KENTUCKYS SUBSTANCE ABUSE TREATMENT OUTCOME STUDY KTOS 19922009

1
KENTUCKYS SUBSTANCE ABUSE TREATMENT OUTCOME
STUDY(KTOS) 1992-2009

• NASADAD ANNUAL MEETING
• Syracuse, New York
• June, 2009

2
HOW IT BEGAN

• Kentucky General Assembly enacted legislation in
  1992 to require all treatment programs to collect
  baseline, discharge and 12-month follow-up data
  on clients to examine the effect of treatment
• Applied to all programs receiving state and
  federal funding for SA tx. services

3
THE ROLLOUT

• Regulations promulgated in 1993 that levied the
  requirement on programs gave power to the SSA to
  impose penalties on programs for non-compliance
• The legislation did NOT allocate funds to
  implement data collection or offset costs to
  agencies or the SSA office

4
THE PROGRESSION

• STAGE ONE
• KTOS was implemented as a volunteer study
  (despite the legislative mandate) from 1992-1996
• The SSA contracted with UK-CDAR to manage the
  data and prepare reports for the legislative and
  executive branches

5
THE PROGRESSION

• STATE ONE (contd)
• Programs were allowed to select convenience
  samples for baseline, discharge data, and
  12-month follow-up interviews
• The results were dismal!! Very few cases, even
  fewer follow-ups

6
THE PROGRESSION

• STAGE TWO
• In 1996, the SSA increased funding for KTOS and
  the study became mandatory
• UK CDAR obtained IRB approval
• UK did analysis for change from baseline to
  follow-up

7
THE PROGRESSION

• STAGE THREE
• A new PI converted to a PC-based data collection
  by community clinicians
• Annual reports on follow-up were prepared on
  outcomes from 19972003
• Contact info was poor and follow up rates ranged
  from 31 -39
• Posed major limitations to generalizing findings

8
THE PROGRESSION

• STAGE THREE (contd)
• Reports became more elaborate with more
  sophisticated analysis
• Instrument modified to incorporate CSAT GPRA with
  12-month variations of GPRA past 30-day measures
• In late 2002, the programmer was experimenting
  with newly-marketed PDAs and suggested using this
  for KTOS

9
THE PROGRESSION

• STAGE FOUR 2004-2009
• Baseline data are collected on PDAs and
  synchronized to UK CDAR
• Follow-ups are done by UK CDAR
• Follow-up data are matched to service event data
  to examine relationships between services and
  outcomes
• Follow-up rates increase to 70

10
THE PROGRESSION

• The information provided by the data and cost
  offset of the KTOS has led to the utilization of
  like studies in multiple areas across our cabinet
  and others in state government. When treatment
  effectiveness is linked with cost avoidance or
  cost savings, the value of our programs increases
  exponentially.

11
THE PROGRESSION

• AKTOS developed and rolled out late 2004
  early 2005
• KORTOS outcome study for opiate replacement
  treatment programs 2006
• 2007 Variant of KTOS developed for cases
  referred by the child protective services agency

12
THE PROGRESSION

• Now have 6 major treatment or service outcome
  studies that use baseline-to-6 month or 12 month
  follow-ups.
• KTOS adults SA
• AKTOS adolescents
• KORTOS opiate treatment
• DCBS KTOS child protective services parent
  cases
• KIDS NOW PLUS Pregnant women with SA
• IMPACT a case management program for youth

13
NEXT STEPS

• With advances in encryption, a web-based system
  is planned for release in July 2010
• Web version will include currently available web
  information for administrators on data collection
  status for each regional provider, site, and user
  for monitoring purposes

14
WHY A 12-MONTH FOLLOW-UP

• Due to the nature of a chronic, persistent
  disease
• The unpredictability of treatment continuation
• A 12-month follow-up, although limited, conveys
  the more lasting effects of treatment exposure

15
IMPACT/COST OFFSET

• KTOS examines treatment costs (direct, per
  service, per client) and the costs of crime in
  the 12 months prior to intake
• At follow-up we examine the costs of crime in the
  12 months post baseline, increased employment,
  and the state taxes that would have been paid on
  that employment to examine net benefit to society

16
IMPACT/COST OFFSET

• We express the avoided costs as for every dollar
  spent on treatment, there is a 5.00 saving.
• This formula has become ritualized among the
  legislators and has been used to help launch new
  recovery and corrections based programs in
  Kentucky

17
IMPACT OF COST OFFSET

• Supported the establishment of Recovery Kentucky
  project due to Executive Branch belief in the
  cost avoidance provided by the provision of SA
  treatment services and the belief that
  intervention in the lives of substance abusers
  works to reduce the financial burden created by
  substance abuse

18
IMPACT OF COST OFFSET

• Development and utilization by the Cabinet for
  Justice and Public Safety of the Criminal Justice
  KTOS (CJKTOS) to provide cost offset information
  related to the effectiveness of expanded SA
  services within the prisons and jails of the
  Kentucky Department of Corrections

19
UTILIZATION OF DATA

• The KTOS report is provided to the Legislative
  Research Commission each year when it is
  published and is utilized to provide information
  on the effectiveness of our programs and the
  costs avoided by providing treatment to persons
  with Substance Use disorders for the General
  Assembly

20
UTILIZATION OF DATA

• Other uses
• Department management
• Other agencies and organizations
• CMHCs local use
• Provide supportive data for grant applications
• Classroom use by University students
• Other states

21
THE FUTURE

• The 12-month follow-up provided by the KTOS has
  proven more effective for us in defining the long
  term impact and the costs avoided by the
  provision of treatment than have our discharge
  measures and The Kentucky Department of Mental
  Health, Developmental Disabilities, and Addiction
  Services will continue to use these outcome
  studies to both justify current funding and to
  support efforts to seek increased funding.