Notable Substance Abuse Issues for 2007

Notable Substance Abuse Issues for 2007 As presented to the Association of Substance Abuse Professionals Austin, TexasJanuary 22, 2007 Dave Wanser, Ph.D. Deputy Commissioner for Behavioral and Community Health Texas Department of State Health Services Highlights • Likely Legislative Issues • Cross Agency Initiatives – Data Sharing • Prevention and Early Intervention Agenda • Focus on Alcohol and Tobacco • Improve Quality of Care • National Outcome Measures • Workforce • Clinical Management for Behavioral Health Services (CMBHS) 80th Legislature • Criminal Justice Diversion • Drug Courts • Medicaid and Healthcare Reform • Crisis Response • Mental Health Transformation • Drug Demand Reduction Advisory Committee (DDRAC) 80th Legislature Criminal Justice Diversion Drug Courts Cross agency, data sharing, workforce Prevention & early intervention (EI), cross agency, data sharing, National Outcome Measures (NOMS) Quality, alcohol and tobacco Medicaid and Health Reform Crisis Response Workforce, prevention & EI, quality, NOMS Mental Health Transformation CMBHS, prevention & EI, cross agency, data sharing, workforce Invest in Results Through Evidence-Based Services • Expand systemic use of evidence-based practices to all substance abuse intervention and treatment services purchased with state dollars • Revise the state Medicaid plan to include reimbursement for screening and brief intervention in emergency, primary care, and women’s health care settings • Remove the exclusion clause for medical expenses from the Uniform Individual Accident and Sickness Policy Provision Law (UPPL) Texas Drug Demand Reduction Advisory Committee Recommendations Intervene Early in Underage Drinking • Require state-funded colleges and universities to implement parent notification programs for minor students who receive alcohol and drug disciplinary violations • Require students that receive alcohol/drug violations on state-funded college campuses to be screened and participate in a brief intervention as a part of disciplinary action Texas Drug Demand Reduction Advisory Committee Recommendations Breaking the Cycle of Addiction and Crime • Authorize the use of sobriety checkpoints as an optional tool for law enforcement • Create a funding stream for Drug Courts and DWI Courts by requiring a $50 court fee to be charged to those convicted of DWI and drug offenses • Amend the existing drug court statute to require counties with a minimum population of 200,000 to establish DWI/Drug Courts for both misdemeanor and felony DWI and non-violent drug offenders contingent upon receipt of state or federal funds for this purpose Texas Drug Demand Reduction Advisory Committee Recommendations Future Interagency Initiatives to Reduce Drug Demand in Texas • Develop a strong workforce using motivational interviewing • Match people to the appropriate services through effective screening and placement systems • Develop mechanisms to share data across agencies Texas Drug Demand Reduction Advisory Committee Recommendations Texas Partnership for Family Recovery  An inter-agency technical assistance project supported by the National Center on Substance Abuse & Child Welfare (NCSACW) and led by DSHS in partnership with: • Department of Family & Protective Services (DFPS) • Office of Court Administration (OCA) • Texas Court Appointed Special Advocates for Children (TX CASA) • Court Improvement Project (CIP) Organizational Structure • Led by an Executive Team: – Dave Wanser, Ph.D., Deputy Commissioner, DSHS – Joyce James, Assistant Commissioner, DFPS – Joe Gagen, CEO, Texas CASA – Honorable John J. Specia, Retired Judge, 225th District Court – Carl Reynolds, Executive Director, OCA • Coordinated by a Core Team: – Kim Gibbons, Child Protective Services – Cathy Cockerham, Texas CASA – Judy Brow, State Health Services – Team Lead – Mena Ramon, Office of Court Administration • Informed & supported by an Advisory Committee: – Includes members from each system with substance abuse represented by Leonard Kincaid, Eric Niedermayer and Becca Crowell Texas Partnership for Family Recovery • Mission – To build a sustainable, family focused, integrated behavioral health service system that will strengthen, stabilize, and unify families involved with the child welfare system • Proposed activities • Design cross-system protocols and service • Design evaluation and communication strategies to support marketing, funding, service integration, and public support • Recommend legal, judicial, child welfare, and substance abuse content for staff training and cross training CSAT Core Review and PRQIP • Core Review – A federal activity in which SAMHSA reviews state policies and practices to determine compliance with the requirements of the SAPT – State officials, two contracted providers and SAMHSA participated • Peer Review and Quality Improvement Project (PRQIP) – The clinical records of five randomly chosen providers were reviewed by Texas licensed counselors “Opportunities for Improvement” Several similar issues were raised in both reviews: 1. The program’s quality assurance (QA) or continuous quality improvement (CQI) processes were not performed well, if at all 2. Knowledge of SAPT priority population regulations 3. Clinical oversight/review of other counselors’ client records and the amount of documentation 4. Provider responsibilities to priority populations 5. Treatment plan trainings need to take place PRQIP Findings Adult Five providers, ten randomly-selected clients from each • Screening – Many screenings done and client sent directly to treatment without an assessment – Most of the recommendation justifications were insufficient in explanatory detail – HIV/STD/TB screening responses indicating a client is at high risk did not have any comments regarding the client being told of the risk, and no referrals for testing were recorded – Recommendations for assessment with a screening score of zero with no documented explanation PRQIP Findings Adult • Assessment – Most had little to no explanatory comments with clients given a severity rating of 8 or 9 with nothing written to support the score – Often high scores were given when the client response of what he believed was the seriousness of their problem was a 1 (cannot give a 9 when the client answers a 1) PRQIP Findings Adult • Admissions – In all agencies, the justification for admission was insufficient – Continuum of care issues • Little linking of residential to outpatient • Majority referred did not show up – Little effort in writing even a few sentences that would list the particulars of the client’s situation PRQIP Findings Adult • Treatment Plans – Generic and virtually the same for every client – Reviews were performed but no additional information was placed into the plan nor was it indicated when a client had completed a goal or objective – Very few of the plans had any problems that were in the client’s own words • It is realized that the plan is usually generated from the assessment, but surely one listed problem could be what the client believes his or her problems to be • Progress Notes PRQIP Findings Adult – Very good and detailed progress notes, but when new information/problems were identified, no resultant problem or resolution of problem was made to the treatment plan • Referrals – At two agencies, no documentation of referrals even when high-risk STD/HIV/TB was noted PRQIP Findings Misc. • Youth assessment problem areas rated 6 and above gave little justification of the reason the rating was high, and often in the screening did not document DSM criteria for diagnosis • Specialized females – Many records had little detail about the clients condition – Only a few records had documentation that prenatal family, domestic, or child issues – Half of the treatment plans had no reviews • In some files there were no individual sessions noted over a 2 ½ month time period • No or little documentation of the special services that SFS are supposed to contain COPSD/Methadone • One COPSD program reviewed had excellent notes and documentation while another was missing assessments and treatment plans in 25% of records reviewed – In those with treatment plans there was little linkage between the progress notes and the plan • Methadone – In 10 out of 10 records reviewed there were no progress notes • Only 6 had a treatment plan • 3 clients admitted with no screening or assessment • 4 clients admitted while reporting no opiate use in the last 30 days, with no explanation as to why they were admitted Detoxification • Virtually all the progress notes were “cut and pasted,” containing the exact wording of other clients going through detoxification • Ambulatory detoxification: Generally OK documentation, but the length of stay of one patient with Cannabis dependence was 24 days with no documentation of the type of withdrawal symptoms they were experiencing Training • DSHS will review what can be done to facilitate educational efforts about definitions in the SAPT (e.g. “interim services”, “priority pop.”) • We can review provider Q/A and CQI activities and provide TA where needed • Increased training on the ASI or we may have it “auto score” each section • Increased focus on continuity of care, retention, and motivational enhancement strategies Other “Outcomes” • Continuity of care • Treatment engagement • Retention/Length of stay • Follow-up status from detoxification • For youth, family involvement in treatment