Accessing Substance Abuse Treatment in Iowa

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1 Accessing Substance Abuse Treatment in Iowa Panel Discussion: Steve Estes, Fonda Frazier (MECCA) Lowell Yoder (UIHC)

2 Overview What kinds of Substance Abuse treatment are available? How do we know who needs what level of care? What are barriers to accessing care and strategies to overcome them? Does treatment work?

3 At any one time: 110,000 waiting for an substance-abuse abuse assessment 42,000 waiting for treatment 32 days from first contact to treatment No-show rates about 50% Based on survey conducted by the survey research laboratory University of Illinois Chicago March 2007

4 Fast access reduces no-shows! 116 clients calling for an outpatient cocaine treatment clinic were randomly assigned to intake appointments scheduled either the same day, 1 day, 3 days, or 7 days later. Significantly more subjects scheduled 1 day later attended their intake appointments (72%), compared to those scheduled 3 days (41%) or 7 days (38%) later. Source: Intake Attendance as a Function of Appointment Delay Addictive Behaviors 27 number 1

5 Fast access reduces no-shows! Clients offered intake appointments approximately 24 h following their initial contact are more than four times as likely to attend their intakes as those scheduled later. This accelerated intake procedure allows clinics to reach more patients in need of services Source: Intake Attendance as a Function of Appointment Delay Addictive Behaviors 27 number 1

6 Three Actions That Make a Difference Provide rapid access to services Improve client engagement Create a seamless transition between levels of care. No Wrong Door

7 LEVELS of CARE Fonda Frazier M.A., ACADC MECCA Clinical Director

8 LEVELS of CARE & ASAM PPC 2-R2 It is a requirement of The Iowa Department of Public Health Substance Abuse treatment programs licensed by the department under Iowa code chapter 125 place individuals seeking services in the appropriate level of care in accordance with the ASAM PPC-2R ASAM PP-2R = American Society of Addiction Medicine, Patient Placement Criteria for the Treatment of Substance Related-Disorders, Second Edition Revised

9 ASAM Defines Level of Care from: Early Intervention through Outpatient services to Medically Managed Intensive Inpatient/Residential care. Each level of care describes a range of resources available to be applied within a given period of time to addiction and related problems.

10 ASAM PPC-2R DIMENSIONS The criteria for determining levels of care vary in intensity and are organized into six dimensions: 1. Acute intoxication and/or withdrawal potential; 2. Biomedical conditions or complications; 3. Emotional, behavioral or cognitive conditions and complications; 4. Readiness to change; 5. Relapse, continued use/continued problem potential; 6. Recovery environment.

11 LEVELS of CARE: Early Intervention (Level 0.5) Encompass individual and/or group counseling sessions and educational programs with at-risk individuals or first- time OWI (operating while under the influence) offenders Persons typically do not meet DSM-IV criteria for Substance-Related Disorder

12 LEVELS of CARE: Outpatient (Level 1) This level of care is similar to Intensive Outpatient, but scheduled sessions provide fewer than 9 hours per week. Family and other support structures may be substantially in place. Persons typically meet the DSM-IV criteria for Substance Abuse.

13 LEVELS of CARE Intensive Outpatient Treatment (IOP) (Level II.1) This level of care is organized, outpatient treatment services with scheduled sessions that provide a range of 9 or more treatment hours per week. Typically, persons in this service have a support structure which is under great stress, but which is essentially intact. Persons meet the DSM-IV criteria for Substance Dependence. Specifically, an IOP has less capacity to effectively treat individuals who have substantial medical and psychiatric problems

14 LEVELS of CARE Partial Hospitalization/Day Treatment (Level II.5) This level of care is an organized, non-residential outpatient treatment service with scheduled sessions that provide a range of 20 or more treatment hours per week. Persons typically meet the DSM-IV criteria for Substance Dependence. This service is intended for persons needing greater clinical care than Level 11.1 (IOP), yet the relative stability of their environment facilitates outpatient involvement.

15 LEVELS of CARE: Medically Monitored Intensive Inpatient (Level III.7) Provides a planned regimen of 24-hour professionally directed evaluation, observation, medical monitoring and addiction treatment in an inpatient setting Clients must participate in at least 50 hours of structured chemical dependency rehabilitation services per week. Persons meet the DSM-IV criteria for Substance Dependence

16 LEVELS of CARE Clinically Managed High-Intensity Residential (Level III.5) Clients must participate in at least 50 hrs. of structured chemical dependency rehabilitation services per week. Persons meet the DSM-IV criteria for Substance Dependence. High-intensity intensity residential services are designed to address significant problems with living skills. One way to conceptualize this level of care is as a Level which may or may not include the 24-hour medical and nursing component

17 LEVELS of CARE Extended Residential (Level III.3) Clients/patients must participate in at least 30 hours of structured chemical dependency rehabilitation services per week. Persons meet the DSM-IV criteria for substance dependence. Level III.3 programs provide a structured recovery environment in combination w medium intensity professional clinical services to support and promote recovery.

18 LEVELS of CARE Halfway House (Level III.I) Persons meet the DSM-IV criteria for substance dependence Clients/patients must participate in at least at least 5 hours per week. Treatment is directed toward applying recovery skills, preventing relapse, promoting personal responsibility and reintegrating the resident into the worlds of work, education and family-life. life.

19 Remember: Addiction Treatment Works - Recovery is Real With treatment, even hard-to to-reach populations reduce their illegal drug use by nearly half. Addiction treatment reduces criminal activity by 80%. Treatment markedly increases employment and decreases homelessness Results in substantially improved physical and mental health; and reduces risky sexual behaviors. When tailored to the needs of the individual, addiction treatment is as effective as treatments for other illnesses, e.g diabetes, hypertension.

20 Finding Resources

21

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