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Partnering to Improve Quality of Care in Substance Abuse Treatment Pat Ebener, RAND Corporation Jim Dahl, Phoenix House Foundation Collaborators RAND: Suzanne Wenzel, PI; Maria Orlando, co-PI; Donna Farley, Kirsten Becker Phoenix House:

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partnering to improve quality of care in substance abuse treatment

Partnering to Improve Quality of Care in Substance Abuse Treatment

Pat Ebener, RAND Corporation

Jim Dahl, Phoenix House Foundation

collaborators
Collaborators
  • RAND:
    • Suzanne Wenzel, PI; Maria Orlando, co-PI; Donna Farley, Kirsten Becker
  • Phoenix House:
    • Wallace Mandell, co-PI; Leslie Damesek, Masami Ohashi
    • Staff in 22 Phoenix House community-based adult and adolescent treatment programs and prisons in California, New York, Texas, Florida, New England
background on our partnership
Background on Our Partnership
  • RAND and Phoenix House: A 7-year partnership
  • Shared objective: Routinely monitor and improve quality of care
  • Task: Develop a system of linked information assessing structure, process, and outcomes of treatment that can be applied in routine practice settings to improve quality of care
study goal and specific aims
Study Goal and Specific Aims
  • Goal: Improve quality of care in the therapeutic community
  • Phases/Aims:
    • Refine and gather validity evidence for client process instrument (DCI) across treatment subpopulations
    • Validate refined DCI by examining factor structure, in-treatment change in client scores, and the association of scores with proximal and distal outcomes and with program activities and environment
    • Examine how treatment programs use treatment process information within a continuous quality improvement (CQI) framework
the dimensions of change instrument dci
The Dimensions of Change Instrument (DCI)

1. Acceptance of Community Responsibility

Community Environment

2. Clarity and Safety in Community

3. Participation in Group Process

4. Resident Sharing, Support, and Enthusiasm

5. Introspection and Self-Management

6. Positive Self-Attitude and Commitment to Abstinence

Personal Development and Change

7. Personal Problem Recognition

8. Maintaining External Social Network

5

the dci measures change over time for residents remaining in treatment

Enter

Treatment

30+

Days

90+

days

180+

days

270+

days

Stay

Stay

Stay

Stay

Leave

Leave

Leave

Leave

The DCI Measures Change Over Time for Residents Remaining in Treatment
slide7
Adolescent Stayers ( 254 residents) vs. Leavers ( 98 residents) at 30 Days:Personal Development & Change Dimensions

# 7

7

slide9
All Adults ( 341 residents) at 90 Days: Community Environment Dimensions vs. ( 139 residents) Long Island Programs

9

phase 3 using the dci data in a quality improvement demonstration
Phase 3: Using the DCI Data in a Quality Improvement Demonstration
  • Participating programs receive information on DCI scores for their members from Phase 2 work
  • Experimental programs prepare and carry out quality improvement action plans aimed at improving DCI scores
  • Monitor implementation and assess effects of quality improvement actions on program outcomes

ProgramsExperimentalControl

Adult 2 1

Adolescent 2 1

partnering to plan phase 3
Partnering to Plan Phase 3
  • Formed joint RAND-Phoenix House Planning Committee
  • Invited candidate programs to briefing at NY Workshop
  • Circulated monthly newsletter on status of Phase 3 planning
  • Jointly developed Workshop agenda and materials
the core tc program elements
Morning Meetings

House Meetings

Seminars

Encounter Groups

Job Functions

Rewards and Sanctions

Staff Roles

Peer Roles

Physical Environment

The Core TC Program Elements
partnering on p3 launch workshop
Partnering on P3 Launch Workshop
  • Analyze DCI scores and assess performance of related program elements
  • Identify barriers to successful implementation
  • Develop an overall quality improvement strategy and specific actions
  • Establish measures and a process to monitor progress
workshop results and preliminary impressions
Workshop Results and Preliminary Impressions
  • Day 1. Group observation forms completed by PH Research Dept. and RAND staff found:
    • Most group members had moderate to mostly sufficient understanding of the data for informed discussion
    • Most groups had enthusiastic participation
    • Members of groups were typically not stressed by the tasks and felt they had sufficient time for discussion
  • Day 2 programs all completed analysis and action planning process and briefed each other on their plans:

- 3 strategies target Encounter Groups

- 1 targets Staff Roles

partnering on next steps support for implementation activities
Partnering on Next Steps: Support for Implementation Activities
  • Training personnel, programs and materials prepared by the Phoenix House Training Center
  • Guidance by RAND for monitoring methods
    • Development of measures
    • Data collection methods
  • One-on-one phone and e-mail consultation, conference calls, site visits
the process evaluation learning from experiences
The Process Evaluation: Learning from Experiences
  • Purposes
    • Learn from the programs’ experiences as they use DCI data and take actions to strengthen relevant program elements
    • Use the process information to help interpret results for outcome measures
  • Process evaluation components
    • Monthly conference calls for progress reports
    • Site visits after months 3 and 9 of Phase 3
    • Mini-QIPs performed in month 6 of Phase 3
outcome evaluation outcomes to be monitored
Outcome Evaluation: Outcomes To Be Monitored
  • Change in DCI scores – administer DCI to clients in experimental and control programs at two points in time
    • Start of phase 3 (baseline)
    • Month 7 of phase 3 (post-intervention)
  • Change in client retention rates
  • Changes in measures collected on the Phoenix House QIP
lessons from planning and launching the demonstration
Lessons From Planning and Launching the Demonstration
  • Novel and creative approach to QI
  • Strong working relationship is critical
  • Complex data can be overwhelming
    • Simplify presentation
    • Reduce volume
    • Provide talking points for group facilitators
  • Include researchers in facilitated break-out groups
  • Structure the planning process
  • Expect to provide ongoing technical assistance