The State of New York Challenges Providers: 100 Walk-throughs in 100 days

The New York State Office of Alcoholism and Substance Abuse Services (OASAS) has a vision to provide "welcoming, affordable and easy access to person-centered addiction services for all." To help make that vision become reality, OASAS launched their new 100 Walkthroughs in 100 Days Campaign on December 1, 2009.

"Our focus in the walk-through campaign is specifically on a client's initial experience with the treatment system," says Susan Brandau, Practice Improvement unit director and the OASAS assigned Change Leader for the Campaign. "That first call for help is a critical time that can determine whether or not a client continues in treatment."

OASAS has been examining access to and retention in substance abuse treatment through involvement in two process improvement projects guided by NIATx: the CSAT initiative, Strengthening Treatment Access and Retention-State Implementation, or STAR-SI (which was funded by the Robert Wood Johnson Foundation in New York and focused on New York City and Long Island), and the NIDA-funded randomized controlled trial, NIATx 200, which focused on upstate communities.

In the NIATx model of process improvement, a walk-through allows an organization to understand the customer and to discover how to make improvements that will better serve clients. In a walk-through, the CEO, senior managers or other agency staff experience the agency from the customer's perspective and experience the treatment processes just as a client does. Organizations use the information they gain from this experience to improve their treatment services—starting with the initial call for help.

"100 Walk-throughs in 100 days" is part of the state's efforts to sustain and spread the practices that contributed to improvements and removed barriers to treatment in the STAR-SI and NIATx 200 projects.

One Hundred Ideas

Anticipating the end of the implementation period for the STAR-SI and other grant-funded projects, NIATx invited all of the STAR-SI grantees to participate in the Whole Systems Change Community of Commitment (WSC) in December 2008. This project included a two-day workshop followed by six months of peer networking and NIATx coaching. From that learning collaborative, the New York team developed a plan for conducting a series of "World Cafes" throughout the state in the spring of 2009.

"In total the cafes attracted about 250 attendees, including OASAS state staff, providers, consumers and county government stakeholders," says Bonnie Cohen, former project director for the New York STAR-SI grant. "We held the cafes to find out about barriers to access as well as how to sustain and spread process improvement across the state."

The World Cafes yielded 100 ideas, which the OASAS team distilled down to 22. They then used the Nominal Group Technique, another tool that NIATx teaches, to vote and select four ideas to implement as part of a spread and sustainability plan.

The four ideas became the framework for the OASAS Communities of Solution. In addition to the 100 Walk-throughs in 100 Days initiative, OASAS is implementing:

• Peer Recovery Coach Training: to build provider capacity to use peer recovery coaches
• Medical Professional Cafes: to increase treatment referrals from the state's mainstream health care system
• Off-site services: to increase the number of sites that may be certified to offer and be reimbursed for treatment services

In designing the walk-through campaign, OASAS staff knew that they had to make it easy for providers to register and to report their experiences. Participants log onto the OASAS website to register; a link takes them to a Survey Monkey to report their walk-through results. "We remind them to keep it simple and tell us about one simple change that they made as a result of doing the walk-through," explains Bonnie.

Each organization that registers receives a note from the OASAS Commissioner, Karen M. Carpenter-Palumbo, thanking them for their participation. An added incentive for participants is that providing a walk-through report counts toward fulfilling the state-required quality improvement activities.

New York providers that have already been involved in STAR-SI or NIATx200 are champions for the effort and have agreed to function as advisers to their peers, but the OASAS team is pleased to report that only six of the approximately 60 organizations registered (as of early January 2010) have NIATx experience.

OASAS staff will also follow up with each organization to gather information on their experience. "We don't view this as only a walk-through campaign," comments Susan. "This gives us a way to expose more providers to other NIATx tools and data-driven thinking."

The "100 Walk-throughs in 100 Days" targets outpatient programs and state administered addiction treatment centers, but the OASAS team has plans to extend the project to residential treatment programs in the future.

"This project represents a great opportunity for the entire state," says Bonnie. "If we all do this across the state—what a great lift for our service delivery system."

For more information the OASAS 100 Walk-throughs in 100 Days Campaign, visit:www.oasas.state.ny.us/hps/cos/WSCwalkthrough.cfm.

The New York State Office of Alcoholism and Substance Abuse Services (OASAS): OASAS oversees one of the nation's largest addiction services systems dedicated to prevention, treatment and recovery, with more than 1,550 programs serving over 110,000 New Yorkers on any given day. Through efforts such as the Your Story Matters campaign at www.iamrecovery.com, the agency hopes to foster a movement of recovery, one that sheds the stigma and promotes a life of health and wellness. For more information, please visitwww.oasas.state.ny.us.