Washington Circle Public Sector Workgroup

Pilot Test for Adolescents

Institute for Behavioral HealthThe Schneider Institutes for Health PolicyThe Heller School for Social Policy and ManagementBrandeis 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)

Deborah Garnick, Margaret Lee, Constance Horgan, Andrea Acevedoon behalf of the Washington Circle Public Sector Public Workgroup

04/27/07 WC Public Sector Workgroup 2

WORKGROUP MEMBERS

Teresa Anderson, Ph.D.Andrew Hanchett, M.P.H.Massachusetts Department of Public Health

Charles Bartlett, MSWKansas Social and Rehabilitation Services

Astrid Beigel, Ph.D.County of Los Angeles, Department of Mental Health

Minakshi Tikoo, Ph.D.Alfred BidoriniMichael J. HettingerConnecticut Dept. of Mental Health and Addiction Services

Kevin Campbell, Ph.D.Washington State Division of Alcohol and Substance Abuse

Maria CanfieldBrad Towle, MA, MPANevada 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. CimaglioVermont Department of Health

Spencer Clark, ACSWAdam HoltzmanNorth Carolina Department of Health and Human Services

Kay MillerThomson Healthcare

04/27/07 WC Public Sector Workgroup 3

WORKGROUP MEMBERS

Sarah A. Wattenberg, LCSW-C Frances Cotter, MA, MPHHal KrauseAnne Herron, M.S.CSAT/SAMHSA

Ann Doucette, Ph.D.The George Washington University

Jay Ford, Ph.DNetwork 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.DMark Reynolds, Ed.D.Tracy Leeper, M.A.Oklahoma Department of Mental Health and Substance Abuse Services

Kathleen NardiniNational Association of Alcohol and Drug Abuse Directors

Melissa Lahr Thomas, M.Ed.Meena ShahiArizona Department of Health Services

Constance Weisner, Dr. P.H., MSWUniversity of California, San Francisco Kaiser Permanente

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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

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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

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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 7

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

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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 9

ADOLESCENT POPULATION (AGES 12-17)

MA NC OK TN WA

N 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

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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

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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

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49%

60%

53%47%

73%

62%

34%

44%42%

33%

0%

100%

MA NC OK TN WA

Initiation

Engagement

RESULTS: ADOLESCENT OUTPATIENT INITIATION AND ENGAGEMENT

1,355 2,027 1,271 820 1,796

Note: Numbers below bars are denominators for measures.

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WHAT IS THE SENSITIVITY OF THE 14-DAY SPECIFICATIONS? ADOLESCENT OUTPATIENT INITIATION EXAMPLES

6% 4% 2% 3%10%

2% 1% 1% 1% 1% 5% 1% 1% 1% 1% 0% 1% 2% 2%9%

35%

2% 1%2%6%

0%

10%

20%

30%

40%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21-24

25-29

30-34

35+

Per

cen

t o

f C

lien

ts

12%6% 3% 4%

13%2% 1% 1% 1% 2% 4% 1% 1% 1% 1% 1% 4% 3% 2% 6%

19%

4% 2%2%4%

0%

10%

20%

30%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21-24

25-29

30-34

35+

Perc

ent o

f Clie

nts

11%8%

4%8%

13%

4% 2% 1% 2% 3% 3% 1% 0% 1% 1% 1% 4% 2% 1% 3%

13%7%

2% 1%5%

0%

10%

20%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21-24

25-29

30-34

35+

Perc

ent o

f Clie

nts

North Carolina

Tennessee

Washington

Days to next service after index:

No next service

No next service

No next service

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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

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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

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57%

77%81%

75%

94%

46%

0%

100%

MA TN WA

Initiation

Engagement

RESULTS: ADOLESCENT INTENSIVE OUTPATIENT INITIATION AND ENGAGEMENT

95

547605

Note: Numbers in bars are denominators for measures.

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DEFINITION: CONTINUITY OF CARE AFTER ASSESSMENT

Assessment Continuity = Individuals with positive assessment

who received another service* within 14 daysIndividuals with positive assessment

*Not detox or crisis care

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RESULTS: ADOLESCENT CONTINUITY OF CARE AFTER POSITIVE ASSESSMENT*

59%

45% 43%

0%

100%

NC TN WA

Per

cen

t

Note: Numbers in bars are denominators for measures. * Shows states that have assessment data.

1,7933,433

State

902

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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

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7%

67%

14% 15%

27%31%

24%19%

0%

100%

MA NC OK TN WA

Residential

Inpatient

RESULTS: ADOLESCENT CONTINUITY OF CARE AFTER RESIDENTIAL AND INPATIENT

270454

286

653858

601

255

1510

Note: Numbers in bars are denominators for measures. MA and OK do not provide inpatient services.

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COMPARISONS WITH ADULTS

MA NC OK WA

OP InitiationAdol. 49% 60% 53% 73%

Adult 42% 42% 61% 73%

OP Engagement

Adol. 33% 42% 44% 62%

Adult 27% 24% 53% 64%

Residential Continuity of Care

Adol. 7% 67% 14% 27%

Adult 28% 37% 22% 36%

Note: TN did not analyze adult data

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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