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