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Arizona Expands Project to Tow New Counties

Chart depicts percent of clients that received each service. SAIS: March 31, 2009

Arizona's ATR project is a collaborative effort among State and local agencies that is administered by the State drug courts in Maricopa, Pima, an Yavapai counties. The State recently expanded the program to coconino and Cochise counties as well in an effor to accomplish its programmatic targets. The program called Changing How Independence Can Ensure Success (CHOICES), specifically targets qualified drug court participants who present with methamphetamine related issues.

Over the past quater, CHOICES expanded its array of services while maintaining a balance between treatment and recovery support services. Clinical treatment and covery support services. Clinical treatment accounted for 56.7% of all services provided. Case management (39.3%) represented the majority of recovery support services (RSS), while the addition of peer-to-peer (2.5%) and education (1.5%) rounded out the RSS that were delivered this quarter.

The program has continued to maintain steady outreach to clients, serving 394 participants this quater, only 82 short of its target goal of 476. Despite this shortfall, enrollment numbers are trending positive, with this quarter's recruitment representing a 25% increase over that of last quarter. The CHOICES program is having a positive impact on the clients it has seen. Abstinence from substance use, as measured by comparing intake data to discharge data, had increased by 466.7%

CHOICES Strengthens Provider Network

Over the course of the past quarter AZ ATR CHOICES has increased the number of provider trainings on the voucher management system (VMS) trainings due to the increased number of newly enrolled providers. The VMS training sessions, which cover topics such as billing processes and procedures, are also open to currently enrolled providers who want or need a VMS refresher. These trainings enable providers to reduce system errors and prevent delays in receiving payment. CHOICES also added a new enhancement to the VMS, which allows the data from multiple providers to be centralized in one system. Staff from each country can now create separate contracts for providers, adjudicate claims and enter information related to provider payment. All counties within the target area recently added a requirement for drug court clients. The requirement select a peer support person upon intake into the program. This requirement was initiated due to the high number of no-shows for the first appoint after the referral. ATR staff hopes that this motivational initiative will increase client engagement and retention in the program.

CHOICES continued to facilitate provider meetings in both secular and faithbased communities. Project staff this quater gaave presentations on ATR's benefits and available treatment options with the intent to recruit more providers into the program. ATR staff has also begun to set up provider forums with county probation officers and treatment and recovery support service (RSS) providers. Also, a recent SAMHSA-sponsored technical assistance proved instrumental in assisting Maricopa and Yavapai counties in recruiting and enrolling faith-based organizations into the provider network. With these efforts, CHOICES hopes to be better positioned to increase their provider base and offer ATR clients more provider choice.

Faith and Community based Updates

SAIS: March 31, 2009

Based on the data ending March 31, 2009, 22.6% of the providers that have received and redeemed vouchers were faith-based organizations, indicating significant faith-based involvement with project.

Maricopa staff and representatives from the Governor's Office of Children, Youth, and Families met with four current providers who provide peer-to-peer mentoring to inform them of the new requirement that all ATR clients will have a peer-mentor to increase client engagement and facilitate access to a wide array of services.

Additionally the program has established a continuous recruitment process in Maricopa County to ensure the enrollment of additional providers.

Success Story:
ATR Helps Drug Court Client Get Treatment

Lesley, now 47, was 17 when she started using drugs. For all of her adult life she says she did all kinds of drugs, but her drug of choice was methamphetamine,, which she used for the past twenty years. Like so many others who suffer from drug addiction, she did not enter treatment until she was arrested. Subsequent to her arrest, Lesley tested positive for meth and shortly thereafter entered treatment through the Drug Court.

Through the ATR program, Lesley was able to access the clinical treatment and recovery support services (RSS) that she needed. The project allowed her to be benefit from an approach that focuses on her as a whole person and not just an addict.

After 30 years of chronic drug use and abuse, Lesley is now clean, sober and very grateful to the ATR staff for a program that she says made her life better by "saving her life." "I got treatment, which led me to find out I had a life threatening illness I was unaware of. And now I am able to live instead of die."

California Excels with Project Targets

Chart depicts percent of clients that received each service. SAIS: March 31, 2009

The California Access to Recovery Effort program (CARE) serves the five State counties that have the largest documented services gap: Butte, Los Angeles, Sacramento, Shasta, and Tehama. The project provides vouchers for treatment and recovery support services to substance-abusing young people ages 12 through 20.

The program is moving toward a longer term, recovery-focused model of services while continuing to provide a full range of support to clients. SAIS distribution data show that clinical treatment (37.4%) and medical (9.6%) services accounted for slightly less than half of services provided. Case management (29.8%) and education (17.0%) were the most utilized recovery support services (RSS). Peer-to-peer and after care RSS each were used by about 3% of clients. The program continued to demonstrate success with its client number, serving a total of 3,869 clients, which exceeded its target goal of 2,696. This reinforces a positive and steady upward enrollment trend that the program has exhibited in previous quarters.

A significant indicator of the value of the project is the ability of its clients to abstain from substance use after intake. When comparing intake and follow-up client data, the rate of change for abstinence had increased by 47.1% among the clients.

California Expands Services, Improves Compliance with Training and Support

During this quarter, California made comprehensive changes to expand services, substantially improve GPRA compliance, and train and support providers. The changes included enhanced ways to serve methamphetamine clients and a new array of step-down services, including Continuing Care and Recovery Management, that are better tailored to the needs of substance abusing youth.

This quarter, the project underwent a significant change by shifting responsibility for discharge and follow-up data collection service providers. Providers were in nearly unanimous agreement that those who had developed relationships with clients could more easily accomplish data collection.

CARE's GPRA follow-up rate of 50.6% has more than doubled since the 21.8% figure in September 2008. This dramatic increase is the result of using input from providers and seeking technical assistance to develop long-term strategies that will drive sustainable achievements in this area. As of the end of this reporting quarter the CARE program produced and accounted for 1,300 valid six-month GPRAs. California has had no difficulty reaching client targets since ATR's inception, and is currently exceeding its cumulative client goal. Part of the new strategic plan calls for serving at least 2,803 clients during year two, which should allow the program to provide cost-effective, continuing care services. Extra efforts to attract and serve methamphetamine users include requiring assessment providers to prescreen youth for methamphetamine abuse and working with treatment and recovery support providers to encourage referrals of methamphetamine abusing youth. The CARE program is also successful with its provider network. There are currently 192 organizations in the ATR network-101 grassroots organizations and 62 faith based. Some fall into both categories.

Faith and Community based Provider Updates

SAIS: March 31, 2009

Based on the data ending March 31, 2009, 35.1% of the providers that have received and redeemed vouchers were faith-based organizations. CARE continues to field, analyze, develop and distribute answers to new provider inquiries through ongoing communication and additional training. The CARE staff have had so many providers interested in joining the network that they worked out a system in which new providers are first trained before actually serving clients. In fact, in February they closed recruitment of new providers in one county in the expansion area - Shasta County - having reached provider capacity. The Coordinator continues to maintain focus on adding and training new providers in the rget areas.

Success Story: ATR Allows Provider to Jumpstart Treatment

Provider Panacea is an organization that is only able to provide services because of CARE. The CARE program allows Panacea and other agencies to serve many schools and thousands of youth who would otherwise never have received services in Sacramento County.

CARE also allows small, but growing agencies like Panacea to establish very positive collaborative relationships with schools and school districts. Instead of signing a memoranda of understanding and then the school having to wait for up to a year and half in some cases to begin services, CARE allowed Panacea to begin services immediately.

One important benefit is that CARE allows for Individual Counseling. The State sponsored programs are very restrictive with regard to allowing for any individual intervention with clients, but we find that, from a clinical perspective, individual sessions are absolutely critical to the alcohol and other drugs (AOD) treatment and recovery process among youth. CARE allows us the precious time to work with clients one-on-one.

Colorado Exceeds Client Target,
Delivers Balanced Service Array

Chart depicts percent of clients that received each service. SAIS: March 31, 2009

Colorado's ATR program targets users of methamphetamine and ecstasy of any age and adolescents and young adults under 25 with any substance use issues. The project encompasses both rural and urban areas in metro Denver and metro Colorado Springs, the I-70 Corridor, and the Greeley/Fort Collins/Loveland area.

The program provided a balanced portfolio of services with a strong emphasis (about 60%) on treatment services. SAIS distribution data indicate that clinical treatment (49.7%) represents nearly half of all client interactions and medical services accounting for an additional 11.6%. Clients seeking recovery support services were most likely to utilize case management (35.3%) with just 3.4% choosing to participate in peer-to-peer support.

The ATR project again exceeded its target number of clients served, continuing a trend that has demonstrated gains across previous quarters. SAIS data show that the program served 3,308 clients, exceeding the target goal of 2,426 by nearly 900 clients, an increase of more than 35%.

The program is maintaining positive outcome statistics in terms of abstinence after intake. Based on the comparison between the intake and discharge data, the rate of abstinence from use increased 94.2% for Colorado ATR clients.

COLORADO CONTINUES TO ENHANCE PROJECT

During the quarter, CO ATR created a web portal feature to their Connect Care's information system. This addition facilitates online communication between assessors, providers and care coordinators. It also allows users to submit GPRA, clinical assessments, and RSS surveys online. This enhancement eliminates previous barriers to efficiency that included incomplete and illegible hardcopy forms and delays in assessments reaching treatment providers.

Also during the quarter, CO ATR conducted three recruitment forums aimed at faith-based organizations. This effort is showing positive results towards meeting CO ATR's goal of increasing their faith-based and RSS provider base within the program. Of the 85 faithbased organizations contacted, 9 have enrolled to become recovery support service (RSS) providers and 19 are in varied stages of the application and approval process.

Additionally, CO ATR advanced the date of ATR's expansion to the western slope. This decision was made in an effort to increase meth client enrollment. This effort resulted in a significant increase in meth-related client referrals. CO ATR is better positioned to reach its meth client targets for Year 2 of the grant as well as exceed overall client enrollment.

CO ATR also developed new strategies to meet the GPRA follow up target. These new strategies were necessary as a majority of clients are no longer in treatment at the 6 month follow up. Strategies include having treatment providers complete the 6 month follow up during the client's appointment, the employment of newly designed locator forms that include the client's contact information as well as two other people.

Faith and Community based Provider Updates

SAIS: March 31, 2009

CO ATR has been working to enroll additional faith based organizations and grassroots community programs. With SAMHSA-sponsored technical assistance, Colorado has conducted successful community enrollment forums that will increase its network. Currently just 7.1% of providers that had redeemed vouchers were faith-based in nature. The ATR staff is committed to expand provider capacity through the inclusion of community and faith-based organizations in future quarters. The provider forums already have lead to a wider selection of faith based organizations for clients, promoted recovery, and helped to build a better community.

Success Story:
Colorado ATR Helps Luke Connect with His Family

CO ATR funding allows many children to receive treatment, and turn high risk youth in the right direction. 16 year old Luke was one such youth.

Luke had a history of gang involvement and a family history of drug dependence and physical abuse. He began using drugs at 13 years old to escape family issues and numb his feelings. He started doing poorly in school and was expelled from his school district due to his drug dependency. His use increased and he ran away from home. After eight months of homelessness, he was picked up by the police and returned home.

Luke's mother heard about CO ATR through a friend and called to have an assessment done. Luke began treatment and did very well. He learned new coping skills to express his anger instead of shutting down. He learned how to have fun clean and sober and make goals for his life. He has completed the treatment program and continues to attend the weekly lifetime aftercare program.

Hawaii Expands Recovery Support Services &
Exceeds Target Recruitment

Chart depicts percent of clients that received each service. SAIS: March 31, 2009

The Hawaii ATR targets a wide range of substance using adults, including those who are in need of treatment, are currently in treatment, or have been discharged from treatment within the last 2 years. This population includes people with open, active Child Welfare Service cases, those with criminal justice involvement who have returned to the community on some form of supervised release, and dual-diagnosis clients working with mental health providers. The program's geographic target is the Island of Oahu, City and County of Honolulu.

This quarter, the program expanded its array of recovery support services (RSS). Case management (49.5%) and peer-to-peer services (33.0%) still represent the majority of services, according to SAIS distribution data. However, education RSS increased over the past quarter to 11.3%, and after care services, added this quarter, accounted for 6.3%.

Project staff successfully overcame earlier recruiting challenges and exceeded the target goal of 1,096 by 521 clients, enrolling 1,617 participants. Staff had proactively expanded its outreach efforts and intensified provider training to boost enrollment. Abstinence outcomes, which are objective indicators of the success of the program, also rebounded significantly this quarter as Hawaii ATR clients experienced an increase in abstinence of 55.0% based on a comparison between intake and discharge data.

HAWAII ATR FOCUSES ON MARKETING, TRAINING, AND MONITORING

During the quarter, Hawaii ATR II continues its full implementation of the electronic Voucher Management System (VMS) through implementation of the Web Infrastructure for Treatment Services (WITS). Direct upload into SAIS is currently effective in generating near real-time tracking of client enrollment, voucher issuance, fund encumbrance, and vouchers redeemed.

HI - ATR II also conducted three hours of marketing strategies training to 10 provider organizations, four RSS Unit and ATR II staff while a customized marketing training session was provided to 15 providers. HI - ATR II staff also presented ATR orientation and other advanced level trainings to case workers and supervisors. With these efforts, conducted at local provider facilities, HI-ATR II is better positioned to increase meth client enrollment and providers are better positioned to showcase their programs to other agencies while building partnerships that extend beyond Hawaii ATR II. Additionally this quarter, HI-ATR II implemented an ACCESS hotline for clients, which has enabled ATR staff to coordinate potential referrals and client engagement activities with recovery support services units. This well-known, trusted, community information line allows clients to be referred to RSS in a confidential manner. HI-ATR II also continues to implement a solid fraud, waste, and abuse prevention and detection system. Its program matic monitoring efforts have included fiscal audits, electronic tracking and client surveys. No substantiated instances of fraud, waste or abuse occurred this quarter.

Faith and Community based Provider Updates

SAIS: March 31, 2009

Based on the data ending March 31, 2009, 52% of the providers that have received and redeemed vouchers were faith-based organizations. This demonstrates HI-ATR's success with engaging faithbased organizations.

Bi-monthly provider forums were initiated with RSS units and existing and emerging provider organizations, providing a vehicle for information-sharing, presentations and trainings within the ATR provider network. ATR provider manuals were issued to all RSS units and providers and elements of the voucher system training were disseminated as part of the provider manual. Expansion of this material continues to be on-going.

Success Story: HI-ATR Leverages Existing Partnerships to Improve Program Performance

Prior to a SAMHSA sponsored technical assistance (TA) visit on provider development, HI ATR staff and their network providers had struggled with meeting the target objectives of the grant.

However, as a result of the TA, HI-ATR uncovered a wealth of client referrals from within its own service provider networks who were already utilizing services.

By enrolling these previously unidentified clients, HI-ATR was able to compensate providers for services provided to clients in the ATR covered-service categories. Two problems were resolved with a consolidated effort: low client enrollment and low provider compensation.

Through ATR, the State of Hawaii has been able to successfully expand service capacity among its provider network. For example, services that previously have not been part of the traditional system are now funded and available for ATR clients.

Enrollment, service array and expenditures increased, and HI-ATR continues to have a fairly concentrated and manageable provider network since the State already had a relationships with most of the participating agencies.

Wisconsin Expands Target Population

Chart depicts percent of clients that received each service. SAIS: March 31, 2009

The Milwaukee WIser Choice (Wisconsin ATR) program serves Milwaukee County residents, with special priority given to pregnant women, families with children, and persons involved with the criminal justice system who are awaiting trial, in alternative treatment diversion, or on probation or parole. The project has extended its reach to working with the PRI-Gang-Project Safe Neighborhood initiative and high-risk, maximum discharge re-entry offenders. The Drug Treatment Court was established January 2009 in Milwaukee County, so this is an additional population served by WIser Choice.

This quarter, SAIS distribution data for WIser Choice showed a continued emphasis on recovery support services, which comprise more than 65% of services provided. Case management (41.2%) maintained the lead in client interactions followed by after care services (24.4%). The treatment services remained evenly divided between medical services (18.2%) and clinical treatment (16.2%).

This quarter, the project exceeded its target number of clients by serving 3,218 clients, 238 participants over its target of 2,980.

The rate of abstinence from substance use, as measured by comparing intake data to discharge data, is a further indication of the program's success. The clients of WIser Choice saw their rate of ab- stinence increase by 92.0%.

WISCONSIN STRENGTHENS PARTNERSHIPS AND PROVIDER BASE

During the quarter, WI ATR conducted training to its network recovery support services (RSS) providers. The training, designed to help increase provider knowledge and expertise in working with substance abusing clients was conducted in preparation for implementation of a CSAT/ASAM-developed RSS assessment tool. With this training, RSS providers are now better positioned to identify and meet the RSS needs of WIser Choice clients.

WI ATR also implemented a new strategy to meet its GPRA target. It has begun utilizing its Central Intake Units to collect the 6 month follow-up GPRA interview. This approach, operational now at two local agency sites, is anticipated to decrease the number of missing GPRA followup interviews and increase WI ATR's ability to meet its overall target numbers. WIser Choice has also developed a referral process to pilot referrals from one of three Wisconsin Works providers in Milwaukee, which is a program with the Department of Children and Families. During the previous quarter, the project began working more closely with MAXIMUS, one of the 3 local Wisconsin Works providers, because they thought there may be a service gap in the TANF eligible population. This new process now grants TANF eligible clients priority access at Central Intake Units. This collaborative effort also identifies job seekers who have substance abuse problems and financial employment planners are able to refer them for treatment.

Additionally this quarter, WI ATR participated in a conference to discuss the behavioral health needs of returning veterans from the Army and Air National Guard. They anticipate that fostering statewide partnerships will provider greater access for soldiers to the treatment they need.

Faith and Community based Updates

SAIS: March 31, 2009

Based on the data ending March 31, 2009, 16.5% of the providers that have received and redeemed vouchers were faith-based organizations and 83.5% were secular.

This quarter, WI ATR WIser Choice provided training for all its providers and partners on how to work with individuals who use methamphetamine. The first part of the training focused on answering questions such as "What is it and Why do people use it?" The second part focused on clinical interventions for providers, targeted specifically to WIser Choice clinical treatment providers. The State will also receive SAMHSA sponsored training for its providers on the Matrix Model which is an evidence based practice.

Success Story: WIser Choice Client Chooses ATR Over Jail

A City of Brookfield detective was about to run a sting operation on a 22-year-old female for heroin charges but did not want to see her go to jail. So the detective decided to call an ATR Central Intake Unit (CIU) for help.

After learning of the situation, the CIU called the Genesis Detox Center and made arrangements to have the client taken straight to the Detox center after being arrested. The CIU made many calls to arrange for different levels of care, from out patient to residential. After three days the woman was given the choice of going through with the plan of recovery or going to jail. She chose recovery and was escorted to Genesis and placed on police hold. When her residential treatment episode ended, she was able to continue in outpatient treatment.

At last contact, the client was still clean, and the charges against her were dropped.