Steps needed to improve the accountability and effectiveness of Californias Alcohol and Drug Treatme

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Steps needed to improve the accountability and
effectiveness of Californias Alcohol and Drug
Treatment System California Outcome
Measurement System for Treatment
(CalOMS)Increased implementation of
science-supported interventionsImproved
educational/professional standards for
Californias AOD workforce

• Richard Rawson, Ph.D., Professor
• UCLA Integrated Substance Abuse Programs
• David Geffen School of Medicine
• www.uclaisap.org

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Californias AOD Publicly Funded Treatment
System Facts and Figures

• Every year 200,000 individuals over the age of
  18 are admitted for treatment into Californias
  publicly funded treatment system.
• The California system is made up of a
  heterogeneous collection of 1200-1500 treatment
  programs.
• The annual budget for this treatment is
  approximately 500,000,000.

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Californias AOD Publicly Funded Treatment
System What does it deliver?

• Treatment programs are diverse and highly
  variable in the setting as well as the type,
  amount and quality (??) of services provided.
• Settings include
• Hospital-based medically supervised
  detoxification services
• Residential services, in which therapies
  (counseling and medications) are integrated into
  the 24 hour facility operations.
• Residential services, which consist of minimal
  services other than sober housing
• Outpatient psychosocial care (eg. counseling)
  without medications
• Outpatient care with medication focus (eg.
  Narcotic Replacement Therapy).
• Most widely used

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Californias AOD Publicly Funded Treatment
System What does it deliver?

• Services include
• Assessment Services (with and without a
  standardized methodology)
• Medications (eg methadone, buprenorphine).
• Individual and Group counseling of an undefined
  nature.
• Behavioral and psychosocial therapies with
  scientific support (eg. Cognitive Behavioral
  Therapy, Contingency Management, 12 Step
  Facilitation Therapy, Motivational Interviewing,
  Matrix Model).
• Specialty services (eg Womens focused therapies,
  employment counseling, medical and psychiatric
  services
• Case management, referral services,
  transportation, educational services, child care
  services.
• Most widely used

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Californias AOD Publicly Funded Treatment
System Does Treatment Work?

• Yes Without Question
• Data from the California Admission and Discharge
  Data System (CADDS) documented over the past
  decade that, in general, individuals who enter
  treatment in Californias system do reduce their
  drug/alcohol use, reduce crime and make
  improvements in their lives.
• Specific studies of selected samples of
  individuals treated in the California Treatment
  system make very substantial improvements and the
  treatment saves taxpayer money (eg Caldata,
  CalTopps, SACPA Evaluation).

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Californias AOD Publicly Funded Treatment
System Unanswered Questions

• Which treatment settings work best for which
  patients?
• How much treatment is enough?
• How much of the treatment used is based on sound
  scientific evidence?
• Do some California counties deliver better care
  than others?
• Is treatment accessible to individuals who need
  it?
• Is California investment in AOD treatment
  producing maximal benefits?
• Is treatment in California improving or becoming
  less effective?
• Do we use effective treatment practices for
  different types of AOD disorders (eg heroin,
  methamphetamine, alcohol, etc)?
• Do we use effective treatment practices for
  different types of clients (women, different
  ethnic groups, homeless people, people with AIDs,
  etc)?
• Do some treatment programs in California work
  better than others?
• CorollaryAre some programs better investments
  than others?

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Californias AOD Publicly Funded Treatment
System An Unpleasant Reality

• Currently, if an addicted individual or their
  family member desire to identify a specific
  treatment program in California that provides the
  most effective and appropriate care for their (or
  their loved ones) specific AOD problem, there is
  no objective means for them to be directed to a
  program or programs which are best suited to meet
  their needs.
• Individuals are referred to treatment based upon
  rumor, unsupported marketing material, personal
  experience, geographic proximity, etc.
• There are no publicly available data on the
  treatment outcomes for a specific program (as
  there are for hospitals) or on the
  quality/credentials of the people delivering care
  within a specific program (as there are for
  schools, colleges, universities) or on the array
  of services provided by the program (as there are
  for hotels) or on the satisfaction of the client
  customers (as there are for restaurants).
• There is no Consumers Guide to the California
  AOD treatment system

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California Outcome Measurement System for
Treatment (CalOMS)

• A major advancement in developing the capability
  to answer the questions posed above is the
  implementation of the California Outcomes
  Monitoring System for Treatment (CalOMS).
• CalOMS is a data collection system developed by
  the Department of Alcohol and Drug Programs (ADP)
  and implemented in Jan 2006.
• With CalOMS, a standardized set of information is
  collected on every adult admitted into
  Californias publicly funded AOD treatment system
  at the time they are admitted to treatment,
  transferred to a different level of treatment, at
  365 days after admission (for those remaining in
  treatment for one year) and at discharge from
  treatment.

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California Outcome Measurement System for
Treatment (CalOMS) What does it measure?

• CalOMs data includes information on
• drug and alcohol use,
• employment and educational activities,
• medical conditions,
• psychiatric symptoms,
• family functioning,
• criminal activity and involvement with the
  criminal justice system.
• CalOMs also captures the length of time
  individuals remain in treatment, the proportion
  who complete episodes of care and the proportion
  who successfully transfer to other levels of
  care.

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California Outcome Measurement System for
Treatment (CalOMS) How will it improve
treatment system accountability?

• CalOMS will produce data that will allow
  California ADP and County Administrators to
  assess the functioning of specific treatment
  programs.
• Impact of treatment on client functioning from
  admission to discharge can be objectively
  measured (eg. reduction in drug use days) (ie.
  program outcomes).
• Degree to which the clients in a particular
  program meet specific benchmarks (eg retention in
  treatment) (ie. program performance).
• Because the information collected on all clients,
  in all programs, in all counties is the same,
  programs can be evaluated with the same yard
  stick.

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California Outcome Measurement System for
Treatment (CalOMS) How will it improve
treatment accountability?

• CalOMs allows California to meet federal
  requirements for participation in the National
  Outcomes Monitoring System (NOMS).
• By linking CalOMS data to other California data
  systems, the fiscal benefits produced by
  treatment from reductions in other taxpayer
  domains (eg. crime, incarceration, welfare costs,
  etc).
• As CalOMs evolves and collects more information
  on the exact therapies/medications used and the
  amount of these services delivered, a better
  understanding on the best match of client with
  treatment type and amount can be obtained.

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California Outcome Measurement System for
Treatment (CalOMS) How will it improve
treatment accountability?

• It will allow ADP and County Administrators to
  identify programs that are performing the best
  and whose clients have the best outcomes.
• This will allow for Counties to implement
  performance-based contracting (if desired).
• It will allow ADP and Counties to target
  technical assistance to poorly performing
  programs and reward exceptional programs.
• In extreme situations where programs continue to
  perform below established standards, it will
  provide information needed to discontinue funding
  for subpar programs

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California Outcome Measurement System for
Treatment (CalOMS) Recommendations

• The systematic measurement of California
  treatment programs has begun with the
  implementation of CalOMS. The potential value of
  this system to improve Californias AOD treatment
  system is great. However, to fulfill its
  promise, there will need to be
• Ongoing evaluation, improvement and systematic
  application of the CalOMS information.
• Input and involvement from California and
  national treatment experts to ADP to ensure
  appropriate and optimal applications.
• Expanded efforts to link CalOMS data with other
  data sets to measure full impact of AOD treatment
  
• Addition of youth treatment programs to CalOMS
  data system.
• Increase linkage between CalOMS findings and
  training, service improvement and workforce
  development efforts.

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Other AOD System Improvement Issues Increased
Application of Science-supported Interventions

• Maximize the application of and training for
  treatment methods with clear scientific support.
• Engagement and Retention strategies (NIATx).
• Trauma-informed treatments
• Empirically supported treatments for stimulant
  dependence (methamphetamine and cocaine).
• Increase application of opiate addiction
  medications (methadone and buprenorphine) and
  medications for alcohol dependence treatment.
• Implement methadone and buprenorphine for opiate
  addiction within and following incarceration in
  prisons and jails.

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Other AOD System Improvement Issues Increased
Application of Science-supported Interventions

• To ensure continued improvement of the AOS
  system, create an ongoing AOD system improvement
  committee to ensure the proper integration of
  data, identification of most appropriate
  treatment methods and training to ensure the
  development of most effective treatment
  approaches.
• Involve leading clinical researchers, clinical
  leaders, educators, treatment providers, county
  administrators and other stakeholders (eg.
  criminal justice).

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Other AOD System Improvement Issues Improved
Educational/Professional Standards for
Californias AOD Workforce

• Educational requirements and certification
  standards for service delivery personnel in the
  California treatment system should be sufficient
  to ensure application of treatments with best
  clinical effectiveness.
• Ensure that the California Substance Abuse
  Counselor Certification program curricula promote
  skill development and competence with science
  supported interventions.
• Use the aforementioned AOD system improvement
  committee to provide input and guidance for
  certification and educational system improvements

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Thank yourrawson_at_mednet.ucla.eduwww.uclaisap.or
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