ADOM Implementation Project Presentation Cutting Edge Conference 6 8 September, 2012
Partnerships & Collaboration Te Pou Research, Information and Matua Raki The Ministry of Health contracted Te Pou to lead the ADOM Implementation project. Te Pou and Matua Raki acknowledge the ADOM Advisory Group comprising addiction sector leaders, clinicians and consumer representatives, MOH representation and ADOM co-author Dr Daryle Deering. Special thanks to the six addiction services who participated in the ADOM Implementation Project Test Site phase
ADOM Implementation Project Purpose 1. To develop an information collection protocol, training package and data collection & reporting system requirements that supports consistent implementation and collection of ADOM across services Three draft resources have been developed to achieve this purpose: ADOM Guide for Addiction Clinicians including the ADOM collection form ADOM Trainer Resource Manual - aligned to the Guide ADOM Training Powerpoint presentation - aligned to the Guide Feedback from six ADOM test sites is being used to finalise these documents over the next weeks. 2. To refine Part B questions - Section 2 questions are currently being refined testing for possible improvement in the current validation scores
Presentation Content 1. About ADOM 2. ADOM collection protocols how it works 3. ADOM data collection & reporting systems Test phase demo 4. ADOM Test Site Experience Midcentral DHB Addictions services Testing the implementation of ADOM in a clinical setting 5. ADOM Key Points - Summary ADOM information available at Cutting Edge Conference ADOM Implementation Guide - outlines key considerations and resource implications for services considering voluntary implementation of ADOM
1. About ADOM The ADOM (Alcohol and Drug Outcome Measure) consists of three parts: Section 1 contains eleven questions related to type and frequency of substance use Section 2 includes seven questions about lifestyle and wellbeing Section 3 contains one recovery focused question. The ADOM is completed in collaboration between the clinician and tangata whaiora. It is a client rated measure.
About ADOM cont. Design and intent: For use in adult community based outpatient addiction services / programmes Collaborative process clinician and client/ tangata whaiora Provides a snapshot of the tangata whaiora s treatment journey Demonstrates change over time. It is NOT a clinical tool for assessment/ review
Some benefits of collecting ADOM Assists clients/tangata whaiora to review their treatment journey changes made over time Provides clinicians with a means of reviewing treatment goals with clients / tangata whaiora and their family and whanau At a team and service level, outcome information can also add value, for example it can: assist organisations to recognise the impact of service models, service delivery and interventions assist in identifying case complexity through clinically significant items or index of severity reporting.
ADOM limitations The ADOM is not valid where it cannot be collected in an ongoing way. It is most relevant and validated for adult community based outpatient addiction services which are non-residential in nature. It is not suitable for very brief interventions, drop in, inpatient and custody settings It s not an audit tool, not designed nor intended for use as a measure of service or clinician performance. It is not designed nor intended for use as a measure of service or clinician performance
2. ADOM collection protocol The ADOM Guide for Addiction Clinicians provides a comprehensive guide to using ADOM in a clinical setting. It contains: Purpose of collecting ADOM Benefits and limitations of ADOM Who can collect ADOM eligible services Who can complete ADOM eligible clients/ tangata whaiora Facilitating completion of the ADOM by the client Understanding the intent of the ADOM questions Collection Protocol - when to collect ADOM during treatment journey ADOM collection form and clinician prompt sheet ADOM information for clients/ tangata whaiora handout FAQ about ADOM clinical and technical answers to frequently asked questions
ADOM eligibility criteria Eligible services are community based outpatient addiction service / programmes includes OST and after /continuing care programmes Eligible clients - all clients / tangata whaiora 18 yrs + who are enrolled with a community based addiction treatment service or programme
3. ADOM data collection and reporting systems One of the most important strategies for successful implementation of outcome measures is having an easy to use rapid turn around & feedback information systems in place.. (Pirkis et al., 2005; Fonagy et al., 2005; OHE Commission, 2008; Ministry of Health, 2008) 3 of the 6 ADOM test sites volunteered to trial entering their ADOM data into a data collection system - 2 sites used the test phase option of Recordbase Wild Bamboo provided this option free of charge for Te Pou during the test phase 1 site (DHB) set up an ADOM data collection system within their DHB patient management system.
ADOM data - visual interpretation using feedback wheel Clinicians also tested the use of a feedback wheel (an excel graph) - that could be used either manually or printed off from data entered. This allows clients/ tangata whaiora to view their data in a meaningful / visual format to see their progress and change over time while in treatment Visual ADOM acknowledgment Wild Bamboo supported the ADOM project by developing an ADOM data collection and reporting system for use in the test site phase. This included a feedback wheel showing up to 3 ADOM collection occasions
ADOM data collection and feedback wheel
Collect new ADOM information View existing ADOM interviews Compare up to 3 interviews using the feedback wheel Information can be saved and sent electronically, and is printable in black and white
Interview 1
Interview 1 and 2
Interviews 1-3
ADOM in Recordbase Kelsey Doughty Relationship Manager 07 857 1216 Kelsey@wildbamboo.co.nz www.wildbamboo.co.nz
4. ADOM Test Site Experience MidCentral DHB AoD Service ADOM Test Site Process High interest in measures to inform tx model outcomes Face validity for consumers reinforces active engagement in recovery Clinicians felt ADOM emerges easily from existing tx practices pity about the paperwork though Train the trainers Valuable: rationale, how to, well resourced, evidence based no problems
MidCentral test site experience cont Training Clinicians Whole team, scenarios & practice made staff ready, willing and able Using the ADOM Form in a clinical setting Visual prompt, consumer pamphlet, timing, give client the wheel ADOM Data Collection Systematise, dedicate time to embed, Recordbase or skilled data analyst [PRIMHD] Timely feedback we re getting there!
MidCentral experience: What s important for successful implementation?? Leadership - outcomes champions Making outcomes measurement part of quality/everyday clin prac IT systems that support front line work client feedback graph Use the information collected R E S P E C T Pacing / phasing of implementation beware of overload Training and education danger of Form vs Outcome measurement National support for trainers through Te Pou
What I learned/ recommend Understand it, be the joy germ Check out the HoNOS for parallel process Include your administrator in training Act out the process whoa to go/ interview in team tg Make it easy e.g. placement, colour Check completed form initially Follow-up tg 1x month later Input data once a week generates bring up for staff Make 2 nd ADOM collection happen value apparent then Staff want this to be therapeutic timing impt Seek consumer feedback
5. ADOM Key Points - Summary Services may register for voluntary implementation of ADOM from September 2012 onwards through Te Pou website or through a link on Matua Raki web site This will start the process of preparing for implementation including access to: ADOM implementation - information seminars for addiction managers / clinical leaders - facilitated by Te Pou and Matua Raki Technical support in determining addiction service options for implementing ADOM data collection and reporting systems Te Pou Information team ADOM Train the Trainer workshops for addiction clinicians nominated by services implementing ADOM facilitated by Te Pou and Matua Raki
ADOM Key Points summary cont. The ADOM Implementation Guide provides information for services about the considerations and resource implications of implementing ADOM The Ministry of Health has indicated it intends to mandate ADOM as part of the PRIMHD national collection within the next few years. Contacts: Te Pou and Matua Raki websites Research on ADOM - Te Pou Outcomes Information webpage THANK YOU