asads presentation - what do we know
TRANSCRIPT
What We Know About What We Know About Substance Abuse Treatment Substance Abuse Treatment
in Alabamain AlabamaKristopher VilamaaKristopher Vilamaa
Director of Information ServicesDirector of Information ServicesAlabama 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?
Alabama’s Substance Abuse Alabama’s 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 Who Do We Serve? – Number of ClientsClients
0
5,000
10,000
15,000
20,000
25,000
Num
ber A
dmitt
ed to
Tre
atm
ent
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Year
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 Indian
African American
White
Asian
Other
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 Who Do We Serve? – Referral SourceSource
0 10 20 30 40 50 60
Individual
Alcohol/ Drug CareProvider
Other HealthcareProvider
School
Employer
Other CommunityReferral
Criminal Justice Referral
Alabama USSource: 2010 – TEDS
Who Do We Serve? - SubstanceWho Do We Serve? - Substance
0 10 20 30 40 50
Alcohol
Cocaine/ Crack
Marijuana
Heroin
Non-Prescription Methadone
Other Opiates
Methamphetamine
Other Amphetamines
Benzodiazepine
Alabama USSource: 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 w ith 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 Primary Drug
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? – State Who 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
Hospital Inpatient
Residential Detox
Short-Term Residential
Long-Term Residential
IOP
OP
Ambulatory Detox
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% $
2,274.92
Clinically Managed Low Intensity Residential (Res Rehab)
1698 $6,468,266.38 19.88% $
3,809.34
HIV Only 4538 $607,675.53 1.87% $
133.91
Intensive Outpatient (IOP) 1561
0$13,821,338.2
542.49% $
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% $
2,520.83
Outpatient 1398 $738,253.00 2.27% $
528.08
Total 2470
0$32,528,935.2
8100.00% $
1,316.96
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%
StateAverage
Percentage of Clients Completing Treatment/Transferring to Another Program
-40%
-20%
0%
20%
40%
60%
80%
100%
StateAverage
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_profile?t_state=AL
• TEDS State Profiles– http://wwwdasis.samhsa.gov/webt/tedsweb/tab_year.choose_year_w
eb_table?t_state=AL• Alabama Department of Mental Health
– http://mh.alabama.gov/SA/StatisticsAndPublications
Q&AQ&A
Contact MeContact MeKristopher VilamaaKristopher Vilamaa
Director of Information ServicesDirector of Information ServicesDivision of Mental Illness and Substance Abuse ServicesDivision of Mental Illness and Substance Abuse Services
Alabama Department of Mental HealthAlabama Department of Mental [email protected]
(334) 242-3969(334) 242-3969