SAPT Block Grant

ATR WEBINAR:
CHANGING CULTURES AND
CULTURES OF CHANGE
Speakers
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John Campbell - SAMHSA
Will Ferriss - SAMHSA
Ijeoma Achara - Achara Consulting
Beverly Haberle - Pro-Act, PA
Kevin Gabbert - Iowa ATR 3 Grantee
THE IMPORTANCE OF EFFECTIVE
STATE-PUBLIC-COMMUNITY
ENGAGEMENT IN ATR
John Campbell
SAMHSA
Substance Abuse Prevention and
Treatment Block Grant Program
An Overview of the Authorizing
Legislation, Implementing Regulation, and
Block Grant Plan and Report Format
Authorizing Legislation
• Title XIX, Part B, Subpart I*, Subpart II** and Subpart
III of the Public Health Service Act
• Community Mental Health Services Block Grant*
• 42 U.S.C. §§ 300x• Substance Abuse Prevention and Treatment Block
Grant**
• 42 U.S.C. §§ 300x-21-35
• General Provisions
• 42 U.S.C. §§ 300x-51-66
Authorizing Legislation
• Title XIX, Part B, Subpart I, Subpart II and Subpart III
of the Public Health Service Act
• ADAMHA Reorganization Act of 1992
• July 10, 1992
• P.L. 102-321
• Children’s Health Act of 2000
• October 6, 2000
• P.L. 106-310
Implementing Regulation
• Substance Abuse Prevention and Treatment Block
Grant; Interim Final Rule
• 45 C.F.R. § 96.46; 45 C.F.R. §§ 96.120-137
• Tobacco Regulations under the Substance Abuse
Prevention Block Grant; Final Rule
• 45 C.F.R. § 96.130
• Charitable Choice Provisions and Regulations; Final
Rules
• 42 C.F.R. Part 54 §§ 54.1-54.13
• Confidentiality of Alcohol and Drug Abuse Patient
Records
• 42 C.F.R. Part 2, Subparts A-E
SAPT Block Grant
• Primary Prevention Activities
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42 U.S.C. § 300x-22(a) and 45 C.F.R. § 96.124(b), § 96.125
• Services Designed for Pregnant Women and Women
with Dependent Children
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42 U.S.C. § 300x -22(b) and 45 C.F.R. § 96.124(c)(e), § 96.131
• Services for Intravenous Drug Users
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42 U.S.C. § 300x-23(a) and 45 C.F.R. § 96.126(b)
• Outreach to Intravenous Drug Users
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42 U.S.C. § 300x-23 (b) and 45 C.F.R. § 96.126(e)
• Tuberculosis Services
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42 U.S.C. § 300x-24(a) and 45 C.F.R. § 96.127
• Early Intervention Services for HIV
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42 U.S.C. § 300x-24(b) and 45 C.F.R. § 96.128
SAPT Block Grant
• Sale of Tobacco Products to Individuals Under the
Age of 18
• 42 U.S.C. § 300x-26 and 45 C.F.R. § 96.130
• Treatment Services for Pregnant Women
• 42 U.S.C. § 300x-27 and 45 C.F.R. § 96.131
• Improvement in the Process for Making Referrals
• 42 U.S.C. § 300x-28 (a) and 45 C.F.R. § 96.132(a)
• Continuing Education
• 42 C.F.R. § 300x-28(b) and 45 C.F.R. § 96.132(b)
• Coordination of Activities and Services
• 42 U.S.C. § 300x-28(c) and 45 C.F.R. § 96.132(c)
SAPT Block Grant
• Statewide Assessment of Needs
• 42 U.S.C. § 300x-29 and 45 C.F.R. § 96.133
• Maintenance of Effort Regarding State Expenditures
• 42 U.S.C. § 300x-30 and 45 C.F.R. § 96.134
• Restrictions
• 42 U.S.C. § 300x-31 and 45 C.F.R. § 96.135
• State Plan
• 42 U.S.C. § 300x-32 and 45 C.F.R. § 96.122(g)
• Opportunity for Public Comment on State Plan
• 42 U.S.C. § 300x-51
• Reports and Audits
• 42 U.S.C. § 300x-52 and 45 C.F.R. § 96.122(f)
SAPT Block Grant
• Independent Peer Review
• 42 U.S.C. § 300x-53(a) and 45 C.F.R. § 96.136
• Confidentiality of Alcohol and Drug Patient Records
• 42 U.S.C. § 300x-53(b) and 42 C.F.R. Part 2
• Nondiscrimination
• 42 U.S.C. § 300x-57
• Technical Assistance
• 42 U.S.C. § 300x-58
• Plans for Performance Partnerships
• 42 U.S.C. § 300x-59
SAPT Block Grant
• Rule of Construction Regarding Delegation of Authority to
States
• 42 U.S.C. § 300x-60
• Solicitation of Views of Certain Entities
• 42 U.S.C. § 300x-61
• Availability to States of Grant Payments
• 42 U.S.C. § 300x-62
• Services Provided by Nongovernmental Organizations
• 42 U.S.C. § 300x-65 and 42 C.F.R. Part 54, §§ 54.1-54.13
• Services for Individuals with Co-Occurring Disorders
• 42 U.S.C. 300x-66
CMHS and SAPT Block Grants
Introduction and Background
Context for Changes in Block Grant Plans
• Impact on State Mental Health and Substance Abuse
Authorities
• States will play an important role in the design and
implementation of health reform
• States may be more strategic in purchasing services
• States will need to think more broadly than the
populations currently supported through CMHS and
SAPT Block Grant funds
• States will need to design/collaboratively plan for
health information technology
CMHS and SAPT Block Grants
Introduction and Background
Context for Changes in Block Grant Plans
• Impact on State Mental Health and Substance Abuse
Authorities
• States may need to establish/enhance strategic
partnerships
• States may focus more on recovery support services
• States will redesign their systems to be more
accountable for improving the experience of care and
for the health outcomes of the targeted populations
CMHS and SAPT Block Grants
Introduction and Background
Goals of the Block Grant Programs are consistent with
SAMHSA’s vision
• A physically and emotionally healthy lifestyle
(health)
• A stable, safe, and supportive place to live
(home)
• Meaningful daily activities (purpose)
• Relationships and social networks
(community)
CMHS and SAPT Block Grants
Introduction and Background
Goals of the Block Grant Programs are consistent SAMHSA’s
vision
• To promote participation
• Shared decision making
• Person-centered planning
• Self-direction of services and supports
• To ensure access to effective culturally and linguistically
competent services for underserved populations
• American Indian and Alaskan Natives
• Racial and ethnic minorities
• Lesbian, gay, bi-sexual, transgender, and questioning
(LGBTQ)
CMHS and SAPT Block Grants
Introduction and Background
Goals of the Block Grant Programs are consistent SAMHSA’s
vision
• To promote recovery, resiliency, and community integration
• To coordinate behavioral health prevention, early intervention,
treatment, and recovery support services with other allied health
and social services
• To increase accountability for behavioral health services through
uniform reporting on access to care, quality and appropriateness
of services, and outcomes
CMHS and SAPT Block Grants
Introduction and Background
Goals of the Block Grant Programs are consistent SAMHSA’s
vision
• To prevent the use, misuse and abuse of alcohol, tobacco
products, illicit drugs, and prescription medications
• To conduct outreach to encourage individuals injecting or using
illicit drugs and/or licit drugs to seek and receive treatment
• To provide health promotion and early intervention services for
HIV
• To ensure access to a comprehensive system of care
CMHS and SAPT Block Grants
Block Grant Plan Changes
Behavioral Health Assessment and Plan
• Framework
• Population-based planning
• Planning Steps
• Assessment of systems strengths and needs
• Gap analysis
• Prioritizing planning activities
• Developing objectives, strategies, and
performance indicators
CMHS and SAPT Block Grants
Behavioral Health Assessment and Plan Focus
• Children with serious emotional disturbance (SED)
and their families
• Adults with serious mental illness
• Individuals with or at-risk of having substance use
and/or mental disorders
• Individuals who inject licit and/or illicit drugs
• Adolescents with substance abuse and/or mental
health problems
• Children and youth at risk for behavioral, emotional,
or mental disorders
CMHS and SAPT Block Grants
Behavioral Health Assessment and Plan Focus
• Pregnant women with substance use and/or mental
disorders
• Parents with substance use and/or mental disorders
who have dependent children
• Military personnel (active, guard, reserve, and
veteran) and their families
• American Indian and Alaskan Natives
• Coordination of services for individuals with
substance use and/or mental disorders who are atrisk for acquiring and/or transmitting communicable
disease, e.g., HIV, tuberculosis
CMHS and SAPT Block Grants
Behavioral Health Assessment and Plan Focus
• Individuals with substance use and/or mental
disorders who are homeless
• Individuals with substance use and/or mental
disorders involved with the juvenile justice or criminal
justice systems
• Individuals with substance use and/or mental
disorders who reside in rural areas
• Underserved racial and ethnic minorities
• Lesbian, gay, bi-sexual, transgender, and questioning
(LGBTQ) adolescents and adults
• Persons with disabilities
CMHS and SAPT Block Grants
Behavioral Health Assessment and Plan Focus
• Community populations for environmental prevention activities,
including policy-changing activities, and behavior-change
activities to change
• Community
• School
• Family
• Business norms
• Community settings for prevention activities
• Universal
• Selective
• Indicated
CMHS and SAPT Block Grants
Behavioral Health Assessment and Plan Focus
• Block Grant Reimbursement Strategies
• Encounter-based reimbursement
• Grant-based reimbursement
• Contract-based reimbursement
• Risk-based reimbursement
• Innovative financing strategies
• Other
CMHS and SAPT Block Grants
Behavioral Health Assessment and Plan Focus
• Block Grant Planned Expenditures
• Planned expenditures for FY 2012 (Table 4a)
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Substance abuse prevention and treatment
Primary Prevention
Tuberculosis services
Early intervention services for HIV
Administration
• Planned expenditures for FY 2012 (Tables 6 and 7)
• Primary prevention by strategy and IOM
• Resource development activities
CMHS and SAPT Block Grants
Behavioral Health Assessment and Plan
• Block Grant Planned Expenditures
• Planned expenditures by service categories for FY
2012-2013
• Service Categories
• A Description of a Good and Modern Addiction
and Mental Health Services Delivery System
• http://www.samhsa.gov/healthreform/docs/good_and_modern_
4_18_2011_508.pdf
• Planned expenditures percentage (estimate) by
categories (Table 5)
CMHS and SAPT Block Grant
Behavioral Health Assessment and Plan
Self Direction
• State’s policies on participant-directed services or
attach a copy to the Block Grant application(s).
• What services for individuals and their support
systems are self-directed?
• What participant-directed options do you have in your
State?
• What percentage of individuals funded through the
SMHA or SSA self direct their care?
• What supports does your State offer to assist
individuals to self direct their care?
CMHS and SAPT Block Grant
Behavioral Health Assessment and Plan
• Data and Information Technology
• Understand if States HIT systems are good and modern
• Are providers required to obtain a National Provider Identifier
(NPI )?
• Does the HIT system use a unique client identifier?
• Does the HIT system comply with Federal data standards in the
following areas (use of ICD-10 or CPT/HCPCS codes)?
• Are States’ HIT systems interoperable with other systems
• Does the HIT systems provide the ability to aggregate Medicaid
and non-Medicaid provider information?
• Does the behavioral health agency participate in the
development of the health information exchange?
CMHS and SAPT Block Grant
Behavioral Health Assessment and Plan
Tribal Consultation
• Interaction should include elected officials of the Tribe or their
designee
• More than input on a committee for the Block Grant planning
process
• Description of States’ consultation process with Tribes
• Description of Tribes’ concerns and how such concerns are
addressed in States’ plans
• Executive Order 13175 Consultation and Coordination with
Indian Tribal Governments
http://www.epa.gov/fedrgstr/eo/eo13175.htm
CMHS and SAPT Block Grant
Behavioral Health Assessment and Plan
Service Management Strategies
• Dollars are extremely limited
• How do we ensure that services are offered in the
right scope, amount and duration
• Some States have developed strategies to:
• Identify under and over utilization
• Address outliers
• Target services to specific populations
CMHS and SAPT Block Grant
Behavioral Health Assessment and Plan
State Dashboard Indicators (Table 10)
• Work over the next year to identify “incentives”
• SAMHSA and States identify four measures:
• Two State-specific planning efforts
• Two National Outcome Measures (NOMS)
• Proposed baseline: 07/01/12 - 06/30/13
• First year: 07/01/13 - 06/30/14
• Second year: 07/01/14 - 06/30/15
CMHS and SAPT Block Grant
Behavioral Health Assessment and Plan
• Suicide Prevention
• Technical Assistance Needs
• Involvement of Individuals and Familes
• Use of technology
• Support of State partners
• State Behavioral Health Advisory Councils
• Comment of State Plan
CMHS and SAPT Block Grant
Behavioral Health Assessment and Plan
Required (9)
• Assessment of strengths and needs of the service delivery
system
• Identification of unmet service needs and critical gaps
• Prioritize State planning activities (Table 2)
• Development of objectives, strategies and performance
indicators (Table 3)
• Planned Expenditures by Service Categories (Table 5)
• Planned Primary Prevention Expenditures Checklist (Table 6)
• Planned State Agency Expenditures for Substance Abuse
Prevention and Treatment (Table 7)
• Planned Resource Development Expenditure Checklist (Table 8)
• Comment on State Plan
CMHS and SAPT Block Grant
Behavioral Health Assessment and Plan
Requested (15)
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Block Grant Reimbursement Strategies (Table 4)
Activities That Support Individuals in Directing the Services
Data and Information Technology
Quality Improvement Reporting
Tribal Consultation
Service Management Strategies
State Dashboards (Table 10)
Suicide Prevention
Technical Assistance Needs
Involvement of Individuals and Families
Use of Technology
Support of State Partners
State Behavioral Health Advisory Council
Advisory Council Membership (Table 11)
Composition of Advisory Council (Table 12)
CMHS and SAPT Block Grant
Annual Reports
• CMHS Block Grant Implementation Report
• Uniform Reporting System
• Format unchanged from prior year
• SAPT Block Grant Report
• Uniform Application
• Format Unchanged from prior year
• Annual Synar Report
• Format Unchanged from prior year
Health Reform Resources
Where can I find additional information?
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SAMHSA Health Reform Website
• http://www.samhsa.gov/healthReform/
SAMHSA/HRSA Center for Integrated Health Solutions
• http://www.integration.samhsa.gov/
SAMHSA Block Grant Website
• http://www.samhsa.gov/grants/blockgrant
Treatment Improvement Exchange Website
• http://www.tie.samhsa.gov
National Association of State Alcohol and Drug Abuse Directors
• http://www.nasadad.org
National Association of State Mental Health Program Directors
• http://www.nasmhpd.org
Health Reform Resources
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Center on Budget and Policy Priorities
• http://www.cbpp.org/
Centers for Medicare and Medicaid Services
• http://www.cms.gov/
The Commonwealth Fund
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http://www.commonwealthfund.org/
Henry J. Kaiser Family Foundation
• http://kff.org/
Office of the National Coordinator for Health Information Technology
• http://healthit.hhs.gov
Pew Center for the States
• http://www.pewcenteronthestates.org/
National Governors’ Association Center for Best Practices Health
Division
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http://www.nga.org/cms/render/live/center/health
Contact Information
John J. Campbell, M.A.
Performance Partnership Grant Branch
Division of State and Community Assistance
Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
1 Choke Cherry Road, Room 5-1069
Rockville, Maryland 20857
Telephone 240.276.2891
Facsimile 240.276.2900
Mobile 301.452.0054
E-Mail john.campbell@samhsa.hhs.gov
HHS Regions I-X
• HHS Region I
• Connecticut*, Maine, Massachusetts**, New Hampshire**,
Rhode Island***, and Vermont
• SAPT Block Grant
• Mary M. McCann, M.S.W., LCSW, CAC III
• 240-276-1758
• mary.mccann@samhsa.hhs.gov
• ATR Grant
• Mary M. McCann, M.S.W., L.C.S.W., CAC III (*)
• Linda K. Fulton, Ph.D. (**)
• Kim Thierry, M.Ed., CAC (***)
HHS Regions I-X
• HHS Region II
• New Jersey, New York*, Commonwealth of Puerto Rico, and
the United States Virgin Islands
• SAPT Block Grant
• Marquitta L. Duvernay, D.H.A., M.A., LCPC, NCC
• 240-276-1244
• marquitta.duvernay@samhsa.hhs.gov
• ATR Grant
• Linda K. Fulton, Ph.D. (*)
HHS Regions I-X
• HHS Region III
• Delaware*, District of Columbia**, Maryland, Commonwealth of
Pennsylvania*#, Commonwealth of Virginia, and Virginia
• SAPT Block Grant
• Steven J. Shapiro, M.C.J.
• 240-276-2908
• Steven.shapiro@samhsa.hhs.gov
• Marquitta L. Duvernay, D.H.A., M.A., LCPC, NCC (*)
• 240-276-1244
• Marquitta.duvernay@samhsa.hhs.gov
• ATR Grant• Linda K. Fulton, Ph.D. (**)
• Enid Osborne, Ph.D., M.S.W., M.P.H. (#)
HHS Regions I-X
• HHS Region IV
• Alabama, Florida*, Georgia, Commonwealth of Kentucky**,
Mississippi, North Carolina, South Carolina, and Tennessee**
• SAPT Block Grant
• Anna B. de Jong, M.A., LCPC, LCADC
• 240-276-2890
• anna.dejong@samhsa,hhs.gov
• Steven J. Shapiro, M.C.J. (**)
• 240-276-2908
• steven.shapiro@samhsa.hhs.gov
• ATR Grant
• Anna B. de Jong, M.A., LCPC, LCADC (*)
HHS Regions I-X
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HHS Region V
• Indiana*, Illinois**, Michigan#, Minnesota, Ohio***, and Wisconsin****
• SAPT Block Grant
• Lisa M. Creatura, M.P.A.
• 240-276-2821
• lisa.creatura@samhsa.hhs.gov
• Christopher D. Craft, M.Ed. (**)
• 240-276-2562
• Christopher.craft@samhsa.hhs.gov
• ATR Grant
• Suzan Swanton, M.S.W., LCSW-C (*)(***)
• Christopher D. Craft, M.Ed. (**)
• Lisa M. Creatura, M.P.A. (****)
• Enid Osborne, Ph.D., M.S.W., M.P.H. (#)
HHS Regions I-X
• HHS Region VI
• Arkansas*, Louisiana, Oklahoma, New Mexico**, and
Texas
• SAPT Block Grant
• Amy Bullock Smith, M.A., LPC, MAC, SAP
• 240-276-2892
• amy.smith@samhsa.hhs.gov
• ATR Grant
• Linda K. Fulton, Ph.D. (*)
• Will Ferriss (**)
HHS Regions I-X
• HHS Region VII
• Iowa*, Kansas, Missouri**, and Nebraska
• Christopher D. Craft, M.Ed.
• 240-276-2562
• christopher.craft@samhsa.hhs.gov
• ATR Grant
• Christopher D. Craft, M.Ed.(*)
• Suzan Swanton, M.S.W., LCSW-C (**)
HHS Regions I-X
• HHS Region VIII
• Colorado*, Montana**#, North Dakota, South Dakota#, Utah***,
and Wyoming#
• SAPT Block Grant
• Debra “Renee” Bergen
• 240-276-1431
• debra.bergen@samhsa.hhs.gov
• Theresa Mitchell-Hampton, Dr.P.H., M.Ed., LCPC (**)
• 240-276-1365
• theresa.mitchell@samhsa.hhs.gov
• ATR Grant
• Kim Thierry, M.Ed., CAC (*)(***)
• Enid Osborne, Ph.D., M.S.W., M.P.H. (#)
HHS Regions I-X
• HHS Region IX
• Arizona, California*#, Hawaii*, Nevada, American Samoa**,
Commonwealth of the Northern Marianas Islands**, Federated
States of Micronesia**, Guam**, Republic of the Marshall
Islands**, and the Republic of Palau**
• SAPT Block Grant
• Theresa Mitchell-Hampton, Dr.P.H., M.Ed., LCPC
• 240-276-1365
• theresa.mitchell@samhsa.hhs.gov
• Sherrye C. McManus, Ph.D., M.S.P.H., M.S.W. (**)
• 240-276-2576
• sherrye.mcmanus@samhsa.hhs.gov
• ATR Grant
• Linda K. Fulton, Ph.D.(*)
• Enid Osborne, Ph.D., M.S.W., M.P.H. (#)
HHS Regions I-X
• HHS Region X
• Alaska, Idaho*, Oregon**, and Washington***
• Thomas Long, M.S.H.A, M.A.
• 240-276-2575
• thomas.long@samhsa.hhs,gov
• ATR Grant
• Thomas Long, M.S.H.A, M.A. (*)
• Will Ferriss (**)
• Suzan Swanton, M.S.W., LCSW-C (***)
The Change Book - A Blueprint for
Technology Transfer
The Change Book: A Blueprint for Technology
Transfer, published in 2000, is a landmark
technology transfer tool developed by the ATTC.
Designed to assist practitioners and
organizations, it includes principles, steps,
strategies and activities for implementing change
initiatives that will improve prevention and
treatment outcomes across systems.
http://www.nattc.org/explore/priorityareas/techtra
ns/tools/changebook.asp
SYSTEMS CHANGE FOR
STATE SYSTEMS
Ijeoma Achara PsyD
Owner, Achara Consulting, LLC.
Current Trends in Healthcare
Increased Focus:
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Access to Care
Service Integration
Quality, Outcomes, and Accountability
Infrastructure Enhancements (e.g. HIT)
Prevention and Wellness
Recovery Support Services
SAMHSA’s Strategic Initiatives
ATR Can Position Your System for Success!
ATR Can Position Your System for Success
Achara Consulting, Inc
Implementing a Practice versus Developing a Culture
Implementing a Practice versus
Developing a Culture
What’s the Difference?
Achara Consulting, Inc
3 Approaches to System Change
ADDITIVE
SELECTIVE
TRANSFORMATIONAL
Adding peer and
community
based recovery
supports to the
existing
treatment
system.
Practice and
Administrative
alignment in
selected parts of
the system – e.g.
pilot projects.
Cultural, values based
change drives practice,
community, policy and
fiscal changes in all
parts and levels of the
system. Everything is
viewed through the lens
of and aligned with
recovery oriented care.
Achara Consulting, Inc
Guiding Principles in a Transformed System
A Few Examples:
• Choice
• Collaborative-partnership approaches
• Strength-based approaches
• Beyond symptom reduction to wellness
Service and Administrative Changes in a
Transformed System
• Assertive Outreach
• Holistic Assessments
• Recovery Planning
• Peer-based Recovery Support Services
• Community-based Recovery Support Services
• Continuing Support
• Social Engagement and Technology-based Services
• New Financial and Information Systems
Achara Consulting, Inc
Poll #1:
• Have you integrated formal peer-based
recovery support services into your
system of care?
Poll #2:
• For those of you who have integrated
formal peer-based recovery support
services into your system of care, what
have been your greatest challenges?
Poll #3:
• Have you integrated recovery planning
into your system of care?
Leading Transformational Change
NOT SO FAST
Achara Consulting, Inc
Not So Fast…
Leading Transformational Change
• Aligning Concepts: Changing
how we think
• Aligning Practice: Changing
how we use language and
practices at all levels;
implementing values based
change
• Aligning Context: Changing
regulatory environment, policies
and procedures, community
support
Achara Consulting, Inc
CONCEPT
PRACTICE
CONTEXT
Leading Transformational Change:
Conceptual Alignment
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Identify the Right Leaders
Set the Context and Establish a Sense of Urgency
Form Powerful Guiding Coalitions
Create and Over Communicate the Vision
Create Transparent Participatory Approaches
Be Prepared for “So What?”
Achara Consulting, Inc
Leading Transformational Change:
Practice Alignment
• Identify Your Areas of Focus
• Ensure Focus is Not Only on WHAT is Available,
but HOW it is Provided
• Clearly Communicate Implications for Services,
Partnerships, Leadership, etc.
• Provide Needed Technical Assistance
• Effectively Manage Resistance
• Establish Effective Feedback Loops at All Levels
• Celebrate Short-term Wins
Achara Consulting, Inc
http://www.dbhids.org/assets/Forms--Documents/tran sformation/Pr acticeGuidelines.pd f
Achara Consulting, Inc
Leading Transformational Change:
Aligning the Context
• Streamline Paperwork and Duplicative Processes
• Identify Needed Policy and Fiscal Alignment
• Transition from a Provider Monitoring Role
Achara Consulting, Inc
Lessons Learned
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Create the expectation that this is a marathon not a sprint
Transformational change requires courageous leadership
Assign a point person with power to make changes and the
necessary skill set
Attend to parallel processes
Identify specific areas of focus
Create short-term wins and celebrate successes
Identify and incorporate mechanisms for skill-building
Collaborate with vibrant recovery community organizations
Move beyond the choir
Achara Consulting, Inc
For More Information
Ijeoma Achara – Abrahams, PsyD
Achara Consulting, Inc.
Ijemoa.achara@yahoo.com
HOW ATR CHANGES
THE CULTURE WITHIN
SYSTEMS OF CARE
GRANTEE PERSPECTIVE
Kevin Gabbert, LISW, IAADC
Access to Recovery Project Director - Iowa Department of Public
Health, Division of Behavioral Health
The Changing Culture in Iowa
In the fall of 2007 there was a lot going on
with SUD treatment services and recovery
in Iowa:
• A new SSA was appointed
• Received the ATR II grant
A New Vision for Iowa
“Iowa envisions a transition to a more
comprehensive and integrated recovery-oriented
system of care for addictive disorders built on
coordination and collaboration across problem
gambling education and treatment, substance
abuse prevention, and substance abuse treatment.
To be effective, the system of care must be a
partnership that encompasses community
partners, prevention and treatment providers, the
recovery community, and other stakeholders.”
The Goal for Iowa
The goal for developing a ROSC in Iowa
is to work with individuals, families, and
communities over time to create a
network of community-based services
and supports for all aspects of the
addictions continuum with clear linkages
to services for other complex issues, like
mental and physical health.
The Role of ATR
• Stepping Stone
• Systems Transition/Service Development
• Accounting Approach
ATR as a Stepping Stone
ATR has impacted the way we as a State
view and deliver services to individuals with
a substance use disorder, specifically:
• Recovery Support Services
• Individual Choice
• Vouchers and use of a VMS (Voucher
Management System)
ATR and Systems Transition/Service
Development
ATR created an opportunity for Iowa to
introduce new concepts and services to the
larger system in a controlled approach.
New Concepts:
• Recovery Oriented System of Care
• Multiple Paths to Recovery
ATR and Systems Transition/Service
Development – Cont’d
New Services:
• Recovery Peer Coaching (SUD)
• Integrated Therapy
• Suboxone/MAT
• Recovery Calls
• Gas Cards and Bus Passes
• Wellness
• Life Skills Coaching
ATR as an Accounting Approach
• Care Coordination Model
• Funding Caps (monthly/total)
• Unit rates
Lessons Learned
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Introducing Recovery Support Services
Consumer Choice
Recruiting New Providers
Bringing everyone together
What are we doing now?
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ROSC website
Service System Transition
Discussion Papers
Gambling
For more information
Kevin.Gabbert@idph.iowa.gov
1-866-923-1085
www.idph.state.ia.us/atr
THE PROVIDER’S
PERSPECTIVE
Beverly Haberle, MHS, LPC, CAC
Executive Director - The Council of Southeast Pennsylvania/PRO-ACT
About PRO-ACT
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Hosted by The Council of Southeast Pennsylvania, Inc.,
which has a 36-year history of community mobilizing,
education and advocacy.
PRO-ACT, Pennsylvania Recovery Organization – Achieving
Community Together, was founded in 1997.
Grassroots advocacy initiative promotes the rights of and ensures
opportunities for those still suffering from the disease of addiction,
members of the recovery community and their family members.
Provides advocacy and peer-to-peer recovery support services
throughout the 5 counties of Southeastern Pennsylvania.
1998, 2001 and 2007 RCSP recipient, helped to grow PRO-ACT.
Operates 3 Recovery Community Centers and a Recovery
Training Center providing peer recovery support services to an
average of 2523 individuals and families monthly.
Offers an average of 199 volunteer delivered skill building
workshops and support programs monthly.
Philadelphia History
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1999 Philadelphia PRO-ACT chapter
established - hosted social events, trainings,
health fairs, and recovery walk.
Hard to mobilize large urban area without visible
presence within the city. Early on provided
tangible support.
DBHID/OAS provided financial support for PROACT to expand activities within the city.
October 2005 - Opened and staffed
Philadelphia office, began providing Peer-toPeer recovery support services.
Partnered to Open 1st Recovery Community Center
in Philadelphia - December 2007
PRO-ACT Role in Access to Recovery
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Deliver approved services
Stakeholder in on-going providers meetings and
system planning
On-going refinement of process
Administrator’s Perspective
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Moving to a fee for service funding from program
funding for selected recovery support services
Identify services to be provided
Technology – updates required
Fiscal oversight
Audit considerations
Liability insurance updated
Credentialing of staff
Staff Perspective
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Pre-implementation Expectations/Concerns
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10-month-in Benefits and Opportunities for
improvement
Prior to Access to Recovery concerns
1. I had no concerns before the project started. 17%
2. Would a "fee for service model" change the quality of our
services? 67%
3. That I would not have enough time to properly engage a
member. 50%
4. My concern was that the ATR clients would take priority
over others in need of service. 50%
5. That there would be too much paperwork for me to spend
quality time with the members. 17%
6. I would not be able to properly administer the GPRA using
an online tool. 0%
7. That members would get involved with other providers and
not come back to the Center for additional support 83%
8. Any other concerns ? (please explain) ____ 0%
Prior to Access to Recovery concerns
Concerns after 10 months of services
provided through Access to Recovery
1. Once a member is assessed and chooses the services
that they want, that they will follow through with their
choice. 67%
2. How can we identify more participants for ATR? 33%
3. How can we make services more attractive/interesting to
the participants? 50%
4. How can we help people with transportation to get and
keep them involved with services? 100%
5. How do we differentiate between ATR services and our
other services 17%
6. Many of the clients are in need of services beyond the
scope of ATR. 50%
Concerns after 10 months of services
provided through Access to Recovery
What I really like about ATR is …
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How it services different populations.
It gives the person a choice.
The options it gives the participants.
The array of support services available to
people in recovery.
5. Anything that gives the consumer a choice to
where they can receive services is a plus for
everyone.
6. That the program allows additional/alternative
treatment options.
The ATR project could be made better if …
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We could add more services and more providers in every
area zip code and community in Philadelphia.
We could verify if the person is eligible instead of going
through a third party.
We could support the people in recovery to follow up with
their selected support service – i.e., when a person in
recovery is in temporary housing, the provider might not
encourage the person to go to other services of their
selection.
We could provide more transportation opportunities.
We could attract more participants. Members are often
denied the ability to make it to where services are
available due to transportation and fluctuating program
schedules at their residence.
We could better track and engage members utilizing the
service.
Services Approved for Reimbursement
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Evaluation and Initial GRPA
Life Skills Training – Group
Money Management, Credit and Financial
Planning – Group
Peer Mentoring, Coaching, and Recovery
Planning – Individual
Therapeutic Recreation – Group
Transportation Tokens
Lessons Learned
Contact Information
The Council of Southeast Pennsylvania/PRO-ACT
252 W. Swamp Rd.
Doylestown, PA 18901-2465
Phone: 215-345-6644
Bhaberle@Councilsepa.org
Thank You
If you have any questions, you may contact us at
webmeeting@altarum.org
THANK YOU