Florida Alcohol Drug Abuse AssociationMary Booker

Joan Helms

NIATx ConferenceJune 2013

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 privatizedForensic Facilities – 2 of 4 privatizedSVPP – privatized

Substance Abuse: privatized

Managing Entities (Includes SA and Community MH) Current contracts: 7

FADAA, incorporated in 1981, is a non-profit membership association representing over 100 of Florida’s premiere community-based 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. 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:

21 individual provider agenciesTwo managing entitiesStaff from the State Substance Abuse Mental Health Program Offices and the Florida Alcohol & Drug Abuse Association (FADAA)

Other accomplishments:

Implemented more than 50 improvement projectsProvided staff training in the use of change teams and rapid cycle process improvements30+ participants have been trained throughout Florida as Change Team LeadersEstablished 19 Peer Mentors and 5 Coaches within Florida

Year 1 Year 2 Year 3 Year 4 FISDACCO ACTS Bayview Mental

HealthBridgeway 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

Human Services Associates

The Village Meridian

River Region

Tri-County

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

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

The State and its partners agreed to implement the evidenced based practice of providing Vivitrol to patients with alcohol addictions.

Vivitrol is only administered in conjunction with psychosocial interventions

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.

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 INITIATIVESSAMSHA Paths to

RecoveryRWJ/NIATx

FADAA

RWJ Resources to Recovery, Advancing Recovery, STAR-SI

Florida Learning System

Florida DCFCollaborative Partners

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

Supported the peer learning network Disseminated project results

Florida Learning SystemFlorida Learning System

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 PartnersLocal Level Partners SA, MH and Prevention Providers Managing Entities Community Anti-Drug Coalitions

Partnership for Quality Performance State Contractual Work Plan

State and National Level Partners

Provider Commitment

Pros Cons

Fluid, flexible – meets on the ground technical service needs

Like a contract

Easy to make changes

No formal contract amendment required

Amount of detail

Tracking

Monitoring partners

Organizational system changes

Data system refinements Improve client engagement and retention Increase use of evidence-based practices

and assessment Contract linkages NIATx resources

Buy-in Trust building Elimination of turf issues Time-consuming Resistance Communication History with individuals, organizations Risk taking Sharing information

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: 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

Provide Technical Assistance◦ Provider Sites◦ State

Tiered approach with increasing levels of expertise

Knowledge Experience Strengths

Standardize approach Develop network – on-line data base

Adjust State’s data Create financial incentives Use evidence-based practices Use uniform, evidence-based assessment Address regulatory and policy barriers Implement system performance

management/CQI

Sustaining successes Implementing rapid change cycles in

interagency matters Diffusing lessons learned and new processes

across provider sites

State/Districts◦ Integrate successful changes

DCF SAMHPO District Office

◦ Provide leadership for Florida Learning System FADAA/Providers

◦ Active participant in Florida Learning System◦ Integrate changes in provider infrastructure

Managing Entities ◦ Integrate changes into Association and agency

infrastructure

Core competencies (PI, Peer Mentors) Define role of managing entities

o Dissemination of educationo Replicating projectso Mentoring Integrated QI approach within and

across managing entities

Engage networks Increase participation of provider agencies Recruit and train additional peer mentors Increase staff competencies in

performance improvement Participation by all provider networks Capacity to implement process

improvements at state and local areas Systems integration

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 Directormbooker@fadaa.org850-878-2196, ext. 115

Joan Helms, Director of Research & Practice Improvementjhelms@fadaa.org850-878-2196, ext. 107

NIATx Conference PowerPoint Presentationhttp://www.fadaa.org/documents/NIATx_Conf.ppt