ACTION Campaign Inspires Improved Access to Treatment in Rhode Island

Phoenix Houses of New England is a division of Phoenix House, the largest substance abuse treatment and prevention provider in the country. Nearly 2,500 adults and teenagers receive treatment each day through the 40 programs Phoenix Houses of New England operates in Massachusetts, Maine, New Hampshire, Vermont, Rhode Island, and Connecticut. Programming throughout the region includes residential and outpatient treatment, detoxification, crisis intervention beds, sober living houses, prisoner intervention programs, juvenile drug courts, drinking driver intervention, and Job Corps treatment services.

As Senior Vice President and Regional Director of Phoenix Houses of New England and Florida, Patrick B. McEneaney is committed to improving access to the entire continuum of care for all who struggle with addiction.

In Rhode Island, Phoenix Houses of New England operates three outpatient treatment programs and two residential treatment programs, one for adults and one for adolescents, along with a medical detoxification site.

Alcohol remains the most widely abused substance among adults and adolescents in Rhode Island, followed by marijuana (among adolescents). Opiate use in the form of prescription painkillers is on the rise among adults.

McEneaney recalls a "What if?" conversation he had with Neil Corkery, director of the Drug and Alcohol Treatment Association of Rhode Island, after attending Kim Johnson's and Nancy Paull's (SSTAR) overview of the ACTION Campaign at the 2008 National Council on Community Behavioral Health Conference. The ACTION Campaign promotes the use of NIATx process improvement to reduce waiting times, improve client engagement, and create seamless transitions between levels of care. McEneany and his team have used the NIATx process improvement approach to maximize the capacity and effectiveness of each Phoenix Houses of New England site.

"One of the key aims of the NIATx model is to reduce waiting times," says McEneaney, "and there are people desperately waiting for help for substance abuse issues but totally without access to care. Neil and I were lamenting Rhode Island's ranking as one of the worst states in terms of access to drug and alcohol treatment. The thought of applying the principle to the entire Rhode Island community was irresistible."

Wouldn't it be great, they thought, if anyone in Rhode Island in need of substance abuse or mental health treatment could get access to treatment within 24 hours of calling? That's when they started to consider the possibility offered by United Way 2-1-1 of Rhode Island, a statewide information and referral service.

McEneany contacted United Way 2-1-1 of Rhode Island and found a willing partner in this innovative approach to linking clients to treatment. "We were also relieved to know that all the 2-1-1 phone operators are certified intervention specialists—we were looking at a very professional service," says McEneaney.

To assure that the system could also help someone who needed a mental health intervention as quickly as it could a substance abuse client, McEneany met with Margaret Holland McDuff of the Family Service of Rhode Island. This organization had an established working relationship with United Way 2-1-1 of Rhode Island and was ready to help address the needs of mental health clients.

The next step was to determine how to accommodate the need. "With five sites in Rhode Island, each Phoenix Houses of New England site was assigned to take United Way 2-1-1-of Rhode Island referrals and provide immediate assessments one day a week," explains McEneaney. "Then we started to look for other agencies throughout the state to partner with in this effort."

The program, named Rapid Response Rhode Island, was launched on a trial basis in December 2008.

McEneaney reports an increase in calls and an increase in admissions, "but we've handled it well. The United Way 2-1-1 Rhode Island responders let us know who to expect on a given morning, or which clients will appear based on referral from another site. It has been very orderly."

The 2-1-1 call does not guarantee that someone will appear for the appointment the following day. "The person calling may not be the person in need of care—it might be a parent or spouse," explains McEneaney.

A more important result of the new 2-1-1 service, says McEneaney, is that "a person can own the process by virtue of showing up. We see people feeling like they have control—they make the call, then they can go somewhere to get help, not only to Phoenix House but to any other provider that is participating."

Adds McEneany, "The NIATx approach is dramatic for a number of reasons—what better initiative can you have for access to care? Process management and seeing systems through the customer's eyes make us better at what we do. We are part of a science that is very hard to validate on a day-to-day-basis, and the focus on data elevates our core mission—as we go about improving our organizations."

While other states and regions have tried rapid-response systems for drug-addiction treatment, Rhode Island is unique in its use of the existing United Way 2-1-1 service. "We believe that we have created a model that other states can adopt," concludes McEneaney.