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A city embraces change

June 1, 2008
by Maureen Fitzgerald
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Philadelphia and provider agencies work with NIATx to create more effective services

NIATx (the Network for the Improvement of Addiction Treatment) works with providers across the country to achieve four aims: reduce wait times between a client's first request for service and first treatment session, reduce the number of client no-shows, increase admissions to treatment, and increase the rate of continuation between the first and fourth treatment sessions. Last year NIATx partnered with providers in Philadelphia to change their approach to behavioral healthcare services by working toward these four aims.

“The NIATx Tools for Change is part of Philadelphia's initiative to transform the entire city into a community of recovery,” says Roland Lamb, director of addiction services at the Philadelphia Department of Behavioral Health and Mental Retardation Services (DBHMRS).

The NIATx Tools for Change learning collaborative is a nine-month project involving 15 behavioral healthcare provider agencies in partnership with DBHMRS. It includes NIATx technical assistance and process improvement instruction, NIATx coach support, and peer networking sessions. The formal contract commenced in September and ends this month.

Transformation is the overarching theme for DBHMRS, which aims to implement innovative tools to improve services to children, adults, and families with mental health and/or substance abuse issues. In the process, Philadelphia seeks to become a national model for a care delivery system that aligns and integrates services to support long-term recovery.

The NIATx model offers a way to operationalize change in Philadelphia's large and diverse provider community, which includes nearly 80 licensed drug and alcohol treatment provider agencies operating at 175 facilities. “The four NIATx aims represent an opportunity for us to bring change into clarity and focus,” comments Lamb.

The project also offers a unique opportunity for NIATx. The first NIATx projects focused on helping individual provider agencies to improve their business systems. Since then NIATx has expanded its scope, adapting its model to payer/provider systems and states. Yet as Lamb points out, Philadelphia's behavioral healthcare system, operating a billion-dollar budget, is larger than some states' systems.

Eighteen provider agencies representing 21 programs responded to the Tools for Change request for applications and 15 were selected, representing small community-based agencies as well as large systems (sidebar). One of those agencies is Intercommunity Action, also known as Interac, which provides a wide range of services to adults, children, and adolescents who suffer from mental illness, behavioral or emotional problems, and substance abuse.

Interac had been struggling with getting people into treatment quickly. Michael Gray, PhD, director of Interac's Greenridge Counseling Center, applied to participate in Tools for Change because of the project's focus on improving client access and retention, which offered an opportunity to test ways to reduce wait times.

“We don't have a lot of time in community behavioral health to look at the big picture,” says Dr. Gray. “The Tools for Change project gives us the luxury of stepping back to get a better view of our services, with the help of an outside consultant.”

Part of this “stepping back” process includes having key staff participate in a walk-through—viewing services from the customer's perspective beginning at the first point of contact. Jon Korczykowski, NIATx's manager of Provider Development and Transformation Initiatives, says, “Many providers recognized the importance of a client's first contact with their organization—from having a well-informed live receptionist answering calls to help link callers to the services they need, to accurate signage and comfortable waiting areas. In some cases, the walk-throughs helped the Tools for Change applicants see the need to go back to square one.”

Dr. Gray describes his team's walk-through experience as “eye-opening,” adding, “We found that we had blinders on. Because we were so focused on the everyday details of running the organization, we weren't aware of how much time a client had to spend just sitting in a chair or the number of forms we require them to complete. The detail we got from the walk-through was extremely valuable.”

Jon korczykowski
Jon Korczykowski

Roland lamb
Roland Lamb

Dr. Gray's team chose to work on reducing the wait time from the first phone call to intake. Shortly after starting the project, the Interac team already had reduced the wait time by 50% (from 24 to 12 days). To achieve this improvement, Dr. Gray and his team began to offer a clinic day for walk-in appointments. Not only did the change reduce wait times, it also increased the number of assessments the agency could complete as well as fee-for-service revenue.

Dr. Gray credits NIATx coach Ken Farbstein with helping his team “keep it simple,” noting that “the simpler changes are the ones that we are more likely to sustain.” Interac's ultimate goal is to eliminate scheduled appointments and offer on-demand service. The agency also is working on reducing the number of forms clients are required to complete and is providing DBHMRS with the “customer perspective” on its authorization process.

“We're confident that we'll continue to see improvements,” says Dr. Gray. “This has really been a great experience for Interac.”