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Improving Continuation from Detox into Treatment – Advancing Recovery in Colorado PowerPoint Presentation
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Improving Continuation from Detox into Treatment – Advancing Recovery in Colorado

Improving Continuation from Detox into Treatment – Advancing Recovery in Colorado

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Improving Continuation from Detox into Treatment – Advancing Recovery in Colorado

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Presentation Transcript

  1. Improving Continuation from Detox into Treatment – Advancing Recovery in Colorado Erik Stone, MS, CAC III Signal Behavioral Health Network Joseph Contreraz, CAC III Denver CARES

  2. The Problem • High admissions to non-medical detoxification programs (~ 50,000 per year) • Clients typically have minimal to mild withdrawal, are brought by law enforcement, stay in detox for a day or so (AH average LOS is 1.4) • Average of less than 10% enter treatment within 30 days of discharge from detox

  3. Advancing Recovery Partners • Signal – Managed service organization (MSO) funding substance abuse detox and treatment services • State Division of Behavioral Health (DBH) – Single state agency; licensing authority • Arapahoe House – Metro Denver provider of outpatient and residential services; has 3 detox facilities • Denver Health – Denver provider of outpatient and residential services; has 1 detox facility • Advocates for Recovery – Advocacy organization for the recovery community in Colorado

  4. Baseline and Goals • Arapahoe House – Aurora Baseline continuation rate is 4.9%; goal is 14.9% • Denver CARES – Denver Baseline continuation rate is 2.7%; goal is 12.7%

  5. Measuring Detox Continuation • Unique clients, not admissions • Who live in metro Denver • Who are recommended for formal substance abuse treatment • Who enter treatment at a Signal provider within 30 days of discharge from detox • And who have a treatment service within 15 days of admission to treatment

  6. State/Payer Changes • Creation of fiscal incentives for detox continuation • Improved reporting on continuation from detox into treatment • Creation of statewide standardized protocol for DUI referrals

  7. Levers for State/Payer Changes • Inter-organizational capability analysis • Bringing DBH, State Judicial, local Judicial districts into the planning process • Reaching out to private DUI providers to turn opponents into willing participants • Purchasing and contracting analysis • Development of fiscal incentives in MSO/State contract • Incentives in Signal contracts with providers for 09-10 contract year → $65K for continuation from detox into tx, from residential into lower levels of care, and for OP lengths of stay > 90 days

  8. Provider Changes • Updating referral information • Providing incentives to staff for OP intakes • Having OP staff come to detox; assess clients • Allowing detox staff to schedule OP intakes • Waiving intake fees for detox clients transferring within agencies • Outreach to DUI service providers

  9. Levers for Provider Changes • Intra-organizational operations analysis • Walk through discoveries → Insurance review barriers, lack of immediate intake appoinments, paperwork duplication • Internal barriers change team created • Inter-organizational capability analysis • Outreach to DUI service providers • Development of preferred providers → Create a partnership with outside providers; agreements for tracking clients, calling no shows, reporting enrollment status; availability of intake slots and warm handoffs; flexibility in fee collection

  10. Success Stories • Clients are getting into treatment more consistently and much faster • Staff morale is increasing as clients get into treatment; as staff are rewarded for referrals and admissions

  11. Role of Incentives • AR funds used to create incentive pools rather than simply paying for participation; providers created incentive plans each year • Results are mixed Useful tool for jump starting & managing project, but • Significant cultural differences between providers • Surprisingly difficult to identify effective levels of incentive • Need faster linkage between performance and incentive • Incentives not sufficient to modify workflow

  12. Next Steps • Continue to work towards continuation goals • Spread continuation project to other detox facilities in Signal network → Provide incentives in 09-10 contract year • Approve DUI Detox protocol; write into state policy; spread statewide • Focus on other populations such as injecting drug users, pregnant women, women with dependent children

  13. Contact Information Erik Stone, MS, CAC III Signal Behavioral Health Network 455 Sherman St., #455 Denver, CO 80203 720-263-4853 estone@signalbhn.org