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Maryland Alcohol and Drug Abuse Administration
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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