Adolescent Continuing Care

1. Adolescent Continuing Care Alabama Partnership Robert Wood Johnson Foundation – Advancing Recovery

2. Alabama AR Partners • Alabama Department of Mental Health & Mental Retardation – Substance Abuse Service Division • Sarah Harkless • Bob Wynn • Tammy Peacock • Coaches • Carolyn Castro-Donlan • Neil Kaltenecker • FORMLL • Mike McLemore • Nova Center for Youth & Families • Gina Koger • Susan Smith • Northwest Alabama Mental Health Center • Gwen Thomas-LeBlanc • The Bridge, Inc. • Jeremy Blair

3. Where we have been • Lack of Availability of Adolescent Services • One-size fits all approach in terms of outpatient treatment • Wrap-around services were viewed as peripheral and not necessarily as a value-added service essential for treatment of adolescents • Client engagement and retention was not measured or tracked • Minimal focus on the consumer’s point of view

4. Enter Advancing Recovery • Began a process of collaboration with three adolescent providers and the SASD • Opened up dialogue among participants about treatment protocols and best practices. • Introduced the NIATX processes of walk-through and PDSA cycles.

5. State-wide Aims • Aim 1. Engage and retain youth in treatment and recovery process. • Aim 2. Effect salutary change on substance use related functioning.

6. Expected Outcomes • Increase adolescent access to and retention in continuing care following residential treatment • Improve outcomes for adolescents following residential treatment • Increase utilization of clinically appropriate levels of care • Utilize advocates to enhance programmatic design to be more consumer oriented • Increase the youth’s protective factors and decrease their risk factors from admission to residential treatment to discharge from continuing care.

7. Provider System Changes • Streamlining of admission process to remove barriers and increase engagement • Instituted referral and tracking system for youth following discharge from residential treatment and input on program design • Use of ASAM PPC-2R criteria to determine levels of care following discharge from residential treatment • Increased communication among residential treatment providers and outpatient providers • Developed a framework for partnerships

8. SASD System Changes • Development of new certification standards based on ASAM PPC2 criteria • Preparation for statewide training on ASAM PPC2 • Development of a standardized adolescent placement assessment to determine appropriate levels of care • Included continuing care as a component in all newly funded programs through the RFP process • Expansion of SASD funded adolescent treatment programs • Support for new adolescent treatment programs that are not state funded • Encourage interagency communication between adolescent providers and the SASD through the Organizational Readiness Workgroup and later the Adolescent Treatment Providers Group

9. The Data • Total number of clients admitted to continuing care increased from 40% in April/May 08 to 56% in April/May 09. • The average days to admission from residential discharge to continuing care decreased from 19 days in April 08 to 5 days in April 09. • A baseline was established in the first year consisting of an average of 22.4 case management referrals per month.

10. Clients Referred to CC Compared to Admitted to CC

11. Average Days to Admission to CC

12. Average Number of Case Management Referrals

13. Intra-Organizational Analysis • Identifying and referring to appropriate levels of care • Developing alternative levels of care (Outpatient, Continuing Care group) • Utilization of the Walk Through: • Provider Improvements: • Consumer focused improvements (expanded locations, privacy, comfort, schedules) • Paperwork reduction (intake and assessment) • Buy-in of staff in 11 locations • Follow up by residential staff post discharge • Identification of areas for improvement in the SASD: • Certification process • Billing • Communication

14. Inter-Organizational Analysis • Network of communication has opened up between the partners and with other adolescent providers which has facilitated: • the referral process for continuing care • new referrals • networking and relationships among providers • Building Relationships – • Awareness and buy in for continuing care by the Department of Youth Services, the Administrative Office of Courts, judges, juvenile probation officers • Statewide spread – developing working relationships and establishing a referral process with adolescent providers outside the AR project • Ongoing discussions with judges educating them on adolescent substance abuse treatment and the benefits of continuing care • Presentations on the benefits of continuing care at statewide conferences • Utilization of consumer advocacy to provide support for youth transitioning from residential treatment and input on program design • Ongoing review of the hand off of the client in the referral process

15. Lessons Learned to Date • It is about communication and relationships • Regular electronic and face-to-face meetings • Value of all participants conference calls • Value of planning then planning some more and then planning a little bit more • “You can observe a lot by watching” – Yogi Berra • Changing or improving processes take time and repetitive learning. Be patient and take the time to observe employees and clients during the implementation process.

16. Lessons Learned to Date – Cont’d • Use the available technology to aid in the implementation. Be creative in using your tools in ways previously unimagined. • Understand the usual operating or business practices can benefit from review and improvement. • Coaches have a wealth of knowledge and experience…..be open to their feedback and suggestions.

17. Eureka Moments!

18. Implement, Spread and Diffuse Financial Analysis • Review funding and service array of case management. • The base rate for these services was established in the previous decade. Inter-organizational • Through established provider network, continue to build effective relationships that removes barriers and opens up communication among adolescent providers.

19. Sustainability • Develop a sense of shared ownership for adolescent care with other providers through regular meetings with the Adolescent Treatment Providers Group • One day workshop on systems change & collaboration at the Alabama School of Alcohol & Drug Studies

20. Where we are going • Continue improving client retention and engagement • Use of video conferencing technology to facilitate transition to continuing care • Establish case management to provide wrap-around services as an integral part of substance abuse treatment for youth in outpatient and residential treatment

21. Contact Information • Jeremy Blair jeremyblair@bridgeinc.org • Gina Koger gina.koger@mhcmc.org • Gwen Thomas-LeBlanc gwen@froglevel.net • Tammy Peacocktammy.peacock@mh.alabama.gov