While addiction treatment facility directors have some intuitive knowledge about what works in treatment, they largely have failed to present that as valid outcome evaluation to influence policy-makers and the public. At this week's annual conference of the National Association of Addiction Treatment Providers (NAATP) in Carlsbad, Calif., association leaders invited colleagues to join an outcomes project that seeks to present aggregate data worthy of publication in peer-reviewed journals.
“For too long, our industry has been criticized for generating self-serving, unreliable success reports,” said Cinde Stewart Freeman, chief operating officer at Cumberland Heights in Nashville, Tenn., and a co-presenter of a conference workshop session on the NAATP outcomes initiative.
With the guidance of nationally known academician and behavioral health consultant Norman Hoffmann, PhD, a dozen NAATP member organizations have begun pilot-testing an outcomes tracking tool under which patients voluntarily consent to be contacted at intervals through one year post-discharge. NAATP is now inviting additional organizations to join the project. While this initiative is open only to NAATP member organizations at present, it has the capacity to inform the entire field on the mechanics and results of patient follow-up on variables ranging from substance use to continuing care.
Foundations Recovery Network CEO Rob Waggener told attendees of the May 18 conference session that addiction treatment providers need to start using common measures of outcome evaluation, in order to build a stronger case for the value of their services.
“When I go to policy-makers, it's 'your company's research,'” he said of the reaction he receives to the data his organization presents individually. “They see it as self-serving.”
For NAATP, which represents many of the most prominent organizations offering high-intensity levels of addiction treatment, the timing of a far-reaching outcomes initiative to generate more impactful data for the field could not be better.
“In 2016 we believe residential treatment will be under the gun again,” said Freeman, referring to the concern that the continued evolution of the Affordable Care Act (ACA) will emphasize lower-intensity alternatives to the exclusion of residential care. Waggener added that insurers also are tiring of being challenged on suspected violations of the federal parity law and will continue to look for ways to have parity provisions re-examined.
Waggener outlined the details of participation in the outcomes monitoring project. NAATP estimates that it will cost participants around $750 to obtain an electronic survey tool license and around $1,800 to contract with a university or other entity to obtain publishable results; the association will select a specific outcomes tool subsequent to hiring a project administrator to oversee the initiative.
Participating facilities will be asked to collect baseline data for patients within 72 hours of admission, in an effort that is recommended to be incorporated into the intake process. Follow-up contacts then will occur at the 3-month, 6-month, 9-month and 12-month intervals. Facilities will not offer patients an incentive to participate in the baseline data collection, but are encouraged to offer modest rewards for participation in follow-up, given that programs routinely have a difficult time maintaining contact with patients even a few months after discharge.
“The Starbucks cards and Target cards work,” Waggener said.
Even with incentives, many NAATP leaders express concern about the staff time and effort necessary in collecting the follow-up information. “It takes us five calls to collect one follow-up,” Waggener said of Foundations' general experience.
It is recommended that participating providers obtain a separate consent from patients for participation in the follow-up. The follow-up will ask about substance use outcomes but also will gauge patients' engagement in aftercare and support groups, as well as ask them to evaluate the impact of activities such as ongoing group therapy, working the Steps, and communicating with other patients.
Freeman and Waggener emphasized that the data generated from a facility would remain under that facility's ownership, and could be used to generate proprietary reports and also to benchmark the center's performance against that of similar organizations. All data would be de-identified, and NAATP pledges in writing not to make the stored data accessible to the general public.
Participating organizations in NAATP are aiming to have at least 80% of their patients who complete intake agree to be part of the outcomes project, and then to have 60% of that number be successfully contacted during the post-treatment follow-up intervals (these figures would meet the test for validity of results). Hoffmann has suggested that for individual programs to have publishable data, they need a study sample of about 250 inpatients and/or 250 outpatients. The overall NAATP pilot is seeking a sample of about 500 in each category, Freeman said.
One audience member in this week's workshop session made the point that the data collected through this project should be considered subjective because patients tend not to respond truthfully about their progress. But Waggener said the information collected will meet the rigor required for publication in peer-reviewed journals. He indicated that some insurance companies still will tend to dismiss any data they see about the effectiveness of high-intensity treatment, no matter how valid it might be.