6.5 FTEs 1 FTE BHD Clinical Supervisor/Contract Monitor 1 FTE Mental Health Therapist III 3.5 FTE Case Managers 1 FTE Peer Support Specialist

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1 Substance Use Residential Treatment and Care Coordination BHD/SA Penny Donovan x5018 Suzanne Somerville x7340 Program Purpose Program Information Maximize treatment completion and abstinence for individuals with drug and/or alcohol dependencies, and connect them to follow-up treatment services. Target population is individuals experiencing moderate to severe substance use disorders; they frequently are involved with the criminal justice system, have prior treatment experiences, have co-occurring psychiatric disorders, are homeless, are IV-drug users, experience various medical problems, and are at high risk for relapse behavior. Case management staff assess clients for appropriate level of care; place clients in services at contract agencies; monitor agency service quality and client progress; link with ancillary services; and connect with follow-up treatment services. Social detoxification provides evidence-based treatment in a safe, supportive residential environment for clients to withdraw from alcohol and/or drugs. Duration is 3-14 days, with an average of 10 days. Services include assessment, individual and group counseling and education, orientation to 12-step programs, and evaluation for and linkage to further treatment services (outpatient, residential, or other levels of care). Social is operated through a contract with Volunteers of America- Chesapeake. Residential treatment () in modified therapeutic community settings provides clients with skills to develop ongoing recovery. Programs incorporate evidence-based strategies, including behavior modification, motivational interviewing, education for clients and their families, and orientation to self-help communities. Duration ranges from three to six months, with an average of three months. is provided at six programs through contracts with Volunteers of America-Chesapeake, and Phoenix Houses of the Mid-Atlantic. Specialized services are provided for women (pregnant women and women with children), Spanish-speaking men, single men, and persons with cooccurring psychiatric disorders. Partners include the criminal justice system; homeless shelters and other social services agencies; public health and primary healthcare providers; private and public sector substance abuse treatment programs; community self-help organizations; and regional Community Services Boards, all of whom refer clients for treatment. PM1: How much did we do? Staff 6.5 FTEs 1 FTE BHD Clinical Supervisor/Contract Monitor 1 FTE Mental Health Therapist III 3.5 FTE Case Managers 1 FTE Peer Support Specialist Substance Use - Care Coordination Page 1

2 Customers And Service Fiscal Year FY 2016 Number of Clients (unduplicated) Total Admissions Number of Bed Days ,464 2,878 2,178 5,892 2,661 9,245 PM2: How well did we do it? 2.1 Client satisfaction 2.2 Compliance with documentation requirements 2.3 Bed utilization rate PM3: Is anyone better off? 3.1 Clients reporting improved functioning as a result of services received 3.2 Clients successful engagement in treatment services Substance Use - Care Coordination Page 2

3 Measure 2.1 Client satisfaction Clients Reported Satisfaction 91% 43/47 86% 19/22 94% 94% 95% 95% 83/88 Goal: 85% 15/16 FY 2019 (proj.) In, all scores were above the BHD 85% satisfaction goal. Residential treatment satisfaction data is for all programs combined. BHD client satisfaction surveys were offered to clients when discharged from. BHD surveys were sent to case managers each quarter to be distributed to clients in residential treatment; case managers distributed them to clients and returned completed surveys to program supervisor. Client satisfaction is rated on a four-point Likert scale for the detox program and residential treatment programs; answers of mostly satisfied or very satisfied are included in above. Satisfaction rates in improved for all residential services. The data is based on a revised survey that was distributed starting in the third quarter of FY Satisfaction rates continued to exceed the goal of 85%. As in previous years, clients reported that they found the program structure, the opportunities to learn about addiction, and the support of staff and peers to be helpful. Begin offering surveys to all clients at the point of discharge from residential treatment in November For FY 2019: Anticipate that client satisfaction will reach 95% for detox and residential treatment programs. Substance Use - Care Coordination Page 3

4 Measure 2.2 Compliance with documentation requirements Documentation Compliance 17% Target: 95% 36% 47% Consensus Scores (36 charts) 35% 55% Consensus Scores FY 2019 (proj.) Excellent Fair Poor In, the chart review process changed, with the Compliance Review Team (C) and the program manager reviewing the same charts each month and coming to consensus on scores when there is a discrepancy. Of the 36 charts reviewed, 17 (47%) were rated as excellent, scoring or above on the criteria reviewed. In, 47% of charts reviewed by the program supervisor scored or above. The most common issues continued to involve timeliness of service plan updates, quarterly reviews, and new regulations about completion of the ASAM assessments. In, program began billing for Case Management services, which added new documentation requirements. Supervisor scheduled a time for C to retrain the team in January 2018 to clarify documentation requirements and to educate the team about documentation changes under Addiction Recovery Treatment Services (AS). Case managers continue to face challenges when in the field due to lack of access to the electronic health record, preventing the ability to do concurrent documentation. Encourage staff to attend regularly scheduled documentation refresher training provided by C. Conduct refresher training with C to ensure alignment with new case management billing requirements. Continue to provide intensive documentation supervision as needed. FY 2019: Anticipate that at least 55% of charts reviewed will be rated excellent by consensus score. Substance Use - Care Coordination Page 4

5 Measure 2.3 Bed Utilization Rate Goal: 56% 6.7/12 75% 51% 6/ / % 1.7/5.8 Average Daily Bed Utilization 61% 7.3/12 77% 18.5/24 65% FY 2016 FY 2019 (proj.) Residential Treatment Programs Utilization of detox and residential beds increased in. Residential data for includes 14 beds at the Independence House program and 10 Early Recovery program beds. The data for FY 2016 does not include the Independence House beds. Decimals reflect beds that were available for only part of the year. Most residential treatment services are purchase-of-services contract; funds are not expended unless a client is placed in treatment. The utilization of these beds is not reflected in the chart. All services are purchased under contract from non-profit agencies, who collaborate with BHD to meet changing client needs. Multiple meetings occurred in with residential vendors to clarify expectations for treatment. Response has been generally positive. Increased residential treatment utilization rates are in part due to partnerships with the Forensic and Jail Mental Health teams to identify individuals appropriate for bond diversion/alternative sentencing plans. The detox program is designed for any person who is under the influence of alcohol or other drugs. It is a social detox program, which does not provide medical detox for clients with medical issues that put them at risk during the detox process. The detox facility is co-located with a shelter program operated by the same vendor. Clients presenting for detox services have Continue working closely with residential treatment providers and with staff from other CSB programs to explore alternative sentencing options that may include residential treatment. The Department of Behavioral Health and Developmental Services (DBHDS) stopped licensing social detox programs in. is now operating under the Early Recovery program operating license. A new RFP for detox and Early Recovery is in process, which will include medical detox services. Any Substance Use - Care Coordination Page 5

6 fewer limitations on eligibility than shelter clients; however, front-desk staff sometimes turn away eligible detox clients due to confusion regarding eligibility. The vendor addressed this issue in early FY There has been an increased demand for medical detox; these clients are not seeking services at a social detox program and are referred to Virginia Hospital Center for treatment. needed upgrades to the programs will be included in the RFP. Continue discussions with detox staff regarding access to services for county residents and to reinforce County expectations regarding service delivery. FY 2019: Anticipate 65% utilization in and in, depending on client need and program status. Substance Use - Care Coordination Page 6

7 Measure 3.1 Clients reporting improved functioning as a result of services received Clients Reporting Improved Functioning 94% 95% 84% Goal: 85% (58/69) (94/100) FY 2019 (proj.) Improved functioning is a self-report measure in the BHD substance abuse case management client satisfaction survey. See measure 2.1 for additional information on survey methodology. Clients rated their ability to manage their cravings on a five-point Likert scale; answers of manageable or higher are included in above. Results in exceeded the goal of 85%. Clients had positive feedback about increased structure and support, and developing insight while in treatment as to how to manage their substance-abuse issues. Areas of dissatisfaction included inconsistent application of rules, lack of structure during evenings and weekends, outdated treatment materials, and difficulties with certain staff members. Continue current schedule of administering surveys. Continue to reinforce county expectation about person-centered and recovery-oriented services with residential-program staff. Monthly meetings with RPC and Early Recovery staff are scheduled to review and update program policies and clinical practices, and to address any new or recurrent program concerns. FY 2019: Anticipate that 95% of clients will report improved functioning. Substance Use - Care Coordination Page 7

8 Measure 3.2 Clients successful engagement in treatment services 56% FY 2016 (86/153) Clients Who Successfully Completed Program Benchmark: 67% 51% (80/156) 56% 57% (87/154) FY 2019 (proj.) 71% FY 2016 (25/35) 55% Benchmark: 46% (31/56) 64% 65% (58/90) FY 2019 (proj.) Clients Successfully Engaged in Follow-up Treatment After Program Completion 55% FY 2016 (47/86) 72% (112/156) Goal: 82% (127/154) FY 2019 (proj.) 92% 93% FY 2016 (23/25) (52/56) Goal: 89% (80/90) FY 2019 (proj.) The percent of persons who completed detox improved in to 56%. The percent of persons who successfully completed residential treatment improved to 64%. The percentage of persons who successfully engaged in follow-up treatment at discharge improved to 82% for detox. For residential treatment, the percentage decreased to 89%. Clients who begin outpatient services within 60 days of discharge are considered engaged in treatment. Program completion goals are based on SAMHSA s Treatment Episode Set (TEDS) 2010 Discharges from Substance Abuse Treatment (July 2013). There is not a national benchmark for engagement in follow-up treatment after program completion, so these goals are based on local standards. Substance Use - Care Coordination Page 8

9 Completion of detox reflects clients absence of withdrawal symptoms. Residential treatment success reflects completion of all aspects of their individual treatment plan. program completion rates continue to fall below the benchmark. The percentage of clients engaged in follow-up treatment following completion of detox improved in, as the case management team continued completing intake assessments before clients left detox. Residential program completion rates exceed the national average of 46% for residential programs of 90 days duration (SAMHSA - TEDS). The completion rate dropped substantially in, but improved in. Follow-up treatment data is captured for Arlington County services only; treatment obtained from other sources is not included. Residential treatment completion rates have been impacted by bond diversion and alternative sentencing candidates. More of these clients have been offered treatment in lieu of continued incarceration; the completion rate for this population is lower. Ensure that detox RFP addresses client engagement strategies and regular monitoring of client satisfaction. Continue to encourage clients to participate in follow-up treatment services. In FY 2019, an RFP for operating Independence House will be released. The RFP will require that potential vendors include proposals addressing client engagement and satisfaction. FY 2019: Anticipate completion rates of 57% for and 65% for Residential, and follow-up treatment engagement rates of for and for Residential. Substance Use - Care Coordination Page 9

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