Substance Abuse Residential Treatment and Detox Care Coordination BHD/SA Joe Bullock, x4974; Nancie Connolly, x5018 Program Purpose Maximize treatment completion and abstinence for individuals with drug and/or alcohol dependencies, and connect them to follow-up treatment services. Program Information Target population is individuals experiencing moderate to severe substance use disorders; they frequently are involved with the criminal justice system, have prior treatment experiences, have co-occurring psychiatric disorders, are homeless, are IV-drug users, experience various medical problems, and are at high risk for relapse behavior. Case management staff assess clients for appropriate level of care; place clients in services at contract agencies; monitor agency service quality and client progress; link with ancillary services; and connect with follow-up treatment services. Social detoxification provides evidence-based treatment in a safe, supportive residential environment for clients to withdraw from alcohol and/or drugs. Duration is 3-14 days, with an average of 10 days. Services include assessment, individual and group counseling and education, orientation to 12- step programs, and evaluation for and linkage to further treatment services (outpatient, residential, or other levels of care). Social Detox is operated through a contract with Volunteers of America- Chesapeake. Residential treatment (RT) in therapeutic community settings provides clients with skills to develop ongoing recovery. Programs incorporate evidencebased strategies, including behavior modification, motivational interviewing, education for clients and their families, and orientation to self-help communities. Duration ranges from three to six months, with an average of three months. RT is provided at seven programs through contracts with Volunteers of America-Chesapeake, Phoenix Houses of the Mid-Atlantic, and Fairfax County Alcohol and Drug Services. Specialized services are provided for women (pregnant women and women with children), Spanish-speaking men, single men, and persons with co-occurring psychiatric disorders. Partners include the criminal justice system; homeless shelters and other social services agencies; public health and primary healthcare providers; private and public sector substance abuse treatment programs; community self-help organizations; and regional Community Services Boards, all of whom refer clients for treatment. Substance Abuse RT-Detox Care Coordination Page 1
PM1: How much did we do? Staff Customers Units of Service 3.5 FTEs 0.75 FTE BHD Clinical Supervisor/Contract Monitor 2.75 FTE Case Managers Fiscal Year FY 2013 FY 2014 Number of Clients (unduplicated) Detox RT Detox RT Detox RT Detox RT 204 71 180 63 175 48 200 54 Total Admissions 269 71 225 63 224 48 276 54 Number of Bed Days 2,803 5,609 2,550 4,524 2,191 3,394 2,760 5,500 PM2: How well did we do it? 2.1 Client satisfaction 2.2 Compliance with documentation requirements 2.3 Bed utilization rate PM3: Is anyone better off? 3.1 Clients reporting improved functioning as a direct result of services received 3.2 Clients successful engagement in treatment services Substance Abuse RT-Detox Care Coordination Page 2
Measure 2.1 Client satisfaction 9 7 5 3 1 88% Clients Reported Satisfaction 93% 86% Detox RT Detox 116/135 9 9 85% RT 9/10 Detox FY 2014 93% RT All scores are above the BHD 85% satisfaction goal. Residential treatment satisfaction data is for all programs combined. Detox clients were surveyed by the provider at program completion. The response rate for detox clients was in FY 2014 and 63% in. In, Arlington BHD conducted a point-in-time survey for clients in residential treatment, with a response rate of 77%. FY 2014 residential treatment data was obtained from various provider surveys. Client satisfaction was rated on a five-point Likert scale for the detox program and a four-point Likert scale for residential treatment programs; answers of mostly satisfied or very satisfied are included in above. Satisfaction rates in were comparable to FY 2014, and exceeded the goal of 85%. Clients reported that they found the program structure, the opportunities to learn about addiction, and the support of staff and peers to be helpful. Arlington collected residential treatment data through a point-in-time survey since data for Phoenix Houses of the Mid-Atlantic is an aggregate of all persons served in Demeter House, Nuevo Dia and Phoenix rather than just Arlington clients. Collect residential treatment client surveys more frequently (first quarter, mid-year and fourth quarter) rather than as a single point in time. For : Anticipate that client satisfaction may increase if more clients are surveyed, reaching 9 for detox and 93% for residential treatment programs. Substance Abuse RT-Detox Care Coordination Page 3
Measure 2.2 Compliance with documentation requirements 9 7 5 3 1 Compliance with Documentation Requirements Target: 9 CRT (no review) 7 9 85% Supervisors CRT Supervisors Documentation compliance is assessed through monthly record reviews conducted by the team supervisor using a standard audit tool. In FY 2015, 7 of the substance abuse case management team records reviewed were rated as Excellent (9 or above); passed compliance and passed risk. for this measure was not reported in FY 2014. Of this four-person team, two staff members had average ratings of 93% and 95% on the monthly supervisor record reviews. CRT conducted a documentation audit in September 2015. Three areas of overall improvement were identified: proper coding of services, alignment of service plans with assessed needs, and plans to resolve potential co-occurring mental-health diagnoses. Ensure that services are coded correctly; create a therapy subunit for use by the case management team. Ensure that service plans are aligned with assessed. Ensure that detox cases are opened to the correct subunit (CMIN) and closed promptly if client does not agree to a plan for follow-up treatment services. : Anticipate that 85% of charts reviewed will be rated Excellent in monthly supervisory reviews and 9 by annual reviews by CRT. Substance Abuse RT-Detox Care Coordination Page 4
Measure 2.3 Bed Utilization Rate 9 7 5 3 1 8 of 10 83% 15 of 18 Bed Utilization/Average Daily Census 7 7 of 10 75% 75% 75% 12 of 16 6 of 10 11.3 of 15 75% 9 of 10 86% 12 of 14 FY 2013 FY 2014 Detox Residential Treatment Programs Utilization of residential treatment remained the same between FY 2014 and FY 2015; utilization of detox declined due to fewer clients seeking services. During both years all persons in need of treatment services were placed. State expectation per the performance contract is 75%. All services are purchased under contract from non-profit agencies, who collaborate with BHD to meet changing client needs. Most residential treatment services are purchase-of-services contract; funds are not expended unless a client is placed in treatment. Monitor placement rate and client need to ensure availability of appropriate treatment services. Utilization of detox is variable. The program will admit any person who presents at the facility who is under the influence of alcohol or other drugs. During, Volunteers of America, the Residential Program Center operator, experienced numerous staff changes. The RPC Early Recovery program was closed as of February 1, 2015 and should be reopening as of December 2015. The number of available for residential treatment have been reduced to reflect this lack of service. Continue to ensure that the Arlington Police, Virginia Hospital Center and providers of homeless services are regularly encouraged to refer persons in need of detoxification. Ensure that the new year-round homeless shelter staff is aware of detox and residential treatment services, and that BHD staff working at the shelter regularly refer clients for these services. Substance Abuse RT-Detox Care Coordination Page 5
PERFORMANCE PLAN Utilization was projected to increase due to the opening of the new year-round shelter; however, the opening occurred in. : Anticipate 75% utilization in Detox and 86% in RT. Utilization will vary depending on client need. Anticipate an increase in client need with the opening of the new year-round homeless shelter. Substance Abuse RT-Detox Care Coordination Page 6
Measure 3.1 Clients reporting improved functioning as a direct result of services received 9 7 5 3 1 Residential Treatment Clients Reporting Improved Functioning 93% 85% 95% FY 2014 Improved functioning is a self-report measure in the BHD substance abuse case management client satisfaction survey. See measure 2.1 for additional information on survey methodology. Clients rated their ability to manage their cravings on a five-point Likert scale; answers of manageable or higher are included in above. One-hundred percent of persons in residential treatment in 2015 self-reported improved functioning, though only 89% successfully completed treatment. Clients reported that they found learning to contain their substance abuse and addressing their mental health issues was helpful. This measure is not reported for Detox because the program is short-term and focused on physical detoxification rather than improved functioning. Collect residential treatment client surveys more frequently (first quarter, mid-year and fourth quarter) rather than as a single point in time. : Anticipate that report of improved functioning will may decrease to 95%. Substance Abuse RT-Detox Care Coordination Page 7
Measure 3.2 Clients successful engagement in treatment services Clients Who Successfully Completed Program 83% 83% 81% Benchmark: 67% 85% 72% 72% 72% 74% Benchmark: 46% FY 2013 (219/264) FY 2014 (184/222) (181/224) (235/276) FY 2013 (33/46) FY 2014 (40/56) (28/39) (32/43) Detox RT Clients Successfully Engaged in Follow-up Treatment After Program Completion 37% 39% 57% 88% 95% 75% 89% 94% FY 2013 (81/219) FY 2014 (72/184) (103/181) (120/200) FY 2013 (29/33) FY 2014 (38/40) (25/28) (30/32) Detox RT The percent of persons who completed detox decreased slightly from FY 2014 to. The percent of persons who successfully completed residential treatment remained steady from FY 2014 to. Percentages are based on the number of clients discharged during the fiscal year. The percentage of persons who successfully engaged in follow-up treatment at discharge increased 18% for detox from FY 2014 to, and decreased 6% for residential treatment programs. Clients who begin outpatient services are considered engaged in treatment. Substance Abuse RT-Detox Care Coordination Page 8
PERFORMANCE PLAN Program completion goals are based on SAMHSA s Treatment Episode Set (TEDS) 2010 Discharges from Substance Abuse Treatment (July 2013). There is not a national benchmark for engagement in follow-up treatment after program completion, so these goals are based on local standards. Completion of detox reflects clients absence of withdrawal symptoms. Residential treatment success reflects completion of all aspects of their individual treatment plan. Detoxification program completion rates consistently exceed the national average of 67% for detoxification of four days duration (SAMHSA - TEDS). Residential program completion rates consistently exceed the national average of 46% for residential programs of 90 days duration (SAMHSA - TEDS). Monitor client success in individual programs to ensure that programs are providing comprehensive services. Detox completion and engagement in followup services increased significantly in FY 2015. There is variability in client treatment needs and level of functioning from year to year, so it is difficult to attribute this increase to any specific factors. Residential Treatment completion remained steady in, while engagement in follow-up services decreased. Continue to ensure that programs respond to changing client needs and acuity. Explore strategies to increase engagement of detox clients in follow-up treatment. Research has shown that the longer an individual is engaged in treatment services, the better the long-term outcome will be. Follow-up treatment data is captured for Arlington County services only; treatment obtained from other sources is not included in the charts. Continue to encourage clients to participate in follow-up treatment services. : Anticipate completion rates of 85% for Detox and 74% for Residential, and follow-up treatment engagement rates of for Detox and 94% for Residential. Substance Abuse RT-Detox Care Coordination Page 9