Abstract
| This grant is focused on non-dependent users. Connections SBIRT, a tribal project, will serve Anchorage, Alaska. It will enhance screening, referral, brief intervention, and treatment services for adults and add those services for adolescents. Its overarching goal is to reduce substance use by participating clients as defined by GPRA outcome measures. We will serve 1,791 annually (unduplicated) at one or more service levels. Connections SBIRT Project is proposed by the Cook Inlet Tribal Council in partnership with Southcentral Foundation, our sister tribal non-profit health arm of the Cook Inlet Region. CIRI family of providers which provides IHS medical services. |
Objectives
Overarching Goal (Goal 1). To reduce substance use by patients receiving treatment through the SBIRT project as measured by GPRA outcome measures.
Outcome Objectives: Percent of adults who receive services who: are currently employed or engaged in productive activities, had a permanent place to live in the community, had reduced involvement with the criminal just system, had no past illegal drug related health, behavior or social consequences, including the misuse of prescription drugs.
Percent of adolescents under age 18 receiving services who: were attending school, were residing in a stable living environment, had no involvement in the juvenile system, had no past month use of alcohol or illegal drugs, experienced reduced substance abuse related health, behavior or social consequences. Baseline established through intake interviews.
Goal 2. To expand the Anchorage continuum of care for Alaska Natives through the addition of screening services, expansion of existing assessment, brief intervention and brief therapy services for adults and the full continuum of SBIRT services for adolescents through increased settings where services will be provided.
Process Objective 2:1: to increase the number of Substance Use Disorder (SUD)-affected Alaska Natives receiving substance abuse services in Anchorage.
Screening: CITC Adult from 0-300; SCF Adult from 0-900; Adolescent from 0-600. Note: Although screening takes place as part of assessment currently, formal screening as a discrete service separate from assessment will be added as a new service under this grant.
Brief Intervention: CITC Adults From 0-165, SCF Adult from 200 to 400, Adolescent from 0-200. SCF is currently offering brief intervention (named Group Education) at 200 clients per year. To this they will add services for 300 maintaining existing numbers.
Assessments: CITC from 750 maintaining 750. During Year 2 SBIRT will absorb the existing First Step Assessment Center which services 750 annually.
Brief Therapy: CITC from 300 to 300. Note: CITC is currently offering Brief Therapy and serving 300. During Year 1 we will increase that by 225, then absorb and then stabilize at 300 with 3rd party billing absorbing a .50 FTE staff to maintain the existing level. This budget does not pay for the full 300.
Adolescent: Screening from 0-600; Brief Intervention from 0-200, Assessment from 0-200, Brief Therapy from 0-152. Note: Numbers from Screening are duplicated as clients flow from one service to another. We will increase by 1,187 unduplicated clients annually for adults and 604 for adolescents.
Process Objective 2.2: To increase the number of community settings where SBIRT services are provided; from one primary health setting and one social service setting to 3 generalist community settings.
Process Objective 2.3: To provide treatment services within approved cost parameters for screening, assessment, and Brief Therapy (treatment gap). The grant request is based upon the approved cost parameters so this will entail appropriate spending of grant funds.
Goal 3: To support clinically appropriate treatment services for non-dependent substance users.
Process Objective 3.1: To add and enhance services for non-dependent users to include screening, brief intervention, and assessment services. See Targets in Process Objective 2.1 above.
Goal 4: To improve linkages among community agencies performing SBIRT and Specialist substance abuse treatment agencies.
Process Objective 4.1: to establish and maintain a linkage between 3 generalist community and 4 specialist setting in the Alaska Native continuum of care.
Goal 5: To identify systems and policy changes to increase access to treatment in generalist and specialist settings.
Process Objective 5.1: Steering Committee work group to identify systems and policy changes within 3 months of grant awad.
Process Objective 5.2: Work Groups develop Systems and Policy Change Plan for Years 1 – 5 of the grant within 6 months of grant award.
Process Objective 5.3: implement plan at 6 months through Year 5.
Indian Nation Served
Anchorage CIRI Tribal region
Key Components
1. Intervention for non-dependent, at-risk users.
2. Client identification through screenings in non-traditional generalist settings. In collaboration with Southcentral Foundation; provides screening at the Primary Care Center and CITC’s First Step Assessment Center, Family Services and Employment and Training Departments. Also offers Brief Intervention (up to 5 visits) and Brief Treatment (6 to 12 visits) for those that screen as non-dependent, but with at-risk use.
Evaluation Design
We have developed a participant-centered, multi-dimensional “Partnership Evaluation” model over the past 10 years working with Alaska Native programs. Partnership evaluation views the evaluation staff as program partners, both working towards the same end result, an effective program that meets the needs of the population it servces. In the partnership evaluation model, the evaluation staff is not seen as external observers but rather equal partners in day to day program operations. Additionally extensive opportunity and weight is given to participant input. The evaluators and the Data Center Manager are integral members of the Management Team of Substance Abuse Services. Partnership evaluation uses input from both process and outcome evaluation to adjust the program as evaluation findings become available. Evaluation findings guide ongoing project development. The end result is a program that can evolve into a “best practice.”
The Substance Abuse Service Division strongly believes in program evaluation and the continuous collection, analysis, and reporting of appropriate data. We have our own database and analysis systems and have been developing our own Management Information System, which is a web-based case management model. Our assessment summary will be generated by the MIS system to improve objectivity and consistent use of the information collected. Our progress notes, treatment plans and discharge summaries will also be included in the web-based system. We have extensive experience collecting and reporting federal GPRA data and data required by the state; however we also collect data needed to conduct quality assurance reviews and basic evaluation comparisons to national research studies.
We have put extensive resources into data and evaluation with an onsite Data Center and two external evaluators on contract. Our Data Center employs 1 manager, 4 data specialists, and 2.5 follow-up specialists who work collaboratively with the evaluators. Our evaluators focus on process and outcomes with Dr. Spero Manson responsible for outcome data and Jodi Trojan, MCJ, responsible for process evaluation.
The Process Evaluation is the primary avenue for determining the fidelity of the program practices to what was proposed. Process questions the evluation answers are:
1. How closely did implementation match the implementation plan? 2. What types of deviation from the plan occurred? 3. Are services occurring when and where planned? 4. Is group content accurate and up-to-date? 5. What services are provided to whom?
Outcome Evaluation involved the assessment of a person as the present, baseline, and comparison their status at some point in the future, after exposure to the treatment intervention. Outcome evaluation questions include:
1. What overall effect did the programs have on participants? 2. What program/contextual factors were associated with the outcomes? 3. What individual factors were associated with outcomes? 4. How long-lasting were the effects?
Evaluation Results
We have developed a participant-centered, multi-dimensional “Partnership Evaluation” model over the past 10 years working with Alaska Native programs. Partnership evaluation views the evaluation staff as program partners, both working towards the same end result, an effective program that meets the needs of the population it servces. In the partnership evaluation model, the evaluation staff is not seen as external observers but rather equal partners in day to day program operations. Additionally extensive opportunity and weight is given to participant input. The evaluators and the Data Center Manager are integral members of the Management Team of Substance Abuse Services. Partnership evaluation uses input from both process and outcome evaluation to adjust the program as evaluation findings become available. Evaluation findings guide ongoing project development. The end result is a program that can evolve into a “best practice.”
The Substance Abuse Service Division strongly believes in program evaluation and the continuous collection, analysis, and reporting of appropriate data. We have our own database and analysis systems and have been developing our own Management Information System, which is a web-based case management model. Our assessment summary will be generated by the MIS system to improve objectivity and consistent use of the information collected. Our progress notes, treatment plans and discharge summaries will also be included in the web-based system. We have extensive experience collecting and reporting federal GPRA data and data required by the state; however we also collect data needed to conduct quality assurance reviews and basic evaluation comparisons to national research studies.
We have put extensive resources into data and evaluation with an onsite Data Center and two external evaluators on contract. Our Data Center employs 1 manager, 4 data specialists, and 2.5 follow-up specialists who work collaboratively with the evaluators. Our evaluators focus on process and outcomes with Dr. Spero Manson responsible for outcome data and Jodi Trojan, MCJ, responsible for process evaluation.
The Process Evaluation is the primary avenue for determining the fidelity of the program practices to what was proposed. Process questions the evluation answers are:
1. How closely did implementation match the implementation plan? 2. What types of deviation from the plan occurred? 3. Are services occurring when and where planned? 4. Is group content accurate and up-to-date? 5. What services are provided to whom?
Outcome Evaluation involved the assessment of a person as the present, baseline, and comparison their status at some point in the future, after exposure to the treatment intervention. Outcome evaluation questions include:
1. What overall effect did the programs have on participants? 2. What program/contextual factors were associated with the outcomes? 3. What individual factors were associated with outcomes? 4. How long-lasting were the effects?
Products Developed
None to date other than brochures, posters, client flow-charts and training manual.