Minn. Treatment Center Ratchets up Process of Analyzing Outcomes

Staff members at Wayside House, a women’s addiction
treatment organization in the Minneapolis area, often
have found themselves taking pride in doing things
differently from other centers. It can be good to be an
“outlier” if you believe you have a better mousetrap, but
the center’s executive director emphasizes that it’s also
important to know why you’re an outlier and if that status
actually is deriving benefits for your clients.

This is why in the past couple of years Wayside House
has moved toward a more sophisticated analysis of
processes and outcomes in the organization. It is now
more active in comparing its numbers to those seen at
similarly sized facilities, to get a better sense of the areas
where it might need to improve.

“We report some outcomes to the state, but that data
didn’t help us move our services,” Wayside House executive
director Ellie Skelton told ADAW. “We often
wondered, ‘Is this a favorable outcome vs. that of our
peers?’”

Over the past two years, Wayside House has become
involved in a formalized benchmarking initiative in
partnership with nationally known behavioral health
benchmarking consultant Behavioral Pathway Systems.
One other treatment facility in the region is working
with Behavioral Pathway Systems as well, but Skelton
has urged other centers in the area to look beyond the
additional management challenge that the benchmarking
process brings.

“A lot of centers don’t want to report another set of data
that they don’t have to,” Skelton said. “But I say that for a
small nonprofit that hasn’t spent a lot of time and energy
on data collection, this process is helpful in improving
your internal infrastructure.”

Lifting barriers

Wayside House’s programs are based largely on field
data showing that women face particularly difficult barriers
to treatment (childcare needs being high on the
list) that drag down their treatment retention rates visà-
vis male clients. With Wayside House treatment services
now generally offered on a continuum that might
include 90 days of residential care, 16 outpatient weeks
and additional aftercare support, program administrators
saw that they needed programs that allowed women
to remain with their children while in treatment.
“We’ve really changed our philosophy,” Skelton said.
“When we used to reunify families post-treatment, we
found that the kids were angrier. If we can keep children
out of out-of-home placement, that’s a benefit.”

Wayside House

Location: Minneapolis

Services: Residential, outpatient and support services for
women; includes programs where children accompany
mothers to treatment

Capacity: 55 beds; 50 outpatient slots

Number of Employees: 70

Payer Mix: 80 percent state-funded treatment; most of the
rest private insurance

Wayside House operates four treatment sites in the
Minneapolis area, with a combined total of 55 beds and
about 50 outpatient slots. Children can be present in
residential treatment and in a non-residential family
treatment program that has a housing option at the Incarnation
Family Connections location. Alcohol and cocaine/
crack are the two most prevalent drugs of abuse
in Wayside House’s treatment population, Skelton said.

She said that over the past two years her organization
has tried to put its practices to the test, challenging its
non-data based assumptions about its usual approaches
to treatment. Productivity outcomes are becoming
an important factor for the clinical staff. For example,
the center has known for some time that its group sizes
are generally smaller than those at similar facilities, but
it has only recently begun to analyze that issue more
closely.

“Does it really deliver what we think?” Skelton said. “If
we can demonstrate that smaller group sizes result
in better client outcomes, that’s one thing. But we’ve
been seeing that as a positive in the absence of data.”

Offsetting losses

Skelton hopes that a more systematic look at care quality
through tools such as benchmarking will help the
agency overcome what has been a “rough” few years,
although she says her organization has not had to enact
the layoffs or outright program closings of some
other treatment organizations in the state. “A few years
ago, we had built some cash reserves, which we’ve had
to access,” she said.

Budget-cutting at the state level and belt-tightening in
the foundation community have affected all providers
who depend greatly on government-funded care, Skelton
said. “It’s like a death by a thousand cuts,” she said.
“A 1.8 percent budget decrease here, a small grant you
used to get that goes away there.”

Compounding the situation are rising costs in many areas
for programs such as Wayside House, with Skelton
citing food service and healthcare benefits as two line
items in which it is consistently challenging to control
growth.

Other challenges Skelton expects her program to face
in coming years include adjusting to managed care
and upgrading technology. Wayside House still bills the
state directly for the services paid for out of the state’s
consolidated treatment fund for chemical dependency
services (which includes federal block grant money),
but word seems to indicate that the center soon will
have to begin contracting with individual insurance
companies. “We’re going to need to be building relationships
with insurers,” Skelton said.

But the nature of how a capitated system might work
in what has been a fee-for-service state still is a mystery
to the provider community. Skelton said of the officials
presiding over sessions to discuss upcoming changes,
“They say something different every meeting.”
Regarding technology, Skelton termed her organization’s
current databases to have reached a “breaking
point,” and she would like to acquire an electronic health
record product within the next year. “This is something
I’ve been looking for grant dollars for,” she said.
County officials have invited the facility to tap into a
planned health record system that is significantly tailored
to general medicine, but that prospect leaves
Skelton worried about maintaining the confidentiality
of substance abuse treatment information. “It makes
me very nervous,” she said.

By Gary Enos

Alcoholism & Drug Abuse Weekly

Minn. treatment center ratchets up process of analyzing
outcomes was first published in Alcoholism & Drug Abuse
Weekly Volume 23, No. 34, September 5, 2011.
Offering significant news and analysis of federal and state
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Alison Knopf, Editor