1. Improving Continuation from Detox into Treatment – Advancing Recovery in Colorado Erik Stone, MS, CAC III Signal Behavioral Health Network Joseph Contreraz, CAC III Denver CARES

2. The Problem  High admissions to non-medical detoxification programs (~ 50,000 per year)  Clients typically have minimal to mild withdrawal, are brought by law enforcement, stay in detox for a day or so (AH average LOS is 1.4)  Average of less than 10% enter treatment within 30 days of discharge from detox

3. Advancing Recovery Partners  Signal – Managed service organization (MSO) funding substance abuse detox and treatment services  State Division of Behavioral Health (DBH) – Single state agency; licensing authority  Arapahoe House – Metro Denver provider of outpatient and residential services; has 3 detox facilities  Denver Health – Denver provider of outpatient and residential services; has 1 detox facility  Advocates for Recovery – Advocacy organization for the recovery community in Colorado

4. Baseline and Goals  Arapahoe House – Aurora Baseline continuation rate is 4.9%; goal is 14.9%  Denver CARES – Denver Baseline continuation rate is 2.7%; goal is 12.7%

5. Measuring Detox Continuation  Unique clients, not admissions  Who live in metro Denver  Who are recommended for formal substance abuse treatment  Who enter treatment at a Signal provider within 30 days of discharge from detox  And who have a treatment service within 15 days of admission to treatment

6. State/Payer Changes  Creation of fiscal incentives for detox continuation  Improved reporting on continuation from detox into treatment  Creation of statewide standardized protocol for DUI referrals

7. Levers for State/Payer Changes  Inter-organizational capability analysis Bringing DBH, State Judicial, local Judicial districts into the planning process Reaching out to private DUI providers to turn opponents into willing participants  Purchasing and contracting analysis Development of fiscal incentives in MSO/State contract Incentives in Signal contracts with providers for 09-10 contract year → $65K for continuation from detox into tx, from residential into lower levels of care, and for OP lengths of stay > 90 days

8. Provider Changes  Updating referral information  Providing incentives to staff for OP intakes  Having OP staff come to detox; assess clients  Allowing detox staff to schedule OP intakes  Waiving intake fees for detox clients transferring within agencies  Outreach to DUI service providers

9. Levers for Provider Changes  Intra-organizational operations analysis Walk through discoveries → Insurance review barriers, lack of immediate intake appoinments, paperwork duplication Internal barriers change team created  Inter-organizational capability analysis Outreach to DUI service providers Development of preferred providers → Create a partnership with outside providers; agreements for tracking clients, calling no shows, reporting enrollment status; availability of intake slots and warm handoffs; flexibility in fee collection

11. Success Stories  Clients are getting into treatment more consistently and much faster  Staff morale is increasing as clients get into treatment; as staff are rewarded for referrals and admissions

12. Role of Incentives  AR funds used to create incentive pools rather than simply paying for participation; providers created incentive plans each year  Results are mixed Useful tool for jump starting & managing project, but  Significant cultural differences between providers  Surprisingly difficult to identify effective levels of incentive  Need faster linkage between performance and incentive  Incentives not sufficient to modify workflow

13. Next Steps  Continue to work towards continuation goals  Spread continuation project to other detox facilities in Signal network → Provide incentives in 09-10 contract year  Approve DUI Detox protocol; write into state policy; spread statewide  Focus on other populations such as injecting drug users, pregnant women, women with dependent children

14. Contact Information Erik Stone, MS, CAC III Signal Behavioral Health Network 455 Sherman St., #455 Denver, CO 80203 720-263-4853 estone@signalbhn.org