Florida Learning System extends lessons learned in NIATx initiatives

As a grantee for two NIATx initiatives, the state of Florida became a laboratory for rapid-cycle process improvement. Florida participated in the CSAT-funded Strengthening Treatment Access and Retention-State Implementation (STAR-SI) and the Robert Wood Johnson Foundation-funded Advancing Recovery: State and Provider Partnerships for Quality Addiction Care (2006–2010). Both initiatives applied NIATx techniques to achieve project goals.

Stephenie Colston, Program Director and the Single State Authority, leads the state’s Substance Abuse Program Office (SAPO), located within the Department of Children and Families (DCF). Ms. Colston is responsible for the management of the substance abuse system. She developed the Florida Learning System to support the state agencies and providers involved in the NIATx initiatives.

“The goal was to create a statewide learning community focused on continuous process improvement,” explains Sheila Barbee, director Performance Improvement and Planning for DC F. “While funding for AR and STAR-SI has ended, DCF has adopted the NIATx approach as its change model.”

Over the course of the two NIATx initiatives, the Florida Learning System built a training infrastructure that is helping Colston and Barbee extend process improvement across the state. Today, NIATx coaches, peer mentors, and change teams are active in five areas of the state. The state now supports five experienced NIATx coaches: Angie Maldonado, Rick Hankey, Kevin Lewis, Larry Allen, along with Barbee, in addition to 15 peer mentors, with plans to train more.

“We’re happy to say that we’ve been able to sustain a lot of what we achieved with STAR-SI and AR,” says Barbee.

A recent statewide improvement project launched in March 2010 focused on training Family Intervention Specialists (FIS) to improve access to and retention in services adults who are involved in the child welfare system.

Adds Barbee, “This project involves multiple agencies. Treatment providers, child welfare, the courts, and community stakeholders all need to be on board.” As she explains, clients in the child welfare can be hard to engage, and failure to get an assessment and referral to treatment could result in the removal of children from the home.

The first phase of the project targeted the northeast, northwest, and central regions of the state. SAPO invited provider agencies and other local stakeholders from these areas were to join the project as collaborative partners. Agencies that volunteered for the project received initial training via webinar, followed by a one-day learning session and ongoing technical assistance from the Florida coaches and peer mentors.

In the first months of the project the FIS change teams made significant improvements. These included reducing the paperwork clients need to complete for assessment and referral and reducing no-shows to scheduled appointments.

Adds Barbee, “The treatment agencies are pleased with the increase in revenue resulting from reduced no-shows. The local community child welfare agencies, the court system and the parents are all expressing greater satisfaction with the system.”

The FIS initiative accompanies a broader state initiative to increase the use of evidence-based practices. “We’re using rapid-cycle change projects to measure the fidelity of EPB implementation,” says Barbee. “Providers self-assess using the fidelity tool that we developed. This helps us meet our independent peer review process for the block grant.”

Treatment providers piloted the EBP fidelity tool, an assessment they can take using an online survey. Any of the state’s 150 contracted substance abuse treatment agencies can request that a NIATx coach and peer mentor visit the agency to validate the results of the survey.

“Depending on their findings, we may recommend additional training on a particular EBP, or assistance from a coach with expertise in that area,” says Barbee. The state is using this approach for prevention and treatment EBPs: Cognitive behavioral therapy, motivational interviewing, motivational enhancement, Seeking Safety, Project Success, and Too Good for Drugs.

Looking back on the evolution of the Florida Learning System, Barbee comments, “In STAR-SI and AR we developed relationships with providers across the state. Now, we are working with coalitions or community-based groups.”

The NIATx model allows the Florida Learning System to prioritize and rollout strategies in a manageable way. “We’re looking at using this approach to help our providers implement electronic health records and build their capacity to collect and analyze data.”

In the months ahead, the Florida Learning System will continue to offer training in the NIATx model across the state, with two regional meetings and a state learning session scheduled.

With the recent merger of the state’s substance abuse and mental health agencies, Barbee sees great opportunity for expanding the NIATx model into mental health.