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MARRCH 2007 Annual Conference October 30, 2007

MARRCH 2007 Annual Conference October 30, 2007. science. TRI. addiction. Addressing “Paperwork Burden” Transforming Data into useful Information for Counselors and Clients Deni Carise, Ph.D. Treatment Research Institute University of Pennsylvania. science. TRI. addiction. Topics.

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MARRCH 2007 Annual Conference October 30, 2007

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  1. MARRCH 2007 Annual ConferenceOctober 30, 2007 science TRI addiction Addressing “Paperwork Burden” Transforming Data into useful Information for Counselors and Clients Deni Carise, Ph.D. Treatment Research Institute University of Pennsylvania

  2. science TRI addiction Topics State of the Field Delaware Paperwork Burden Review Decreasing Paperwork at Assessment Role of Computer Systems Benefits of Standardizing Data

  3. State of the Field science TRI addiction Results of Initial Work from Recruiting Programs for the National Treatment Outcomes Monitoring System (NTOMS) Leadership Management Staffing Information

  4. NTOMS National Sample Expansion NY science TRI addiction Information on the First 175 Sites Recruited

  5. science TRI addiction The Treatment System Modality 1975 1990 2006 Residential 64%39% 8% Outpatient 27% 59%81% Methadone 9% 10% 11%

  6. science TRI addiction Program “Turnover” • 8 % closed altogether • 7 % stopped providing SA Treatment 15% no longer providing SA Treatment • 29% of remaining programs had been taken over, usually by MH agencies McLellan, A.T, Carise, D, & Kleber, H. (2003). Can the national addiction treatment infrastructure support the public’s demand for quality care? Journal of Substance Abuse Treatment, 25 (117-121)

  7. 54% of directors have been there Less Than 1 year Counselor turnover 50% per year STAFF TURNOVER! science TRI addiction

  8. science TRI addiction Intake/Admission Process: No Standard Intake/Assessment Procedures • ASI was most used assessment (35%) • Total admission process 2-4 hours, or 0 • 15 – 20% Don’t Do Assessment • 30% of programs collected only the information that was required by regulating agencies

  9. science TRI addiction Intake/Admission Process: No perceived value for assessment “Simply Paperwork” Not related to Treatment Plan Not related to services delivered

  10. A Typical Counselors Day? Who are the Counselors? science TRI addiction 3 - 4 Hours – Group Counseling 2 - 3 Hours – Intakes 2 - 3 Hours – “Paperwork”

  11. Addressing “Paperwork” Who are the Counselors? science TRI addiction An Example with the Delaware State Concurrent Recovery Monitoring Grant

  12. science TRI addiction Delaware CRM Project 4 Phases: • Evaluation of current data collection in an effort to minimize paperwork burden • Collaboratively select CRM items 3)Pilot the collection and reporting of these items in 4 state adult OP SA programs 4) Expand to all 11 state adult OP SA programs and monitor progress

  13. Phase 1: Who are the Counselors? science TRI addiction A Comprehensive Paperwork Burden Review

  14. science TRI addiction Goal: Paperwork Burden Review • Diminish any unnecessary or burdensome paperwork • Develop a more efficient data collection system by consolidating and streamlining paperwork • Facilitate programs’ ability to participate more fully in expanded CRM effort in Phase 3

  15. science TRI addiction Methods • Conducted a systematic evaluation of multiple, competing data collection demands (state, grant, contract, managed care, credential agencies, etc.) • Conducted site visits with clinical and admin staff from 11 OP Tx Programs in DE in July/Aug 2005

  16. science TRI addiction Methods During site visit, reviewed paperwork completed thru continuum of care: • Screening, • Intake & Assessment, • Treatment planning process, • During treatment, • Discharge or transfer, and • Follow-up

  17. science TRI addiction Recommendations • Eliminate Michigan Alcohol Screening Test - MAST (7-10 min) • Recommended 2-item screener for South Oaks Gambling Screen (5 min)

  18. science TRI addiction Recommendations • Eliminate Interpretative Summary (repeat of ASI Narrative) (30 min) • Eliminate Assessment Summary (repeat of ASI) (10-15 min)

  19. Recommendations science TRI addiction Recommendations • Develop consistent Physical Exam Refusal forms for use by all sites • Eliminate ASI at Discharge (30 min)

  20. science TRI addiction Recommendations • Eliminate ASAM at Intake for all OP Programs (lowest level of care), as well as 90 Day ASAM Updates & ASAM at Discharge(45 Min: 15 min @ admin, 90 days and discharge)

  21. science TRI addiction Paperwork Burden Reduction • Eliminations reduced @ 2 hours per client across continuum of care • Approx 1,500 clients/year enter tx at 11 OP programs • Total reduction: @ 3,000 counselor hours per year

  22. Paperwork Burden at Assessment science TRI addiction How do computer systems and standardizing data help?

  23. science TRI addiction The Drug Evaluation Network System DENS • A national system collecting standardized, automated information (using ASI) • that is clinically important and policy relevant • on people entering addiction treatment and their treatment programs

  24. Purpose of DENS science TRI addiction Purpose of DENS Standardize information at treatment intake Unified picture of people coming into treatment Quickly gather questions of current interest (Changes since 9/11) so this information isn’t always anecdotal Identify new trends - ex: Oxycontin use AND to inform policy

  25. science TRI addiction Significance of DENS • The only “real-time” source of information on treatment programs and their patients. • Ability to collect varied additional timely and policy relevant patient and program information

  26. science TRI addiction Standardizing Data Collection:The Blood Pressure Model

  27. science TRI addiction An Example of Non-Standardized Reporting Blood Pressure Nurse 1 – It’s getting better (better than what??) Nurse 2 – It’s much lower than before (too low??) Nurse 3 – The patient is in denial (???) Nurse 4 – The patient is non-compliant, lets not treat him until he’s really ready

  28. science TRI addiction An Example of Standardized Reporting Blood Pressure Nurse 1 – It’s 120/80 Nurse 2 – It’s 116/78 Nurse 3 – It’s 122/82 Nurse 4 – The patient is non-compliant, lets not treat him until he’s really ready

  29. How Could Standardizing Data Help? science TRI addiction Allows for better guidance in clinical/treatment decisions and tailored treatment. Allows tracking trends, enabling us to show that treatment works

  30. science TRI addiction Standardized Assessment An example with the Addiction Severity Index

  31. science TRI addiction The Addiction Severity Index • Developed by Tom McLellan & colleagues at University of Pennsylvania • Standardized, semi-structured, multi-focused screening and assessment tool

  32. A. Thomas McLellan science TRI addiction

  33. science TRI addiction 7 Sections of the ASI • Medical • Employment/Support • Drug • Alcohol • Legal • Family/Social • Psychiatric

  34. science TRI addiction DENS Software Automates collection of the ASI data Provides: Automated error-checks A comprehensive intake assessment Room for additional comments Automated narrative summary Comprehensive treatment care plan

  35. DENS ASI Software science TRI addiction • Software designed with input from clinicians • Assumed most users have little/no computer experience • Users report administration time shorter with software • Can enter comments for every ASI item

  36. It Writes a Narrative Summary?

  37. Software: Hints & Comments

  38. DENS ASI Data Flow  Client data – ASI • DENS Programs • Server in Philadelphia receiving all non-identifying data • Quarterly reports

  39. Trends of Interest? science TRI addiction Who is coming in to treatment?

  40. Age Group Categories science TRI addiction n Age Group % of Total

  41. science TRI addiction Heroin: PercentInjectingBy Age Group * Over Time

  42. Percent Regularly Using Heroin (Years) by State

  43. Change Over Time: 1996-2005Criminal Justice System Involvement

  44. What Can Data Do for You? science TRI addiction Track Trends – Current drug trends OxyContin 

  45. science TRI addiction A Flexible Monitoring System Benefits of “Real-Time” Knowledge

  46. The research question: science TRI addiction Did the September 11th attacks result in changes in the behaviors of counselors and patients in substance abuse treatment?

  47. science TRI addiction Methods • Surveyed 86 counselors at 25 DENS treatment programs • Chicago, Miami, Philadelphia & New York. • November 28, 2001 and January 4, 2002 • Counselors at a Veterans Affairs Medical Center were surveyed to evaluate potential differences in their population

  48. science TRI addiction Specific Questions: Following the events of September 11th: • Would counselors perceive a change in their patients’ demands for services? • Would counselors perceive a change in their patients’ substance use patterns? • Would VA counselors observe a change in the frequency of their patients’ PTSD symptoms?

  49. science TRI addiction Changes in Patients Percent reporting a change in the demand for services since the attacks • 56% (N=48) of the counselors noticed a change in patients’ demand for services

  50. science TRI addiction Changes in Substance Use Patterns Percent reporting change since the attacks • 22% (N=19) of the counselors saw a change in patients’ use patterns • Most reported an increase in drug and alcohol use

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