September 8, 2008
THE IMPACT OF IDDT
Affiliation code more efficiently tracks consumer outcomes, IDDT effectiveness
—by Paul M. Kubek and Matthew K. Weiland
Columbus, OH—The Ohio SAMI CCOE—in partnership with the Ohio Department of Mental Health (ODMH), the Ohio Department of Alcohol and Drug Addiction Services (ODADAS), and the Mental Health and Recovery Board of Ashland County—announces the commencement of the Integrated Dual Disorder Treatment (IDDT) Affiliation Code Initiative. IDDT is an evidence-based practice that helps improve quality of life and other outcomes for people diagnosed with a severe mental illness and a co-occurring substance use disorder.
The initiative gives agency providers, county boards, and State of Ohio stakeholders the capacity to collect data and to examine indicators and outcomes systematically for IDDT consumers and to use this knowledge to inform and advance public policy, community service plans, and day-to-day service delivery locally and across the State of Ohio. The IDDT Affiliation Code is assigned to consumers receiving IDDT services who are enrolled in the Multi-Agency Community Services Information System (MACSIS).
"The affiliation code enables community decision makers and researchers, among others, to draw together information that already exists in MACSIS to answer important questions in order to improve services and evaluate resource allocation," says Deb Hrouda, MSSA, LISW, assistant director of research and evaluation at the Center for Evidence-Based Practices (CEBP) at Case Western Reserve University. The Ohio SAMI CCOE is an initiative of the CEBP. "The affiliation code becomes the common denominator showing what types of integrated-treatment services are utilized by consumers and the related outcomes."
Hrouda emphasizes that use of the code will be rather simple, because the initiative is built upon MACSIS, which is a statewide database system that county boards are already using. The first phase of the initiative will focus on these three factors related to IDDT service:
- Service utilization
- Cost
- Quality of life
IMPLEMENTATION TOOLS
Hrouda explains that the Ohio SAMI CCOE, the Ashland Board, ODMH, and ODADAS formed a workgroup this past winter to plan and implement a pilot test of the IDDT Affiliation Code. The process took several months and has culminated in the production of a number of free tools to help agency providers and boards integrate affiliation-code routines into their day-to-day work. These tools include the following:
- Step-by-step guide (booklet) (click here)
- Online message board for agency providers and county boards to post questions and get answers from the initiative's partners (use the "Discussions" section of this website)
- Web page of additional free resources (click here)
- IDDT consumer roster
- SQL computer code
- Data table
- Report templates
CONSULTATION SERVICES
Consultants and trainers from the Ohio SAMI CCOE are available to provide technical assistance for utilization of the IDDT Affiliation Code and interpreting data. Agency providers and county boards that are implementing IDDT are encouraged to contact the consultant and trainer from the SAMI CCOE with whom they work and/or to make contact through the online IDDT Affiliation Code web page.
THE PILOT PROJECT
The Mental Health and Recovery Board of Ashland County volunteered to pilot test use of the IDDT Affiliation Code. In the process, it developed the computer code to generate reports from affiliation-code data. The Board is using these tools to evaluate IDDT services in its county and to communicate with board members, agency providers, and advocates and stakeholders in its community.
We asked David C. Ross, MA, LPCC, director of planning and evaluation at the Ashland board, a few questions about his participation in the initiative. Ashland County is using IDDT-Affiliation-Code data to evaluate the following in its community:
- Service utilization (hospital bed-days, crisis services)
- Costs of services for IDDT consumers
The Board has found a reduction of both with the onset of IDDT.
WHAT IS THE IDDT AFFILIATION CODE?
DR: It is basically a code assigned to an individual within the service
system that stays with the person regardless of the services he or she
receives. For example, in the State of Ohio, there's a database that's
strictly for reporting and recording outcomes information. There's
another system that is specific to capturing costs. The IDDT Affiliation
Code is a bridge, if you will, between these different kinds of
disparate databases.
WHY DID ASHLAND COUNTY GET INVOLVED IN THIS INITIATIVE?
DR:
Our field is not one that is always easy to explain to folks-what we
do, how we do it, why we do it this way and not another way. It's a
constant education to present reports about programming at a level of
clarity that we really haven't had before the affiliation code. Most
board members want to know:
- What's a program about and what's it supposed to do?
- Do people get better because of this program?
- Does the program work and how much does it cost?
With
the affiliation code, the tangible result [is that] we're able to
provide to our board members information that gives them a far better
idea about what IDDT is and how it's working in the county.
WHAT IS THE ADVANTAGE OF THE AFFILIATION CODE?
DR: If we
know a consumer is in a specialized program like IDDT and we know the
time frames of services, the boards and agencies can then access this
data and evaluate service utilization, costs, and outcomes. In my mind,
it's a relatively pain-free way to track evidence-based practices,
specifically Integrated Dual Disorder Treatment.
WHAT IS YOUR MESSAGE TO OTHER COUNTY BOARD MEMBERS THROUGHOUT THE STATE?
DR:
I ask the boards and agencies who are implementing IDDT currently to
give this process a try. It really doesn't require much additional
effort and in my opinion the payoff is well worth any efforts that will
be expended.
DATA ANALYSIS & RESULTS
DR: We looked at data for
people in our county enrolled in IDDT during a six-year span—three years
before they started IDDT services (pre-IDDT) and three years after they
started (post-IDDT). The number of consumers varied. Sometimes there
were 12, 19, or 20 consumers receiving services during the time span.
1.) SERVICE UTILIZATION | HOSPITAL BED-DAYS
- Pre-IDDT/ 2 to 3 years: 76 bed days (x $481 per day = $36,556)
- Pre-IDDT/ 1 to 2 years: 52 bed days (x $481 per day = $25,012)
- Pre-IDDT/ 1 year: 118 bed days (x $481 per day = $56,758)
- Post-IDDT/ 1 year: 16 bed days (x $481 per day = $7,696)
- Post-IDDT/ 1 to 2 years: 19 bed days (x $481 per day = $9,139)
- Post-IDDT/ 2 to 3 years: 1 bed day (x $481 = $481)
+ Look at the graph, PDF version (click here)
+ Look at the graph, Excel version (click here)
Policy implications/decisions
DR: We are re-directing the dollars we
receive from the Ohio Department of Mental Health to pay for hospital
bed-day usage to support community-based IDDT services.
2.) SERVICE UTILIZATION | CRISIS SERVICES
- 23 hours of service = pre-IDDT/ 2 to 3 years
- 67 hours = pre-IDDT/ 1 to 2 years
- 87 hours = pre-IDDT/ 1 year
- 71 hours = post-IDDT/ 1 year
- 15 hours = post-IDDT/ 1 to 2 years
- 12 hours = post-IDDT/ 2 to 3 years
+ Look at the graph, PDF version (click here)
+ Look at the graph, Excel version (click here)
Policy implications/decisions
DR:
A decrease in hospital bed-days appears at the same time there is a
decrease in crisis services, which has a direct impact on total average
costs of services.
3.) COST | AVERAGE COST PER CLIENT PER SERVICE
DR: Average
costs were calculated for the following services: hospital bed-days;
mental health assessment from a non-physician; mental health crisis
intervention; employment/vocational support; group psychiatric support;
group counseling; individual psychiatric support; individual counseling;
pharmacological management.
- $23,693 = pre-IDDT/ 2 to 3 years
- $18,322 = pre-IDDT/ 1 to 2 years
- $18,194 = pre-IDDT/ 1 year
- $12,469 = post-IDDT/ 1 year
- $12,149 = post-IDDT/ 1 to 2 years
- $6,883 = post-IDDT/ 2 to 3 years
+ Look at the graph, PDF version (click here)
+ Look at the graph, Excel version (click here)
Policy implications/decisions
DR:
This data may help those agency providers and boards that are
on-the-fence about IDDT to tip their decision to start implementation.
4.) OUTCOMES | QUALITY-OF-LIFE SCALES
DR: We are still writing the SQL code to examine outcomes data from
affiliation-code extract files, so we don't have a report for this yet. I
am very interested in seeing the results. We know that IDDT is
decreasing costs and that's important. But it's just as important to see
an improvement in consumer outcomes, such as their quality of life. The
goal of services is to improve lives.
SHARE YOUR RESULTS
County boards and agency providers are
encouraged to use the free computer code available online and to create
their own code and share it via the IDDT Affiliation Code web page
(click here).
IDDT AFFILIATION-CODE INITIATIVE PARTNERSHIP
- Mental Health and Recovery Board of Ashland County
- Ohio
Substance Abuse and Mental Illness Coordinating Center of Excellence
(Ohio SAMI CCOE), an initiative of the Center for Evidence Based
Practices at Case Western Reserve University
- Ohio Department of Mental Health (ODMH)
- Ohio Department of Alcohol and Drug Addiction Services (ODADAS)
THE NATIONAL SCENE
Integrated
Dual Disorder Treatment (IDDT), the evidence-based practice, was
developed and continues to be studied by researchers at the Psychiatric
Research Center of Dartmouth Medical School in Lebanon, New Hampshire.
The researchers include Robert E. Drake, MD, PhD, and Gary Bond, PhD,
and their colleagues.
The Dartmouth PRC has provided leadership
for national implementation of IDDT via the Substance Abuse and Mental
Health Services Administration. The State of Ohio and the Center for
Evidence-Based Practices at Case Western Reserve University—through its
SAMI CCOE initiative—have participated and continue to participate in
these national initiatives.
Listen to and read about the CEBP's interviews with Dr. Drake (click here) and Dr. Bond (click here).
ACADEMIC-COMMUNITY PARTNERSHIP
The Ohio SAMI CCOE is an initiative of the Center for Evidence-Based Practices (CEBP) at Case Western Reserve University, which is a partnership between the Mandel School of Applied Social Sciences and the Department of Psychiatry at the Case School of Medicine. The CEBP works in collaboration with and is supported by the following:
- Ohio Department of Mental Health
- Ohio Department of Alcohol and Drug Addiction Services
Paul M. Kubek, MA, is director of communications and Matthew K. Weiland, MA, is senior writer, producer, and new-media specialist at the Center for Evidence-Based Practices at Case Western Reserve University.
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