A Clinical Quality Improvement Program Today: National completion - - PowerPoint PPT Presentation

IMPLEMENTING RECOVERY ORIENTED CLINICAL SERVICES IN OPIOID TREATMENT PROGRAMS PILOT UPDATE

A Clinical Quality Improvement Program

Today:

• National completion rates for OTP’s hover between

11 – 14%

• Retention is dropping
• Clients enter OTP’s for a respite, get a “time out”

and then move on

• OTP’s are a harm reduction, not a recovery orientation
• The needs of the medication, not the client, organize the

program

A recovery orientation:

• Shifts the focus from program based care to

client-based care

• Medications are an important, but not sole focus
• f OTP treatment
• Requires a comprehensive clinical needs assessment
• Uses standardized placement criteria, and
• Matches the client to the most appropriate

Level of Care

IRETA is currently implementing recovery oriented Level I

• utpatient services in existing OTP programs

6 OTP’s selected Pilot site complete; 2 active 2 years on site at each OTP

• Conducting individual sessions
• Conducting group sessions

Review and analyze outcome and performance data for past 2 years Review policy and procedures Review clinical record keeping Attend staff meetings Observe all counselors:

Implementation Activities

• Introduction to Cognitive Behavioral Therapy (CBT)
• Introduction to group therapy concepts
• Advanced training and application in the use of CBT
• Introduction to case consultation as quality assurance
• Introduction to Recovery Oriented Methadone Maintenance

Next

• Survey clients on treatment satisfaction, perceived needs and openness to

changes in their treatment

• Implement ongoing CBT therapy groups
• Clients are assigned to a group that meets weekly
• Clients are assigned to a primary counselor
• Assess all new clients for Level of Care assignment within the OTP
• Plan to assess all relapsing clients for Level of Care assignment
• Case Consultation and Process Improvement modeling continue

Pilot Site

• Patient outcomes were at the low end of national averages

(11%)

• There was no particular clinical orientation
• There was not a recovery orientation
• Groups were didactic, open, thematic and disconnected to a

theory of change

• Clinical staff display competent interviewing skills but

program design limited their scope of practice

Pilot Site Implementation Questions

• Can weekly therapy groups be established in an OTP?
• Are patients willing to attend the groups?
• Do patients see the groups as important to their treatment?

Pilot Site Implementation Questions

• Are staff able and willing to lead the groups?
• Do staff see the groups as an important part of treatment?
• Do the groups contribute to improved patient and program

performance?

RESULTS FROM PILOT SITE

Can weekly therapy groups be established in an OTP?

11 11 12 12 15 19 24 34 31 30 23 21 32 21 5 10 15 20 25 30 35 40 Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep 2017 2018

Number of Clients Served per Month

(Clients appear in multiple months)

Are patients willing to attend the groups?

0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 10 15 20 25 30 35 40 Average number of sessions per month T

• tal number of sessions attended

Do patients see the groups as important to their treatment?

50 100 150 200 250 300 350 400 450 500 Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree

“The group was supportive and helpful”

50 100 150 200 250 300 350 400 Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree

“This group was helpful to my recovery”

Do patients see the groups as important to their treatment?

50 100 150 200 250 300 350 400 450 Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree

“I would recommend this group to a friend”

Do patients see the groups as important to their treatment?

Are staff able and willing to lead the groups?

50 100 150 200 250 300 350 400 450 500 Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree

“The counselor was familiar with the topic”

Do staff see the groups as an important part of treatment?

Stakeholder Meeting at the end of the project

• Staff at the clinic were clearly committed to continuing groups

after the contracted project was over

• Staff shared examples of clients who went to residential treatment

and/or jail, and then re-engaged at the clinic because of the groups

• One of the facilitators said she could not imagine going back to

the way things were

Do the groups contribute to improved patient and program performance?

71% 15% 10% 4%

Client status at end of project

Still attending group Completed group Transferred to a different level of care Left group prior to completing

Comparison of Craving over Time

1 1.5 2 2.5 3 3.5 4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Strongly Disagree - Strongly Agree Session Index

Among clients who at some point reported that their dose was *not* controlling craving (n=21)

1 1.5 2 2.5 3 3.5 4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Strongly Disagree to Strongly Agree Session Index

Among clients who never reported that their dose was *not* controlling craving (n=37)

Baseline Measures Clinical Matching Expected Outcomes Indicators

• Retention Rates of

prior years

• Drug (non Rx) and

alcohol use prior year/s

• Employment rates

prior year/s

• Arrest rates while in

Tx Prior year/s Clinical Assessment ASAM Criteria Match

• Level I Outpatient
• Level II IOP
• Improved retention

rate

• Increased abstinence

rate

• Improved

Employment Rate

• Decreased Arrest

rates Increase:

• Days in treatment
• Abstinence
• Employment

Decrease:

• Arrests while in

treatment

Sample Data Analysis Plan

Thank you! Questions?