1. Advancing Recovery: Evaluation Team University of Georgia Oregon Health & Science University

2. A Long Term Perspective: 1966 AA NCA, a community of ideology Summer Schools of Alcohol Studies Minnesota Model emerging “Schick-Shadel,” antabuse (1949) No drug treatment (Lexington/Fort Worth “prisons”)

3. Advancing Recovery 2010 Talking about large system change? Rare across human service delivery Guidance from industrial engineers? Support from a top-10 national private foundation Practically all project participants with college degrees, most with advanced degrees Multitude of evidence of successful treatment MAT is a genuine platform for mainstream medical involvement

4. Lessons We Might be Learning Continually scan the environment to find all important stakeholders. Not immediately obvious (Medicaid authority, Opioid maintenance sector) Build a total consensus of Active support among the stakeholders. “Across the board buy-in” at all levels. Not easy, not quick, defies measurement “Across the board buy-in” at all levels. Not easy, not quick, defies measurement

5. More Lessons We Might be Learning Identify stakeholders who will facilitate the diffusion (“spread”) of innovative ideas. State population as an issue. How are they brought on board? Need to share beyond state borders Make change invulnerable to the turnover of specific personnel

6. Spirit of Thinking -Has AR “taught” a spirit of thinking at the large system level? This is rarely part of the training of clinicians. The collaboration has prepared these participants to constructively shape parity and health care reform- “horizontal integration” The power of communication

7. Evidence-Based Practices How “loosely” can we talk about Evidence- Based Practices? Is the adaptation of an innovation a fatal step? AR has demonstrated many adaptations

8. “Making Stone Soup” (Stealing baldly) A very critical concept The core of NIATx thinking. The future will make us do more with less. Need to be able to recognize soup ingredients we hadn’t known before

9. Concerns Where are the physicians? Where are our new sources of support for exploration within the practitioner community? Will our concepts of “wraparound” overwhelm us?

10. Evaluation and Patience Evaluation can a dangerous device by demanding results within the same timeframes as project funding. Evaluations almost never extend well beyond the life of the funded effort, but such opportunities are rarely available. We hope to maintain the follow-ups for at least one more year Change happens slowly. Fast changes often are short-lived Further, like the child waiting for real soup, there is impatience waiting until “Change Happens”

11. What’s Next? Completing research papers to “spread” the “lessons” Watching how large system change is sustained Continuing to collect information on these projects for as long as possible