Problem Gambling NIATx Pilot Project


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By Janet Bardossi, LCSW and Nicole Corbin, LPC, CGAC II, CADC I, at May 2011 Oregon Problem Gambling Services Spring Training.
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  • Nolan’s model--three questions and PDSA, but not just one PDSA. Difference between this and Juran is the emphasis on repeated PDSA cycles
  • Problem Gambling NIATx Pilot Project

    1. 1. The NIATx Model and Problem Gambling Treatment Reducing Paperwork Improving care
    2. 2. Thanks!!!!! <ul><li>AMH </li></ul><ul><li>Oregon Council on Problem Gambling </li></ul><ul><li>Cascadia </li></ul>
    3. 3. What is NIATx? <ul><li>NIATx offers a model to use in improving access to and retention in behavioral health treatment and making process improvement part of their culture. </li></ul>
    4. 4. What we know <ul><li>The research shows that access to and retention in treatment are the greatest predictors of successful recovery </li></ul><ul><li>Washington Circle (NIATX 2004) </li></ul>
    5. 5. Why Process Improvement? <ul><li>Clients are served by processes . </li></ul><ul><li>85 percent of client-related problems are caused by processes. </li></ul><ul><li>We must improve our processes to better serve clients . </li></ul>
    6. 6. Four AIMS Reduce Waiting Times Reduce No-Shows Increase Admissions Increase Continuation
    7. 7. IT works!!!!! NIATx members have realized… <ul><li>34 percent reduction in waiting times </li></ul><ul><li>33 percent reduction in no-shows </li></ul><ul><li>21 percent increase in admissions </li></ul><ul><li>22 percent increase in treatment continuation </li></ul>
    8. 8. Can this model work for problem gambling treatment?
    9. 9. The Iowa NIATx-Problem Gambling Project Issues to be addressed <ul><li>Increasing admissions different than substance abuse treatment program </li></ul><ul><li>Many crisis calls do not convert to a screening or admission. </li></ul><ul><li>Gambling treatment resources in Iowa currently underutilized </li></ul><ul><li>Continuation through early treatment </li></ul>
    10. 10. Walkthrough Results for the State <ul><li>Walk-through forced state staff to see: </li></ul><ul><ul><li>How unreasonable paperwork was </li></ul></ul><ul><ul><li>State data tool-three pages-overly detailed </li></ul></ul><ul><ul><li>Outcome monitoring tool – two pages – very repetitious of the data tool </li></ul></ul><ul><ul><li>State licensure requirements are intensive </li></ul></ul><ul><li>State staff made commitments: </li></ul><ul><ul><li>Reduce repetition </li></ul></ul><ul><ul><li>Reduce requirements </li></ul></ul>
    11. 11. Program Barriers <ul><li>Too much paperwork up front </li></ul><ul><li>Often seemed to be more important to complete paperwork than listen to client </li></ul><ul><li>Most programs were doing three distinct gambling screens with each client despite being required to only do one. </li></ul>.
    12. 12. Reduce Paperwork
    13. 13. Reduce Paperwork--Eliminate Redundancy in Assessment Jackson
    14. 14. Reduce Paperwork by Using DT Form [Distance Treatment Form]
    15. 15. Reduce No Shows
    16. 16. Jackson Recovery Used Reminder Calls to Reduce No Shows
    17. 17. Counselors Used MI Skills to Increase Successful Discharge
    18. 18. The Model for Improvement <ul><li>The place to start </li></ul><ul><li>3 Fundamental Questions </li></ul>
    19. 19. Question #1 What are we trying to accomplish? <ul><li>Make sure that the team is working on important problem </li></ul>
    20. 21. Question #2 How will we know a change is really an improvement? <ul><li>Establish clear and relevant measures </li></ul>
    21. 22.    Key Paths to Recovery    NIATx measures: <ul><li>Reduce waiting (Time from the first request for service to the first post-assessment treatment) </li></ul><ul><li>Reduce no shows </li></ul><ul><li>Number of Clients with an assessment) (Number of Clients who schedule an assessment appointment) </li></ul><ul><li>Increase admissions (Unduplicated Admissions = Sum of Clients Admitted to ASAM Level of Care I Outpatient services) </li></ul><ul><li>Increase continuation (% clients continuing from first request to assessment, onto a 1st, 2nd, 3rd & 4th treatment session </li></ul>
    22. 23. Data, data, data!!!! <ul><li>Keep it simple </li></ul><ul><li>Keep it measurable </li></ul><ul><li>Establish a baseline </li></ul><ul><li>Use hand tallies- Do not depend on IT </li></ul><ul><li>Give up the idea of perfect measures </li></ul><ul><li>Compare apples to apples- </li></ul><ul><li>e.g. counseling vs dosing engagement </li></ul>
    23. 24. Question #3 What changes can we make that will result in an improvement? <ul><li>Develop and test changes </li></ul>
    24. 25. Model for Improvement 3. What changes can we test that will result in an improvement? 1. What are we trying to accomplish? 2. How will we know that a change is an improvement? Act Plan Study Do
    25. 26. So can we do this in Oregon???
    26. 27. Oregon Gambling NIATx Project <ul><li>Project Goals: Streamline paperwork and remove barriers to care </li></ul>
    27. 28. The Guinea Pig Cascadia <ul><li>Started in March 2011 </li></ul><ul><li>Original Goals </li></ul><ul><ul><li>Reduce Paperwork </li></ul></ul><ul><ul><li>Increase access </li></ul></ul>
    28. 29. We started with a….
    29. 30. What we found <ul><li>Access was strong- within 72 hours-Show rate was 78% </li></ul><ul><li>However…. The next appointment took weeks </li></ul><ul><li>The show rate to the next appointment was poor losing almost half </li></ul>
    30. 31. Goal to reduce paperwork <ul><li>Initial appointment was 75-90 minutes </li></ul><ul><li>Great engagement </li></ul><ul><li>Too much paperwork </li></ul><ul><li>Streamline information and eliminate uneccessary paperwork </li></ul>
    31. 32. What we created….
    32. 33. Program Handbook
    33. 34. Required Paperwork
    34. 35. Overall
    35. 36. Intake/Assessment Time to Complete
    36. 37. Next goal- Get people in quicker
    37. 38. Average # of Days to 2 nd Appointment
    38. 39. The Big Goal Keep them coming back!
    39. 40. Show Rate to 2 nd Appointment
    40. 41. Business Case <ul><li>Reduced time with paperwork and client </li></ul><ul><li>Quality increased with less focus on paperwork </li></ul><ul><li>Ultimately-increased show rate </li></ul>
    41. 42. Lessons Learned <ul><li>The law of unintended consequences-Increased access at the expense of continuation </li></ul>
    42. 43. The role of data- easy and let’s you see what might not be obvious
    43. 44. Improved staff’s sense of ownership of paperwork- involved in the development and modification
    44. 45. <ul><li>Because it didn’t work before doesn’t mean that it won’t work now </li></ul><ul><li>The critical role of front office staff </li></ul><ul><li>The role of the state- nimble, supportive of change </li></ul>
    45. 46. About paperwork… <ul><li>More is not better </li></ul>
    46. 47. Next Steps <ul><li>Expanding and modifying to Clackamas site </li></ul><ul><li>Training new staff in paperwork- both form and function </li></ul><ul><li>Tracking ongoing data- show rate to the next four sessions </li></ul><ul><li>Future projects??? </li></ul>
    47. 48. Resources <ul><li>NIATx website </li></ul><ul><li> </li></ul><ul><li>Janet Bardossi, LCSW </li></ul><ul><li>[email_address] </li></ul><ul><li>503-380-1730 </li></ul>
    48. 49. THANKS!!!