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 Paths
to Recovery
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What is P2R?
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Meet the P2R Teams
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See the Changes We've Made
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P2R Official Site
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Advancing Recovery
 What
Is P2R?
Paths to Recovery is a revolution in addiction
treatment.
In September 2003, BCI began an effort to improve patient access and retention
as a member of the Network for Improvement of Addiction Treatment (NIATx).
This nationwide initiative is sponsored by the Robert Wood Johnson
Foundation and the Center for Substance Abuse Treatment, Substance Abuse
and Mental Health Services Administration.
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Read the story of how same-day admission made a
difference for one client in "This Time".
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P2R
currently has two active teams; one agency-wide team focusing on our
mental health services, and one at the Alpha drug free program.
These programs have made many changes that have
benefited clients, including same-day methadone intake and medication.
In December 2006, the state of Delaware and
BCI began work on the Advancing Recovery initiative, an extension of the
NIATx project focusing on state-provider partnerships.
On this page, we will
report on the improvements we've made and the benefits for our patients.
Meet
the P2R Teams
Brandywine Counseling's P2R Change
Teams have representation from all job categories critical to the
functioning of the program, as well as staff not directly connected with
the program who have expertise in relevant areas like data collection.
Each team has a Change Leader who provides day-to-day leadership of the project and ensures
the objectives are accomplished. BCI Executive Director Sally Allshouse
serves as Executive Champion, providing overall leadership. The teams
meet weekly to develop, implement, and study ways to improve access and
retention. A climate where team members bring their experience, not their
title, to the table has brought enthusiasm and productivity to a process
that would otherwise be very challenging.
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BCI Agency-Wide Team
- James Harrison, Change Leader
- Valerie Brown, Clinical Director
- Ena Dryden, Nurse Supervisor
- Lynn Fahey, Alpha Site Director
- Matt Friedman, Executive
Assistant
- Dr. Joe Glick, Medical Director
- Keith Kaut, Counselor
- Dr. Mike Krafchick, Psychistrist
- Mark Lanyon, Alpha Program Manager
- Janice Sneed, Newark Site Director
- Dr. Carol Tavani, Psychiatrist
- Jeremy Zane, Therapeutic Supervisor
- Chris Zebley, Nurse Practitioner
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Drug Free Program
- Lynn Fahey, Change Leader
- Steve Burns, Housing Coordinator
- Matt Friedman, Executive
Assistant
- Evelyn Handley, Receptionist
- Denise Hartrick, Therapeutic
Supervisor
- Mark Lanyon, Program Manager
- Daniel Lumpkin, Counselor
- Daniel Norvell, Counselor
- Jessi Washington, Counselor
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We're
Making a Difference!
P2R's overall goal of improving access
and retention actually consists of 4 aims: increasing admissions, reducing
wait time, increasing continuation, and reducing no-shows. All of our change
projects are directly related to one or more of these 4 aims. Learn more about
each project in the
Opioid Treatment and
Drug Free programs below.
► Access
►
Retention
 Increase Admissions
Reduce Wait Time
Increase Continuation
Reduce No-Shows
Opioid Treatment Program
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Change Project |
NIATx Aim |
Results |
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6/2008-present:
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Reduce wait list for mental health services
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The
wait time to see the psychiatrist was 9 weeks; to see the
psychologist, 6 weeks. We began to prioritize patients on the list
by how quickly they need service. The nurse practitioner took over
some of the medication checks.
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No
results yet
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11/2006-3/2007:
► Evening
Program
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Late
afternoon dispensing hours introduced to alleviate AM volume.
Clients with at least 12 months of clean time are eligible. New
level of take home privileges introduced: 13 days of medication
after 24 months of clean time.
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More than
700 people were coming in the morning. Expanded hours shifted 86
people to afternoon.
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8/2006-11/2006:
► Intake
on demand
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Supervisors review weekly reports and discuss caseload management
with counselors.
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- When a
counselor has an extended absence, individuals and groups will be
provided by any counselor available to get clients their required
contacts.
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- 92% of people requesting service were
admitted in September '06. Our previous high was 71% and average was
63%. - Shortest ever wait from
first contact to admission - under 3 days. |
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2/2006-7/2006:
►Provide 100% of required monthly
contacts
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Supervisors review weekly reports and discuss caseload management
with counselors.
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- When a
counselor has an extended absence, individuals and groups will be
provided by any counselor available to get clients their required
contacts.
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- No-shows decreased from
22% to 16%, equivalent to 50 more people per month showing for their
appointment.
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7/2005-3/2006:
►Reduce number of clients who drop
out of treatment
- “Before You Walk
Away” posters give information
- New groups
focusing on cocaine use and orientation of new admissions aim to
improve engagement. Take-home medication awarded for successful
completion.
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- About 6
clients have received permanent 1-day take-homes after completing
the 6-week series and meeting other take-home criteria including
negative drug screens.
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Discharges
down 12%.
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% of
discharges who left voluntarily down 12% (from 77% to 68%).
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4/2005-11/2005:
►Reduce missed doses early in
treatment
Clients who do not
miss a day of medication pickup during the first 30 days will
receive an incentive
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No apparent effect. Number
of clients picking up all doses in their first 30 days varied between
26%-41% with no apparent trend. |
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7/2004:
►Enforce
penalties for missed appointments
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Clients missing 3 appointments in a row must see counselor before
being medicated.
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- Time from admission to 1st individual session
▼
9 days (to 9). |
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7/2004:
►Special
focus on Suboxone patients
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Increase % of
Suboxone clients who continue in treatment with faster transfer &
separate group
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- Change abandoned. Majority of Suboxone clients failed and
transferred to methadone.
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- 6/2004:
►Recovery
Counts - Alternative
program for repeat clients
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Increase % of clients continuing treatment by offering alternative
program without penalty for continued drug use
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- - Two clients
awarded first travel bottle and will graduate, returning to
traditional treatment.
- - Five clients have
negative drug screens for 2 months or less.
- - Census maintained
at 25. Of initial group of 12, 10 remained in program 5 months or
longer.
- - Four clients found
jobs; many obtained housing.
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1/2004:
►Same
day admission
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Instant urinalysis screening eliminates wait for results.
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Orientation video
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- Average
wait from intake to first medication dose▼
from 2 days to same day
- - Average time from
first contact to first dose▼
from 6 days to 4
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3/2004:
► Increase
intake slots from 15 to 18 per week
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- Monthly
admissions▲
to all time high
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- Wait from first
contact to first dose
▼ to 6 days
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9/2003:
►►Faster
transfers/ increase intake slots
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Shorten stay in intake unit;
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Increase intake
slots from 12 to 15 per week.
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- Intake Unit
caseload ▼
49%
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- Wait for transfer ▼by 10 days
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- Admissions ▲ 20%
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3/2003:
►Phone
pre-screen at 1st contact
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Nurses make appointments
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- Wait for intake
▼
50% (to 2 weeks).
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Drug Free Treatment Program |
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Change Project |
NIATx Aim |
Results |
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2/2008-present:
►Increase
recovery support to decrease recidivism
- We want to decrease our readmission
rate from 32%, and increase our average length of stay from 102
days. We introduced the Evidence Based Practice of Telephone
Continuing Care for clients who have done well in treatment and want
to prevent relapse.
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· Clients
remain with the same counselor and call in at least twice a month
for 12 weeks. Clients also offered recovery coaching through the
1212 Club as community-based peer support.
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9 clients have enrolled since February 2008. 12 out of 20 scheduled
telephone contacts have been completed. Many anecdotal success
stories.
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9/2007-6/2008:
►►Meet
& Greet as first session
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Replace First Step
Group with a Meet and Greet as the first session after admission.
Instead of a large group where rules are explained, clients meet
with their assigned counselor in a smaller group and view an
orientation video. Goal is to improve retention by having clients
meet their counselor sooner (Day 4 compared to Day 10).
Assessors assign
clients to counselors using decision tree. Meet and Greet structure
standardized.
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For several months we
saw no improvement. Further adjustments were needed.
Rather than give
clients an appointment to return, they are given a list of four weekly
slots with their assigned counselor and can choose when to return.
Staff began to use a computerized scheduler to keep track of
appointments. The receptionist began to help counselors make reminder
phone calls.
Following these
changes, clients progressed from admission to their first unit of
service in 9 days, down from an average of 12. |
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6/2006-present:
►Improve
early engagement
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Retention had plateaued at 82% through 1st individual, 60% through
2nd individual. Longer time in treatment is associated with
successful outcomes, which are rewarded by performance based
contract. Incorporate the Evidence Based Practice of Motivational
Incentives to encourage early attendance.
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· Survey
showed that clients would like different incentives (grocery cards,
hair/nails done, gas cards).
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Staff increased our knowledge of motivational
incentives through training and literature review.
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Fishbowl drawing procedure developed. Draws begin at Meet and Greet
session. Individual session and group attendance also
earns draws.
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Program fully operational since
2/15/07.
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Staff objections about incentives addressed through
survey about attitudes.
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After our first year, we
did not see our target 5% improvement in retention, so retooling was
needed.
Beginning 2/2008 we increased the chances to earn prizes and allowed
clients to bank their credits.
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Two months into
the retooled program, our
no-show rate for individual appointments dropped to 19%, which is
our lowest in two years. Our average had been 26%. Client retention
is also better, with more people staying in the program 45 days or
longer.
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1/2006-6/2006:
►
Earlier first treatment
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Open groups – clients are encouraged in First Step Group to start
coming to any group right away. Any client who cannot make their
regular group and wants to come to a different group is permitted to
do so.
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·
Time from admission to first treatment session
reduced from 15 days to 11, lowest in a year.
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Time from First Step Group to first treatment session
reduced from 9 days to 7 days, lowest in a year.
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8/2005-12/2005:
►Reduce individual no-shows
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Receptionist makes reminder calls before each individual session.
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No-show rate averages 39% without calls, 32% with calls. This is
equivalent to 26 more people keeping their appointment each month. |
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5/2005-11/2005:
►Reduce
probation discharges
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Letters of continuation after loss of contact sent to probation
officers as well as client to see if more re-engage in treatment
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Re-engagement rate increases from 41% to 53%. |
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3/2005-7/2005:
►
Improve
return rate with session rating scale
One counselor asks clients to rate the helpfulness of the session
using SRS at end of every individual session
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No improvement. Counselor’s no-show rate averaged 34% pre-change and
37%
post-change. |
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12/2004-7/2005:
►
Increase group attendance
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Get ideas from the
customer
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Do structured exercises
designed to raise interest
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Videotape groups and
give feedback to facilitators
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Group continuation showed
little change. Pre-change, 61% completed at least one group,
post-change 70%. Completion of five groups was unchanged from 42%.
While the project succeeded at improving content and facilitation
skills, other factors are believed responsible for why clients do not
attend group, such as schedule conflicts and transportation problems.
The project did increase the skills and enthusiasm of staff, and
benefited the clients who did attend in the short and long term. |
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7/2004:
►►Faster
engagement
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Orientation video
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New "First Step" group
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Clients given
appointment slips.
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- - Time from
admission to orientation ▼ 6 days (to 0).
- - Time to 1st group
▼ 11 days (to 6).
- - Continuation to
1st group ▲ 100% (to 87%).
- - Time to 1st
individual session ▼ 6 days (to 13).
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Advancing Recovery
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National Effort to Improve Addiction
Treatment Quality Moves Forward
- Delaware is one of six state-provider
partnerships working to improve addiction treatment success rates.
December 5, 2006
Princeton, N.J., December
5, 2006 – The Robert
Wood Johnson Foundation (RWJF) has selected six state-provider
partnerships to improve the quality of alcohol and drug addiction
treatment in the
United States.
The grant funding is provided through the Foundation’s Advancing
Recovery: State/Provider Partnerships for Quality Addiction Care
national initiative, which seeks to promote the use of evidence-based
clinical practices through innovative partnerships between substance abuse
treatment provider organizations that deliver care and single state
agencies.
The six state-provider partnerships (see list below) will
participate in a learning network that will provide them the tools to improve
the delivery of addiction treatment. Funding will support the process of making
changes at both the state and the service provider levels to maximize the
implementation of proven addiction treatment practices.
"By changing and strengthening state- and provider-level practices that promote
the use of evidence-based care, the Advancing Recovery partnerships are in a
unique position to improve patient outcomes and highlight addiction treatment as
an essential component of the health care system,” said Victor Capoccia, RWJF
senior program officer. “People who seek treatment for addiction experience wide
variations in the quality of care they receive. The goal of Advancing Recovery
is to help us overcome the barriers to using ‘what works’ and increase the use
of proven addiction treatment practices.”
Advancing Recovery is co-directed by David Gustafson, Ph.D., of the Network for
the Improvement of Addiction Treatment (NIATx) at the University of
Wisconsin–Madison and A. Thomas McLellan, Ph.D., from the Treatment Research
Institute (TRI) in Philadelphia.
“There is so much that can enhance the chances of a sustainable adoption of an
evidence-based practice,” said David Gustafson. “Some involve training or
organizational arrangements such as supervision changes. Our focus, however, is
on systemic changes at the state level, such as providing liability coverage
when a new level of care is added, and also at the provider level—for example,
creative use of technology to maintain contact during continuing care.”
“Advancing Recovery continues the treatment program-level innovation and
practicality of the NIATx program, but improves the potential for sustained
change in system financing, regulation and purchasing by engaging the state as a
partner in the process,” said A. Thomas McLellan.
According to the Substance Abuse and Mental Health Services Administration’s
2004 National Survey on Drug Use and Health, an estimated 23 million Americans
age 12 and older need treatment for substance use disorders and addictions. Yet
less than 10 percent of them actually receive treatment and among those who do,
very few have access to quality treatment services.
The partnerships selected through Advancing Recovery will focus on five
categories to improve treatment quality, including the use of: (1) medications
for specific diagnoses; (2) screening and brief intervention in primary care
settings; (3) specific psychosocial clinical interventions; (4) post-treatment
care; and (5) case management, wraparound, and supportive services.
The six Advancing Recovery Partnership Projects are Delaware, Florida, Kentucky,
Maine, Missouri, and Rhode Island.
For more information, visit
www.advancingrecovery.net.
About
the Robert Wood Johnson Foundation
www.rwjf.org
The Robert
Wood Johnson Foundation focuses on the pressing health and health care issues
facing our country. As the nation's largest philanthropy devoted exclusively to
improving the health and health care of all Americans, the Foundation works with
a diverse group of organizations and individuals to identify solutions and
achieve comprehensive, meaningful and timely change. For more than 30 years the
Foundation has brought experience, commitment, and a rigorous, balanced approach
to the problems that affect the health and health care of those it serves. When
it comes to helping Americans lead healthier lives and get the care they need,
the Foundation expects to make a difference in your lifetime.
About
NIATx
www.niatx.net
The Network
for the Improvement of Addiction Treatment (NIATx) is a national initiative
supported by the Robert Wood Johnson Foundation’s Paths to Recovery program and
the Center for Substance Abuse Treatment’s (CSAT) Strengthening Treatment Access
and Retention (STAR) program.
About the Treatment Research Institute
www.tresearch.org
The
Treatment Research Institute is a not-for-profit research and development
organization dedicated to reducing the devastating effects of alcohol and other
drug abuse on individuals, families and communities by employing scientific
methods and disseminating evidence-based information.
Last updated
July 18, 2008
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Where the Journey 