Transcript Kansas Grant Management (AAPS Funds)

Access to Recovery
Kansas Summit
Jim Clarkson, MA, LADAC
July 19, 2010
Access to Recovery
• ATR is a presidential initiative which
provides vouchers to clients for purchase of
substance abuse clinical treatment and
recovery support services. The goals of the
program are to expand capacity, support
client choice, and increase the array of
faith-based and community based providers
for clinical treatment and recovery support
services using voucher based
reimbursement.
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ATR I 2004
• President Bush announced in the 2003
State of the Union Address a new
substance abuse treatment initiative,
Access to Recovery. This new initiative will
provide people seeking drug and alcohol
treatment with vouchers to pay for a range
of appropriate community-based services.
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ATR I Continued
• 44 states and 22 tribes and territories applied.
• Up to 7.5 million awarded for three years.
• 14 states and one tribal organization were awarded:
California, Connecticut, Florida, Idaho, Illinois,
Louisiana, Missouri, New Jersey, New Mexico,
Tennessee, Texas, Washington, Wisconsin,
Wyoming, and the California Rural Indian Health
Board.
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ATR II 2007
• Methamphetamine Initiative.
• 40 states/tribes applied.
• 24 awards up to 4.5 million for three years.
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ATR II Awards
• 24 three-year Access to Recovery grants were
awarded in September 2007 to:
Louisiana, Hawaii, Missouri, New Mexico,
Oklahoma Cherokee Nation, California, Alaska
South central Foundation, Inter-Tribal Council of
Michigan, Indiana, Illinois, Connecticut,
Tennessee, Oklahoma, Montana Wyoming Tribal
Leaders Council, District of Columbia, California
Rural Indian Health Board, Arizona, Rhode
Island, Washington, Ohio, Iowa, Texas, Colorado,
and Wisconsin.
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Jurisdictions funded in ATR I but not
ATR II
• Of the original 14 ATR grantee recipients 5
did not receive ATR II funding.
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ATR II Client Level Results-Demographics
• Served over the targeted 160,000
individuals.
• 69% males.
• 31% females.
• 50% white.
• 30% African American.
• 9.7% Native American/Alaskan Native.
• 1.5% Asian/Pacific Islanders.
• Ethnicity: About 10% reporting being
Hispanic.
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ATR II Client Level Results--Services
• 89% received recovery support services.
• 49% of dollars expended on recovery support
services.
• 28% of dollars paid to faith-based organizations.
• Faith-based organizations accounted for 33% of
Recovery Support and 31% of Clinical Treatment
services.
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Outcomes (measured at 6 months
post intake)
 80.4% abstinent from substance use.
 46.5% reported being stably housed.
 49.8% reported being employed.
 90.8 % reported being socially connected.
 90.6% reported no involvement in the criminal justice
system.
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ATR III
• 30 awards for between 2-4 million per year for up to
4 years will be announced.
• Requires returning veterans substance abuse
recovery component.
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ATR III Requirements
ATR grantees will be expected to use their
ATR grant funds to facilitate individual
choice and promote multiple pathways to
recovery through the development and
implementation of substance abuse
treatment and recovery support service
voucher systems
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ATR III Requirements Continued
• Ensure genuine, free, and independent
client choice for substance abuse clinical
treatment and recovery support services
appropriate to the level of care needed by
the client. Choice is defined as a client
being able to choose from among two or
more providers qualified to render the
services needed by the client, among them
at least one provider to which the client has
no religious objection.
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ATR III Requirements Continued
Provide all substance abuse assessment,
clinical treatment, and recovery support
services funded through the ATR grant
through vouchers given to a client by an
SSA/Tribe/Tribal Organization. No funding
shall be given directly to a provider through
a grant or contract to provide any services
under this program, including assessments.
By vouchering services, the ATR program
employs an indirect funding mechanism.
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ATR III Requirements Continued
Ensure each client receives an assessment
for the appropriate level of services and is
then provided a genuine, free, and
independent choice among eligible
providers, among them at least one
provider to which the client has no religious
objection.
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ATR III Requirements Continued
Allow eligible clients to use their vouchers to pay for
assessment and other clinical treatment and
recovery support services from a broad network of
eligible providers. The network of eligible providers
should include provider organizations that have not
previously received public funding. Eligible service
providers for the voucher program may include the
following: public and private, nonprofit, proprietary
organizations, including faith-based and communitybased organizations, as approved through
established procedures by the SSA.
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ATR III Requirements Continued
Ensure that faith-based organizations
otherwise eligible to participate in this
program are not discriminated against on
the basis of their religious character or
affiliation.
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ATR III Requirements Continued
Maintain accountability by creating an
incentive system for positive outcomes and
taking active steps to prevent waste, fraud
and abuse.
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ATR III Requirements Continued
Expand clinical treatment and recovery
support services by leveraging use of all
Federal funds, preventing cost shifting, and
ensuring that these funds are used to
supplement and not supplant current
funding for substance abuse clinical
treatment and recovery support services in
the State.
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Important ATR III Milestones
 Grantees are expected to fully implement their
voucher programs no later than 4 months after the
award date.
 Grantees must complete and maintain an 80%
GPRA follow up rate.
 Service mix should reflect an approximate 50-50
recovery support and clinical services utilization rate.
 Faith and community based providers should be part
of the Access to Recovery network.
 Grantees must hit their annual and aggregate target
for clients served within annual allowable budget.
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Keys to Success
 Meet annual client targets.
 Meet and maintain the 80% GPRA follow up
rate.
 Manage the project within budget and
within allowable cost bands for services.
Possible supplemental funding may be available if
these requirements are met.
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ATR Kansas Proposed ATR Clinical
Service Array
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Clinical Assessment
Outpatient Counseling
Intensive Outpatient Treatment
Adult Residential
Medication Assisted Treatment
Tobacco Medication Assisted Treatment
ATR Kansas Proposed Recovery
Support Services Array
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Recovery Support Services Assessment
Transportation
Housing Gap Fund
Smoking Cessation Support
Peer Mentoring
Child Care
Family Support Services
Job Development
Pastoral Guidance/Spiritual Support
Stress Reduction Management
ATR Kansas Targets
 Goal of 10,000 individuals served over 4
years.
 Year One 1,500
 Year Two 2,000
 Year Three 3,000
 Year Four 3,500
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ATR Kansas Eligibility
• Eligibility criteria for clients to receive
vouchers. Client eligibility will include
verification of Kansas residency, adult
age 18 or over, income level, and
meeting of clinical criteria for substance
use disorders – based on the Kansas
Client Placement Criteria Instrument
(KCPC).
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ATR Kansas Eligibility Continued
• Kansas ATR has proposed the following priority
populations:
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Priority persons under current block grant and Medicaid funding at
200% and below poverty level will be eligible for recovery
supports not available under current funding streams. This
includes those currently on waiting lists with a focused priority on
pregnant and parenting women and women with a need for
gender specific, trauma informed care.
Uninsured/underinsured persons at 400% and below poverty level
will be eligible for treatment of choice at public funded and private
programs (may supplement sliding fee scales when appropriate)
to reduce barriers to engaging in treatment services and to
support recovery stability upon discharge.
Offender on post-release and community-based supervision who
meet ASAM criteria and in need of recovery supports.
ATR Kansas Eligibility Continued
• Veterans returning from current wars at
400% or below poverty levels who meet
ASAM criteria, with a preference for those
identified with Traumatic Brain Injury (TBI)
or Post Traumatic Stress Disorder (PTSD)
and substance use disorders (exemptions
from income requirements will be allowable
for returning veterans with justification that
ATR type services cannot be adequately
accessed in other venues).
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Preparation: GPRA
• Government Performance and Results Act.
• Interview covering drug and alcohol use, family and
living conditions, education, employment and
income, crime and criminal justice status, mental
health problems, physical health problems and
treatment and recovery.
• Must be completed before a voucher can be issued
at intake, at discharge from ATR and at 6 months
post intake.
• Client engagement and retention critical in ATR.
• Client incentives, assertive outreach, health study
locator forms, cross provider communication, etc.
• CSAT Trainings/State Trainings.
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Preparation: Recovery Oriented
System of Care
Recovery-oriented systems support
person-centered and self-directed
approaches to care that build on the
strengths and resilience of individuals,
families, and communities to take
responsibility for their sustained health,
wellness, and recovery from alcohol and
drug problems.
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Preparation ROSC: Identifying
Partner Providers and Referral
Sources
• Who are the natural partners to develop a recovery
oriented system of care with current providers?
• Develop a plan to gather these agencies/individuals
together.
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Preparation: Process Improvement
NIATx (www.niatx.net)
• Since 2003 Partnership between Robert
Wood Johnson Foundations Paths To
Recovery, The Substance Abuse and
Mental Health Services Administration
(SAMHSA) and the National Institute on
Drug Abuse.
• University of Wisconsin Center for Health
Enhancement System Studies.
• There are agencies in all 50 states using
NIATx process improvement principles
along with 25 State Substance Abuse
Authorities. Free Provider Tool Kit.
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NIATx Aims
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Reduce Waiting Time
Reduce No-Shows
Increase Admissions
Increase Continuation
Each of these activities has had a
marked improvement in agency bottom
lines (Business Case Series 3/07).
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NIATx 5 Key Principles
• Understand and involve the customer
• Fix key problems that keep the CEO up at
night
• Pick a powerful change leader
• Get ideas from outside the organization or
field
• Use rapid-cycle testing to establish effective
changes (Plan-Do-Study-Act)
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NIATX Results
• 34.8% reduction in waiting times
• 33.0% reduction in no shows
• 21.5% Increased Admissions
• 22.3% Increase in continuation
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Begin with a Walk-through
• Staff members experience the treatment
process just as a customer does. The goal
is to see and feel the agency from the
customer’s perspective. Taking this
perspective of services—from the first call
for help, to the intake process, and through
final discharge—is the most useful way to
understand how the customer feels and to
discover how to make improvements that
will serve the customer better.
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Preparation: The Spirit of
Motivational Interviewing
• “Motivational Interviewing, Preparing People for
Change” (Miller & Rollnick, 2002, The Guilford
Press)
• Faith/Hope Effect: The counselor, doctor, or
teacher’s beliefs about a person’s ability to change
can become a self-fulfilling prophecy.
• Accurate empathy, nonpossessive warmth, and
genuineness.
• Directive, confrontational counseling styles increase
resistance.
• Empathetic counseling styles facilitate change by
empowering clients to deal with painful issues and
ambivalence.
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Motivational Interviewing
 Model describes how people change
 Helps people change their behavior and
improve their motivation to change
 Identifies fears and difficulties and helps to
resolve these issues
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Motivational Interviewing
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Client-centered approach
Meets the client where they are at
Self-determination
Self-autonomy
Non-judgmental
Motivational Interviewing Counselor
• Respect individual differences
• Tolerance for disagreement and
ambivalence
• Patience with gradual changes
• Caring and interest in client
• Not the expert, but a partner
• Willing to negotiate with the client
• Open to ideas from client
• Supports what the client wants to do
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Thank You!
Jim Clarkson
Director, Grants Management Practice
ValueOptions
(505) 944-5284
[email protected]
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