Fostering*Cross,System* Collaboraonfor Substance,InvolvedYouth · with substance use problems...
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Fostering CrossSystem Collabora3on for SubstanceInvolved Youth
Transcript of Fostering*Cross,System* Collaboraonfor Substance,InvolvedYouth · with substance use problems...
Fostering Cross-‐System Collabora3on for
Substance-‐Involved Youth
Adolescent Substance Use high school students
75.6%
§ Have ever used any addic3ve substance8
Adolescent Substance Use high school students
§ Have used substances in the past 30 days8
46%
Adolescent Substance Use
1 in 20 adolescents have a substance use disorder7
Adolescent Substance Use
§ Have received treatment for their SUD in the past year8
high school students with a substance use disorder
6.4%
CONNECTING ADOLESCENTS TO TREATMENT IS CHALLENGING
Adolescents’ Systems
• School • Primary care • Substance use treatment • Mental health treatment • Foster care • Juvenile JusCce
Collabora3on between systems is vital
CollaboraCon Improves Outcomes
• Improved quality of services3
• Reduced cost of care6 • Increased awareness of the issues6
• BeLer communicaCon with other agencies3
• BeLer informaCon-‐sharing3
• BeLer decision-‐making3
• Building shared value systems3
• Decreased anxiety6
CollaboraCon is Challenging
• Lack of funding/resources1, 2, 3, 4 • Lack of appropriate and Cmely services2
• Lack of adequate training1, 2 • Lack of understanding about other agencies’ perspecCves1, 3, 4
• ConfidenCality concerns for clients1, 3 • Difficulty disseminaCng informaCon to families2
• Differing organizaConal structures4 • Differing client informaCon systems4
DATA-‐DRIVEN DECISION-‐MAKING FOR COLLABORATION
ConCnuous Quality Improvement5
Small changes piece by piece add up to big improvements
Data-‐Driven Decision-‐Making
• CollecCng and analyzing data to make decisions
• Small-‐scale empirical tests to see if changes are worth implemenCng
ConCnuous Quality Improvement5
Small changes piece by piece add up to big improvements
Requires fewer resources
ConCnuous Quality Improvement5
Data-‐Driven Decision-‐Making • CollecCng and analyzing data to make decisions
• Small-‐scale empirical tests to see if changes are worth implemenCng
IdenCfy service and training gaps
TroubleshooCng issues around confidenCality and informaCon systems
Change Teams5 Small, representaCve group to plan and test proposed changes • Key stakeholders
– Supervisors/directors – Front-‐line staff
• RepresentaCves from all agencies involved in change process
More opportuniCes to communicate and cooperate across agencies and systems
Change Teams5 Small, representaCve group to plan and test proposed changes
Other agencies’
perspecCves
How other agencies are structured
More opportuniCes to communicate and cooperate across agencies and systems
IdenCfy service and training
gaps
PLAN DO STUDY ACT CYCLES
PDSA Cycles for TesCng Changes5
Springfield ProbaCon Office and
ABC Rehab
Goal: Improve rate of successful referral for youth with substance use problems
Substance Use Problem
Referred to treatment
20% Currently only of those with substance use problems are referred successfully
Plan Step
Design a test to invesCgate a parCcular quesCon or idea
Decide: What goal are you working toward? What can you test to make progress on that goal? How will you run your test? Prepare: What do you need to do before you can run your test? Plan: When and where?
Springfield and ABC’s PLAN Step What are you testing? What questions are you trying to answer with this test?
What do you expect will happen and why?
How will you measure the results of this test?
What data do you need to collect?
How will you collect the data?
Who will collect the data?
Phase 1. DECIDE: What will you test and how will you test it?
Staff will make the initial call to the treatment provider during their meeting with the family (as opposed to giving the family the provider’s information) to complete the treatment referral for youth with substance use problems.
Does having the staff member call the treatment provider (rather than the family) improve the rate at which youth with substance use problems are referred to treatment?
The proportion of youth with substance use problems being referred to treatment will increase because having staff make the initial call to the treatment provider together with the family (instead of families making the call on their own) will result in more successful referrals.
Proportion of youth with identified substance use problems who are referred to treatment using this procedure.
-number of youth with substance use problems -number of youth referred to treatment
Jason, Hazel and Leo will track which of their youth have substance use problems and the referrals they make on a shared spreadsheet.
Luke identifies which youth have substance use problems during assessment. Jason, Hazel and Leo track referrals. Leo manages spreadsheet.
Springfield and ABC’s PLAN Step
Task Who will complete task Completion Date Target Actual
Create spreadsheet to track # with problems, # referred
Annabeth 7/15/14 7/15/14
Briefly meet with Jason, Hazel and Leo to review procedure and answer questions
Annabeth 7/18/14 7/28/14
Phase 2. PREPARE: What tasks must be completed BEFORE you can run your test? Consider: communication with staff, training staff, assembling materials, etc.
WHEN? WHERE? WHO? Test start date
August 1, 2014 Location of test
Springfield Probation Office Who will carry out test Jason, Hazel and Leo
Who will be affected by test Jason, Hazel and Leo’s youth and families
Test end date August 31, 2014
Phase 3. PLAN: Now that you are prepared, when and where will the test occur and who will be involved?
Do Step
Conduct your test
Collect data Document problems Note surprising observaCons
InformaCon to be analyzed
Springfield and ABC’s DO Step What is going well?
What problems have you had with this test?
What has surprised you? What problems have you had collecting data?
DATA
Staff report that the number of confirmed referral appointments have increased—especially in cases where they are able to schedule with the provider without making multiple calls
-Process can be time-consuming: having to call provider multiple times -Families are likewise inconvenienced
We have had to make multiple calls to get an appointment scheduled—we did not realize that this would be a problem (and probably has been a problem for families in the past when they were scheduling the appointment themselves)
None
Study Step
Analyze the data and summarize what you’ve
learned
Analyze results Compare your results to your predicCons Consider observaCons from Do step (problems and surprises)
Springfield and ABC’s STUDY Step What do the data tell you?
What did you predict? (From your PLAN stage)
How do your results compare to your predictions?
What issues arose during the test? (From your DO stage)
What have you learned?
Rate of scheduled intake appointments improved for Jason, Hazel and Leo’s youth (from 20% to 50%). They note that it was particularly successful when they reached the provider on the first try
The process can be time-consuming (requiring multiple calls, which is
inconvenient for staff AND families)
More referrals were successfully completed by having staff make the initial appointment, but this can be time-consuming for staff and families
The proportion of youth with substance use problems being referred to treatment will increase
by having staff make the initial call to the treatment provider
Successful referrals improved for Jason, Hazel and Leo’s youth (from 20% to 50%),
as predicted
Act Step
Decide whether to implement the change or run a new test
Did the change result in improvement? Did the change cause any problems?
Ohen, mulCple PDSA cycles will be required to refine a change
Springfield and ABC’s ACT Step ADOPT
the change
ADAPT
the change
ABANDON
the change
Did the change result in the
improvement you were hoping
for?
Were there problems when
you ran the test?
Do you believe you can alter the change to make
it more successful?
YES YES
YES
NO
NO
NO
Next
PDSA cycle
Next PDSA: Identify a single contact person at each treatment provider to call to schedule the appointments
PDSA tools • PLAN Step Worksheet
– Document the decisions you make during the Plan step
• DO Step Worksheet – Document how your test is going
• STUDY Step Worksheet – Document your discoveries
• ACT Step Worksheet – Make and document your decision about this change
References 1. Darlington, Y., Feeney, J. A. and Rixon, K. (2005). Interagency collaboraCon between child protecCon and
mental health services: PracCces, ajtudes and barriers. Child Abuse & Neglect, 29, 1085-‐1098. doi: 10.1016/j.chiabu.2005.04.005
2. Garcia, A. R., Circo, E., DeNard, C. and Hernandez, N. (2015). Barriers and facilitators to delivering effecCve mental health pracCce strategies for youth and families served by the child welfare system. Children and Youth Services Review, 52, 110-‐122. doi: hLp://dx.doi.org/10.1016/j.childyouth.2015.03.008
3. Green, B. L., Rockhill, A. and Burrus, S. (2008). The role of interagency collaboraCon for substance-‐abusing families involved with child welfare. Child Welfare, 87 (1), 29-‐61.
4. Kingsnorth, S., Lacombe-‐Duncan, A., Keilty, K., Bruce-‐BarreL, C. and Cohen, E. (2013). Inter-‐organizaConal partnership for children with medical complexity: the integrated complex care model. Child: Care, Health and Development, 41 (1), 57-‐66. doi: 10.1111.cch.12122
5. Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L. and Provost, L. P. (2009). The improvement guide: A pracJcal approach to enhancing organizaJonal performance (Second ed.). San Francisco, CA: Jossey-‐Bass.
6. Palinkas, L. A., Ell, K., Hansen, M., Cabassa, L. and Wells, A. (2010). Sustainability of collaboraCve care intervenCons in primary care sejngs. Journal of Social Work, 11 (1), 99-‐117. doi: 10.1177/1468017310381310
7. Substance Abuse and Mental Health Services AdministraCon. (2014). SAMHSA: Age-‐ and Gender-‐Based PopulaJons. Retrieved from: hLp://www.samhsa.gov/specific-‐populaCons/age-‐gender-‐based.
8. The NaConal Center on AddicCon and Substance Abuse (CASA) at Columbia University. (2011). Adolescent substance use: America's #1 public health problem. New York, NY: Author.
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