Hatching Creativity: Conversations on Success, Innovation, and Growth
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Hatching Creativity: Conversations on Success, Innovation, and Growth
Collecting & using data in Behavioral Health with Dr. Annie Peters
Can addiction be treated like chronic illnesses such as heart disease or diabetes? Join us on Hatching Creativity as we sit down with Dr. Annie Peters, a leading expert in behavioral health care and the Director of Research and Education at the National Association of Addiction Treatment Providers (NAATP). Dr. Peters takes us through her fascinating career, from her impactful clinical work at renowned institutions like Hazelden Betty Ford and Harmony Foundation, to her innovative endeavors with FORCE (Foundation for Recovery, Science, and Education). FORCE is setting new standards in addiction treatment by supporting providers in measuring and improving treatment outcomes through meticulous data collection. Dr. Peters shares key insights from their groundbreaking first report, released in June 2023, which included contributions from 55 treatment providers and detailed plans for future expansions.
Understanding addiction as a chronic illness requires more than treating symptoms; it necessitates a holistic approach to improving health and behaviors over time. Dr. Peters discusses the hurdles in measuring treatment outcomes, emphasizing the subjective nature of success and the critical role of understanding procedural nuances. We also explore how staff satisfaction and client feedback are indispensable tools for enhancing treatment quality. Through tools like staff surveys and net promoter scores, Dr. Peters explains how actively involving staff in data analysis can reflect patient progress, fostering a more engaged and effective treatment environment. Tune in for an enlightening conversation that places transparency, accountability, and innovation at the forefront of addiction treatment.
Welcome to Hatching Creativity. This isn't just another behavioral health podcast. This is the place where thought leaders converge to talk about real-life challenges, breakthroughs and pivotal aha moments. Hey everybody, I'm really excited for today's guest, dr Annie Peters with NATAP, or NAATP as some call it. Annie Peters with NATAP, or N-double-A-T-P as some call it. Annie is a behavioral health care expert. She's been in this field for a long time, working with her current project, now FORCE. And, annie, I'd love if you can talk a little bit just about yourself and your background and tell us about FORCE and what you're doing with FORCE.
Speaker 2:I can Great Well, thanks, mike. Thanks for having me. This is fun always to just chat about things of interest in the field and what we're doing and collaborations. So currently I am the Director of Research and Education at NATAP, or the National Association of Addiction Treatment Providers. I've been in this role for three years now.
Speaker 2:I'm a clinical psychologist and so most of my career was in clinical work. So I started in 2006 at Hazel and Betty Ford and worked there for about nine years. Eight years I mostly did you know co-occurring disorders, support of patients in both long-term outpatient settings and, of course, in patient and residential treatment at Hazelden and Betty Ford. And then I transitioned into their graduate school and was an assistant professor in their graduate school, helping people as they became addiction counselors. So that was a really fun component of my career. Then I moved to a treatment center in Colorado Harmony Foundation and was chief clinical officer there for six years and then I joined the staff at NAATP.
Speaker 2:Etap had been talking for years. I was actually on the board when I was working at Harmony. For a couple of years I was on the board of NAATP and we were talking all the time about measurement outcomes. How do we do this in addiction treatment? What is a positive outcome? How do you measure it? How do you use that measurement to get paid, to help, obviously, help your patients to improve your practice, you know, etc. Etc.
Speaker 2:And so NWATP did a pilot study on treatment outcomes, published in that 2019. And after that they said you know, we really need to do this bigger scale and help treatment providers to do this work. So they brought me on board and we established the NWATP Foundation, which is the Foundation for Recovery, science and Education, which is what FORCE is, and so FORCE is the. It's a part of NWATP, but it's also a standalone 501c3 nonprofit. Essentially, the work we do is supporting addiction treatment providers and recovery support providers in measuring their outcomes, helping them initiate measurement.
Speaker 2:If they're not doing it, improve measurement. And then we collect data. So all fully de-identified data, so no patient identifying information, and we have a lot of data that we use to provide insights back to the provider, back to the public. It's a really cool project because it doesn't really have its counterpart in the rest of health care, where a group of providers came together to say, hey, we want to be accountable for the work we're doing. We want to show the work we're doing, we want to demonstrate this. So we want to put our outcomes out front and center and say how well are we serving people? And so it's pretty neat that it's a nonprofit that's supporting providers in being transparent about the care they provide. So I've been very excited to be part of it.
Speaker 1:I got a lot of questions about force, because I've had a chance to look a little bit through the report that came out last year. So in 2023, that was the first force report that came out correct. What month did you put that? That was like June or something, yeah, June.
Speaker 1:So it came out this year, and it's great because obviously, longitudinally over many years, you're going to have a lot more that you can do with the data. Right, this was just the first year. I'm curious, though, after looking at all the data that you collected from just the first year first, how many providers are giving you information and submitting this data to you?
Speaker 2:So at the time of the report, we were summarizing data across 55 treatment providers across the country. We now have 100 provider participants across the US and we have one international site. So that's exciting to have international data. So that's now. Right now, I would say about 80% of them are actively submitting data. They rely on typically on their EMR company to de-identify the data and push it to us. Some do it internally, but some are not submitting data yet because they haven't quite connected in the way that they're able to submit data. So but now we have about I'd have to look at the exact numbers but about 80 or so different locations pushing data actively.
Speaker 1:When they submit information? What surveys are they using? What outcomes measurement tools are they using to submit this to you?
Speaker 2:When we chose what we wanted to collect, we tried to be as simple as possible. We wanted to say keep it simple, let's start with what you're already collecting and common data points and indicators and things that people are already using, and we knew that we didn't just want a bunch of outcome surveys. We obviously have to know a little bit about the people being served and a little bit about the service being provided. So that's kind of the three buckets of data. We have Data about the patient, data about the treatment and data about the outcome. So before I get to the outcome surveys, the patient and treatment or service data. For patients, we have basic demographics and social determinants of health, so age, race, ethnicity, gender. We're adding sexual orientation. We have things like employment status, housing status, things like that. And then also about the patient, the primary substance use diagnostic category. We have mental health diagnostic category if they have a co-occurring mental health issue.
Speaker 2:And then about the service, we want to know what level of care, of course. Is it outpatient, residential detox, recovery support, how many, you know? What's the length of engagement, how long are they staying in that service? And then things like their discharge type, you know. Are they completing treatment? Are they AMA? Is there another type of discharge? What medications are they receiving, particularly for substance use disorders? Those are the basics. So it's not very many data points about the person and the treatment, but if you think about it, if we knew all those things about every person being treated by 100 organizations, yeah, that's a lot of data and so then we said OK so those are kind of our independent variables, right, the things we really want to look at.
Speaker 2:how do outcomes relate to? You know, are there differential outcomes for different racial and ethnic groups, different gender groups, different levels of care, different lengths of engagement, things like that? Different medications, different substances. So what do I mean by outcomes? That's the third bucket. I wish I had the answer to the best outcome measure in substance use disorder research, and I don't, because if you asked, I think you know 20 researchers or 20 providers or we would have a list of about at least 20 different answers.
Speaker 1:So that's one of the things we come across all the time right. Is. Everybody has their own way that they think is the best way to do it. Yeah, that's actually one of the things that I wanted to hop into with you, and I don't mean to cut you off there, I was just, you know, one of the things that I wanted to hop into with you, and I don't mean to cut you off there.
Speaker 2:No, please.
Speaker 1:One of the things that I was really curious about is that, because so many treatment providers feel like their method of collecting data or the data points that they're looking at is the best Right, how do you actually decide what is good outcome and I think that's also part of the big challenge that we're facing industry wide right now is what's good? I mean, you can compare to yourself potentially, but you know where. Where do we go with that?
Speaker 2:Totally Well, if you think of the, you know I mean ultimately we're kind of talking about value-based care. You know how do you determine what the value is of treatment, what the quality is, what the outcome is? And it depends who you're talking about. Who values what so society or a family? Let's take a family, for example. Who values what so society or a family? Let's take a family, for example.
Speaker 2:I have had many family members who went to treatment or needed treatment and didn't go to treatment, and of course, I have ideas about what I wanted to happen for them, and mainly it was to reduce or stop using the substance that was causing them the problem have good quality of life, be less depressed, have more self-esteem, have more hope, be able to engage with me better or my family better, be able to have a job that was fulfilling to them or a life that was fulfilling those kinds of things. So that's what I would want to measure. As a family member or a person in recovery. I am a person in long-term recovery, so for me, I wanted to stop using. I was mainly alcohol, so I wanted to stop using alcohol and I wanted to get my, get a life back that was worth living and so all of those things kind of hard, you know, hard to measure.
Speaker 2:And then you look at providers. What do providers want? Similar things, you know they want to know. It depends If they're sort of a more abstinence-based treatment program, they want you, you know, to not quote relapse. You know they don't want you to have a recurrence of symptoms. If they're more harm reduction approach, then they want you to see your use reduced, the harm to your body and your health reduced. And again, you know, quality of life and fewer depression and anxiety and mental health symptoms.
Speaker 2:Payers if you ask them what's valuable addiction treatment, the outcomes they want to see are reduced healthcare claims, right, they don't want you to be going to the ER all the time or detoxes. Or you know they want you to be physically healthy and able to function. It really depends who you ask. You know, a lot of times payers will want to know are they readmitting to treatment all the time? And for a provider that's not. You know readmitting to treatment isn't necessarily a bad thing. You know they might. It might be a good thing because they're ready for help again.
Speaker 2:So that's why with addiction it's so. It affects, you know, I always say every system in the body and every piece of life. You know it affects spirit, mind, body. So it's so hard to measure what a good outcome of treatment is and I think we also still have the mindset of the quick fix that you know you go to treatment for 30 days or something and you're fixed and you never need treatment again. You've stopped using completely functioning well. And that's not the case. It's a chronic illness. We have to look at it like every other chronic illnesses heart disease, diabetes that the person's life is improving, their health is improving, their behaviors are becoming more healthy, their bodies are becoming more healthy and with addiction it's hard to measure all of that and we also don't want to burden the patient with too much measurement.
Speaker 2:We want to ask it'd be nice if we had five questions to ask, or we had a blood pressure cuff that told you how well the person was doing with their substance use disorder. We don't have something that simple, so that's why we're all struggling with how do you measure outcomes?
Speaker 1:Well, the thing too is, you know outcomes is subjective, based on who's looking at it, right, like you just said, I have these conversations with organizations all the time because if you were to go to a conference, right, and I'm in conferences, like three times a month or so, and you talk to people what's the most important thing? And you hear outcomes you know you're hearing outcomes from pretty much everybody and you know from an organization that focuses on compliance, like our company, right, I think it's really important for people to kind of understand that the outcome is the answer that you're looking for, right, but understanding the procedures that it takes to get to those outcomes is so important. And because, like you said, you can't ask all of these questions to the clients all the time. But there's a lot of things that can be done along the way, procedurally. For example, staff satisfaction surveys, looking at turnover of your staff and how you're treating your staff, how that relates to your outcomes it's a huge impact, right. Or staff satisfaction surveys, nps scores you know your net promoter score is so huge because you can compare, like, what does a client feel about the treatment center that they and their experience at that treatment center and how does that relate to the outcome? Right, and it's.
Speaker 1:It's a really hard thing to get across because there are still a lot of hurdles to people efficiently collecting that information. Um, and I think that's one of the things that we're trying to get across, you know, as a compliance organization, is it doesn't have to be a pain in the ass to collect this information. If we don't actively show the people that we're asking to help us with this what we're doing with the information that they're giving us, it becomes a waste of time for people and that's really where compliance has sat for so long is people are like yeah, I'll do all of this, but you're not going to be able to use the information for anything. It's just too much of a hassle, you know, which is, you know, a big part of what we do.
Speaker 2:Yeah, it's kind of like we're talking about you know how do you demonstrate value? Big picture, what's value based service? We were talking about you know how do you demonstrate value? Big picture, what's value-based service? But then now we're getting just more granular, measurement-based practice, not just clinical practice. So there's measurement-based care and clinical practice, meaning that I take, I get your information and I reflect it back to you and I say look, here's what. Either you know whether it's they're using a wearable and it's you know your sleep and your heart rate variability data over time, or we're doing patient reported outcomes and we're looking at your depression scale screens over time, craving screens over time. I have to reflect it back to the patient for it to be useful to say here's what we've been doing and here's what you're reporting back. So what do we need to change about what we're doing so we can serve you better?
Speaker 2:And then, what you're also talking about is measurement-based practice in the sense of the provider. So are we measuring our staff satisfaction, our patient satisfaction, our safety indicators, our medication errors, our incidents? You know critical incidents. You know we usually have to if we're licensed or accredited. Are we looking at that stuff internally with our staff and saying, oh look, we have a disparity in our African American patients. You know they're leaving treatment AMA at a much higher rate, or you know their satisfaction scores in treatment are much less.
Speaker 2:If we're not looking at that stuff as a staff and then the staff you know, the clinicians or the techs you know can say, I think I might know part of why this is happening, that the team comes together and says what are we doing that we could do better to improve? That's an outcome you know is completing treatment, who's being well served by treatment you know satisfied with treatment and who isn't? Again, that reflection back in that analysis of the data. It's one thing to collect it all, but then to really get in there and make meaning of it and make change because of it, make process improvement because of our data, that's another thing.
Speaker 1:For sure. I also find from my experience with this that when you share it with the staff and you start reviewing the data with the staff, they feel very empowered. They're like, oh, wow, this all makes sense, this lines up with this, this lines up with this. And now I see how this all impacts this. You know and we talk all the time and I think you and I had a conversation about this last time about turnover and keeping staff on right. Staffing shortage is huge right now.
Speaker 1:So being able to do something that helps your outcomes, it helps your business efficiency and it keeps people engaged, it keeps your staff like excited to be there.
Speaker 1:Cause, man, when you look at I'm not telling you anything, you don't know when you look at actual evidence that something exists.
Speaker 1:The other thing with that, with the evidence that I come across and I have to imagine you're seeing this too it's like you walk around a conference, right, and you can go to a booth of ABC Treatment Center and there's three people at the booth that work there and you ask them about their center and they say, oh, we're an evidence based practice and we're this and we're that.
Speaker 1:And then you know they pass you a brochure worth this and worth that. And then you know they pass you a brochure and you say, oh good, what evidence are you looking at? And they'll rattle off a couple of different things and you say, well, when and how often are you collecting this and when are you reviewing it? What are you reviewing it? What are you using it to review with or who are you reviewing with? And you'll get a set of answers. Or you get the deer in the headlights look usually one or the other right, and you can go back like an hour later and talk to somebody else at that same booth who will give you a whole different set of answers.
Speaker 2:Right, you'll think it's a different center. Yeah.
Speaker 1:And it's really hard because what I guess the point I'm getting at with it is that it's it's something that and good outcomes need to be pushed by leadership, and it all has to start at the top of the organization and really be working its way down consistently. As we have more tools to collect data, I think that there will be more use of it and people are respecting it more now for sure.
Speaker 2:Yeah, we all know we need to look at outcomes. We need to come to some kind of consensus on what that means and measure together, like you said, not just one treatment center, measuring what they think is important and then not comparing that to other treatment centers. You know if you're not making the same things as other treatment centers, then how do you compare A big part of with force? We want to provide that opportunity for people to look at their outcomes by some type of definition.
Speaker 1:I really appreciate you coming on and I'm looking forward to the next conversation. Can you tell people how they can get in touch with you, how they can get involved with FORCE and this way they can reach out?
Speaker 2:Sure, so you can check out our website, naatporg slash foundation. You can email us at outcomes at NAATPorg. Right now we're just trying to help providers measure and use their data for good, so Annie, thank you very much.
Speaker 1:I really appreciate it. Yeah, Thank you, Mike. Thanks for tuning into Hatching Creativity. We appreciate your support. Please don't forget to like and subscribe and tell all your friends about the show and remember it's never just about one thing.
