NIATx tools improve access and efficiency at Maine’s Addiction Resource Center

Using NIATx tools and promising practices for the past decade has helped the Mid Coast Hospital’s Addiction Resource Center (ARC) in Brunswick, Maine, reduce overdose deaths, treat more clients, and increase efficiency overall, says Eric Haram, director of outpatient behavioral health.

ARC was featured in a recent news article in the Portland Press Herald, Bath-Brunswick addiction program seen as possible model. The article notes that there were very few drug overdose deaths in 2015 in the counties ARC serves, ”at the same time that overdoses were soaring through the rest of the state.”

The article also notes a “workflow system designed by University of Wisconsin industrial engineers” —a.k.a., NIATx—as an essential ingredient in ARC’s success.

Haram attributes the drop in overdose deaths, in part, to his agency’s focus on the original NIATx aims.  ARC relies on open access to reduce waiting time between first request for service and first treatment session.  For example, at ARC, the average wait time for patients seeking medication-assisted treatment for opioid addiction is two to three days.

Making NIATx part of the culture

ARC first began to use the NIATx approach in 2005 as a participant in the Strengthening Treatment Access and Retention-State Implementation project.  Haram says that ARC’s first change projects and the resulting improvements—wait times decreased by 77 %, and volume in the intensive outpatient program increased by 137% over baseline—helped to make NIATx part of the agency’s organizational culture.

The NIATx walk-through is used regularly at ARC, and Haram has made it an annual competency for ARC staff at all levels of the organization.  “Everyone is required to know how to lead a change team.” he says.

Change projects target improving access as well as business practices. Haram recalls one change project to improve co-pay collections, conducted by an administrative support team in 2011. After four or five PDSA cycles, the change team adopted a change that improved co-pay collections from $13,000 to 127,000 annually—based on co-pays as small as $3.00 per person.

“One person is assigned to make a one-minute announcement about co-pays at the beginning of group sessions each day,” explains Haram. “The staff person talks about the co-pay as a reflection of a patient’s investment in growth and recovery, and then informs the group when and where they can make the payment. To make it easy, the staff person is available just outside the door and ready to collect the co-pay at the end of the session.” 

This change has been sustained for the past five years.

A current ARC change team is working on creating a tool to teach friends and family members how to administer naloxone (Narcan), the medication used to reverse the effects of opioid overdose.  “The team is using the NIATx tools to identify the barriers and legal issues,” says Haram.

Building a medication-assisted treatment program

The NIATx model also helped ARC implement its medication-assisted treatment (MAT) program in 2007.

One of the first challenges was to overcome the stigma associated with MAT. There was a strong bias against MAT from the institution (Mid Coast Hospital) as well as from doctors and the counseling staff.

Says Haram, “The hospital was concerned about that we’d be treating more patients without generating revenue. Doctors were already overextended and didn’t think they could handle more patients.  Many counselors viewed MAT as replacing one drug for another. “ 

Education and training helped to change attitudes among staff who were firmly rooted in the abstinence-only approach to treatment and recovery.  The NIATx focus on data that showed the effectiveness of MAT compared to abstinence-based treatment also helped to change the hospital’s attitude about MAT.  For example:

·       Before MAT implementation, 25% of ARC’s clients with opioid addiction made it to their first treatment session. Following implementation of buprenorphine treatment, this number grew to 80%. 

·       After one year of MAT implementation, ARC used the Behavior and Symptom Identification Scale (BASIS-24 ®) results to demonstrate the improvement in client outcomes

“And in 2013, ARC’s BASIS-24 scores were double the national average,” says Haram.

ARC’s MAT program has grown exponentially since 2007, with the annual budget expanding from $700,000 to $1.7 million in 2015. The buprenorphine program that originally employed just one half-time physician now operates with a team of six-full time physician prescribers.

While enlisting physicians to prescribe buprenorphine remains a challenge across the country, Haram says physicians who take on the work find it very fulfilling.  At ARC, they’ve also become advocates for MAT.

“We require them to tell their stories to other doctors,” says Haram. “By getting the word out about the rewards of helping people with opioid addiction reclaim their lives, they’re helping to convince other doctors to pursue the buprenorphine certification.”

Haram says that adding NIATx to ARC more than 10 years ago helped the agency meet the growing need for effective treatment stemming from the opioid epidemic.

“Working at ARC means staff are connected to program development,” says Haram.   “We need our employees to help guide our continued improvement.  This makes ARC a dynamic and fun place to work, grow, and continually improve.”

Related resources:

NIATx Promising Practices:

Reduce Waiting Time to Assessment

Reduce Waiting Time to Treatment

Getting Started with Medication Assisted Treatment