Discrepancies between County Contract and Services Received by Consumers of ARTC

For More Information Contact: Lisa Lowe, Heroin Action Coalition 240-370-1436 / LisaALowe@aol.com

Reports from consumers of substance abuse treatment services at Avery Road Treatment Center (ARTC), in Montgomery County, highlight discrepancies between the services contracted for by the County, as specified within the License Agreement, and the services that are actually received by consumers. For example: Family involvement and counseling Although the License Agreement stipulates that patients should receive family counseling, none of our families received it, nor were the patients offered it. Family involvement and counseling is regarded as an evidence-based best-practice treatment, and as such, is supported by the community. According to the contract, a description of program services...that provides for a minimum of 36 hours per week of therapeutic activities that includes but is not limited to: individual, group, and family counseling sessions , and each consumers ITP [individualized treatment plan] must includea Family Care Plan, family counseling and support services as identified in the consumers ITP and to facilitate a discharge plan, with any person providing family therapy having formal training in this modality. The Family Care Plan is to include: (1) assessment of service needs of the consumer in relation to his/her family of origin, significant other, and/or minor children who will be involved in the treatment process and discharge plan, and the Contractor must provide the following treatment servicesfor each admitted consumer: c. individual, group, and family counseling Treatment on demand, rather than waiting lists All of our families acknowledged that their family member often waited several weeks for a bed to become available before they could get into treatment. They were instructed to call every morning at 11:00 a.m.. If they missed the call-in time, their name was placed at the back of the list. There is often a very small window when the addicted individual is committed to entering treatment. If this opportunity is lost, the individual may change his or her mind. This could mean the difference between life and death. Treatment admission engagement is an evidence-based best-practice treatment initiative, and is therefore supported by the community. According to the contract, knowledge of and experience with the application of evidence-based practices that improve treatment admission engagement Patient retention in treatment, rather than premature discharge Many patients have told us that they have been prematurely discharged for a variety of reasons, including making a lewd gesture to another patient, false positive urine test confirmed negative for substances later that day at a hospital ER, taking an extra Suboxone, and giving away an extra Suboxone. Opiate addiction is a fatal disorder with highly successful outcomes when a patient remains engaged in treatment for 90 days or more. Since premature discharge can lead to death, and since most of the reasons given for premature discharge could easily be resolved by the provider, the current rate of discharges is unacceptable. Retention measures which keep patients in treatment are evidence-based best-practices, and are supported by the community. According to the contract, the provider must have knowledge of and experience with the application of evidencebased practices that improve retention rates for this level of residential care ; and [utilize] treatment modalitiesthat improve retention and motivation to continue in further treatment. The contract also mandates that, persons who are therapeutically discharged or otherwise do not complete treatment will be referred back to the Countys central assessment and referral site for evaluation and placement in an appropriate treatment program. Our families report that this currently does not occur.

Patient assessment of needs and referral to providers According to our families, many substance abuse patients have related issues, which unless resolved, will lead them back to substance abuse. They may require mental health, legal, housing, educational, vocational and family services. Although the contract requires the ARTC to coordinate with the providers of these other services, families have found that this does not occur. According to the contract, there must be a mechanism and a protocol to coordinate the provision of services to each consumer with other agencies to whom the County or Contractor refers the consumer, or with other agencies providing services to the consumer and/or family; and the Contractors case management protocol must include coordination with other residential and outpatient treatment providers, homeless and income support programs, and care coordination for continuity of medical and psychiatric needs of consumers as they transition back into the community. Outcome measures for all clients are tracked, recorded and readily available for review Tracking clients for at least 90 days is an evidence-based best-practice. Maintaining contact with a client in early recovery for 90 days allows the treatment provider to monitor the clients success and modify his or her treatment plan accordingly. Additionally, tax payers and policy makers are able to measure and assess the success of the program to ensure that tax-payer dollars are well spent. Families report that there is no follow up or assessment after the initial treatment and patients have no connection to a counselor to support their post treatment transition. According to the contract, the Contractor must present and implement a written client satisfaction survey as part of the overall plan for Continuous Quality Improvement (CQI)The Contractor must develop outcome measures for CQI purposes that must be linked to improved client engagement and retention, and improved customer satisfaction.A written report and summary of CQI activities is to be provided to the County every 90 days in addition to an annual summary of data and corrective actions taken and The Contractor must develop a policy on data collection activities and reporting on outcomes and The Contractor must develop and implement a planto maintain an internal quality review system that includes a customer satisfaction survey and a mechanism for addressing customer complaints, resolving grievances of consumers and The Contractor must provide an annual report to the Countywhich details achievement under this Contract of the Countys goal of providing effective treatment for individuals suffering from substance abuse and mental illness as measured by the aggregate number and percentages of consumers who: achieve the following within 90 days of discharge: a. become employed; b. pay for treatment services (from ARTC); c. are arrest free while in the next level of care; d. attend 12-step fellowship. Environment is drug-free and conducive to sobriety Patients consistently report a wide availability of illicit drugs within the facility. Obviously, a patient who needs to enter residential treatment in order to resist the temptation to use drugs and to create a sober environment simply cannot achieve this when their roommate is popping pills or shooting heroin. The community feels strongly that this problem must be resolved.