Last Updated: December 2015

Author: Alcohol & Drug Abuse Programs, Vermont Department of Health

Behavioral health treatment for substance abuse is an ongoing process which requires multiple visits in order to modify behavior, build the skills needed to address the contributing factors in addiction, and prevent relapse. In order for substance abuse treatment to be effective, the individual must stay in treatment. Research indicates that those who are engaged in treatment have better treatment outcomes. For more information on this, please see the Journal of Behavioral Health Services and Research.

Treatment engagement is a measure of the portion of individuals who have two or more alcohol or drug services within 30 days of beginning treatment (initiation).

• Medicaid beneficiaries and families
• Community Providers – such as Licensed Alcohol & Drug Counselors (LADCs), primary care physicians and mental health practitioners
• ADAP Preferred Providers
• Recovery Centers
• AHS Departments (Department of Vermont Health Access, Vermont Department of Health Division of Alcohol and Drug Abuse Programs, Department Children and Family, Department of Corrections, Department of Aging and Independent Living, Department of Mental Health)

Services must match the needs of the individuals. They must be evidence-based, the appropriate level of care needed by the individual, and population specific. For instance, women's services must address needs specific to women such as trauma informed treatment and provision of childcare. Adolescent care must be aligned with the individual’s developmental stage.

Providers who offer attendance incentives to individuals (contingency management) have better engagement rates than those who don't.

Providers focus on quality improvement processes such as Network for the Improvement of Addiction Treatment, NIATx (http://www.niatx.net/), to determine the root causes of low treatment engagement. For example, a survey of treatment participants indicates that the primary reasons individuals miss appointments is because of lack transportation or childcare. The quality improvement process may test the reallocation of resources to address one or both of those issues.

ADAP and DVHA are in the process of developing a performance improvement project (PIP) that will address both the treatment and initiation performance measures and involve internal and external stakeholders. A PIP is a concentrated effort on a particular problem; it involves gathering information systematically to clarify issues or problems, and intervening for improvements.

Continue

the work of the Substance Abuse Treatment Coordination Initiative (SATC). The

purpose of this initiative is to establish a coordinated approach to serving

Vermonters with substance abuse problems across all departments. AHS recognizes

the substantial burden that substance abuse has on individuals seeking AHS

services, particularly those who need multiple services and therefore enter the

AHS system through different doors. If we can intervene early and better serve

Vermonters dealing with substance abuse issues, then other outcomes will improve.

Other

activities that may impact this measure

·

Increase

focus on this measure

o

Publish

provider level data

o

Include

treatment engagement as a performance measure in cross-departmental work for

substance abuse treatment populations

o

Decrease

variability in provider performance

o

Provide

technical assistance to providers with low engagement rates

·

System

Improvements

o

Improve

care transitions between different types and levels of behavioral and physical

health

o

Improve

collaboration between the providers and recovery centers

o

Provide

clinical supervisor training to emphasize individual engagement through the

recovery process

o

Coordinate

efforts between Agency of Human Services Departments to better support

individuals in treatment

o Increase overall system capacity through the addition of Licensed Alcohol and Drug Counselors (LADC) to better address access issues

These rates are based on the Healthcare Effectiveness Data and Information Set (HEDIS) Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) access to care measure. Substance induced mental disorders were not included. The rates exclude beneficiaries with Medicare or other medical insurance due to incomplete Medicaid claims history.

In

Vermont Medicaid, medication assisted treatment (MAT) is currently billed as

one unit per month. The HEDIS IET specification looks for one service within 14

days of index event to count as initiation and two services within 30 days of

initiation for engagement. An adjustment to the IET rate was used to count the

multiple visits each week occurring at the MAT opioid treatment programs. Also,

Vermont billing codes for behavioral health residential treatment do not match

the IET measure, but for this measure are counted as sub-acute facility visits.

Engagement – the % of Medicaid beneficiaries diagnosed with alcohol and other drug (AOD) dependence who then received two (2) additional AOD services within 30 days after the start of AOD treatment. (The data represented in the chart here is the engagement total rate (13-17 years combined with 18+ years. Separate engagement rates for those population sub-sets are also tracked.)