IBR -- Projects, Treatment Costs and Organizational Monitoring (TCOM)

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tcom.html

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Project Summary

Project Supplement

Project Training Activities

Publications and Selected
Presentations

Newsletter Stories

TCU Treatment Assessment Forms (Organizational Assessments)

“Uncovering the real cost of rehab,” (also in PDF: 37K/4 pages) from Endeavors, TCU’s new research magazine

Highlights

Title: Treatment Costs and Organizational Monitoring
Principal Investigator: Patrick M. Flynn, Ph.D.
Co-Principal Investigator: D. Dwayne Simpson, Ph.D.
Project Director: Danica Knight, Ph.D.
Graduate Research Assistants: Jennifer Edwards, M.S., ABD; Brittany Landrum, B.A.
Funded by: National Institute on Drug Abuse (NIDA)
Project Period: April 2003 to March 2009

TCOM Project Summary

This project focuses on developing an assessment and information system for treatment providers that will monitor organizational attributes and program resources, and link these factors to client performance and program changes over time. It uses the TCU Program Change Model as a conceptual framework for this technology transfer process. The sample consists of 115 outpatient drug-free (i.e., non-methadone), community-based, treatment providers—by far the most common and diverse setting for addiction treatment in the United States. This work extends our thematic program of research designed to better understand treatment and research diffusion. It also expands applications of our client-level Treatment Process Model (i.e., a framework for integrating interventions with client assessments of needs and measures of performance changes over time).

A primary goal is to develop reliable instruments that can measure and provide feedback on program resources and organizational dynamics (along with aggregated client data) for the purpose of clinical management in real world outpatient community settings. While the ability to effectively use information technology is increasing at most agencies, integrated data systems that meet these crucial clinical management needs have not been developed and tested, and are not yet available for routine use. The specific aims are to: (1) develop a set of field instruments and procedures that treatment programs will use in assessing their organization and its resources, (2) demonstrate the feasibility and utility of these assessments in a sample of 100 or more outpatient drug free treatment providers from different regions in the U.S., (3) monitor organizational changes over time and relate them to client-level indicators of program effectiveness, (4) plan and evaluate a training protocol for program directors on how to use assessment information for improving program management and functioning, and (5) study the process of program change and the long-range implementation of this new technology.

The conceptual approach, assessment strategy, and sampling design build on previous work and experience in conducting organizational and client functioning assessments. Integrated into this plan for collecting and interpreting information about program resources is work by colleagues from the Heller School for Social Policy and Management at Brandeis University. The domains addressed by the comprehensive assessment battery include program structure, organizational factors, staff, clients, and program resources. In addition to improving scientific understanding of these issues (communicated through journal publications, conferences, newsletters, and our Web site), several “application” products are expected from this project, including the development of a comprehensive system for assessing and reporting organizational and client functioning.

TCOM Project Supplement

Computer-Assisted Cost Analysis Interview
A new methodology for collecting drug abuse treatment cost data was developed. It adapts computer-assisted data collection and web-based technology to support community-based outpatient drug treatment providers in their efforts to conduct routine economic evaluations of services. This supplement transforms the parent project’s economic assessment tool from accounting-style spreadsheets into an interactive, computer-assisted interview. This costing tool, and a prototype of a web-based version, was developed by a multidisciplinary research team from IBR and the Heller School for Social Policy and Management at Brandeis University.

TCOM Training Activities

The TCOM Project provided collaborative training for 129 staff from 102 selected programs affiliated with the Southern Coast, Northwest Frontier, Great Lakes, and Gulf Coast Addiction Technology Transfer Centers. Participants were taught how to use a practical, self-guided tool for determining the actual service delivery costs of different treatment components. The TCOM tools assist programs in pricing their services competitively and maintaining fingertip access to financial information that can be used for grant writing and negotiating reimbursement rates. In addition, these tools allow agencies to compare their costs and organizational performance with national and regional data.

Feedback Reports

An important aim of the TCOM project is to provide information to participants about program improvement through individualized reports. Reports detail how each program changes over time and compares with regional means on organizational and client data. Several participating programs have used findings as a basis for discussion and training among staff and as a rationale for proposed changes designed to address “weak” areas of organizational functioning. Their response confirms the utility of the TCOM assessment system and will serve to guide future reports and analyses.

TCOM Publications and Selected Presentations

Flynn, P. M., & Brown, B. S. (2008). Co-Occurring Disorders in Substance Abuse Treatment: Issues and Prospects. Journal of Substance Abuse Treatment, 34(1), 36-47. [Abstract]

Broome, K. M., Flynn, P. M., Knight, D. K., & Simpson, D. D. (2007). Program structure, staff perceptions, and client engagement in treatment. Journal of Substance Abuse Treatment, 33(2), 149-158. [Abstract]

Knight, D. K., Broome, K. M., Simpson, D. D., & Flynn, P. M. (2008). Program structure and counselor-client contact in outpatient substance abuse treatment. Health Services Research, 43(2), 616-634.

Selected Conference Presentations
Beaston-Blaakman, A., Flynn, P. M., Reuben, E., & Shepard, D. (2007, October). Findings from a comparative study of brief cost methods in substance abuse treatment research. Paper presentation at the Addiction Health Services Research Conference, Athens, GA.

Broome, K. M., Beaston-Blaakman, A., Knight, D. K., & Flynn, P. M. (2007, October). Organizational and clientele predictors of costs in outpatient drug abuse treatment. Paper presentation at the Addiction Health Services Research Conference, Athens, GA.

Edwards, J. R., Knight, D. K., Broome, K. M., & Flynn, P. M. (2007, October). Transformational leadership in outpatient substance abuse treatment programs. Poster presentation at the Addiction Health Services Research Conference, Athens, GA.

Flynn, P. M. (2007, October). Implementation science & research. Invited symposium presentation at the annual Addiction Health Services Research Conference, Athens, GA.

Knight, D. K., Broome, K. M., Simpson, D. D., Edwards, J. R., & Flynn, P. M. (2007, October). Stability and change in staff perceptions of organizational functioning. Poster presentation at the Addiction Health Services Research Conference, Athens, GA.

Flynn, P. M. (2007, December). Data for cost function analysis: Data collection lessons learned III—TCAT. Invited panel presentation at the NIDA technical meeting on Cost Function Analysis of the Substance Abuse Treatment Industry: Information Needs, Methods, and Next Steps, Bethesda, MD.

Flynn, P. M. (2007, December). The substance abuse treatment system—Background. Invited panel presentation at the NIDA technical meeting on Cost Function Analysis of the Substance Abuse Treatment Industry: Information Needs, Methods, and Next Steps, Bethesda, MD.

TCOM Newsletter Stories

Research Reports from IBR Fall 2006 issue (PDF: 290KB / 4 pages)

Monitoring outpatient program change (link to Research Roundup, Fall 2005 issue; also in PDF; 131KB / page 4)

User-friendly management systems for improving treatment (link to Research Roundup, Spring-Summer 2003 issue; also in PDF; 444KB / page 1)

Treatment Costs and Organizational Monitoring: Taking a program's pulse (link to Research Roundup, Spring-Summer 2003 issue; also in PDF; 444KB / page 1)