Transcript DALLAS COALITION FOR TREATMENT IMPROVEMENT

DALLAS COALITION FOR TREATMENT IMPROVEMENT
A sudden rise in Heroin use among adolescents and young adults served as a call to
action and inspired this treatment systems improvement project.
s:
Treatment Providers
Homeward Bound, Inc. - Adult - Detox, Residential, and Outpatient
Nexus Recovery Center - Adult – Residential and Outpatient Women/children Adolescent - Residential and Outpatient
Phoenix House - Adolescent - Residential and Outpatient
Dallas County Juvenile Department - Adolescent - Day Treatment
Payers & Policy Makers
Other Participants
Texas Department of State Health Services (DSHS)
Value Options/North STAR Managed Care Program
Dallas County
Carlos Tirado, MD, UT Southwestern Medical Center
Medical Director, Nexus – MAT
Jane Maxwell, PhD, Local Evaluator
Center for Excellence in Drug Epidemiology, Addiction Research
Gulf Coast Addiction Technology Transfer Center, UT-Austin
An under-funded system of care

Texas ranks 48th in the nation in substance abuse
treatment funding and the Medicaid Substance
Abuse benefit is very limited

Our substance abuse treatment system of care is
funded to meet approximately



5% of the Adult need, and
7% of the Adolescent need
This is a perfect environment for implementing
evidence-based practices that increases efficiency
and effectiveness
The Problem

First noticed in 2005, the use of inhalable Heroin among adolescents in
the Dallas area began to increase,

Several deaths from Heroin overdoses or complications were reported,

Numerous arrests for Heroin possession in the Dallas area ISD’s were
reported,

IV Heroin admissions to adult detoxification services among persons 25
& under increased significantly,

Heroin is readily available in the schools and in the neighborhoods. It is
cheap and highly addictive
The Challenge –
With no extra funding coming into the system,
how do we:
 1) Increase retention and time in treatment to reach
a therapeutic dose or length of stay?

2) Prevent relapse to heroin use in a community
where heroin is readily available to children,
adolescents and adults?
Solutions in Science to Service
Our experience in the Texas Node of the CTN helped
remove barriers and prepared us for the Robert
Wood Johnson Advancing Recovery Project
1) Knowledge of the NIDA clinical trials and
evidence–based practices opened our minds to new
ideas for treatment improvement
2) Recognition of the importance of bringing
science into service in the ‘real’ world
Selection of Evidence Based Practices to
Overcome Barriers
To address our problems, we chose:
 CTN #0005 Motivational Interviewing as a
technique for engagement and retention

CTN #0010 Medication Assisted Treatment
– Bup/Nx facilitated rehabilitation for heroin
dependent adolescents

CTN #0030 Prescription Opioid Addiction
Treatment Study (POATS)
Summary of EBP Implementation Data
Motivational Interviewing
Over 300 clinicians attended DSHS coach
supported trainings in Austin, Dallas/Ft
Worth, Houston, Corpus Christi, El Paso,
Lubbock, and San Antonio in 2008/2009
130 support staff in Dallas/Ft. Worth area attended
DSHS supported MI 101 training in 2008
Dallas County Community College provided MI
training for professionals and support staff
in 2009
Advancing Recovery agencies actively implement
MI in their programming
Example of Results: Phoenix House significantly
reduced their AMA rate by using the MI
approach
25
20
15
10
5
0
3rd Q
2008
4thQ
2008
1st Q
2009
2nd Q
2009
AMA Rate
Eureka Moments

Phoenix House
Traditional Therapeutic Community
 Initial Skepticism about MI
 Attended & Implemented MI Training
 Experienced Dramatically Reduced AMA
NIATx Processes - Rapid Change & Walk Through
 Actually work, and
 Can be applied to almost any problem or situation


Summary of EBP Implementation Data
Medication Assisted Treatment
(MAT)

Overcame resistance to MAT through
exposure to CTN data

Medical Directors get Suboxone waiver

Value Options, public payor, agreed to pay for
Suboxone on a case by case basis

Implemented a small pilot study at Nexus that
included adults and adolescents - 2008

Expansion at Homeward Bound for public and
private pay clients – 2008 and 2009

Physicians are hesitant to prescribe
adolescents Suboxone. Phoenix House
psychiatrist just received his waiver. DCJD has
a new psychiatrist who is MAT ‘friendly’
Number
Suboxone
Clients per
Month
Jan
09
Feb
09
Mar
09
April
09
May
09
Jun
09
45
40
37
23
25
29
Nexus
Adults
5
7
7
9
12
13
Nexus
Adolescent
0
5
5
1
2
3
0
0
0
0
0
0
Homeward
Bound
DCJD &
Phoenix
House
More Than Medication is Needed for Recovery
Fidelity to the Recovery Model
Suboxone-MAT
Physical Health Medications
Mental Health Medications
Mental Health Evaluation, Counseling,
Case Management
Substance Abuse Treatment
Case Management
Wrap-around Services
After-care and Peer Support
Sponsor
12 Step Program
Physical Health Assessment,
Treatment, Follow-up
FUTURE DIRECTIONS

Watch for EBTs coming out of the CTN, especially those
supported by SAMHSA and the ATTCs, in looking for
solutions for treatment improvement

Expand MAT to include Naltraxone, Vivitrol and others

Continue using NIATx analysis and change techniques to
continuously evaluate and modify processes for systems
improvement

Be innovative. For example: CYT + Promotora
complementing MAT in the treatment of heroin dependent
Latino adolescents