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Science and Service Awards

2013 Opioid Treatment Program Winners

Drug Abuse Comprehensive Coordinating Office, Opiate Addiction Treatment Services

“Comprehensive, Coordinated Care” is a promising practice implemented by Drug Abuse Comprehensive Coordinating Office (DACCO), in conjunction with the University of Florida College of Medicine, to treat opiate-dependent pregnant and post-partum women. This multi-disciplinary approach coordinates substance abuse and co-occurring mental health disorder treatment with obstetric care, primary care, and other health and support services, to provide pregnant women and post-partum mothers with quality healthcare including medication assisted treatment. This approach effectively engages them in treatment and promotes positive birth outcomes, long-term recovery, and long-term health outcomes for their children. Key to the model is: the professional coordination of substance abuse treatment with obstetrical care provided outside the agency; personalized attention from onsite physicians specializing in addiction; pregnancy and parenting education; and intensive case management and service coordination. In addition to providing addiction services, staff monitor mothers’ prenatal OB/GYN visits, and the physicians conduct weekly pregnancy rounds and education groups to educate women on their gestational stage/baby’s development. DACCO connects the mother to a pediatrician for ongoing care, and she and her family are given referrals to community services to provide ongoing support. The comprehensive nature of the program enables DACCO to address complex client needs. DACCO offers a “one-stop shop” where clients can receive MAT dosing and counseling, as well as access to onsite detoxification services (opening 2013), evidence-based outpatient and residential treatment, family housing for mothers in treatment, a psychiatric clinic, a primary health care clinic, HIV testing, daycare, adult education, and other supports.

F. Cornelius Ogundele, PhD, CADC, LCSW

8014-8018 South Ashland Avenue, Chicago, Illinois 60620

Fola Community Action Services Inc. (FCAS), a community based non-for-profit 501 c (3) organization, was founded and incorporated in Illinois State in 2001. FCAS provides methadone services to 300 clients annually. Other services include HIV/AIDS prevention, housing advocacy for individuals living with HIV/AIDS, and case management. FCAS current innovative approach to opioid maintenance services is the implementation of integrated evidence-based Cognitive Behavioral Therapy (CBT) with Methadone Maintenance Therapy (MMT) as required in September 2010 by the U.S. Probation Office competitive bid to provide methadone services to opioid dependent Criminal Justice clients. Low retention rate, chronic relapse to narcotic use, and high rates of unsuccessful program completion foster the need to combine a specific well-researched psychotherapeutic model with MMT. To face the challenge, FCAS attempted to implement an innovative model integrating CBT with MMT for better treatment retention. Outcome results of over two years implementation of the innovative model indicate that the CBT-MMT model results in better patient retention, which, in turn, may translate into better behavior management, commitment to treatment, increased patients’ participation in planning treatment of choice, reduced relapse frequency, and better administrative/clinical practice.

Addiction Treatment Services At Hopkins Bayview

5510 Nathan Shock Dr., #1500, Baltimore, MD 21224

Addiction Treatment Services at Hopkins Bayview (ATS) is a community-based program that provides methadone maintenance and a range of outpatient drug abuse treatment services for patients with opioid dependence and other substance use and psychiatric disorders. Faced with the challenge of delivering effective and comprehensive care, ATS developed an adaptive stepped-care service delivery model called Motivated Stepped Care (MSC). This evidenced-based and cost-effective model fully integrates delivery of methadone with attendance to prescribed psychosocial services to improve both treatment engagement and outcomes. Patients using substances in addition to methadone are advanced to higher intensities of psychosocial care, while those achieving abstinence graduate to lower intensities of care. Movement through these steps is based on objective indices of counseling attendance and urinalysis results, with behavioral reinforcement used to motivate adherence. The most experienced clinicians lead therapy groups for those advanced to more intensive steps of care. A randomized controlled evaluation of MSC demonstrated its efficacy in improving counseling utilization and reducing substance use. ATS has used MSC for over 15-years, and through a number of publications has shown how this model facilitates engagement in other important recovery-oriented activities, including employment, health-care, and building drug-free support. ATS employees appreciate the structured and consistent approach to treatment planning, and endorse job satisfaction scores that are high compared to employees in other areas of the hospital. Patients appreciate these same features, and also report high satisfaction.

New York City Health and Hospitals Corporation, Kings County Center Opioid Treatment Program

648 Albany Avenue, Brooklyn, NY 11203

Kings County Hospital Center’s Opioid Treatment Program, a member of the New York City Health and Hospitals Corporation, initiated services in 1971 and. The overall mission is to ensure that individuals seeking treatment for drug addiction and related problems are provided with the highest quality individualized care with utmost priority on safety and respect regardless of ability to pay. The program’s total population of 750 recipients of care is 65% male, with the majority being African American (63%), followed by Latino (34%) and Caucasian (3%). The majority are publically insured with Medicaid (85%) or uninsured (15%). The program’s approach to treatment combines the use of medication with evidence-based behavioral interventions to support recovery and bring about behavioral change to promote a drug free lifestyle. With the Trans-theoretical Model of Change and Motivational Interviewing at its core, this approach provides person-centered treatment designed to match each individual’s stage of readiness for change. Contingency Management is also used to provide reinforcement for targeted behaviors. In 2009, the program adopted the NIATx approach for rapid cycle process improvement to increase admissions, and decrease no show rates. Despite initial benefits, it was difficult to retain patients in early treatment. To address this gap, starting in April 2011, the NIATx approach to focus on improving early engagement in treatment was used and this resulted in an increase in 30-day retention from a baseline of 83% to 95%, correlating with increased program utilization and revenue.

Sharon Dembinski, Director of Quality and Clinical Services

MedMark Services, Inc., 401 E. Corporate Dr, Suite 220, Lewisville, TX 75057

MedMark Services, Inc. (MSI) operates 18 Opioid Treatment Programs (OTPs) in four states. In 2009, MSI in the state of California created a data oriented environment to measure, track and improve performance. Sharon Dembinski, MSI’s Director of Quality worked to identify needs, set operating targets, and developed a data collection process and feedback mechanism for Program Directors to observe results and improvements based on actions taken. This process was referred to as “The Dashboard.” The Dashboard tracks performance improvement following implementation of multiple initiatives. The improvement areas targeted in California were access, retention and effectiveness. Target goals were set in each area. The results of this quality initiative were: 1) the percent of patients admitted within 24 hrs of first contact improved from 55% in 2010 to approximately 80% in 2012; 2) the percent of patients that stayed in treatment for at least 90 days improved from 25% in 2010 to 66 - 79% by 2012, and, 3) the percent of urine drug screens positive for illicit opioids decreased from 24 - 39% in 2009 to 18 - 22% in 2012. MSI knew bringing a data oriented process to performance improvement would be costly, time consuming, and required strong leadership. This project demonstrates that when an organization is innovative, resources are in place, and quality leadership is given data on the results they achieve before and after improvements are initiated, significant improvements will occur.

Last updated: 05/20/2013