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ASADS Presentation - What Do We Know

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Kris Vilamaa, ACHE
Kris Vilamaa, ACHE

Alabama's substance abuse treatment system serves over 21,000 clients annually. It relies on data from national surveys and the Alabama Substance Abuse Information System to understand who it serves and assess outcomes. The majority of clients are male, between 25-34, white, and being treated for drug rather than alcohol abuse. Most come from Jefferson, Mobile, and Montgomery counties. The average cost of treatment is $1,316 per client. Common treatment modalities include intensive outpatient, residential rehabilitation, and methadone maintenance. The system aims to measure outcomes like employment, housing stability, and abstinence from drugs and alcohol.

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What We Know About SubstanceWhat We Know About Substance Abuse Treatment in AlabamaAbuse Treatment in Alabama Kristopher VilamaaKristopher Vilamaa Director of Information ServicesDirector of Information Services Alabama Department of Mental HealthAlabama Department of Mental Health Substance Abuse Services DivisionSubstance Abuse Services Division
IntroductionsIntroductions Who Am I? Who Are You? Why Are You Here? What Makes You Unique?
Alabamas Substance AbuseAlabamas Substance Abuse Treatment SystemTreatment System How Do We Know? Who Do We Serve? What Services Do They Get? Where Do They Get Them? What Does it Cost? What Are the Outcomes?
How Do We Know?How Do We Know?
How Do We Know?How Do We Know? NSDUH National Survey on Drug Use and Health N-SSATS National Survey of Substance Abuse Treatment Services Surveys ALL providers registered with SAMHSA, includes non-contract certified providers, VA, military and hospital treatment providers TEDS Treatment Episode Data Set ASAIS Alabama Substance Abuse Information System
Who Do We Serve?Who Do We Serve? FY2010 21,610 Clients Admitted to Treatment 24,676 Clients Served
Who Do We Serve? Number of ClientsWho Do We Serve? Number of Clients 0 5,000 10,000 15,000 20,000 25,000 NumberAdmittedtoTreatment 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year
Who Do We Serve? Non-DMHWho Do We Serve? Non-DMH N-SSATS Census 15,820 clients in service 8,781 in for-profit facilities 1,136 in federal government facilities (VA, DOD) 60% only being treated for drug abuse (not alcohol or mental health)
Who Do We Serve? - GenderWho Do We Serve? - Gender Source: TEDS 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year Gender of SA Clients Female Male
Who Do We Serve? - AgeWho Do We Serve? - Age 0 5 10 15 20 25 30 35 < 15 15-17 18-19 20-24 25-34 35-44 45+ Alabama USSource: 2010 TEDS
Who Do We Serve? - RaceWho Do We Serve? - Race 0 10 20 30 40 50 60 70 American I ndian African American Whit e Asian Ot her Two or More Races Alabama US Source: 2010 TEDS
Who Do We Serve? - CountyWho Do We Serve? - County Top Residence Counties (FY2010 Clients Reported Served to ASAIS) Jefferson County 23.4% Mobile County 7.7% Montgomery County 6.5% Madison County - 4.8% Tuscaloosa County 4.6% Bottom Residence Counties Perry County 0.1% Greene County 0.1% Choctaw County 0.1% Sumter County 0.1% Washington County 0.1%
Who Do We Serve? Referral SourceWho Do We Serve? Referral Source 0 10 20 30 40 50 60 Individual Alcohol/ Drug Care Provider Ot her Healt hcare Provider School Employer Ot her Communit y Referral Criminal Just ice Referral Alabama US Source: 2010 TEDS
Who Do We Serve? - SubstanceWho Do We Serve? - Substance 0 10 20 30 40 50 Alcohol Cocaine/ Crack Marijuana Heroin Non-Prescript ion Met hadone Ot her Opiat es Met hamphet amine Ot her Amphet amines Benzodiazepine Alabama US Source: 2010 TEDS
0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year SA Clients with Alcohol as Primary Drug Alcohol Only Alcohol with Secondary
0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Cocaine as PrimaryDrug Cocaine (Smoked) Cocaine (other route)
0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Other Drugs Marijuana Other Opiates Amphetamines
Source: TEDS 2006 Highlights - http://www.oas.samhsa.gov/teds2k6highlights/Tbl6b.htm Who Do We Serve? StateWho Do We Serve? State ComparisonComparison
Who Are We Missing?Who Are We Missing? NSDUH (2002-2004) Needing, but not Receiving, Treatment for Illicit Drugs
Who Are We Missing?Who Are We Missing? NSDUH (2002-2004) Needing, but not Receiving, Treatment for Alcohol
Who Are We Missing?Who Are We Missing? Same questions by catchment area (NSDUH 2002-2008) Needing but not Receiving Treatment for Illicit Drug Use ranged from 0.9% to 3.4% Needing but not Receiving Treatment for Alcohol Use ranged from 2.1% to 8.2% SAMHSA looked at another measure, people needing but not receiving treatment in past year per $1 million of SAPTBG funding (2006) Lowest was Alaska = 1,723 Highest was Maine = 6,070 Alabama = 3,849 Almost exactly in the middle
What Services Do They Get?What Services Do They Get?
What Services Do They Get?What Services Do They Get? 0 10 20 30 40 50 60 70 Hospit al I npat ient Resident ial Det ox Short -Term Resident ial Long-Term Resident ial I OP OP Ambulat ory Det ox Alabama USSource: 2010 TEDS
What Services Do They Get?What Services Do They Get? FY2010 Reported 16,315 Assessments 4,940 days of Detoxification 108,316 days of Crisis Residential 52,550 days of Co-Occurring Residential 74,857 days of Residential Rehabilitation 863,000 hours of Group Counseling 29,000 hours of Case Management 25,894 hours of Individual Counseling 76,712 daily doses of Methadone
The PipelineThe Pipeline
Stoppages in PipelineStoppages in Pipeline Waiting Waiting for an Assessment Waiting for Treatment Admission Waiting for Transfer Loss of Communication Transfers who Do Not Enroll Lost to Contact from Waiting Lists Termination by Program Want to put hard numbers to each of these stoppages Need screenings on all clients who seek service Accurate updating of enrollments including No Contact
Where Do They Get Them?Where Do They Get Them? FY2010 Clients Reported to DMH UAB Drug Free 3,412 clients Aletheia House 2,845 clients Alcohol and Drug Abuse Treatment 1,961 clients Chemical Addictions Program 1,837 clients Spectracare Health 1,534 clients Altapointe Health Services 1,192 clients Madison County Mental Health 1,097 clients East Alabama Mental Health 1,026 clients
Where Do They Get Them?Where Do They Get Them? 0 1000 2000 3000 4000 5000 6000 7000 Methadone/Buprenorphine Intensive Outpatient Regular Outpatient Long-Term Residential Rehabilitation Short-Term Day Treatment Outpatient Detox Residential Detox Hospital Inpatient Detox
What Does it Cost?What Does it Cost? FY2010 Cost by Level of Care Report a Variation of this for the Substance Abuse Treatment and Prevention Block Grant Reflects the Level of Care at the time services were billed All LOCs add up to more than the bottom line number served because of people who move between levels Overall Average Cost per Client $1,316.96
# Total $ % Cost/Client Assessment 5419 $608,407.26 1.87% $ 112.27 Clinically Managed High Intensity Residential (Crisis Res) 3819 $8,687,920.47 26.71% $ 2,274.9 2 Clinically Managed Low Intensity Residential (Res Rehab) 1698 $6,468,266.38 19.88% $ 3,809.3 4 HIV Only 4538 $607,675.53 1.87% $ 133.91 Intensive Outpatient (IOP) 15610 $13,821,338.25 42.49% $ 885.42 Medically Monitored Inpatient Detoxification (Detox) 922 $727,389.34 2.24% $ 788.93 Opioid Maintenance Therapy (Methadone) 345 $869,685.05 2.67% $ 2,520.8 3 Outpatient 1398 $738,253.00 2.27% $ 528.08 Total 24700 $32,528,935.28 100.00% $ 1,316.9
What are the Outcomes?What are the Outcomes? National Outcome Measures Standards established by the federal government to measure effectiveness of mental health and substance abuse services Currently reported using the data from the assessment and discharge summaries are: Employment Stable Housing Criminal Justice Involvement Change in Abstinence Alcohol and Drug Use Social Support for Recovery
What are the Outcomes?What are the Outcomes? Source: 2010 TEDS
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% State Average Percentage of Clients Completing Treatment/Transferring to Another Program
-40% -20% 0% 20% 40% 60% 80% 100% State Average Change in Abstinence of Primary Drug
DiscussionDiscussion How can you find data? Services paid for by DMH/Medicaid Clients served by DMH Outcomes Number and types of Providers Needs Assessment
ResourcesResources NSDUH State Level Data http://oas.samhsa.gov/statesIndex.htm N-SSATS State Profiles http://wwwdasis.samhsa.gov/webt/tedsweb/tab_year.choose_year_state_p TEDS State Profiles http://wwwdasis.samhsa.gov/webt/tedsweb/tab_year.choose_year_web_ta Alabama Department of Mental Health http://mh.alabama.gov/SA/StatisticsAndPublications
Q&AQ&A
Contact MeContact Me Kristopher VilamaaKristopher Vilamaa Director of Information ServicesDirector of Information Services Division of Mental Illness and Substance Abuse ServicesDivision of Mental Illness and Substance Abuse Services Alabama Department of Mental HealthAlabama Department of Mental Health kristopher.vilamaa@mh.alabama.govkristopher.vilamaa@mh.alabama.gov (334) 242-3969(334) 242-3969

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ASADS Presentation - What Do We Know

  • 1. What We Know About SubstanceWhat We Know About Substance Abuse Treatment in AlabamaAbuse Treatment in Alabama Kristopher VilamaaKristopher Vilamaa Director of Information ServicesDirector of Information Services Alabama Department of Mental HealthAlabama Department of Mental Health Substance Abuse Services DivisionSubstance Abuse Services Division
  • 2. IntroductionsIntroductions Who Am I? Who Are You? Why Are You Here? What Makes You Unique?
  • 3. Alabamas Substance AbuseAlabamas Substance Abuse Treatment SystemTreatment System How Do We Know? Who Do We Serve? What Services Do They Get? Where Do They Get Them? What Does it Cost? What Are the Outcomes?
  • 4. How Do We Know?How Do We Know?
  • 5. How Do We Know?How Do We Know? NSDUH National Survey on Drug Use and Health N-SSATS National Survey of Substance Abuse Treatment Services Surveys ALL providers registered with SAMHSA, includes non-contract certified providers, VA, military and hospital treatment providers TEDS Treatment Episode Data Set ASAIS Alabama Substance Abuse Information System
  • 6. Who Do We Serve?Who Do We Serve? FY2010 21,610 Clients Admitted to Treatment 24,676 Clients Served
  • 7. Who Do We Serve? Number of ClientsWho Do We Serve? Number of Clients 0 5,000 10,000 15,000 20,000 25,000 NumberAdmittedtoTreatment 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year
  • 8. Who Do We Serve? Non-DMHWho Do We Serve? Non-DMH N-SSATS Census 15,820 clients in service 8,781 in for-profit facilities 1,136 in federal government facilities (VA, DOD) 60% only being treated for drug abuse (not alcohol or mental health)
  • 9. Who Do We Serve? - GenderWho Do We Serve? - Gender Source: TEDS 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year Gender of SA Clients Female Male
  • 10. Who Do We Serve? - AgeWho Do We Serve? - Age 0 5 10 15 20 25 30 35 < 15 15-17 18-19 20-24 25-34 35-44 45+ Alabama USSource: 2010 TEDS
  • 11. Who Do We Serve? - RaceWho Do We Serve? - Race 0 10 20 30 40 50 60 70 American I ndian African American Whit e Asian Ot her Two or More Races Alabama US Source: 2010 TEDS
  • 12. Who Do We Serve? - CountyWho Do We Serve? - County Top Residence Counties (FY2010 Clients Reported Served to ASAIS) Jefferson County 23.4% Mobile County 7.7% Montgomery County 6.5% Madison County - 4.8% Tuscaloosa County 4.6% Bottom Residence Counties Perry County 0.1% Greene County 0.1% Choctaw County 0.1% Sumter County 0.1% Washington County 0.1%
  • 13. Who Do We Serve? Referral SourceWho Do We Serve? Referral Source 0 10 20 30 40 50 60 Individual Alcohol/ Drug Care Provider Ot her Healt hcare Provider School Employer Ot her Communit y Referral Criminal Just ice Referral Alabama US Source: 2010 TEDS
  • 14. Who Do We Serve? - SubstanceWho Do We Serve? - Substance 0 10 20 30 40 50 Alcohol Cocaine/ Crack Marijuana Heroin Non-Prescript ion Met hadone Ot her Opiat es Met hamphet amine Ot her Amphet amines Benzodiazepine Alabama US Source: 2010 TEDS
  • 15. 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year SA Clients with Alcohol as Primary Drug Alcohol Only Alcohol with Secondary
  • 16. 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Cocaine as PrimaryDrug Cocaine (Smoked) Cocaine (other route)
  • 17. 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Other Drugs Marijuana Other Opiates Amphetamines
  • 18. Source: TEDS 2006 Highlights - http://www.oas.samhsa.gov/teds2k6highlights/Tbl6b.htm Who Do We Serve? StateWho Do We Serve? State ComparisonComparison
  • 19. Who Are We Missing?Who Are We Missing? NSDUH (2002-2004) Needing, but not Receiving, Treatment for Illicit Drugs
  • 20. Who Are We Missing?Who Are We Missing? NSDUH (2002-2004) Needing, but not Receiving, Treatment for Alcohol
  • 21. Who Are We Missing?Who Are We Missing? Same questions by catchment area (NSDUH 2002-2008) Needing but not Receiving Treatment for Illicit Drug Use ranged from 0.9% to 3.4% Needing but not Receiving Treatment for Alcohol Use ranged from 2.1% to 8.2% SAMHSA looked at another measure, people needing but not receiving treatment in past year per $1 million of SAPTBG funding (2006) Lowest was Alaska = 1,723 Highest was Maine = 6,070 Alabama = 3,849 Almost exactly in the middle
  • 22. What Services Do They Get?What Services Do They Get?
  • 23. What Services Do They Get?What Services Do They Get? 0 10 20 30 40 50 60 70 Hospit al I npat ient Resident ial Det ox Short -Term Resident ial Long-Term Resident ial I OP OP Ambulat ory Det ox Alabama USSource: 2010 TEDS
  • 24. What Services Do They Get?What Services Do They Get? FY2010 Reported 16,315 Assessments 4,940 days of Detoxification 108,316 days of Crisis Residential 52,550 days of Co-Occurring Residential 74,857 days of Residential Rehabilitation 863,000 hours of Group Counseling 29,000 hours of Case Management 25,894 hours of Individual Counseling 76,712 daily doses of Methadone
  • 26. Stoppages in PipelineStoppages in Pipeline Waiting Waiting for an Assessment Waiting for Treatment Admission Waiting for Transfer Loss of Communication Transfers who Do Not Enroll Lost to Contact from Waiting Lists Termination by Program Want to put hard numbers to each of these stoppages Need screenings on all clients who seek service Accurate updating of enrollments including No Contact
  • 27. Where Do They Get Them?Where Do They Get Them? FY2010 Clients Reported to DMH UAB Drug Free 3,412 clients Aletheia House 2,845 clients Alcohol and Drug Abuse Treatment 1,961 clients Chemical Addictions Program 1,837 clients Spectracare Health 1,534 clients Altapointe Health Services 1,192 clients Madison County Mental Health 1,097 clients East Alabama Mental Health 1,026 clients
  • 28. Where Do They Get Them?Where Do They Get Them? 0 1000 2000 3000 4000 5000 6000 7000 Methadone/Buprenorphine Intensive Outpatient Regular Outpatient Long-Term Residential Rehabilitation Short-Term Day Treatment Outpatient Detox Residential Detox Hospital Inpatient Detox
  • 29. What Does it Cost?What Does it Cost? FY2010 Cost by Level of Care Report a Variation of this for the Substance Abuse Treatment and Prevention Block Grant Reflects the Level of Care at the time services were billed All LOCs add up to more than the bottom line number served because of people who move between levels Overall Average Cost per Client $1,316.96
  • 30. # Total $ % Cost/Client Assessment 5419 $608,407.26 1.87% $ 112.27 Clinically Managed High Intensity Residential (Crisis Res) 3819 $8,687,920.47 26.71% $ 2,274.9 2 Clinically Managed Low Intensity Residential (Res Rehab) 1698 $6,468,266.38 19.88% $ 3,809.3 4 HIV Only 4538 $607,675.53 1.87% $ 133.91 Intensive Outpatient (IOP) 15610 $13,821,338.25 42.49% $ 885.42 Medically Monitored Inpatient Detoxification (Detox) 922 $727,389.34 2.24% $ 788.93 Opioid Maintenance Therapy (Methadone) 345 $869,685.05 2.67% $ 2,520.8 3 Outpatient 1398 $738,253.00 2.27% $ 528.08 Total 24700 $32,528,935.28 100.00% $ 1,316.9
  • 31. What are the Outcomes?What are the Outcomes? National Outcome Measures Standards established by the federal government to measure effectiveness of mental health and substance abuse services Currently reported using the data from the assessment and discharge summaries are: Employment Stable Housing Criminal Justice Involvement Change in Abstinence Alcohol and Drug Use Social Support for Recovery
  • 32. What are the Outcomes?What are the Outcomes? Source: 2010 TEDS
  • 33. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% State Average Percentage of Clients Completing Treatment/Transferring to Another Program
  • 35. DiscussionDiscussion How can you find data? Services paid for by DMH/Medicaid Clients served by DMH Outcomes Number and types of Providers Needs Assessment
  • 36. ResourcesResources NSDUH State Level Data http://oas.samhsa.gov/statesIndex.htm N-SSATS State Profiles http://wwwdasis.samhsa.gov/webt/tedsweb/tab_year.choose_year_state_p TEDS State Profiles http://wwwdasis.samhsa.gov/webt/tedsweb/tab_year.choose_year_web_ta Alabama Department of Mental Health http://mh.alabama.gov/SA/StatisticsAndPublications
  • 38. Contact MeContact Me Kristopher VilamaaKristopher Vilamaa Director of Information ServicesDirector of Information Services Division of Mental Illness and Substance Abuse ServicesDivision of Mental Illness and Substance Abuse Services Alabama Department of Mental HealthAlabama Department of Mental Health kristopher.vilamaa@mh.alabama.govkristopher.vilamaa@mh.alabama.gov (334) 242-3969(334) 242-3969