Washington Circle Public Sector Workgroup Pilot Test for Adolescents

Deborah Garnick, Margaret Lee, Constance Horgan, Andrea Acevedo

on behalf of the Washington Circle Public Sector Public Workgroup Institute for Behavioral Health The Schneider Institutes for Health Policy The Heller School for Social Policy and Management Brandeis University

Joint Meeting on Adolescent Treatment Effectiveness, Washington, D.C., April 27, 2007 Supported by: SAMHSA, CSAT through a supplement to the Brandeis/Harvard NIDA Center on Managed Care and Drug Abuse Treatment (Grant #3 P50 DA010233)

WORKGROUP MEMBERS

Teresa Anderson, Ph.D.

Andrew Hanchett, M.P.H.

Massachusetts Department of Public Health

Charles Bartlett, MSW

Kansas Social and Rehabilitation Services

Astrid Beigel, Ph.D.

County of Los Angeles, Department of Mental Health

Minakshi Tikoo, Ph.D.

Alfred Bidorini Michael J. Hettinger

Connecticut Dept. of Mental Health and Addiction Services

Kevin Campbell, Ph.D.

Washington State Division of Alcohol and Substance Abuse

Maria Canfield Brad Towle, MA, MPA

Nevada State Health Division

Doreen A. Cavanaugh, Ph.D.

Georgetown University Public Policy Institute

Mady Chalk, Ph.D.

A. Thomas McLellan, Ph.D.

Treatment Research Institute

Barbara A. Cimaglio

Vermont Department of Health

Spencer Clark, ACSW Adam Holtzman

North Carolina Department of Health and Human Services

Kay Miller

Thomson Healthcare 04/27/07 WC Public Sector Workgroup 2

WORKGROUP MEMBERS

Sarah A. Wattenberg, LCSW-C Frances Cotter, MA, MPH Hal Krause Anne Herron, M.S.

CSAT/SAMHSA

Ann Doucette, Ph.D.

The George Washington University

Jay Ford, Ph.D

Network for the Improvement of Addiction Treatment

Frank McCorry, Ph.D Robert J. Gallati, M.A.

Dawn Lambert-Wacey, M.A.

New York State Office of Alcoholism and Substance Abuse Services

Craig Anne Heflinger, Ph.D

.

Robert Saunders, M.P.P.

Vanderbilt University

Keith Humphreys, Ph.D.

VA Palo Alto Health Care System

Jack Kemp, M.S.

Delaware Health and Social Services

Steve Davis, Ph.D

Mark Reynolds, Ed.D.

Tracy Leeper, M.A.

Oklahoma Department of Mental Health and Substance Abuse Services

Kathleen Nardini

National Association of Alcohol and Drug Abuse Directors

Melissa Lahr Thomas, M.Ed.

Meena Shahi

Arizona Department of Health Services

Constance Weisner, Dr. P.H., MSW

University of California, San Francisco Kaiser Permanente 04/27/07 WC Public Sector Workgroup 3

OVERVIEW

• Discuss importance of developing performance measures focused on adolescents • Describe the Washington Circle • Present results for adolescents using 2005 data • Conclusion and next steps

4 04/27/07 WC Public Sector Workgroup

IMPORTANCE OF PERFORMANCE MEASURES FOR ADOLESCENTS

• Treatment gap for adolescents in entering SA treatment and in receiving recommended services • Process measures are focused on providing the right services at the right time • Washington Circle performance measures are process measures • Performance measures key for tracking quality improvement efforts 5 04/27/07 WC Public Sector Workgroup

WASHINGTON CIRCLE: HISTORY

• Convened in 1998 by SAMHSA’s Center for Substance Abuse Treatment • Goals: – Develop and pilot test performance measures for substance abuse treatment – Promote adoption of these measures by public and private stakeholders • Brandeis works with Washington Circle to develop and test performance measures for substance abuse beginning with application in commercial managed care plans • NCQA adoption of measures in 2003 04/27/07 WC Public Sector Workgroup 6

WC PUBLIC SECTOR WORKGROUP

• Formed in Fall of 2004 • Goals:

– Improve delivery of substance abuse treatment services in public sector at state level – Adapt WC performance measures for use in states for continuous quality monitoring – Develop common approach among states

• Representatives from 12 states and some local jurisdictions have participated

7 04/27/07 WC Public Sector Workgroup

REVISIONS TO SPECIFICTIONS – EXPANDED TO TEN MEASURES

1. Identification 2. Initiation after Outpatient 3. Engagement after Outpatient 4. Initiation after Intensive Outpatient 5. Engagement after Intensive Outpatient 6. Continuity of care after Assessment Service 7. Continuity of care after Detoxification 8. Continuity of care after Short-term Residential 9. Continuity of care after Long-term Residential 10. Continuity of care after Inpatient 04/27/07 WC Public Sector Workgroup 8

ADOLESCENT POPULATION (AGES 12-17)

N

MA NC OK TN WA

482,812 695,274 284,112 454,406 527,665

% below poverty

12.8% 20.2% 16.4% 18.5% 14.3%

% abuse/ dependence of any illicit drug/alcohol

9.9% 7.2% 10.7% 7.5% 9.0%

Sources: U.S. Census Bureau/2004 American Community Survey; 2003 and 2004 National Survey on Drug Use and Health

04/27/07 WC Public Sector Workgroup 9

DEFINITION: OUTPATIENT INITIATION

Initiation = Individuals with an OP index* service who received a second service** within 14 days after the index service Individuals with an OP index service *Index service defined as first service after a 60-day “service-free period.” Can have assessment or detox during service-free period.

**Not detox or crisis care 04/27/07 WC Public Sector Workgroup 10

DEFINITION: OUTPATIENT ENGAGEMENT

Engagement = Individuals who initiated OP SA treatment and received two additional services** within 30 days after initiation Individuals with an OP index* service *Index service defined as first service after a 60-day “service-free period.” Can have assessment or detox during service-free period.

**Not detox or crisis care 11 04/27/07 WC Public Sector Workgroup

100% RESULTS: ADOLESCENT OUTPATIENT INITIATION AND ENGAGEMENT Initiation Engagement 49% 33% 60% 42% 53% 44% 47% 34% 73% 62% 0% 1,355 MA 2,027 NC 1,271 OK Note: Numbers below bars are denominators for measures.

04/27/07 WC Public Sector Workgroup

820 TN 1,796 WA

12

WHAT IS THE SENSITIVITY OF THE 14-DAY SPECIFICATIONS? ADOLESCENT OUTPATIENT INITIATION EXAMPLES Days to next service after index: 3 0 % 2 0 % 10 % 12% 6% 0 % 1 2 3 4% 3% 4% 4% 13% 2% 4 5 6 7 8 9 10 North Carolina 2% 1% 1% 1% 2% 4% 11 12 13 14 15 2% 1% 1% 1% 1% 1% 4% 3% 2% 6% 16 17 18 19 19% 2 0 2 1 2 4 2 5 2 9 3 0 3 4 3 5+

No next service

4 0 % 3 0 % 2 0 % 10 % 0 % 6% 4% 1 2 3 2% 2% 6% 3% 10% 2% 4 5 6 7 8 9 10 11 Tennessee 2% 1% 1% 1% 1% 5% 12 13 14 15 1% 1% 1% 1% 1% 0% 1% 2% 2% 9% 16 17 18 19 35% 2 0 2 1 2 4 2 5 2 9 3 0 3 4 3 5+

No next service

2 0 % 10 % 11% 8% 5% 4% 7% 8% 13% 4% 0 % 1 2 3 4 5 6 7 8 9 2% 2% 1% 2% 3% 3% 10 Washington 11 12 13 14 15 1% 1% 0% 1% 1% 1% 4% 2% 1% 3% 13% 16 17 18 19 2 0 2 1 2 4 2 5 2 9 3 0 3 4 3 5+

No next service 04/27/07 WC Public Sector Workgroup 13

DEFINITION: INTENSIVE OUTPATIENT INITIATION

Initiation = Individuals with an IOP index* service who received a second service** within 14 days after the index service Individuals with an IOP index service *Index service defined as first service after a 60-day “service-free period.” Can have assessment or detox during service-free period.

**Not detox or crisis care 04/27/07 WC Public Sector Workgroup 14

DEFINITION: INTENSIVE OUTPATIENT ENGAGEMENT

Engagement = Individuals who initiated IOP SA tx and received two additional services** within 30 days after initiation Individuals with an IOP index* service *Index service defined as first service after a 60-day “service-free period.” Can have assessment or detox during service-free period.

**Not detox or crisis care 15 04/27/07 WC Public Sector Workgroup

RESULTS: ADOLESCENT INTENSIVE OUTPATIENT INITIATION AND ENGAGEMENT

100% 94% Initiation Engagement 77% 81% 75% 57% 46% 605 547 95 0% MA TN Note: Numbers in bars are denominators for measures.

04/27/07 WC Public Sector Workgroup

WA

16

DEFINITION: CONTINUITY OF CARE AFTER ASSESSMENT

Assessment Continuity = Individuals with positive assessment who received another service* within 14 days Individuals with positive assessment *Not detox or crisis care 04/27/07 WC Public Sector Workgroup 17

RESULTS: ADOLESCENT CONTINUITY OF CARE AFTER POSITIVE ASSESSMENT* 100% 59% 1,793 45% 902 43% 3,433 0% State NC TN WA Note: Numbers in bars are denominators for measures.

* Shows states that have assessment data.

04/27/07 WC Public Sector Workgroup 18

DEFINITION: CONTINUITY OF CARE AFTER RESIDENTIAL AND INPATIENT

Residential Continuity = Individuals who had a residential service that was followed by another service* within 14 days after discharge Individuals discharged from a residential stay Inpatient Continuity = Individuals who had an inpatient service that was followed by another service* within 14 days after discharge Individuals discharged from an inpatient stay * Not detox or crisis care 04/27/07 WC Public Sector Workgroup 19

RESULTS: ADOLESCENT CONTINUITY OF CARE AFTER RESIDENTIAL AND INPATIENT 100% Residential Inpatient 67% 601 27% 31% 24% 19% 7% 270 454 14% 858 15% 653 255 286 1510 0% MA NC OK TN WA Note: Numbers in bars are denominators for measures.

MA and OK do not provide inpatient services.

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COMPARISONS WITH ADULTS

OP Initiation OP Engagement Adol.

Adult Adol.

Adult Residential Continuity of Care Adol.

Adult

Note: TN did not analyze adult data MA

49% 42% 33% 27% 7% 28% 04/27/07 WC Public Sector Workgroup

NC

60% 42% 42% 24% 67% 37%

OK

53% 61% 44% 53% 14% 22%

WA

73% 73% 62% 64% 27% 36% 21

CONCLUSIONS

• Feasible to calculate Washington Circle performance measures for adolescents from routinely available information within public sector programs • Measures can be used to estimate basic quality of care • Variable results across states • Not possible to determine reasons for the results – Could be due to: Client motivation, quality improvement needs, financial issues, and/or other factors • Ongoing work and next steps – Reporting to providers – Dissemination 22 04/27/07 WC Public Sector Workgroup