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Transformation in Philadelphia

April 7, 2014
by Jon Korczykowski, M.A.
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Commissioner Arthur C. Evans, Jr., PhD

Since the Institute of Medicine’s Crossing the Quality Chasm report regarding the provision of substance abuse and mental health services, Philadelphia’s behavioral health system has been undergoing a transformation. The call for change came from people in recovery and their families, treatment providers, the advocacy community, additional stakeholders, as well as the Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) itself. Leading the change has been Commissioner Arthur C. Evans, Jr., PhD, who has served as the local catalyst in defining the values, culture, and strategic direction of the DBHIDS since his arrival in Philadelphia in 2004.

Collaboration and teamwork were essential to the transformation. “Through our initial discussions with multiple community constituencies, there was a desire to move our system of care toward greater recovery orientation, which was consistent with national policy directions as indicated by the New Freedom Commission Report and recent Institute of Medicine reports,” says Evans. Focusing on a vision of recovery, DBHIDS has moved to align its treatment philosophy, service delivery models, and fiscal administration policies to provide Philadelphians with access to services and supports essential for living meaningful lives of recovery while participating fully in their communities.

Among the many efforts focused on system transformation is a seven year initiative with the NIATx Foundation, which has resulted in long term benefits and mirrors a larger transformational process.

With a long and distinguished role in the history of behavioral health treatment and recovery in America the provider network was fairly settled and uniform when Evans brought NIATx to Philadelphia in June 2007. However, grassroots recovery advocacy movements in mental health and addiction, combined with moderate growth in funding for support programs, called “upon traditional mental health and addiction treatment agencies to transform themselves into ‘recovery-oriented systems of care’ and to use recovery as a conceptual bridge to improve services for persons with co-occurring disorders,” wrote Chestnut Health Systems' Emeritus Senior Research Consultant William L. White of Punta Gorda, Fla. 

No longer interested in change demonstrated by the repackaging of the same product in the form of services delivered, DBHIDS wanted to transform the services provided by the entire system. The agency wanted to stress the support of recovery and resilience through assessment, evaluation, and the quality of services provided. DBHIDS’ Practice Guidelines for Resilience and Recovery Oriented Treatment, which is composed of 10 core values, four service domains, and seven system goals, was generated by local stakeholders as a guide the development of principles and strategies.

As DBHIDS sought recovery-oriented ways to grow and improve treatment services and internal efficiencies, as well as enhance and support a higher performing system, the “Communities of Recovery: NIATx Tools for Change” initiative flourished.

The NIATx Foundation began as the Network for the Improvement of Addiction Treatment. It works with treatment providers to make more efficient use of their capacity by sharing strategies to improve access to and continuation in treatment while reducing wait times and “no shows.”

NIATx also works with states, counties, and other governing bodies to provide tools for change that encourage use of a process improvement model. This model, which is quality-driven, customer-centered, and outcome-based, has proven effective in transforming business practices and the quality of care provided using data and existing resources to measure change in order to sustain improvements and spread them across organizations.

In Philadelphia NIATx has worked with both mental health and drug and alcohol treatment providers serving children, adolescents, and adults.

DBHIDS / NIATx Transformation Phases

2008 Improving Access and Retention in Treatment

2009 Expanding to Mental Health Services

2010 Building Infrastructure within the System

2011 Strategic NIATx and the development of system-wide Practice Guidelines

2012 Practice Guideline Implementation and NIATx

2013 DBHIDS Internal Spread and Sustainability

2014 Re-thinking NIATx: Getting the Most “Bang for the Buck”

“Buy in,” readiness, support

Research suggests the way to influence and create “buy in” is through warmth and collaboration and the Practice Guidelines’ core values of community inclusion, partnership, and transparency have facilitated trust and fostered a connection with Philadelphia treatment providers. It was important that DBHIDS acknowledged system problems as perceived by stakeholders, made a commitment to change the problems, and invited all stakeholders to participate in mapping out the process. This was done via the creation of advisory boards, steering committees, workgroups, task forces, and other forums supporting partnership and recovery.