—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
MPLEMENTATION 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) ((DEAD LINK))
- 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.
THE CONVERSATION
Featuring David C. Ross, MA, LPCC, director of planning and evaluation at the Mental Health and Recovery Board of Ashland County.
What is it? Part 1 (1m 45s)
Tracking the impact of an EBP with the IDDT Affiliation Code.
Download this audio file (right-click and 'Save As')
What is it? Part 2 (2m 5s)
Bridging several databases, getting meaningful information about people and their service experiences.
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Improving communication (1m 17s)
Reports help board members and other leaders make informed decisions.
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Graphs and charts (1m 29s)
Exporting the IDDT Affiliation Code data into Excel spreadsheets to examine state hospital bed-days and costs.
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Multiple databases (1m 18s)
Structured Query Language (SQL) looks for information in a variety of databases and brings it all together.
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Advice to others (39s)
Ross encourages county boards and service agencies to use the Affiliation Code.
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The data sample (2m 48s)
Three years prior to the onset of IDDT services and three years after.
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State hospital bed-days (1m 38s)
$481 per day per bed.
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Data-informed decision (2m 9s)
Ashland redirects hospital bed-day dollars to community-based IDDT for people who are high utilizers of bed days.
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No new money for IDDT (1m 50s)
Ashland redirects the projected cost of 300 hospital bed-days to support community-based IDDT services.
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Crisis services (1m 9s)
Intensive, expensive services that typically accompany a state hospital admission decrease as hospital bed-days decrease.
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Average cost per client per service (4m 5s). Ashland is a small county but cost savings from IDDT services are relevant for larger, more urban areas.
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Quality-of-life outcomes, Part 1 (1m 31s). Do you want to spend $24,000 per person on treatment-as-usual or only $6,800 with IDDT?
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Other outcome scales (1m 43s)
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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.
- 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.
- 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) ((DEAD LINK))
+ Look at the graph, Excel version (click here) ((DEAD LINK))
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.
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) ((DEAD LINK))
+ Look at the graph, Excel version (click here) ((DEAD LINK))
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.
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.