Expand the MAJORS program, now offered in 12 of the 39 Area Programs, to every current area/county program and every judicial district.
Recommendation 9.2
Double the capacity of clinically intensive residential program beds (ASAM Level III.5 or III.7) for adolescents with serious substance abuse problems.
Doubling the capacity will increase from the current 59 beds to about 120 beds.
Recommendation 9.3
Develop, fund, implement, and monitor the progress of a comprehensive statewide plan that will ensure consistent and effective screening, assessment, and referral to appropriate treatment for identified youth.
Screening systems should be developed in all sectors that work with youth, such as mental health, juvenile justice, schools, health providers, and social services.
Recommendation 9.4
Systematically strengthen early intervention services (ASAM Level 0.5) for youth and adolescents in mainstream settings such as schools, primary care, and juvenile justice settings
Early intervention will ensure that problems and potential problems with substance use are identified and addressed as early as possible.
Recommendation 9.5
Develop a specialized, statewide 8- to 10-bed residential program for pregnant adolescent girls who have serious substance abuse problems and who require this level of care.
Recommendation 9.6
Integrate and mainstream substance abuse prevention and treatment services into school-based health clinics and primary care settings through strong contractual agreements with area/county programs and the evolving LMEs.
Substance Abuse System Recommendations
Recommendation 9.7
Develop systems to provide hospital-based outreach and treatment to homeless, pregnant adolescent and adult women with serious substance abuse problems who are having their babies delivered in local hospitals.
Engage them and their fetal alcohol syndrome (FAS) vulnerable children in local treatment systems.
4.4.4 Suggested Time Frame:
DMHDDSAS Implementation Report to the Oversight Committee March 2002
Implementation Complete June 2005
4.5
Recommendation 10
Expand statewide outcomes measurement to all publicly funded substance abuse services.
4.5.1 Goal
Ensure that all individuals receiving publicly funded substance abuse treatment services are included in a single, statewide outcome measurement system.
4.5.2 Findings
North Carolina’s current substance abuse outcome measurement system, the
North Carolina Treatment Outcomes and Program Performance System (NC-TOPPS),6
is widely recognized as one of best program-based systems in the country. The SAS section coordinates this initiative with the assistance of two partners—the National Development and Research Institutes-North Carolina (NDRI-NC) and North Carolina State University’s Center for Urban Affairs and Community Services.
6
The current project grew out of a federal Center for Substance Abuse Treatment (CSAT) grant where North Carolina was selected as one of the initial TOPPS-I sites. This CSAT pilot was built upon substance abuse treatment research findings and practitioner input. Current data collection instruments and feedback reports were developed through a participatory and consensus process with the pilot sites’ substance abuse directors, clinicians, and participating researchers. Key personnel from the pilot sites continue to meet
Substance Abuse System Recommendations
Page 4-33
Because this is a program-based outcome system, the NC-TOPPS assessment tool is used on a regular basis by program counselors and the clients they treat. Both the clinician and the client complete the evaluation on a regular basis. The use of the tool, a sophisticated collection of well-respected nationally based measures, is thus occurring in real time, in the context of the therapeutic relationship and in a way that the information gained is well-positioned to be acted upon and positively influence the quality of care.
The NC-TOPPS tool is also very adaptable to different situations and populations within North Carolina. In fact, the North Carolina criminal justice system has used many of the NC-TOPPS items and adapted others in developing a tool for the population they serve. The NC-TOPPS system is currently being used in the following areas:
! the original five program pilot sites (Blue Ridge, Durham, Piedmont, Sandhills, and Southeastern Area) for all substance abuse clients;
! one contract agency (Coastal Horizons);
! each of the 39 area/county programs (to varying degrees);
! several specialty programs such as Perinatal/Maternal program,
Methadone programs, MAJORS (Managing Access for Juvenile Offender Resources and Services), and Work First/Substance Abuse Initiatives.
Despite usage in the above-mentioned programs, NC-TOPPS is now reaching only about 5,000 to 8,000 clients a year out of an annual pool of about 70,000 individuals. The pool of substance abuse clients, who are treated in the state for substance abuse problems with public dollars, is growing steadily. In other words, about 3 to 4 percent of those treated for substance abuse with public monies are involved in the state’s outcome measurement and quality improvement system. In sum, we believe that NC-TOPPS provides the state with a high-quality, standardized, and effective system for substance abuse related outcome and performance measurement.
Substance Abuse System Recommendations
Appendix H contains the full NC-TOPPS outcomes measurement report and provides an example of the type of information that can be developed.
While NC-TOPPS provides an excellent foundation for program-based outcome measurement, the state may also be interested in obtaining other types of outcome information to guide the development of public policy. Currently, services for an individual or family are often provided in two or more sectors of government, but there is no capacity to efficiently examine and utilize data and information gathered in other systems that would be highly relevant and useful. For example, in developing state policy, one might want to understand the impact of substance abuse treatment on:
! recidivism rates of North Carolina criminal justice offenders within two years of release;
! the percentage of mentally ill offenders who are receiving mental health services three months after being released from incarceration; or
! the impact of DSS intervention on the outcomes of treatment of
mothers with substance abuse problems and their affected children five years down the road.
Whatever the particular interest, easy-to-access interdepartmental outcome- related data can provide a wealth of useful information that can be used to inform public policy development. Sharing of outcome data is currently being done in a few states. For instance, the Washington state MIS systems allow relatively easy interdepartmental exchange of data that are used to track outcomes of individuals across services systems and inform the state’s legislative decision-making. Building this capacity in North Carolina would be especially useful in tracking outcomes of those who received substance abuse treatment, because the outcomes of this treatment are experienced in many aspects of government services such as the criminal justice system, health care, child welfare, and social services. Such development is neither easy nor inexpensive,
Substance Abuse System Recommendations
Page 4-35
but represents the future of how integrated information systems will be used to enhance the quality and efficiency of client monitoring and outcomes improvement.
4.5.3 Specific Recommendations