SAMHSA TCE/HIV Program

NIATx Learning Collaborative

Executive Summary

The SAMHSA TCE/HIV Program launched a NIATx Learning Collaborative in Februray 2010 as a nine-month pilot. The Government Project Officer of CSAT’s TCE/HIV program appointed 15 grantees from the 2009 cohort to participate. The goal was to help the grantees use the NIATx model to improve access to and retention in treatment. Five additional sites later joined the pilot.

The pilot was a remarkable success, given the short time available for the participating sites to use the NIATx model. All of the 17 sites that completed the pilot reported improvements such as increased admissions, increased continuation in treatment, and an increase in follow-ups.

Representative results include increases such as these:

30 to 90 % increase in clients attending next four sessions following intake, Bienvenidos-East Los Angeles
10 to 80 % increase in the number of clients agreeing to HIV testing, Urban Renewal Corporation, Newark
44 to 100% increase in clients completed intake and assessment, Community Health Awareness, Detroit

The pilot was also successful in using the NIATx model to address the challenges of specific populations: African American, Latino/Hispanic, and or other racial and ethnic communities highly affected by the twin epidemics of substance abuse and HIV/AIDS. Coaches and participating agencies regularly commented on how the NIATx model offers a concrete and pragmatic way to address complex social issues.

The pilot provided valuable lessons for NIATx, the coaches, and the participating sites. The experience and promising practices that have emerged from this pilot will help to inform future NIATx Learning Collaboratives with TCE/HIV Program grantees.

SAMHSA TCE/HIV Program

NIATx Learning Collaborative Activities

Through coaching and peer networking, participating agencies learned the fundamentals of the NIATx process improvement model and how to apply them to increase access to and retention in treatment. They learned how to focus on the customer by using the walk-through, an activity that allows change teams to view their systems through the eyes of a customer. Participants also learned how to make improvements using existing resources and the importance of using data to track and measure the effectiveness of a change.

Activities included:

February 2010 kick-off meeting following the CSAT grantee meeting. This three-hour meeting gave participants an overview of the project. It introduced the NIATx model of process improvement and shared information on how other organizations have used it to improve service delivery. The participating sites began to form their NIATx project charters.
April 12 and April 15, 2010: NIATx offered a one-hour kick off webinar on each of these dates for sites that had not been able to attend the kick-off meeting. The webinars provided a condensed version of the February introduction and training.
March–November 2010: Each site received technical assistance from an expert NIATx coach. Coaches completed one-day site visits to each site in the first half of the pilot. At these visits, coaches helped the change teams identify barriers, track improvements, and manage change cycles. Coaches also maintained regular contact with their teams through phone and e-mail.
August, June, and September: One-hour webinars on specific topics, one each month. All participants were invited to attend the webinars. The June webinar focused on access and recruitment. The August webinar centered on keeping clients in treatment.. During the September webinar, several of the sites shared their success stories.

The pilot concluded at the CSAT grantee meeting in November 2010. Sixteen of the sites shared the results of their projects by presenting storyboards during the poster exhibition. This encouraged peer networking and allowed all attendees to learn more about the NIATx pilot.

Summary findings

Sites commented on additional benefits of the pilot, such as:

Understanding the customer: One of the core activities in a NIATx change project is the walk-through—an exercise in which change team members experience their services just as their clients do. An interesting adaptation of the walk-through in this pilot was that change teams ventured outside the walls of their facilities to gain a better understanding of the barriers their clients face in attempt to get care for their medical conditions and substance abuse disorders. Many of the grantees work in urban environments plagued by poverty, gang activity, racism, and homophobia. Using the walk-through exercise allowed them to assess their intake and engagement processes from the consumers’ perspective.

“The walk-through opens your eyes to what a client goes through—invaluable!” Yale University, Clinical and Community Research New Haven, Connecticut

Rapid-cycle change: Participating sites used the NIATx model to focus on making small changes over a short period of time. Seeing positive results from a small change transformed attitudes from “This will never change” to “What can we change next?”
The importance of data: Experience with data for many of the sites had been limited to the burden of GPRA. The NIATx model taught sites how to use data in new ways. Collecting baseline data and measuring for improvement were new and exciting activities. For some of the sites, the NIATx focus on data was a major contributor to the increase in their intake and follow-up GPRA numbers.

“The change project helped Urban Renewal Corporation understand the importance of setting measured goals and measuring results.” Urban Renewal Corp., Newark, NJ

Reaching hard-to-reach or specialty populations: NIATx strategies made it easier for grantees to test creative ways to engage specific communities highly affected by substance abuse and HIV/AIDS.
Show rates improved: One agency noted that they assumed that they were doing “fine” because of the volume of clients in their waiting room each day. They were surprised to find that their show rate was only 37%. This agency’s change efforts produced an 89% show rate at project’s end. Their GIPRA admission rates also increased from about 80% to 169% at project’s end.
Teamwork improved: Most sites noted that the NIATx change projects involved more staff members. Working in change teams encouraged input and problem solving from everyone. Process improvement became a team process, rather than something required by management.

“The change team developed through NIATx mentoring has improved outreach, intakes, follow-up, retention and staff knowledge and work distribution.” Safe Haven Outreach Ministry, Washington, D.C.

Challenges of the pilot

Limited information in advance. Initially, team members at participating sites lacked information about the pilot and wondered why they had been assigned to it. Early reactions from some of the sites were mixed or negative. Coaches needed to provide extra information and support to convince them of the benefit of participating. This slowed down projects at some sites.
The short time frame. A longer project would allow sites to get to know their coaches, demonstrate more improvements, and gain an understanding of the business case for process improvement and how to sustain change—two components of the NIATx model that this pilot did not have time to address.
Limited peer networking opportunities. This pilot offered fewer teleconference calls than what is usually included in a NIATx Learning Collaborative. While this reduced the cost of the pilot, it reduced the sharing of ideas. The participating teams’ enthusiastic response to the June–September webinars and the storyboard session underscore the importance of including multiple peer networking opportunities. A collaborative with a more time that offers multiple opportunities for peer networking, via teleconference calls, webinars, and face-to-face meetings, will help to ensure success for all.

New directions

At the end of the pilot, nearly all of the sites expressed a strong appreciation for the opportunity to participate. Their successful change projects helped to transform their organizations. These sites offer great potential as peer mentors for other organizations in the next NIATx learning collaborative for TCE/HIV program grantees. These exemplary sites could also help spread lessons from the pilot as presenters at the next NIATx Summit/SAAS National Conference, to take place in Boston in July 2011. This would share information on how the NIATx model can help communities highly affected by substance abuse and HIV/AIDS and could also serve as a recruitment tool for the second NIATx Learning Collaborative for TCE/HIV program grantees.

Results by site

Site / Aim / Results
Asian Pacific AIDS Intervention Team (APAIT), Los Angeles / Increase admissions / Improved admissions from 1/month to averaging 5/month
Bienvenidos-East Los Angeles / Increase admissions
Increase continuation / Increase percentage of clients attending next four sessions following intake from 30 to 90%
Boston Medical Center / Increase admissions of African Americans / Unable to complete project due to significant staff turnover
Caare, Inc., Durham, NC / Increase continuation / Increased show rate from first call to intake from 37% to 89%
Community Health Awareness, Detroit, MI / Increase continuation / Increased percentage of clients completing intake and assessment from 44% to 100%. Shortened process from 7 hours to 2.5 hours.
Gandara Mental Health Center,
West Springfield, MA / Increase continuation (follow-ups) / Did not complete project
Gaudenzia, Norristown, PA / Increase continuation
(specific to level of care transitions) / Increased continuation from 67% to 75%
Latino Commission on AIDS, New York, NY / Increase admissions (intakes) / Increased from baseline of 7 to an average of 15 per month.
Lower Eastside Service Center,
New York, MY / Increased continuation / Continuation increased from 1 person referred for continuing care to 3
Mazzoni Center, Philadelphia, PA / Increase follow-ups, GPRA rate / Improved GPRA follow-up rate to 80%
New Horizons, Columbus, GA / Agency did not respond to coach contacts
North New Jersey AIDS Alliance,
Newark, NJ / Increase follow-ups / Increased follow-up rate from 59% to 72%
Promesa, Inc., Bronx, NY / Improve follow-ups / Increase from 62% to 82%
Safe Haven Outreach Ministry, Washington, DC / Increase follow-ups / Increased completed follow-ups from 40% to 75%
Substance Abuse Foundation, Long Beach, CA / Increase continuation / Increased number of clients continuing from IOP Week 1 to Week to from 40 to 71
The Coastal Bend AIDS Foundation, Corpus Christi, TX / Increase admissions / Increased admissions from baseline of 4.5 to 17
Test Positive Awareness Network (TPAN), Chicago / Increase admissions / Increased admissions from 70% of GPRA requirement to 83%
Urban Renewal Corporation, Newark, NJ / Increase HIV testing / Increased number of clients agreeing to HIV testing from 10% to 80%
Watts Healthcare, Los Angeles / Increase Latino admissions / Increased Latino enrollments from 4 in Year 1 to 9 in Year 2
Yale University, New Haven, CT / Increase show rate for counseling appointments / Increased show rate from 69% to 90%