1. Program Improvement from a Provider Perspective Bob Mirel, MSW Senior Associate Peter Gaumond, MA Senior Associate Strategic Planning for Providers to Improve Business Practices Sponsored by the Center for Substance Abuse Treatment, Division of State and Community Assistance - Arlington, Virginia, October 22, 2009

2. 2 A Life in the Community for Everyone Recovery

3. 3 Session Objectives ▲ You will be able to: –Identify recovery outcomes –Describe the process of using data to improve those outcomes –Define terms associated with the collection and analysis of data –Use recovery outcomes to make decisions about practice

4. 4 RECOVERY Definitions: ▲ Recovery refers to the ways in which a person with a mental illness and/or addiction experiences manages his or her disorder in the process of reclaiming his or her life in the community. ▲ Recovery from Alcohol and Drug Problems is a process of change through which an individual achieves abstinence and improved health, wellness and quality of life. ▲ An emerging definition goes beyond abstinence alone to include a full re-engagement—based on resilience, health, and hope—with one’s family, friends, and community.

5. 5 Recovery ▲ Person Centered ▲ Client Choice ▲ Build / Rebuild life in community ▲ Holistic

6. 6 ROSC ▲ Recovery Oriented Systems of Care shift the question from “How do we get the client into treatment” to “How do we support the process of Recovery within the person’s environment.”

7. 7 Recovery Oriented System of Care Include: ▲ A comprehensive menu of services and supports that can be combined and readily adjusted to meet the individual’s needs and chosen pathway to recovery ▲ An ongoing process of systems-improvement that incorporates the experiences of those in recovery and their family members. ▲ The coordination of multiple systems, providing responsive, outcomes-driven approaches to care.

8. 8 ATR Program ▲ Client choice ▲ Voucher-based purchase of services ▲ Sophisticated information systems ▲ Faith and community-based provider engagement ▲ Recovery Oriented System of Care (ROSC)

9. 9 Terms ▲ Data – discrete facts that can be captured and stored ▲ Outcome – client’s personal mission statement ▲ Goal – specific components of the personal mission statement ▲ Objectives – observable and measurable steps in achieving the goal ▲ Indicator – specific data item that is collected to inform attainment of the goal or objective ▲ Measure – level of an indicator (frequency, duration)

10. 10 Process ▲ Outcomes ▲ Goals ▲ Objectives ▲ Data collection ▲ Data review/analysis ▲ Evaluation of current recovery plan based on data review ▲ Modification of recovery plan as needed

11. Using Data to Improve Recovery Outcomes

12. 12 Using Data to Improve Recovery Outcomes ▲ What are recovery outcomes? ▲ Can they be distinguished from treatment outcomes?

13. 13 Recovery Outcomes ▲ Emphasize client goals and quality of life ▲ Do not view an episode of treatment or recovery support services in isolation, but rather as a component of a larger whole ▲ Are best achieved by cross-agency, cross- systems collaboration

14. 14 Indicators, Measures & Benchmarks ▲ Indicators must be –Quantifiable –Possible to track over time and across clients –Reflect aspects of systems and services that can be modified ▲ Measures quantify indicators ▲ Benchmarks establish targets, thresholds, or ranges for measures of specific indicators

15. 15 Sample Recovery Outcomes ▲ I would like to have an apartment and job and would like to regain custody of my children. ▲ I would like to complete parole and find a job that will allow me to give back to other persons with drug/alcohol problems who have problems with the law. ▲ I would like to complete high school and go to college to study music.

16. 16 Sample Recovery Indicators ▲ Days of services received ▲ Use of recovery support services ▲ Substance use ▲ Family/social functioning ▲ Education/Employment ▲ Housing ▲ Criminal Justice System Involvement ▲ Establishment and/or Attainment of Personal Goals ▲ Satisfaction with services/outcomes/role in service planning/relationship with and role of staff

17. 17 Sources of Data ▲ Screening, Triage, Referral, Assessment/Intake ▲ Treatment and/or recovery plans ▲ Service notes ▲ Referral Logs ▲ Client Satisfaction Data ▲ Treatment Episode Data Set (TEDS) ▲ Billing ▲ Other service providers

18. 18 Evaluating & Selecting Data ▲ Is the data collected in a consistent manner? ▲ Can it be measured? ▲ Is it collected at more than one point in time? ▲ Is it in a form that can be analyzed? ▲ Is there data you do not collect that might be of value as an indicator or outcome? ▲ Is there potentially useful external data to which you could gain access?

19. 19 Sample Data Inventory Table

20. 20 Systematizing the Use of Data – Practitioner Level ▲ Develop a mechanism for consistently collecting information on client goals, satisfaction with services. ▲ Develop reports using existing data to track indicators and outcomes as feasible. ▲ Set personal benchmarks that are measurable and achievable and track progress

21. 21 Systematizing the Use of Data – Program Level ▲ Develop a data plan and strategy for systematically collecting and analyzing data and for using it to improve quality, performance, and outcomes. ▲ Implement rapid cycle process improvement approaches to systematically improve systems and services. ▲ Consider cross-agency, cross-systems data sharing, planning, and coordination.

22. 22 Data-driven Systems & Services Improvement

23. Case Studies Using Data to Improve Recovery Outcomes