ucla integrated substance abuse programs richard rawson, ph.d. rachel gonzales, ph.d. funded by:...

UCLA Integrated Substance Abuse Programs

Richard Rawson, Ph.D.

Rachel Gonzales, Ph.D.

Funded by: California Alcohol and Drug Programs

CalOMS Training for Counties

Learning Objectives

• Goals of the CA Data System

• Importance of using data to improve treatment

• Basic models for disseminating CalOMS data

Goals of CA Data System• Provide a comprehensive data

collection and management system

• To establish greater accountability of the treatment system for providing quality services

• Ensure efforts are in accordance with SAMHSA’s National Outcome Measurement System – NOMS – essential Indicators used to

evaluate the quality of substance abuse treatment

Importance of CalOMS Data• CalOMS data are standardized –same data are collected

across programs/counties at admission (t1) and discharge (t2)

• CalOMS data are comprehensive - allows for understanding:

– Client’s in treatment (Demographic data)– Treatment patterns (Service data)– How programs are performing (Performance data)– Impact of treatment on client outcomes (Outcome data)

CalOMS data helps us keep up to date with treatment improvement initiatives: Use data to improve treatment

Step 1: What do you want to know: Tx Priority

Step 2: Identify CalOMS Data Needed (demographic, service, performance, outcome)

Step 3: Request Data/Run Data Report

Step 4: Examine & Analyze Results

Step 5: Determine, what, if any, changes should be made to improve service delivery

Steps: Using CalOMS Data

Exercise: CalOMS Demographic Data

• Who’s in treatment?

– Primary substance problem(e.g., alcohol, marijuana, cocaine,

opiates, prescription, meth)

– Special needs: Pregnant(e.g., injectors, homeless, youth,

disabled, veterans, criminal offenders, mentally ill)

Apply CalOMS demographic data to treatment improvement initiatives

Primary Substance Problem

CalOMS Treatment Admission Report

Clients with Special Needs

• 6% of admissions were pregnant women• Meth most commonly reported among

pregnant women

Exercise: CalOMS Service Data

• What are treatment trends?

– Service utilization

(e.g., detox, outpatient, residential, NTP)

– Treatment referral sources (e.g., SACPA, Self, DMC)

Apply CalOMS service data to improve treatment

Service Utilization & Referral

LT Residential17%

ST Residential2%

Outpatient58%

Detox12%

NTP Detox5%

NTP Maintenance6%

Other21%

Self31%CJ - SACPA

24%

CJ - Non-SACPA24%

•Most admissions are to outpatient programs

•½ of referrals are from criminal justice system

CalOMS Assessing Services Report

What is Performance Data?

Desired Desired OutcomesOutcomes

Access

Retention/Completion

Continuity of Care

TreatmentTreatment

Performance indicators measure the treatment process at the program level

Exercise: CalOMS Performance Data

Access

Retention

Continuity of Care

Applying CalOMS performance data to improve treatment

Access

(Wait time)

Research supports: reduced wait time is associated with improved engagement and

retention in treatment…

CalOMS Assessing Services Report

Access for Priority Populations

5.1 4.8 4.5

0

2

4

6

Mean Waitlist Time

Day

sPregnant Homeless Injector

Retention

(Length of stay)

Research supports: without an adequate amount of time in

treatment, few improvements are observed….

<30 days

<90 days

>90 days

CalOMS Service Utilization Report

What do the data indicate?

0

25

50

75

100

<30 days 30-89 days 90+ days

Large Counties

Statewide

Outpatient Treatment

Sub-optimal< ½ Optimal Dose

< 1% are staying

365 days or more

40% not retaining

during initial 30

days

Continuity of Care Measure

Do individuals who enter treatment proceed through appropriate levels of care?

Per CalOMS: matched admission-discharge treatment service sets that occur within 30 days of a prior discharge (via client unique client ID)

Treatment Episode

Continuing Care/Aftercare Programs

Detox/Inpatient Long-term

Residential Treatment

Intensive Outpatient/Psychosocial Behavioral Treatment

Sober Living Residence

Continuity of Care Patterns

87.5747765.5

75.888.4

2612.5

2334.524.211.6

0

25

50

75

100>1 TreatmentService

1 TreatmentService

Majority of clients only receive 1 service (level of care)

75% of clients in detox do not go to another level of care

What is Outcome Data?

Desired Desired OutcomesOutcomes

Substance use

Employment/Education

Criminal Activity

Housing Stability

Social Connectedness

TreatmentTreatment

Outcome indicators measure client status at the client level

Exercise: CalOMS Outcome Measures Interested in treatment impact

• Stopping or Reducing– Substance use– Unemployment – Crime– Homelessness– Family conflict

Applying CalOMS Outcome data to improve treatment

Reductions in Criminal involvement and crime

Changes During Treatment Reports

Improvements in Client Outcomes

65

25

35

2012

36 34

45

17

6

0

50

100

Primary drug use Employment Employed/school

Homeless Family conflict

Perc

ent

admission discharge

Step 5: Using Data to Improve Treatment

Desired Program/Policies/Services

DataWhat’s being done

What NEEDS to be done

What To Look At?Start at the…

Program and Provider Level

ACTIVITIES: Use of evidence based practices FACTORS: Staff, license/training, resources, tx environment

PERFORMANCE MEASURESAccess, retention, continuity of care

Tx Improvement: What changes are needed?

• What program elements can affect performance measures?

– Improved screening and placement

– Timeliness & rapid response – Comfortable, friendly

environments – Flexibility– Case management

Strategies for Enhancing Service Linkages

• Active referral/transfer

• Case management processes

• Integrating staff at different tx levels

• Creating personal linkages

• Arranging transportation

• Referring to appropriate geographical location

Illustration: NIATX Strategies Improve Access & Retention

Screening/Screening/PlacementPlacement

Timeliness/Timeliness/Rapid Response Rapid Response

Enhanced Enhanced Tx Tx

ResponseResponse

Contact your ATTC Representative

Summary: Utility of CalOMS Data

Provides Evidence Establish Priorities Decision-Making Improvement

and…

.... increase and sustain

Community & Financial Support $$$

For Services & Programs

Remember•Data in a system is only as good as how the data is collected…

•Data quality efforts are essestial

Data Validity is Essential

Goal: Improved Measures

• More work is needed to improve upon CalOMS performance and outcome measurement

• Standard data collection of discharge is necessary for valid data and assessing treatment quality & effectiveness

Continued Training is Critical

Disseminate the Data

• Demonstrates utility

• Gives feedback on services and outcomes

• Increases buy-in & engagement

• Improves data collection

Greater data quality & valid data

Effective Dissemination Models

Using CalOMS data you can create:

Program Site Reports (report card)Brief Treatment UpdatesFact Sheets on specific topicsState CalOMS Reports

Program Site Reports

• Report Style

• Executive Summary

• Highlight Program Performance

• Tables/Graphs with Outcomes

• Engaging

Treatment Updates

• Specific data topic

• Newsletter Style

• One-page Format

• Graphs/Tables

• Short Summary

Treatment Updates

• Innovative

• Quick Reference

• Targeted Subject

• Concise

Fact Sheets

• Comprehensive• Visual • Summary of major

trends• Downloadable

State CalOMS Reports

CalOMS Resources

• Data Dictionary

• Data Collection Guide

• Reports User Guide & Instructions

• Data Quality Standards

http://www.adp.ca.gov/CalOMS/CalOMSmain.shtml

Contact Information

Richard Rawsonrrawson@mednet.ucla.edu

Rachel Gonzalesrachelmg@ucla.edu

www.uclaisap.org