Advancing Recovery in Missouri

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Advancing Recoveryin Missouri

• Partnership between the Missouri Division of
  Alcohol and Drug Abuse and 10 Provider Agencies
• Terry Morris, M.S.
• May 18, 2007

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Missouri Partnership
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Missouri Partners

• ADA
• MIMH
• Comprehensive Mental Health Services
• Family Counseling Center
• Family Counseling Center of Missouri

• Family Guidance Center
• Gibson Center
• Ozark Center
• Preferred Family Healthcare
• Queen of Peace
• ReDiscover
• St. Patrick Center

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State-wide aim

• Adoption of medication assisted treatment
• Improve consumer engagement
• Improve treatment outcomes
• Increase clinically appropriate utilization of
  less expensive and more available levels of care
• intensive outpatient rehabilitation
• supported recovery

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Targeted Evidence Based Practice

• Medication Assisted Treatment
• Treat alcohol dependence or severe abuse
• naltrexone
• acamprosate

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Target Population

• 18 years and older
• Informed consent to participate
• Diagnosis of alcohol dependence or severe abuse
  which is one of but not necessarily primary
  diagnosis
• Meets criteria for medical appropriateness

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Baseline Measures

• 0 of consumers prescribed naltrexone reported in
  legacy information systems
• We know this figure is not completely accurate
  but we know the frequency was extremely low (lt
  1)

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Business Case for Aim

• Total budgeted dollars will remain unchanged
• Treatment will be more efficacious
• Consumers will experience improved treatment
  outcomes
• Overall cost per consumer will be reduced
• Overall access to treatment will increase
• More consumers will be appropriately treated in
  less intense levels of care
• Reduce bottleneck at primary treatment with
  residential support

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Problems to be Solved

• Screening consumers
• Physician availability
• Cost of medical assessment
• Cost of laboratory tests
• Cost of the medications
• Development of centralized purchasing
• Dispensing medications
• Compliance with medications

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Web Supported Community

• Members only web site
• Supports
• Project calendar
• Forums (threaded asynchronous QA)
• Document repository
• Wiki (collaborative writing)
• Contacts
• Subscriptions (RSS)
• Search

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Accomplishments System Changes

• Providers may bill for physician to evaluate and
  prescribe naltrexone or acamprosate
• Providers may bill for laboratory services
• Providers may purchase naltrexone at reduced cost
  with central purchasing procedure
• Built clearing house of clinician and consumer
  level educational information
• inform the decision to use medication assisted
  treatment
• increase medication compliance by the consumer

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Accomplishments System Changes

• Expanded services
• Now authorizing lengthened services for
  individuals getting MAT
• Client education groups
• Creating groups of individuals using MAT and
  their families help individuals provide mutual
  support and allow for targeted staff assistance
• Increase availability of medication
• Medication was unavailable from the state before
  this project

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Accomplishments System Changes

• Major paradigm shift for staff and clients
• Little use of MAT prior to the project. Educating
  staff, clients, families, and prescribers have
  turned MAT into a viable treatment option
• Learning community
• Project specific web site has facilitated
  communication and information sharing and has
  built a common information repository
• Change Leader conference calls and meetings with
  NIATx Coaches
• Increase treatment time for those who are taking
  medications

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Accomplishments System changes

• MAT introduced later in treatment than initially
  expected
• Initially introduced at admission
• Found that later introduction improved the
  consumers readiness for MAT
• Evidence based practice
• Liked by the Drug Courts
• Liked by consumers

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Problems/Barriers

• Could treat more individuals
• With more dollars, many more individuals could
  use MAT
• Current model is regular treatment dollars
  diverted to provide MAT
• Continuity
• Providers of intense services cannot make
  referrals to less intensive providers who offer
  MAT
• Prescription of choice?
• Prescribers and clients gravitate toward
  different medications from site to site

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Problems/Barriers

• Data system
• Lack of understanding of the new state data
  system and processes make entering and retrieving
  accurate data difficult
• Enthusiasm varies
• Client enthusiasm is related to staff enthusiasm
  which varies from location to location.

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Planned changes/activities

• Expanding target groups to include those in less
  intensive treatment modalities
• Expand MAT education of clients, their families,
  counseling staff and prescribers
• Share provider-created medication ID card for
  clients to carry with them in case of emergencies

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Planned changes/activities

• Expand consumer participation at provider and
  state level
• Work with new prescribers who are more interested
  in learning about and using MAT
• Capture improvement/compliance data from direct
  client interviews