IMPLEMENTING RECOVERY ORIENTED CLINICAL SERVICES IN OPIOID TREATMENT PROGRAMS PILOT UPDATE A Clinical Quality Improvement Program
Today: • National completion rates for OTP’s hover between 11 – 14% • Retention is dropping • Clients enter OTP’s for a respite, get a “time out” and then move on • OTP’s are a harm reduction, not a recovery orientation • The needs of the medication, not the client, organize the program
A recovery orientation: • Shifts the focus from program based care to client-based care • Medications are an important, but not sole focus of OTP treatment • Requires a comprehensive clinical needs assessment • Uses standardized placement criteria, and • Matches the client to the most appropriate Level of Care
IRETA is currently implementing recovery oriented Level I outpatient services in existing OTP programs Pilot site 2 years on site 6 OTP’s complete; selected at each OTP 2 active
Review and analyze outcome and Review policy performance data for past 2 years and procedures Review clinical record Attend staff meetings keeping • Conducting individual sessions Observe all counselors: • Conducting group sessions
Implementation Activities • Introduction to Cognitive Behavioral Therapy (CBT) • Introduction to group therapy concepts • Advanced training and application in the use of CBT • Introduction to case consultation as quality assurance • Introduction to Recovery Oriented Methadone Maintenance
Next • Survey clients on treatment satisfaction, perceived needs and openness to changes in their treatment • Implement ongoing CBT therapy groups • Clients are assigned to a group that meets weekly • Clients are assigned to a primary counselor • Assess all new clients for Level of Care assignment within the OTP • Plan to assess all relapsing clients for Level of Care assignment • Case Consultation and Process Improvement modeling continue
Pilot Site • Patient outcomes were at the low end of national averages (11%) • There was no particular clinical orientation • There was not a recovery orientation • Groups were didactic, open, thematic and disconnected to a theory of change • Clinical staff display competent interviewing skills but program design limited their scope of practice
Pilot Site Implementation Questions • Can weekly therapy groups be established in an OTP? • Are patients willing to attend the groups? • Do patients see the groups as important to their treatment?
Pilot Site Implementation Questions • Are staff able and willing to lead the groups? • Do staff see the groups as an important part of treatment? • Do the groups contribute to improved patient and program performance?
RESULTS FROM PILOT SITE
Can weekly therapy groups be established in an OTP? Number of Clients Served per Month 40 34 35 32 31 30 30 24 23 25 21 21 19 20 15 15 12 12 11 11 10 5 0 Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep 2017 2018 (Clients appear in multiple months)
Are patients willing to attend the groups? 4.5 4 Average number of sessions per month 3.5 3 2.5 2 1.5 1 0.5 0 0 5 10 15 20 25 30 35 40 T otal number of sessions attended
Do patients see the groups as important to their treatment? “The group was supportive and helpful” 500 450 400 350 300 250 200 150 100 50 0 Strongly Agree Somewhat Agree Somewhat Strongly Disagree Disagree
Do patients see the groups as important to their treatment? “This group was helpful to my recovery” 400 350 300 250 200 150 100 50 0 Strongly Agree Somewhat Agree Somewhat Strongly Disagree Disagree
Do patients see the groups as important to their treatment? “I would recommend this group to a friend” 450 400 350 300 250 200 150 100 50 0 Strongly Agree Somewhat Agree Somewhat Strongly Disagree Disagree
Are staff able and willing to lead the groups? “The counselor was familiar with the topic” 500 450 400 350 300 250 200 150 100 50 0 Strongly Agree Somewhat Agree Somewhat Strongly Disagree Disagree
Do staff see the groups as an important part of treatment? Stakeholder Meeting at the end of the project • Staff at the clinic were clearly committed to continuing groups after the contracted project was over • Staff shared examples of clients who went to residential treatment and/or jail, and then re-engaged at the clinic because of the groups • One of the facilitators said she could not imagine going back to the way things were
Do the groups contribute to improved patient and program performance? Client status at end of project Still attending group 10% 4% Completed group 15% Transferred to a different level of care 71% Left group prior to completing
Comparison of Craving over Time Among clients who never reported that Among clients who at some point reported their dose was *not* controlling craving that their dose was *not* controlling craving (n=37) (n=21) Strongly Disagree to Strongly Agree Strongly Disagree - Strongly Agree 4 4 3.5 3.5 3 3 2.5 2.5 2 2 1.5 1.5 1 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Session Index Session Index
Sample Data Analysis Plan Baseline Measures Clinical Matching Expected Outcomes Indicators Retention Rates of Clinical Assessment Improved retention Increase: • • prior years rate Days in treatment • ASAM Criteria Match Abstinence • Drug (non Rx) and Level I Outpatient Increased abstinence Employment • • • • alcohol use prior Level II IOP rate • year/s Decrease: Improved Arrests while in • • Employment rates Employment Rate treatment • prior year/s Decreased Arrest • Arrest rates while in rates • Tx Prior year/s
Thank you! Questions?
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