Educating State Legislators on the Outcomes of Addiction Treatment and Approaches to Measuring Performance

Final Phase of SAMHSA Funded Project Sponsors Visits to Four State Legislatures

The final phase of this SAMHSA-funded project continued helping legislators address issues of performance measurement and treatment efficacy in substance abuse. Begun in 2005 by the State Associations of Addictions Services (SAAS) in collaboration with the Treatment Research Institute (TRI) and NCSL, in 2007 and 2008, TRI’s A. Thomas McLellan, Ph.D., Mady Chalk, Ph.D., and Deni Carise, Ph.D. took the message directly to state capitols where legislators have asked for help on locally specific issues, such as:

• Whether patient relapse really means treatment “failed” when it can be shown to have saved public dollars through decreased costs for incarceration, emergency room use or less need for expensive child welfare services.
• Ways to know if treatment is producing savings in excess of the investment, and if the savings appear in other agency budgets such as criminal justice, public health, public safety, or child welfare. 
• Innovative experiments in other states to increase return on investment through purchasing, administrative and regulatory reform. 
• Ways to relieve provider burden by eliminating duplicative and time-consuming data collection requirements.

During 2007 and 2008, four requesting states received project-sponsored visits to help them address performance and measurement topics of their choosing. 

On April 19, 2007 TRI’s Deni Carise, Ph.D, presented Performance Measurement in Addictions Treatment Programs to members of the Colorado State Legislature, a discussion of ways performance should be measured in substance abuse treatment and models for performance based contracting.

On October 31, 2007, in a full-day session in the North Carolina State Capitol, TRI Chief Executive Officer A. Thomas McLellan, Ph.D. delivered Reconsidering Addiction Treatment discussing new ways to look at treatment effectiveness and legislators’ options for promoting accountability through performance improvement initiatives.  Dr. McLellan also led an afternoon workshop, along with Kimberly Johnson, former Director of the Single State Agency in Maine (Performance Based Contracting: Some Things to Consider), and TRI’s Mady Chalk, PhD. (­Funding Tools for Service Systems).  The supplementary afternoon session discussed models for contracting for addiction services, reimbursement methods, and performance measurement and monitoring models.

On January 17, 2008, Dr. Chalk presented Public Responsibility and Addiction Treatment before joint public health and fiscal committees of the Kansas State Legislature.  At the request of Senate sponsors, Dr. Chalk discussed public and private financing of addiction treatment; using outcomes and performance measures to improve treatment quality; and purchasing alternatives for publicly funded systems.

The final project presentation was January 23, 2008 before Connecticut legislators from the House and Senate Appropriations and Public Health Committees.   TRI’s Dr. McLellan presented What’s Wrong with Addiction Treatment: What Could Help, a discussion of treatment effectiveness; addiction as a chronic relapsing disease with implications for treatment and funding; ways to stretch limited State dollars, and basic principles for evaluating treatment effectiveness. 

Helpful Resources

"What's Wrong with Addiction Treatment: What Could Help." a presentation by Thomas McLellan, Ph.D. before the Connecticut Legislature, January, 23, 2008.

“Public Responsibility and Addiction Treatment,” by Mady Chalk, Ph.D., before the Kansas State Legislature; January 18, 2008.

“Reconsidering Addiction Treatment,” a presentation by A. Thomas McLellan, Ph.D. before the North Carolina State Legislature, October 31, 2007.

“Performance Based Contracting: Some Things to Consider,” by Kimberly Johnson, former SSA Director, State of Maine; before the North Carolina Legislature, October 31, 2007.

­“Funding Tools for Service Systems,” by Mady Chalk, Ph.D. before the North Carolina Legislature, October 31, 2007.

“Performance Measurement in Addictions Treatment Programs,” a presentation by Deni Carise, Ph.D. before the Colorado State Legislature, April 19, 2007.

 “The Burden of Public Responsibility,” a presentation by Mady Chalk, Ph.D. before the Massachusetts State Legislature, March 2006.

“Reconsidering Addiction Treatment: How Can Treatment be More Accountable and Effective?” A presentation by A. Thomas McLellan, Ph.D. before the Colorado State Legislature, March 2006

SSI Cost-Offset Study from Washington State, available at: http://www1.dshs.wa.gov/pdf/ms/rda/research/11/125.pdf

Report from the National Quality Forum: “Evidence-Based Treatment Practices for Substance Use Disorders”

National Expenditures Report from SAMHSA

Fact Sheet on SAMHSA’s National Outcomes Monitoring System: “NOMS”

“The Economic Benefits of Substance Abuse Treatment,” a report by TRI’s Steven Belenko, Ph.D.

“Drug Dependence, A Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation” by A. Thomas McLellan, Ph.D.

“Rewarding Results: Improving the Quality of Treatment for People with Alcohol and Drug Problems.” Recommendations from a national policy panel convened by Join Together.

Report on the Costs and Effectiveness of Alcohol and Drug Abuse Programs in Colorado.

Reconsidering Addiction Treatment, a presentation by Mady Chalk, Ph.D., before the Select Committee on Mental Health and Substance Abuse, Casper Wyoming, May 15, 2006.

Expanding Alcohol/Drug Treatment: An Investment in Health Care Cost Containment and Public Safety, by Antoinette Krupski, Ph.D., before the Select Committee on Mental Health and Substance Abuse, Casper Wyoming, May 15, 2006.