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                                                                                and employment opportunities.
                                                                                and benefit from DHMH services, programs, benefits,
                                                                                disabilities are given an opportunity to participate in
                                                                                Disabilities Act, ensures that qualified individuals with                         Q
                                                                                                                                                                A Qua                                                              r
                                                                                                                                                                                                                                  ers
                                                                                Department, in compliance with the Americans With

                                                                                                                                                    Fall 2005
                                                                                advantages, privileges and accommodations. The
                                                                                policy prohibits discrimination on the granting of


                                                                                                                                                                               Management Conference 2005
                                                                                are operated on a non-discriminatory basis. This
                                                                                Department of Health and Mental Hygiene (DHMH)
                                                                                The services and facilities of the Maryland State
                                                                                                                                                Conference at a
                                                                                     S. Anthony McCann, Secretary
                                                                                     Michael S. Steele, Lt. Governor
                                                                                                                                                    Glance...
                                                                                     Robert L. Ehrlich, Jr., Governor
                                                                                                                                                                             The Eastern Shore was the site of this year’s
                                                                                                                                                 Keynote Address             Management Conference held at the Tidewater
                                                                                                                                                Jerome Jaffe M.D.            Inn and Conference Center in Easton. The con-
                                                                                                                                              “Towards Improving the         ference was attended by approximately 180
                                                                                                                                               Quality of Treatment”         participants representing program managers
                                                                                                                                                   (See page 4)              from Maryland’s funded treatment programs.
                                                                                              Catonsville, MD 21228                              Plenary Address             Highlights of the conference included a keynote
                                                                                              55 Wade Avenue                                    Deni Carise, Ph.D.           address by Jerome H. Jaffe, M.D. (see page 4)
                                                                                                                                                  “The Power of              and a plenary address by Deni Carise, Ph.D. (See
                                                                                                                                               Transforming Data”            the ADAA Compass, Summer 2005.)
                                                                                                                                             (www.maryland-adaa.org)
                                                                                                                                                                             Plenary speakers included Amelia Arria, Ph.D.
                                                                                                                                                 Plenary Speakers            from the Center for Substance Abuse Research
                                                                                                                                               Amelia Arria, Ph.D.           at the University of Maryland who presented
                                                                                                                                            Assessment and Treatment of      recently released findings from a statewide study
                                                                                                                                            DWI Offenders in Maryland:       on DWI offenders in Maryland. Also present-
                                                                                                                                                 Current Findings            ing, from the Addiction Technology Transfer
                                                                                                                                             (www.maryland-adaa.org)         Center (ATTC), were Aaron Williams, M.A. and
                                Maryland Alcohol and Drug Abuse Administration                                                                                               Jeffrey Knudsen, M.A. who provided a brief
                                                                                                                                            Aaron Williams, M.A. and         look at Preliminary Results from the Maryland
                                                                                                                                              Jeffrey Knudsen, M.A.                                                                What Did You Find
                                                                                                                                                                             Workforce Survey.
                                                                                                                                            Preliminary Results from the
                                                                                                                                            Maryland Workforce Survey;       Film-maker Lee Boot was on hand for a preview
                                                                                                                                                                                                                                  Most Valuable About the
                                                                                                                                              Using Needs Assessment         and discussion of his film Euphoria. This creative         Conference?
                       A Qua
                         Q                                                                                          ers
                                                                                                                     r                      Data to Advance the Current      and innovative work was funded by National
                                                                                                                                            State of Addiction Treatment     Institute of Drug Abuse, (NIDA). The film is          The conference topics and
                                      Peter F. Luongo, Ph.D., ADAA Director                                                                  (www.maryland-adaa.org)         aimed at preventing kids from becoming depen-         keynotes were well thought
                                                                                  Compass Bulletin                                                                                                                                 out.
                                                                              ADAA Publication # 05-1-004                                      Evening Presentation          dent on substances by understanding how to feel
                                                                         To submit information for publication in the                          The Electronic Record:        good without drugs. (See Page 5)
   Fall 2005                                                                 Compass or to update subscription                                 A Look into Our Future                                                              Opportunities to talk with
                                                                                    information contact:                                                                     On the opening night of the conference par-           national professionals.
Management                                                                                                                                      Cindy Shupe, ADAA
Conference                1                                                      ADAA Information Services                                   IS Division Director and        ticipants were offered a look at ADAA’s new
                                                                                       55 Wade Avenue                                         Stephen Sherman, BGR           Web-based core case management system which           Availability and ability
What the Data Say...      2-3                                                       Catonsville, MD 21228                                                                                                                          to speak, network, and
                                                                                                                                                 Associate Director          is still in the development stage. The Statewide      collaborate in a relaxed
Director’s Corner         3                                                         Editorial Board Members
                                                                                                                                                    (See page 6)             Maryland Automated Record Tracking system             setting.
OETAS Spring                                                                                                                                     Film Presentation
                                                                                                                                                                             (SMART) will be piloted in early 2006. (See
                          3
Courses                                                                                Debbie Green                                         “Euphoria” with discussion       page 2)                                               Overall the conference
Improving the Quality                                                           dgreen@dhmh.state.md.us                                                                                                                            continues to be a welcomed
                         4-5                                                                                                                  led by the film’s creator      This year’s workshop themes were varied with
of Treatment                                                                            Cindy Shupe                                                                                                                                asset to management.
                          6                                                       shupel@dhmh.state.md.us
                                                                                                                                                      Lee Boot               a focus on timely topics that support program
  SMART
                                                                                     Peter Cohen, M.D                                               (See page 6)             management. PowerPoint presentations used in
 ..From the Field         7                                                     pcohen@dhmh.state.md.us
                                                                                                                                                                                                                                   The quality of the presenters.
                                                                                                                                                                             the workshops can be found on the ADAA Web
                                                                                        Erik Gonder
                                                                                                                                                Director’s Remarks           site at www.maryland-adaa.org.
                                                                                gondere@dhmh.state.md.us                                                                                                                           Gathering information about
                                                                                        Sunya Smith
                                                                                                                                              Peter F. Luongo, Ph.D.                                                               challenges and successes in
                                                                                 ssmith@dhmh.state.md.us                                       Director’s Comments                                                                 treatment.
                                                                                                                                                    (See page 3)
                          Fall 2005                                                                 Compass                                                                          Page 2       Fall 2005                                                    Compass                                                            Page 7

            What the Data Say.....                                                                                                                                                               ...From the Field                     Community Clinic Meets the Clinical Trials Network
                                                                                                                                                                                                 By Patricia Quinn Stabile, LCSW-C, C- CATODSW, and CPP
                    Abstinence and Employment Performance Measures
                                   for Selected Populations                                                                                                                                        Pat is the director of          The NIDA clinical trials
                                                                                                                                                                                                                                                                       •
                                                                                                                                                                                                                                                                           community based, clinical settings.
                                                                                                                                                                                                                                                                           We found it important to have the Primary Investigator (PI)
                                                                                                                                                                                                   the HARBEL Prevention           network was developed as
                                                    By Bill Rusinko, ADAA Research Director                                                                                                                                                                                available and invested in educating the staff regarding the
                                                                                                                                                                                                   and Recovery Center,            a mechanism to demonstrate
                           An issue discussed in the outcomes mea- sion lost their jobs during treatment.                                                                                                                          the effectiveness of treatments         nature of the concepts being studied and the background that
                                                                                                                                                                                                   a community-based
                           surement workshop in Easton concerns the                                                                                                                                                                for substance abuse disorders           feed the goals of the research. To accomplish this researchers
                                                                                  The figures for the total population, including people outside                                                   treatment program serving
                           tendency for ADAA to run performance mea-                                                                                                                               adults and adolescents          in community based settings.            led in-service training for our staff so they would be familiar
                                                                                  the workforce who joined the workforce and others who lost
                           sures for all discharges from particular levels                                                                                                                         in Baltimore City. She          Much of the existing substance          with the concepts of the study.
                                                                                  their jobs, are 42.7 percent employed at admission and 48.4
                           of care when, in some cases, performance can                                                                                                                            is a graduate of Towson         based research has been             •   Building a consent process that allowed for two-way
                                                                                  percent at discharge. The best approach, given these findings,
         be enhanced by focusing on the most appropriate subgroups.                                                                                                                                University and earned her       done in academic settings,              communication, so researchers and clinicians could
                                                                                  is probably to present the finding that 31 percent of those who                                                                                                                          communicate on items of common interest involving the
         Improvement in abstinence and employment are two of the                                                                                                                                   Master’s degree in social       and the NIDA Clinical
                                                                                  were unemployed and available for employment at admission                                                                                                                                client, was crucial. Our clinicians needed to know if the
         measures that the federal Substance Abuse and Mental Health                                                                                                                               work from University of         Trials Network (CTN) was
                                                                                  (17 percent of the discharge population) found work during                                                       Maryland. She has served                                                client had tested positive/negative for drug use when they
         Services Administration (SAMHSA) will be reviewing for all                                                                                                                                                                developed as a mechanism to
                                                                                  treatment, while the employment rate for the entire population                                                   as a volunteer, as a direct                                             came for their research visit, and the researchers needed to
         50 states as part of the National Outcome Measures (NOMS)                                                                                                                                                                 demonstrate the effectiveness
                                                                                  increased by 14 percent.                                                                                         service clinician, as a                                                 know if the clients were keeping their appointments with
         in the near future. The current configuration looks at total                                                                                                                                                              of substance abuse treatment
         discharges, but there are exclusions that treatment programs Programs with substantial adolescent populations may want                                                                    clinical supervisor, and as     in community based clinics.             our counselors.
         should consider for reporting performance measures to to differentiate their employment outcomes by age. Using                                                                            a program manager.              In 2001, the first clinical         •   It was important to have the research assistants (RAs) attend
         ADAA. Some examples using FY 2005 ADAA-funded Level age at admission to differentiate patients revealed adolescent                                                                                                        trials were begun. HARBEL               clinical team meetings and report on items such as the status
         I discharges are discussed below.                                        employment, which was 18 percent at admission, increased by                                                                                      Prevention and Recovery                 of the study, the recruitment of subjects, and the progress
                                                                                                                                                                                                 Center, an outpatient center in Baltimore City, was fortunate             of the study at other sites. This practice helped clinic staff
               Percentage Employed at Discharge by Employment Status at Admission 28 percent during treatment. Adult employment went up by
                               ADAA-Funded Level I Discharges                     only 12.5 percent. Given this result, it would be counter-pro-                                                 to be chosen to serve as one of the community based settings              feel connected to the ongoing research at our clinic. We did
                                          FY 2005                                                                                                                                                for these initial trials. The results of this clinical trial were         not want the RAs to be “outsiders”, we included them in all
                                                                                  ductive to exclude adolescents from the mix. Even when age
           100
                                                                                                                                                                                                 published in October. The CTN experience presented                        clinic activities, such as copies of memos, staffing updates,
                                                                    86.6          at discharge was used to differentiate the youngest adolescents
                                                                                                                                                                                                 opportunities to look at how to make integrating research into            and holiday parties. RAs learned our crisis procedures, we
                                                                                  and adults, reducing the size of the adolescent discharge pop-
Discharge Employment Percentage




            80                                                                                                                                                                                   a community clinic an active growth experience. We learned                learned their research procedures.
                                                                                  ulation from 3,152 to 2,800 and the admission employment                                                                                                                             •   Throughout the course of the study it was essential that
                                                                                                                                                                                                 some very valuable lessons.
                                                                                  rate to 16 percent, the employment increase during treatment                                                                                                                             we recognize that it was an evolving process that required
            60
                                                                                  was reduced only slightly.                                                                                                                                                               continual evaluation and tweaking. We frequently examined
                                                                                                                                                                                                 First and foremost, to successfully implementing a research
                                  40                                                                     ABSTINENCE: The biggest factor suppressing improvement                                  protocol into a community based clinic, was the recognition               what was working.....or not working, and built in a continued
                                                                          31.3                           on this measure is the admission of a substantial proportion                            that researchers and clinicians have different histories, different       mechanism for feedback between the researcher and the
                                                                                                         of patients who did not use substances during the month pre-                            languages, and different goals. In order to bridge these                  clinic. Although there were not opportunities to change the
                                  20             15.2
                                                                                                         ceding admission. The following chart shows that 46 percent                             differences, we had to communicate about our differences and              research protocols once the project began, we felt it was
                                                                                                         of ADAA-funded Level I admissions were abstinent in the                                 develop a model for collaboration. While we were assured we               valuable to contribute to what might need to be different
                                   0
                                                                                                         month prior to entering treatment. The chart also shows that                            had the same professional interest in promoting the effective             in future studies.
                                   Out of Workforce/Not Seeking Work   Unemployed        Employed
                                             N=8,046                    N=3,441          N=8,559         separating out admissions that were in a controlled environ-                            treatment of substance abusers, we had been living in parallel        •   Finally, relationship building was very important. It is these
                                                                   Status at Admission                                                         (Continued on page 3)                             universes. The researchers had little contact with clinic staff           relationships that will enable community clinics to increase
                                                                                                                                  Percentage Abstinent
                                                                                                                                                                                                 who worked with substance abusers on a daily basis, and clinic            their capacity for research, to help insure that researchers
                                                                                                                              ADAA-Funded Level I Discharges
                                                                                                                                                                                                 staff had no contact with researchers unless they happened to             identify practices that are sustainable in community settings.
         EMPLOYMENT: Programs with patient populations that                                                                             FY 2005
                                                                                                                                                                                                 have read one of their publications.                                      By working together, we can more effectively share
         include a substantial percentage of persons in “out-of-the-
                                                                                                       100                                                                                                                                                                 resources, develop infrastructures that support evidence
         workforce” categories (homemakers, retired, disabled,
                                                                                                                                                                       Admissiom                 Early on we recognized the need to communicate, connect                   based implementation, deal with issues such as research
         incarcerated, students) might benefit by excluding                                                                                                            Discharge                                                                                           fidelity vs. practical adoptions, and promote information
                                                                                                        80                                                                                       and interact at a very basic level. This helped us to focus on
         such patients from the measurement. The chart above                                                                                                                                                                                                               dissemination about effective treatments.
                                                                                                                             68.4                                                                our common goals and in doing so to develop the teamwork
         shows discharge employment percentages for categories                                                                                                      62.2
                                                                                                        60           55.6                    55.2   54.1     57.7                                essential to our collaborative effort. Through this process
         of employment at admission to ADAA-funded Level I.                                                                         52.6                                            52.6                                                                               Overall it is the sense of teamwork and collaboration that can
                                                                                                                                                                                                 there were valuable lessons learned, some surprising but many
         For the first two groups, out of workforce or not seeking                                            46.1
                                                                                                                                                                             40.7                predictable. In short the things that helped build a collaborative    distinguish the CTN from other similar efforts that have failed.
                                                                                                        40
         employment and unemployed, the admission employment                                                                                                                                     atmosphere and encouraged us to work as a team were:                  While it may not be very difficult to bring a research study into a
         percentage is zero and for the last group it is 100 percent.                                                                                                                            • Creating a structure that allowed for communication and             clinic, unless you also put collaboration and teamwork in place,
         While 15 percent of the out-of-workforce group became                                          20
                                                                                                                                                                                                     collaboration. This meant we met regularly and faithfully         the active learning and actual participation in a change process
         employed during treatment (most were probably students or                                                                                                                                   to discuss ideas. We recognized the researchers were              that is needed to produce meaningful integration of research into
         in training), 13 percent of those who were working at admis-                                    0
                                                                                                                                                                                                     the experts in science, and they recognized we were               a community treatment clinic doesn’t occur. To learn more about
                                                                                                                 Total                    Referred from Tx                All Other Discharges
                                                                                                                      Referred from Prison/Jail      Other Controlled Environment                    the experts on practical implementation strategies in             the CTN visit www.nida.nih.gov/CTN/Index.htm.
                                                                                                               N=20,047      N=57               N=268          N=6,107          N=13,615
Fall 2005                                                 Compass                                                                     Page 6   Fall 2005                                                 Compass                                                       Page 3


                                S M A R T Tracking                                                                                                             �        ����������
                    Statewide Maryland Automated Record
By Cindy Shupe, ADAA Information Services Division Director
The Maryland Alcohol and Drug Abuse Administration
                                                                                                                                                               �        ����� The               Three Most Important Words
and the Bureau of Governmental Research have been                                                                                              The three most important words in real estate are, Location!        use, etc) they were explained away by the difficulty of the
involved in the development of a federally funded Web-                                                                                         Location! Location! The three most important words for              caseload, the intractability of the problem, or how hard it
                                                                                     Maryland Alcohol and Drug Abuse Administration
based core case management system, which was developed                                                                                         the substance abuse business are going to be, Data! Data!           was to show results. We didn’t seem to approach it from the
by incorporating key concepts and functions from HATS,                                                                                         Data!                                                               idea that maybe we can do something different. The reaction
and two additional state-wide systems from Texas and                                                                                                                                                               was that we just don’t do enough, or have enough. In other
Washington states.                                                                                                                             Information-based decision making is not new. You do it             words, we just need more resources. Maybe so, maybe not.
                                                                                                                                               all the time. You comparison shop, select one brand over            How would you know?
To meet our goal of moving funded programs to a                                                                                                another, decide on a school for your children and select a
complete electronic record, we have adopted this core                                                                                          health care provider. You as consumer, and purchaser access         Questioning belief systems is at the heart of a data driven
case management information system developed for the                                                                                           information to assist in the decision making. Often, you go to      decision making process. Starting from the quizzical
Center for Substance Abuse Treatment and are modifying                                                                                         the Internet for help. You conduct searches. You expect the         skepticism of a scientist instead of as a defender of the
it to meet the needs of Maryland providers.                                                                                                    information to be there for you. With that information, and         belief system opens up an honest inquiry. To do it you need
                                                                                                                                               some personal estimation of value to guide you, you make            to have data, and to use the data. To use it, the data needs
Not only will providers be able to enter and maintain their                                                                                    decisions. And eventually you evaluate the quality of your          to be an accessible and essential part of your clinical and
SAMIS data, the new application will provide treatment                                                                                         decision. Routine.                                                  administrative practice. Data used by clinicians to improve
providers with the ability to electronically monitor client                                                                                                                                                        patient care, data used by program managers to improve
progress, review treatment plans, monitor and approve                                                                                          Not so routine in the business of substance abuse.                  program outcomes, data used to improve system design
client services, and conduct quality assurance activities.                                                                                                                                                         and outcomes, and data to evaluate whether we just don’t
The full electronic record will include but not be limited                                                                                     For years, we operated more from our belief system than             do enough, or have enough of what we should do, is the
to the following items and functions:                                                                                                          from facts. Both our administrative and clinical practices          point.
                                                                                                                                               remained isolated and insular and we were certain in our belief
  •   Client Profile                     •   Referrals                                                                                          that we were doing things the right way. When inconvenient          That’s the smart thing to do. That’s what SMART will
  •   Client Intake                     •   Wait list Management                                                                               facts appeared, (high dropout rate, no reduction in age of first     help us to do.
  •   Screening Tools                   •   Facility Management               ADAA will pilot the system during the months
  •   Assessment Tools                  •   Staff Management                  of January, February and March. Prior to the                     What the Data Say.... (Continued from page2)
  •   Treatment Plans                   •   Provider Billing                  full implementation of the application and based
                                                                                                                                                                                                                      OETAS Spring Training
  •   Treatment Plan Reviews            •   Staff Scheduling                  on the results of the pilot project, ADAA, in                                                                                              Opportunities
                                                                                                                                                 ment for part or all of the 30 days before admission does
  •   Treatment Encounters              •   Treatment Teams                   collaboration with BGR, will further modify                        enhance the measure of improvement. Abstinence increased              The Office of Educaton and Training for Addiction
  •   Pre authorization                 •   Capacity Management               the system to better meet the needs of Maryland                    21 percent for the total Level I admissions, 29 percent among         Studies (OETAS) offers courses designed for
  •   Progress Notes                    •   Data Exporting                    providers. Look for more information on the                        those who were not reported to have been referred from                addiction professionals and other professionals
  •   Drug Testing                      •   Client, Agency, and State         SMART system coming soon to the ADAA                               prison, jail or another treatment provider or otherwise in a          interested in learning more about the treatment of
  •   Case Management                       Reports                           Web site at www.maryland-adaa.org.                                 controlled environment in the month preceding admission.              addictive disorders. The 2006 Spring Catalogue
                                                                                                                                                 Programs should consider making these and possibly other
                                                                                                                                                                                                                       of course offerings will be posted to the ADAA
       Euphoria of happiness in America.
                                                                                                                                                 distinctions when reporting abstinence performance mea-
                                                                                                                                                                                                                       Web site by the first of the year. Classes begin
                                                                                                                                                 sures, but the most effective way to maximize improvement
                                                          In a country built for the pursuit of happiness, Euphoria asks, “is                                                                                          in February so be sure to check the Web at www.
       A film about the pursuit                                                                                                                   may be to ensure that patients’ frequency of use at admission
                                                          it working? Are you happy?” Roving narrator and film creator                                                                                                  maryland-adaa.org to find the course right for
      A project funded by the National Insitute on Drug                                                                                          is reported accurately. If counselors become aware during
                                                          Lee Boot takes us on a tour through backyards, forests and                                                                                                   you. Registation instructions and forms for mail-
           Abuse (NIDA) and created by Lee Boot                                                                                                  treatment that a patient concealed his/her true frequency of
                                                          industrial wastelands finding symbols and clues that form a new                                                                                                                             ing are also on the
                                                                                                                                                 use at admission, or his/her true employment status for that
                                                          story about the American Dream. This film is about answering                                                                                                                                Web. If you have
                                                                                                                                                 matter, it is important to correct that information to maximize
                                                          the question: what makes us feel best, for longest? Interjected,                                                                                                                           questions contact
                                                                                                                                                 the potential for demonstrating improvement on these impor-
                                                          are stark stories from people who have built lives that work,                                                                                                                              OETAS by calling
                                                                                                                                                 tant measures.
                                                          often after surviving what would derail most of us. (Excerpt                                                                                                                               410-402-8585. See
                                                          from the Project Euphoria Web site at www.theeuphoriaproject.                                                                                                                              you in February!
                                                          com/index.html)
Fall 2005                                               Compass                                                        Page 4     Fall 2005                                                Compass                                                             Page 5
                                                                                                                                  Continued from page 4
               Dr. Jerome Jaffe, on “Improving the Quality of Treatment...”                                                       severity of the problems presented by their patients is such
                                                                                                                                  that the outcomes are as good as can be expected, or they                                          Meet Dr. Jaffe
                                                                                                                                  will select only those patients likely to do well. This prob-
Reported By Debbie Green, ADAA Compass Editor and edited by Jerome H. Jaffe, M.D.                                                                                                                                                Dr. Jerome Jaffe is a psychiatrist
                                                                                                                                  lem of adjusting for baseline severity is one that must be
                                                                                                                                                                                                                                 and pharmacologist whose work
                                                                                                                                  dealt with by the health care industry in general. The hope
Dr. Jerome H. Jaffe was the keynote speaker at this year’s        have the necessary resources.                                                                                                                                  in the area of addiction spans
                                                                                                                                  is that the process of providing incentives for good outcome
management conference. In his address titled, Toward                                                                                                                                                                             treatment, research, teaching,
                                                                  Dr. Jaffe then noted that we also need to deal with the         can be made fairer as programs, hospitals, and practitio-
Improving The Quality Of Treatment: Lessons From                                                                                                                                                                                 writing, policy, and government
                                                                  movement toward rewarding good outcomes and provid-             ners move to electronic systems of recording patient data.
Freakonomics And Other Odd Sources, he offered the                                                                                                                                                                               service. From 1971 to 1973, Dr.
                                                                  ing incentives for programs and practitioners to use the        Dr. Jaffe said he was impressed by the Alcohol and Drug
participants the following proposition: If the field of sub-                                                                                                                                                                     Jaffe served at the White House
                                                                  best methods. He related that the notion of rewarding           Administration’s movement toward enhanced electronic
stance abuse treatment is to remain part of the health care                                                                                                                                               as the first Director of the Special Action Office for
                                                                  results was the central recommendation of a working             data tracking and clinical record management.
delivery system, addiction practitioners and program man-                                                                                                                                                 Drug Abuse Prevention, creating many programs that
                                                                  group convened by Join Together, a project of the Robert
agers will have to be responsive to four major trends or                                                                          Returning again to the idea of megatrend interactivity, Dr.             form the basis for current efforts in drug abuse research
                                                                  Wood Johnson Foundation. The purpose of the group,
developments in the health care field. He identified these                                                                        Jaffe observed that programs that are unable to incorporate             and treatment. He was also head of the National
                                                                  which Dr. Jaffe chaired, was to explore ways of improving
mega-trends as follows:                                                                                                           new evidence-based treatments are less likely to produce                Institute on Drug Abuse (NIDA) Addiction Research
                                                                  the quality of treatment. The group applauded the efforts of
                                                                                                                                  above average outcomes and may, therefore, fare poorly in               Center and later served as acting director of NIDA
                                                                  National Institute on Drug Abuse (NIDA) and the Center
                                                                                                                                  a pay for performance environment. In the longer term, he               and in several other capacities in government agencies,
                                                                  for Substance Abuse Treatment (CSAT) to support train-
               MEGATRENDS IN                                      ing and to move research findings to the clinic, but it also
                                                                                                                                  said, rewarding results may force some weaker or smaller                including Director of the Office of Evaluation, Scientific
                HEALTH CARE                                                                                                       programs to seek mergers with more effective or efficient               Evaluation, and Synthesis at the Center for Substance
                                                                  recognized that the high turnover of clinical and manage-
                                                                                                                                  programs, but this is not necessarily a bad thing. Larger               Abuse Treatment (CSAT). He is currently a clinical
                                                                  ment staff in many programs meant that the effects of most
              Evolving professionalism                            training were likely to be lost. The Join Together group
                                                                                                                                  entities may be better able to afford new technology and to             professor of psychiatry at University of Maryland School
                                                                                                                                  provide for career advancement and job stability, which in              of Medicine and an adjunct professor at Johns Hopkins
                                                                  concluded that as long as programs producing substandard
                                                                                                                                  turn could reduce staff turnover that is detrimental to patient         University School of Hygiene and Public Health..
              Demand for evidence-based practice                  outcomes were paid as much as those producing better
                                                                                                                                  care.
                                                                  than average results, treatment outcome and quality were
                                                                  unlikely to get sustained management attention.                 In closing, Dr. Jaffe said that we are still in the early stages        To learn more about the contributions that Dr. Jaffe has
              Introduction of information technology                                                                              of measuring results, and it will be a slowly evolving pro-             made to the treatment of addictive disorders visit
                                                                  Dr. Jaffe also pointed out that the notion of rewarding                                                                                 www.pbs.org/wgbh/pages/frontline/shows/
                                                                                                                                  cess. We need to avoid systems that drive out our most
                                                                  results is not a radically new notion and is already being                                                                              drugsinterviews/jaffe.html
                                                                                                                                  talented clinicians. In the long run the impact of these four
              Use of incentives to improve quality                used in areas of general health care. For example, some
                                                                                                                                  megatrends may not only improve the outcomes of treat-
                                                                  managed care companies are paying bonuses to physician
                                                                                                                                  ment, but also the public’s perception and respect for what
                                                                  groups that achieve certain goals in terms of the proportion
                                                                                                                                  we do.
                                                                  of patients being properly treated for hypertension or diabe-
                                                                  tes. Hospitals that meet requirements for quality of care in
Dr. Jaffe emphasized that these trends are not entirely dis-      areas of heart attack, heart failure, and pneumonia receive
tinct, separated by sharp boundaries, but are continually         full payment from Medicare; those that don’t provide data                        Employment Opportunities on the Web
interacting.                                                      face a 0.4 percentage point reduction. The administrator
                                                                  for Medicare and Medicaid, Dr. Mark McClellan, has said                                                                            •   The ADAA Web site hosts Employment
The major part of the presentation was an elaboration of
                                                                  that at one level this is pay for performance.                                                                                         Opportunities for professionals in the substance
these trends, how they are relevant to the field of addic-
tion treatment, how they interact, and the challenges they        It was here that Dr. Jaffe introduced some of the observa-                                                                             abuse treament and prevention fields.
represent. He pointed out that we cannot deliver evidence         tions contained in a recent best-selling book, Freakonomics:
based health care treatment without a trained workforce           A Rogue Economist Explores the Hidden Side of Everything,                                                                          •   Job seekers can access the
– one that can understand and apply the findings emerging         by Steven D. Levitt and Stephen J. Dubner. Although these                                                                              Employment Opportunites listing
from our country’s very generous investment in research           authors, he pointed out, believe that “Incentives are the                                                                              from the main menu of the ADAA home
on alcohol and drug related problems Such a workforce             cornerstone of modern life…”, they were also aware that                                                                                page located at www.maryland-adaa.org.
implies progressive professionalization. At the same time,        incentives can sometimes produce unintended consequences,
we cannot hope to introduce and use emerging information          and “…for every clever person who goes to the trouble of cre-                                                                      •   Employers can post their job specifications
technology without a stable work force capable of learn-          ating an incentive scheme, there is an army of people, clever                                                                          to the Web by following on the Job Posting
ing how to use it. To do this, he said, we need supportive        and otherwise, who will inevitably spend even more time try-                                                                           Instructions on the Employment Opportunites
management structures with the stability to create opportu-       ing to beat it.” (Levitt and Dubner, pg. 25).                                                                                          page.
nities for career satisfaction for the front line practitioners
                                                                  Dr. Jaffe stated that two obvious possibilities to consider
and the economic resources to acquire and maintain the                                                                                                                                               •   For questions or assistance contact the Web
                                                                  when introducing economic incentives for good outcomes             Copy of ADAA Employment Opportunites page on
new technology. Currently, he said, the field consists of
                                                                  are that all programs or practitioners will insist that the        December 12, 2005                                                   Team at adaaino@dhmh.state.md.us
relatively small, often unstable, organizations that do not
                                                                                                       (Continued on page 5)

				
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