Link Updates

The Office of Co-Occurring Disorders in TDMHDD has been added to the list of TN Govt links to your right. I've also updated links and naming for the Bureau (now Division) of Alcohol and Drug Abuse Services.

MJ and Psychosis: Link for Latest in AOD Research

You may link directly to NewScientist.com, a source for recent posts regarding drug and alcohol research, for brief summaries of recent academic research.

Currently featured is a Lancet report that links marijuana use to psychosis later in life:

Moore TH, Zammit S, Lingford-Hughes A, Barnes TR, Jones PB, Burke M, Lewis G. (28 July 2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. The Lancet, 370(9584): 319-328.

I will try to link to a non-gated version of the article, or at least its abstract, when it goes online this weeekend.

Update: Article posted.

All the Young Mice

Australian researchers examined differential reactions to THC in adolescent and adult mice. Adult mice, unlike their younger cohorts, over time avoided the area of their habitat in which they would receive injections, which the researchers interpreted as a sign of distaste for the drug. Also, autopsies on the mice brains indicated greater damage to the regions associated with short-term memory compared with adults.

Teens in AA

The Washington Post ran a feature on teens in a DC-area Alcoholics Anonymous group who were systematically subjected to sexual and financial predation by their sponsors and others in the group.

Whatever the merits of the allegations in this specific case, the story suggests several questions that may be relevant for the adolescent treatment system in Tennessee:

1. Under what circumstances is it appropriate for teens to participate in Alcoholics Anonymous programs with adults?
   
   
2. What are the ethical obligations and legal liabilities of treatment professionals if they recommend a teen participate in AA and the group turns out to be abusive in the ways described in this article?
   
   
3. Given that the national AA program does not manage or supervise chapters in any meaningful way, does this influence the level of "due diligence" that providers, case managers, or others must demonstrate before connecting youth to AA? Surely addictions professionals or service managers cannot fall back on, "Hey, we just said they had to go to AA, we didn't tell the youth which AA group to attend." Can they?

Commonwealth Fund Newsletter: Quality and Payment

The current issue of the Commonwealth Fund's "Quality Matters" newsletter discusses ways to link quality of care to physician payments. You may want to look at a couple of the options presented and think about how they might apply to adolescent substance abuse services.

Linking Families to Services

The Commonwealth Fund has developed a document to help states develop linkages between families and state resources. Based upon the Help Me Grow program in Connecticut, the document outlines the steps for building partnerships to between agencies, providers, and families to ensure connections and evaluate the success of those efforts. Help Me Grow focuses specifically on younger children and the developmental and behavioral problems, but the process likely generalizes to other age groups and problems, such as adolescents with substance use problems.

Quality Improvement in Medicaid Health Plans

The Commonwealth Fund released its review of Denver Health, a managed care Medicaid health insurance plan in Denver, Col. The focus is on the aspects of quality improvement initiated by the plan to improve:

• no-show rates,
  
• patient- and family-centered care,
  
• culturally sensitive care, and
  
• costs of treatment.

Although the focus is on medical practices, information on how Denver Health has implemented the "Toyota model" of lean manufacturing for quality, efficiency, and cost improvement may benefit Tennessee provdiers, plans, and consumers.

PAB Meeting 7/26

This quarter's Project Advisory Board meeting is scheduled for 10:00-2:00 Thursday 26 July 2007 at the Bureau of TennCare complex in Metro Center, Nashville. Below is some background on the main topic to be presented; we are inviting additional folks from the state agencies and other groups to attend. Below is that invitation:

We would like to invite you to attend a presentation on the Washington Circle performance measurement system for substance abuse services at the next T-ACT project advisory board meeting, 26 July 2007, at the Bureau of TennCare.

The panel should be of interest to:

• state agency policy experts interested in data-based policy planning and measuring quality of care in the service delivery system using existing data collected by the state;
  
• state agency data experts interested in developing methods to convert existing data into planning information;
  
• executive directors and administrators of provider agencies interested in demonstrating the effectiveness of their treatment services to policy makers and payors;
  
• insurance and managed care companies that are interested in assuring value in the services they purchase on behalf of their consumers.

Below is some background information about the Washington Circle program, the speakers, and the content of their presentation.

We very much hope that you will be able to attend.

Sincerely,

The T-ACT Team


Fast, Cheap and Under Control: Quality Improvement Using the Washington Circle Performance Measurement System
Washington Circle is an initiative sponsored by SAMHSA (Substance Abuse and Mental Health Services Administration) that has developed process quality measures for substance abuse services using administrative databases. The group is comprised of representatives from state and federal government, universities, and private sector groups. Examples of measures include: rates of identification of substance use disorders, rates of treatment initiation, and rates of treatment engagement. Besides developing the measures, the group has made public its decision rules and procedures for calculating the measures so that other states may participate, for both adult and adolescent populations.

Their work in the private sector resulted in several measures being adopted by NCQA (National Committee on Quality Assurance) into its HEDIS performance measurement system, standards to which TennCare has determined the new middle-Tennessee MCOs must adhere. The group has worked recently to adapt these measures for clients served in the public sector but outside of traditional insurance, in particular, SAPT block grant funded services. Among the states presently participating are: Oklahoma, Delaware, North Carolina, Washington, New York, Arizona, Connecticut, and Los Angeles County.

The state of Oklahoma has been a leader in implementing this performance measurement system. They have calculated these measures using existing administrative data and are reporting the data publicly and to contracted providers. In working with Brandeis University, which is the lead university in the Washington Circle program, they have demonstrated that clients who are more engaged in treatment (as measured by Washington Circle) also tend to have less future involvement in the criminal justice system. In fact, it was Oklahoma's success in implementing these performance measures that resulted in their Commissioner, Terry Cline, being appointed administrator of SAMHSA in 2006.

We've invited Dr. Deborah Garnick (Brandeis University) and Tracy Leeper (State of Oklahoma) to speak about the Washington Circle performance measurement program. Dr. Garnick will speak about the Washington Circle measurement system and how it fits in a process of quality monitoring and system improvement. She will also describe how these measures fit with other SAMHSA initiatives like the National Outcomes Measures (NOMs). Ms. Leeper will speak about how Oklahoma has implemented these measures, including issues involved in developing organizational support for calculating the measures and working with treatment providers to ensure acceptability to addiction professionals. They will also present information about Oklahoma's system and how it is performing.

Bios
Deborah Garnick is a Professor in the Institute for Behavioral Health at The Heller School for Social Policy and Management at Brandeis University and Associate Dean, Academic Personnel. She received her doctorate in health services research from Johns Hopkins University. Currently, Dr. Garnick leads the Brandeis team in a collaboration with RTI focused on technical development of the National Outcome Measures (NOMs) for behavioral health in a project funded by the SAMHSA. She has led NIH-funded studies focused on exploring the association between substance performance measures and outcomes. She serves as is the Co-Principal Investigator on studies that involve tracking of drug and alcohol abuse services and mental health services provided by the managed behavioral health care industry. In addition, she is a member of the Washington Circle Policy Group and leads their workgroup on public sector performance measures for substance abuse. Dr. Garnick often serves as an expert consultant, most recently as a member of the National Quality Forum’s Substance Use Disorders and Evidence Based-Practices Technical Advisory Panel. Dr. Garnick has published widely the topics of injuries among Medicare and Medicaid beneficiaries, state-level health insurance reform legislation, quality of hospital and ambulatory care, methods of using data collected for administrative purposes for health services research, and performance measures for substance abuse.

Tracy Leeper has worked for the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) for the last fifteen years in the Decision Support Services Division, conducting data analysis, performance monitoring and program evaluation. She has served as manager of all of the Department's data system and performance indicator grant projects for the last nine years. She is a member of the Governing Board's Performance Improvement Committee, serves as the chair for the State's Interagency Behavioral Performance and Outcome Monitoring Workgroup involving eight state agencies, is a member or the Department's Institutional Review Board and serves as the Chair for the Southern States Mental Health Statistics Improvement Program User Group. Ms. Leeper has also served as an ATR consultant, providing technical assistance to the California ATR team on compiling and reporting project outcomes.

New Calendar Function

A calendar has been added on the right-hand panel. This calendar is to promote upcoming conferences, events, and trainings related to the T-ACT project or adolescent substance abuse treatment generally.

By clicking on the calendar, anybody may view upcoming events. To add an event for the first time, you must:

1. obtain a Yahoo! ID;
   
2. email that Yahoo! ID to tactblog@yahoo.com asking Robert Saunders to add you as an approved person to edit the calendar;
   
3. go to the calendar page--calendar.yahoo.com/tactblog--and sign in to Yahoo!.

Once you have completed these steps, you should be able to add an event.

Interview with NIDA Director

NIDA Director Nora Volkow discussed the neurobiology of addiction on the NPR program, Fresh Air, today.

Another Upcoming Conference: Health Summit of Minority Communities

From Nancy Reed:
12th Annual Health Summit of Minority Communities
Reclaiming a Legacy of Healthy Communities: The Time is Now
Sheraton Music City Hotel
22-24 August 2007
Contact: Carlice Knox
615.741.9443
1.877.606.0089

From the TDH website:

The Minority Health Summit is an annual conference sponsored by the Office of Minority Health in collaboration with the Black Caucus of State Legislators and the Tennessee Black Health Care Commission. It provides a forum for professionals—state and national—and other interested citizens to exchange ideas and dialogue with one another on matters that pertain to minority health.

Issues concerning new technologies, prevention strategies, policy making and managed care are among the topics discussed. Individuals identified as active in their professional arena and known for their leadership on relevant health care subjects are invited as presenters. The annual conference occurs in the late summer of each year.

From PAB member Frances Clark, via Nancy Reed:
TAADAC is co-sponsoring the Journey Together Conference 2007 5-8 September 2007 at the Renaissance Nashville Hotel. The link contains a conference brochure, registration information, exhibitor information, hotel rates, and information about the different sessions.

The Journey Together conference will be featuring speakers who
will be presenting on many topic areas. Featured topics include:

• Adolescents
• Special Populations
• Treatment Skills/Issues
• Workforce Development

From Nancy Reed:

Thursday 19 July 2007, TAMHO is sponsoring a plenary session (8:30 - 2:30) at the Sheraton Music City Hotel. Topics of interest will include:

• Commissioner's Update - New Legislation, FY2007-08 Budget, Division of Alcohol and Drug Abuse Services
  
• Senate Joint Resolution 799 - A study of the Children's Mental Health System in Tennessee
  
• Proposed Social Work Licensure Law Amendments
  
• Opportunities for Behavioral Health Interface with Pediatric Practices - Models for Collaboration.

Please click on this link for more information.