Transcript How To Create Innovative State and Community Collaborative

Florida Alcohol Drug Abuse Association
Mary Booker
Joan Helms
NIATx Conference
June 2013
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Learn to engage and identify stakeholders
Identify tools and benchmark process
Develop and expand collaboratives
Initiate and grow peer mentor networks
Present outcomes to stakeholders
Integrate and replicate outcomes
Current Budget
Substance Abuse: $215,672,421
Mental Health: $760,060,545
Sources of Funding
Substance Abuse
State: 40%
Federal: 60%
Mental Health (including State MH Facilities)
State: 81%
Federal: 19%
Operational Structure
Central Office: Guides State System of Care,
Monitors progress
Regional Offices (6): Manage regional systems of
care
Percent Funds in Contracted Services
Mental Health:
Civil Facilities – 1 of 3 privatized
Forensic Facilities – 2 of 4 privatized
SVPP – privatized
Substance Abuse: privatized
Managing Entities
(Includes SA and Community MH)
Current contracts: 7
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FADAA, incorporated in 1981, is a non-profit membership
association representing over 100 of Florida’s premiere communitybased substance abuse and co-occurring treatment and prevention
agencies, managing entities, community anti-drug coalitions and
approximately 3,500 individual members.
Throughout its history, FADAA has been involved in leading industry
change to better serve consumers and communities and has been at
the forefront in creating responsive systems and tools to facilitate
the transfer of evidence-based practices to the field and to initiate
and expand continuous quality improvement activities.
FADAA is perceived as the “lead voice” by national, state and local
policy makers, providers and the recovery community on substance
abuse policy and related practice improvement.
The State and FADAA aggressively pursued grants to
build the capacity for system improvements while
removing regulatory and administrative barriers to
client access to service:
• Robert Wood Johnson – Resources for Recovery
• Strengthening Treatment Access and Retention State Implementation
• Robert Wood Johnson – Advancing Recovery
• Partnership for Quality Performance State Contract
In 2005, FADAA and DCF collaborated to
establish new state Medicaid codes for
substance abuse services and legislative
authorization for a local match program to
maximize reimbursement for substance abuse
services.
In 2006, FADAA, DCF and 6 (initial) substance abuse
provider agencies received a 3-year STAR-SI grant to
improve client access and retention.
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Reduce average time between an individual’s first
contact for OP treatment and an initial
screening/assessment by 25%.
Reduce average time between initial
screening/assessment and delivery of first OP
treatment service by 25%.
Increase the number of persons who complete
detoxification and then enter OP treatment by 50%.
By the end of the 3-year project, the team included:
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21 individual provider agencies
Two managing entities
Staff from the State Substance Abuse Mental Health Program Offices
and the Florida Alcohol & Drug Abuse Association (FADAA)
Other accomplishments:
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Implemented more than 50 improvement projects
Provided staff training in the use of change teams and rapid cycle
process improvements
30+ participants have been trained throughout Florida as Change
Team Leaders
Established 19 Peer Mentors and 5 Coaches within Florida
Year 1
Year 2
Year 3
Year 4
FIS
DACCO
ACTS
Bayview Mental
Health
Bridgeway
Center for Drug
Free Living
Lakeview
Family Resource
Center
Centre for Women
DATA
CDAC
Manatee Glens
Gateway
Coastal
EPIC
Clay County
Meridian
Jackson North
River Region
Lifestream
DISC Village
Stewart Marchman
Lifestream
Sutton Place
River Region
Gateway
The Village
The Harbor
Tri-County Human
Services
The Village
Human Services
Associates
Meridian
River Region
Tri-County
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Cadre of Peer Mentors (NIATx trained)
NIATx Process Improvement Training &
Coaching
Florida Learning System Established
System of Care - Client Access & Retention
Improved
NIATx Training for Family Intervention
Specialists
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Two year funding - $180,000 per year
Three providers (Operation PAR,
Spectrum-Miami Behavioral Healthcare,
River Region Human Services)
Focus on the use of medication
(Nalotrexone), case management and
support services for improved client
outcomes
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The State and its partners agreed to implement the
evidenced based practice of providing Vivitrol to
patients with alcohol addictions.
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Vivitrol is only administered in conjunction with
psychosocial interventions
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Partner agencies:
◦ Identified and implemented client screening and selection
criteria
◦ Developed a medication protocol;
◦ Provided educational training regarding Vivitrol to over 130
staff;
◦ Initially provided Vivitrol to 10 clients;
◦ Tracked client progression.
The State reviewed and selected evidenced
based practice to enhance case management
services to substance abuse clients.
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Partners reported experiencing the following
barriers to implementing the program:
◦ Obtaining the medication
◦ Prohibitive costs
◦ Getting Vivitrol on the Medicaid formulary
Partners reported that staff were fully supportive of
the program due to the information received from
the medication representatives and staff comfort
with administering medication in conjunction with
counseling.
NATIONAL INITIATIVES
SAMSHA Paths to Recovery
RWJ/NIATx
Florida DCF
Collaborative Partners
RWJ Resources to Recovery,
Advancing Recovery, STAR-SI
Florida Learning System
FADAA
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Provided guidance on the progress of the grant as
appropriate
Monitored data collection and reporting
Assisted with the revision of regulations and policies
that impede service delivery and process
improvements
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Supported the peer learning network
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Disseminated project results
Florida Learning System
Florida Learning System
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NIATx
SAAS
SAMHSA
The National Council for Behavioral Health
Florida Department of Children & Families
Florida National Guard
Florida Certification Board
Florida State University
Local Level Partners
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SA, MH and Prevention Providers
Managing Entities
Community Anti-Drug Coalitions
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Partnership for Quality Performance State
Contractual Work Plan
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State and National Level Partners
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Provider Commitment
Pros
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Fluid, flexible – meets
on the ground
technical service needs
Cons
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Amount of detail
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Tracking
Monitoring partners
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Like a contract
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Easy to make changes
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No formal contract
amendment required
Organizational system
changes
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Data system refinements
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Improve client engagement and retention
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Increase use of evidence-based practices
and assessment
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Contract linkages
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NIATx resources
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Buy-in
Trust building
Elimination of turf issues
Time-consuming
Resistance
Communication
History with individuals, organizations
Risk taking
Sharing information
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Research based grants
Transformation
Creativity
Flexibility
Acknowledgement & recognition of what
issues partner’s are dealing with
Group dynamics
Drawing on talent of providers
Three Key Roles:
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Use their experience and expertise during
site visits, telephone and online technical
assistance to the providers
Identify promising process improvement
strategies, tools, and products to be
disseminated through the repository
Continue to participate in and expand the
peer learning network
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Provide Technical Assistance
◦ Provider Sites
◦ State
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Tiered approach with increasing levels
of expertise
 Knowledge
 Experience
 Strengths
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Standardize approach
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Develop network – on-line data base
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Adjust State’s data
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Create financial incentives
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Use evidence-based practices
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Use uniform, evidence-based assessment
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Address regulatory and policy barriers
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Implement system performance
management/CQI
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Sustaining successes
Implementing rapid change cycles in
interagency matters
Diffusing lessons learned and new processes
across provider sites
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State/Districts
◦ Integrate successful changes
 DCF
 SAMHPO
 District Office
◦ Provide leadership for Florida Learning System
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FADAA/Providers
◦ Active participant in Florida Learning System
◦ Integrate changes in provider infrastructure
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Managing Entities
◦ Integrate changes into Association and agency
infrastructure
 Core competencies (PI, Peer Mentors)
 Define role of managing entities
o Dissemination of education
o Replicating projects
o Mentoring
 Integrated QI approach within and
across managing entities
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Engage networks
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Increase participation of provider agencies
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Recruit and train additional peer mentors
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Increase staff competencies in performance
improvement
Participation by all provider networks
Capacity to implement process
improvements at state and local areas
Systems integration
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Tremendous talent and leadership exists at
the provider level.
Improvements are demonstrated quickly at
the provider level.
State level change is slower - but not
impossible.
State budget and procurement practices can
be difficult but leveraging resources are
critical.
National partners are essential (e.g., NIATx).
Mary Booker, Assistant Director
[email protected]
850-878-2196, ext. 115
Joan Helms, Director of Research & Practice
Improvement
[email protected]
850-878-2196, ext. 107
NIATx Conference PowerPoint Presentation
http://www.fadaa.org/documents/NIATx_Conf.ppt