or share on the online Workspace…

18. For more info see www.niatx.net or talk with Mike Ellis of BSAS
NIATx Change Projects
Gather a team
Pick something that matters
Select a small change, with measurable effects
Collect baseline data
Try it out! Briefly
Look at your data
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
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)

20. Online Workspace – All Participants Join
Peer Review 2017 online workspace at
It has:
All forms, including Expense Form
Announcements
Online discussions
notifications of new discussions (opt-out)
These slides and other references

21. Reimbursement
Reimbursement will be provided for mileage, tolls and parking expenses related to Peer Review 2017.
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 19th.

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 to your address book so s from the online group don't get filtered as spam.
Track mileage and parking
Join the online group if you have not already!

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.

24. Bureau of Substance Abuse Services
Contact
If you have questions about the Peer Review, contact
For free training & information on overdose prevention for your program, contact
Cheryl Gagne
PRAXIS
Deborah Strod
DMA Health Strategies
Michael A. Ellis
Bureau of Substance Abuse Services