The Department of Alcohol and Drug Programs (DADP) has contracted with ADPI to provide training, consultation and technical assistance services to substance use disorder treatment agencies in California. These services are supported by DADP contract # 10-00214 and are provided at no charge to the recipients.
The purpose of this contract is to provide Technical Assistance (TA) and training to the alcohol and other drug (AOD) treatment field and to assist ADP in designing and implementing the statewide system of care. The intended result of this TA will be improved quality and performance of AOD treatment program services for California’s alcohol and drug recovery, treatment and/or detoxification facilities.
A broad range of services is provided to prospective and existing residential licensees; prospective and existing certified programs; programs that provide detoxification services; and Narcotic Treatment Programs (NTP). In addition, TA and training services will address special populations such as women, pregnant women, mothers and their children, persons with disabilities, as well as other unserved or underserved populations.
ADPI has been a leader in providing training and TA to counties and providers in the area of preparing for health care reform. Although health care reform readiness is not a primary focus of the services proposed by ADPI, it does serve as a proxy measure of provider infrastructure. ADPI’s goal is to help providers increase their administrative as well as program capacity above and beyond the minimum standards contained in DADP requirements to become capable of providing the highest quality services and being capable of meeting the significant challenges posed by health care reform. In addition to providing training, consultation and TA on specific health care reform topic areas as appropriate within the scope of the proposed DADP contract, ADPI will also address agency administrative infrastructure issues so that the agency has the capacity to implement trainings regarding specific health care reform topics.
Training services are offered in three general areas. One area covers the requirements for the requirements for licensing and certification of alcohol and drug facilities. Another training topic area concerns the development of policy and procedures manuals. The third training area covers a broad range of topics of concern to providers. Examples of such topics include:
- Resolve pressing issues that impact service delivery, management, and financing;
- Anticipate and prepare for major policy, organizational, and economic shifts;
- Adopt evidence-based practices;
- Comply with federal requirements, including the SAPT Block Grant and national outcome measures (NOMs);
- Effective strategies for providing AOD detoxification, treatment and recovery services;
- Tools and techniques for safe and efficient use of electronic health records, data collection, and integration;
- Licensing and certification common problems and solutions;
- Issues involving medication-assisted treatment;
- AOD counselor education and training to improve or enhance skills, e.g., treatment planning, progress note writing, motivational interviewing, etc. (not for the purpose of fulfilling education requirements to obtain certification or licensure);
- Tobacco cessation policies for clients and staff;
- Culturally competent client services;
- Intravenous drug use issues;
- HIV/AIDS prevention;
- Hepatitis and other infectious disease prevention and treatment.
Consultation and Technical Assistance
Consultation may be provided through on-site assistance an agency’s facility, or via webinar, telephone, e-mail, or other written correspondence. Consultation services are outcome-focused and are intended to address specific program challenges or opportunites. Onsite consultation is typically short term in nature. Descriptions of typical areas for which consulation and TA are provided follow.
Compliance with Technical Requirements
Compliance with technical requirements of state, federal and local laws, regulations and standards is essential to agency survival and maintenance of program certification and licensure. Basic clinical and service documentation is a significant issue for many agencies, including maintenance of progress notes, ensuring that treatment plans and treatment plan updates are properly reviewed and signed, and ensuring that client files (e.g., consent to treatment, confidentiality releases, medical screenings, admission forms, treatment and discharge plans, etc.) are complete and up to date. These documentation issues are particularly apparent among Drug Medi-Cal and narcotic treatment programs (NTPs), where the documentation requirements tend to be more extensive, are more strictly enforced, and are connected to reimbursement. Meeting state and federal data requirements (e.g., CalOMS admission and discharge data and DATAR waiting list data) is often an issue due to staff not understanding data requirements and definitions of data elements, and not being adequately trained on provider and county data systems.
Staff and Program Development
Staff and program development issues are certainly related to compliance with technical requirements, but also go beyond narrow technical compliance to affect the broader issue of quality of client services. Community relations are also included in this category. Core staff knowledge and skills are frequently cited as being in need of development, including:
- Use of standardized assessment instruments, including standardized
assessment tools for co-occurring disorders as well as AOD issues
- Developing treatment plans that are comprehensive, based on the assessment,
match level of care to the client’s needs (meet medical necessity criteria and are based on American Society of Addiction Medicine patient placement criteria), and contain measurable objectives and outcomes
- Assessing clients for ancillary service needs (employment, housing, parenting, childcare, domestic violence, sexual abuse, medical issues, etc.)
and connecting them with community resources
- Strengthening clients’ work skills (resume building, job interviewing, job“soft skills”) and assisting them to find jobs
- Group counseling techniques, including cognitive behavioral therapy and basic group counseling skills (e.g., ensuring that every one has an
opportunity to speak, keeping the group on task)
- Motivational interviewing and strengths-based approaches to treatment
- Effective, culturally appropriate approaches to working women, persons with PTSD, youth, racial and ethnic groups, persons with disabilities, and LGBT individuals
- Appropriate staff behavior, with a particular focus on confidentiality, HIPAA compliance, dual relationships, ethics, boundary issues, and sexual
Program development issues most frequently cited include the need to:
- Implement evidence-based practices (e.g., NIATx, Matrix model intensive outpatient services, motivational interviewing, trauma-informed curricula such as Seeking Safety)
- Implement strengths-based program strategies to increase retention and completion
- Implement effective strategies for outpatient, residential, detoxification, and narcotic treatment program services that are based on the collective wisdom and experience of the field (e.g., CSAT Treatment Improvement Protocols, evidence-based practices, and mentoring from high quality programs)
- Routinely evaluate program services through quality assurance procedures, collection of data on client outcomes and client experiences in the program, and using the data to evaluate and improve service quality
Community relations issues most commonly encountered include:
- Community concerns about siting of new programs that are related to fears about crime and drug dealing, safety of neighborhood children, and possible declining property values
- Concerns about existing facilities (particularly unlicensed clean and sober houses) most commonly focus on how many single adults are occupying the house, multiple people coming and going from the house (i.e., suspected drug dealing), traffic and cars on the street, people congregating in front of the house and being unpleasant (smoking, swearing, etc.), not having a clear understanding about who to complain to, and not getting a positive response to complaints.
Administrative Infrastructure and Preparing for Change.
Many of the problems encountered in compliance with technical requirements, staff development, and program development are rooted in weaknesses in agency infrastructure. Programs may come into compliance with technical requirements in response to monitoring, training and TA, only to backslide into non-compliance a few months later due to workload related pressures or staff turnover. Agency staff attends trainings on evidence-based practices, but the practice is not implemented or is not implemented with fidelity. Agencies often do not routinely collect their own data on client outcomes, or do not use the data that it has collected to evaluate and improve services.
Weaknesses in administrative infrastructure make it more difficult for an agency to anticipate and prepare for major policy, organizational and economic shifts. The advent of health care reform will present opportunities for AOD agencies, but will also place greater burdens on their administrative infrastructure, from data systems and electronic health records to insurance billing, staff qualifications, program certification, integration of services with primary medical and mental health care, and reporting on client outcomes.
To request training, consultation or technical assistance services please go to our online request form.