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Resource Center > System-Level Toolkit > System-Level Change Projects > Systems and Level of Care Transitions

Systems and Level of Care Transitions

Transitions are precarious times for people in need of substance abuse treatment. Whether we are talking about moving between levels of care or from some other system like child welfare or the criminal justice system, the process of transfer or hand-off provides many opportunities for mistakes and confusion that lead to clients not making the transition. While many of these processes can be improved at the provider level, there are also opportunities for those who have a system view to make improvements to ensure that effective transitions happen.

One of the most common drop-out points is when people leave detoxification. According to TEDS data, for example, only 12 percent of people discharged from detoxification services were referred to further treatment. Since detoxification alone has the same effect as no service at all, nearly all of the money currently spent on detoxification is wasted. How can systems managers improve this transition? Payers who manage care can organize processes to follow up with providers and with clients. Systems can be instituted at the payer/claims management level to ensure that the client makes it to the next level of care. The system manager can play the role of care manager and ensure successful transitions occur.

Systems managers can also use the role of convener to address transitions. A state or county system manager could convene multi-provider change groups to create Change Projects to improve transitions between providers. Systems managers also often have the power to convene multi-system groups to work on transitions between service systems (e.g., child welfare, criminal justice, or mental health systems). These groups can act as a cross-system Change Team and use the NIATx model of process improvement to solve systems issues. In this role, the systems manager could bring in technical assistance to aid the process and teach other systems how to make change happen.

Cross-system Change Teams may identify policy changes that need to be made to allow the provider-level changes to occur. These changes might be concerned with licensing regulation, contractual agreements, data collection requirements, or with communication structures or requirements. Systems managers may need to waive or change regulations to improve transitions. Finally, systems managers can provide incentives to ensure hand-offs are made.

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