Planning and Hosting a Community Dialogue Between Regional Payer, Provider and Policy-Making Organizations

This summary has been made possible by the Northeastern States Addiction Technology Transfer Center (NSATTC), partnered with the University at Buffalo School of Social Work, 685 Baldy Hall, Buffalo, N.Y., 14260, with consultation from the Research Institute on Addictions, Buffalo, N.Y. Additional copies can be requested from the NSATTC office at 716-645-3381 x243. In part, the mission of the NSATTC is to increase the knowledge and skills of addiction treatment practitioners from multiple disciplines by facilitating access to state-of-the-art research, education and best practices.

In the summer of 2000, the Northeastern States Addiction Technology Transfer Center (NSATTC) State Office at the University at Buffalo began planning a regional event to raise the level of addiction treatment and prevention dialogue. The planning went through several stages of evolution, and the resulting community meeting was held in October of 2000. It included approximately thirty invited guests from leading addiction treatment and prevention organizations in the area and a panel featuring fourteen high-level representatives from payer, provider and policy-making organizations. Researchers were represented as well, both in the audience and on the panel. The three- hour event provided an opportunity for open discussion among individuals representing these different interests.

In early July of 2000, the staff of the NSATTC office at UB began planning an event which would not be training per se but which was envisioned as a half-day session providing an overview of empirically based interventions. The emphasis would be on best practices that work in engaging and retaining clients in treatment. This idea was presented to the NSATTC, University at Buffalo's Advisory Committee through the listserv created for efficient communication with this group. When no adverse comments were received, staff considered the next steps in putting the session together.

At this point, only a day or two after the e-mail was sent out via the listserv, a member of the Advisory Committee stopped by the University at Buffalo NSATTC office to offer some thoughts on the upcoming event. This individual works closely with treatment providers in the Buffalo, New York area, and her insights often prove to be on-target as to what topics will interest the addiction treatment community. She suggested that staff consider bringing together all elements of the addiction treatment/prevention community who seldom sit together and discuss common interests and concerns. Hearing this suggestion, the staff of NSATTC, University at Buffalo office, immediately saw the potential.

After some discussion, staff gave the newly conceptualized event a title: "Advancing Addiction Prevention/Treatment: A Dialogue Between Payers, Providers, and Policy Makers." The stated purpose of the event was to bring together providers, payers, policy makers, and researchers involved with addiction treatment/prevention for a dialogue resulting in better application of research to practice. There would be two parts to the dialogue the first would include high-ranking individuals representing influence and knowledge in each of the provider, payer, policy-maker, research areas, and the second part of the dialogue would include the invitation-only audience. It was decided that NSATTC, University at Buffalo, would co-sponsor the event with the University at Buffalo School of Social Work which has provided space and support for the office.

As an aside, it should be noted that the original topic considered for the regional event (i.e., one related to best practices) was not off-target. In the "what next" conclusion of the October meeting, the first suggestion for continuing the dialogue was to find out what is easily do-able among best practices (see Appendix A, Summary of "Advancing Addiction Prevention/Treatment: A Dialogue Between Payers, Providers, and Policy Makers"). A best practices session with emphasis on local best practices may be the next topic for an NSATTC-sponsored community discussion.                  

Basic planning decisions related to the following questions: who to invite, how to find an appropriate moderator, when to schedule (day and time), and where to hold the event.

Who to invite the audience. As the format for the event was taking shape, it seemed obvious that the active participants would need to be knowledgeable, known to their colleagues in the addiction/prevention community, and willing to participate. Because the dialogue was seen as having two distinct parts first, discussion between panelists, and second, interaction between the audience and the panel it was decided to make the event a special invitation-only meeting. This accomplished two things: it insured that the audience was knowledgeable, and it sent a message that it was a serious, somewhat prestigious gathering.

Dr. Nancy Smyth, the Director of NSATTC, University at Buffalo, is active in the provider community and knows the players well. After reviewing mailing lists compiled previously by the staff and with input from local Advisory Committee members and Charles Syms, a faculty member working with NSATTC, a preliminary guest list of individuals representing forty-five organizations was created. It included executive directors or high-level staff from the larger provider agencies (both county and private), representatives from hospitals with treatment programs, faculty from several schools and departments in the University at Buffalo and its medical school, regional researchers active in addiction and addiction treatment topics, representatives from the New York State Office of Alcoholism and Substance Abuse Services, members of the Advisory Committee, and staff from the NSATTC office in Albany.

Letters asking individuals to join the discussion were faxed on September 22, 2000 (see Appendix B for the invitation letter). It was decided that the invitation would be more likely read and taken seriously if the letters were faxed.

Who to invite the panel. The panel list took more time to create. Some individuals who would be naturals for the panel were obvious. Other individuals, especially those from the policy-making and payer communities, took more time to identify. Ultimately, thirteen panelists represented providers, payers, policy-makers, or researchers.

It was decided that Dr. Nancy Smyth, the Director, and Charles Syms, the faculty representative, would make phone contact with potential panelists and personally invite them to participate; each would call the panelists he or she knew the best. The one exception would be initial contact with the major health organizations of Independent Health and Blue Cross/Blue Shield. In this instance, Lawrence Shulman, Dean of the School of Social Work, wrote letters to the President/CEO of Independent Health and the Chief Operating Officer of Blue Cross/Blue Shield asking them to participate personally or to suggest individuals from their organizations who are responsible for setting policy for behavioral health care in the areas of substance abuse and mental health (see Appendix B, Letter to Health Organization President/CEO). This was decided as the most effective strategy because it was thought that Presidents and CEOs would be most likely to respond to an invitation from an individual holding a high level, prestige position within the university. Follow-up calls were made to the health organizations to get names of their designated participants who were then contacted by phone by Dr. Smyth.

Within a matter of days, the panel was in place with the exception of the health representatives which took more time to identify. After phone contact, memos confirming the individuals' agreement to participate were faxed (see Appendix B,). The memos were held and faxed on October 5^th so they would not arrive too far in advance of the event. The memo contained details of the meeting as well as six sample questions that might be used to generate discussion.

An appropriate moderator. When planning began for the event in a dialogue format, it was hoped that Dean Shulman could serve as the moderator. He is experienced in leading and moderating panels. He would be capable of eliciting open discussion and at the same time would be forceful enough to run a good discussion between opinionated professionals. Unfortunately, his schedule made him unavailable for that day. 

The talents the Dean possesses seemed to be the ideal to find in any moderator. After a good deal of discussion, a leader of the provider community was selected for his knowledge of the profession, his participation in state-wide initiatives, and his experience in running training and discussion groups. He graciously accepted the invitation.

When to schedule. As the summer drew to a close and as the guest list was compiled, it became imperative to set a date for the dialogue. After ruling out Mondays or Fridays, and seeing the need to set a time far enough in the future to allow participants to plan but not too far so that they forgot about the commitment to attend, staff selected Tuesday, October 17, 2000 as the date. Based on the format, a length of three hours was thought to be appropriate. An afternoon session was thought to be more compatible with busy professional schedules--guests and panelists could have a full morning at work before the event.

Where to hold the event. In an effort to make the meeting something out of the ordinary and to pique attendee interest, it was decided to hold the event at a facility newly available to the University at Buffalo. This facility is one of the older mansions in the general downtown area of Buffalo. Its grandeur and extensive gardens make it appealing as a meeting place, and an added advantage was its location near many of the attendees' offices. Also, meetings at the mansion are a new experience for most groups in Buffalo.

When compared with University at Buffalo facilities, the mansion had not only originality but also parking and convenience advantages in comparison with the University's location north of the city and the common university problem with insufficient parking.                  

The details of the day included handouts for all attendees, set-up for the meeting room, and identification of all participants. Important to the success of the day was having one person serve as the event coordinator. Nancy Mandell, Deputy Director of the NSATTC, University at Buffalo, served in this role.

Handouts. The handouts prepared in advance for attendees included the names, titles, and professional affiliations of the panelists and a list of audience attendees who were expected, i.e., those who had sent a positive RSVP (see Appendix C, Handouts). In addition, a cover letter was attached to two evaluation forms explaining that one would evaluate the day's event and one would provide information requested by NSATTC's funding organization, (see also Appendix C, Handouts).

In addition to these items handed directly to the attendees, informational materials were available on a table set up at the entrance to the foyer of the mansion. These items included bibliographies pertaining to addiction treatment, information on the ATTC network around the country, and information describing the NSATTC (both in Albany and Buffalo). In addition, a sign-up sheet was available for information requests.

Room set-up. Attendees arrived and picked up their name badges and handouts in the main foyer of the first floor. The actual event was held in the library that opened onto the foyer.

The configuration of the library was debated at some length by staff prior to the event. At first, it was envisioned that the panel would be in the center of the audience, seated facing each other at a long conference table. However, it was noted that if the panel were placed in the center of the room with the audience grouped around them, members of the audience would have a difficult time hearing comments whenever a speaking panelist's back was to them.

Microphones were not a possible solution to alleviate the problem because the library, in keeping with its turn of the century elegance and furnishing, is not wired for microphones. In a compromise configuration, tables were set up in a horseshoe shape with the open side to the audience. Thus four panelists sat on the right, five panelists sat at the back table looking straight out at the audience, and four panelists sat on the left. This configuration may have given the illusion that the panel was an extension of the audience, and thus it may have contributed to prematurely including the audience in the initial dialogue that was originally meant to include panelists only (see Evaluation below).

The audience sat on arm chairs, sofas, and in some instances, chairs from the dining room for a more relaxed seating arrangement than would be possible in the usual conference room. The back and side of the room had long tables where coffee and sodas were available throughout the meeting. Cookies were added at the break. 

Identification of participants. Because the event was seen as a networking opportunity as well as a discussion forum, it was felt that name tags were essential. Computer-printed name tags were created for every individual who had responded they would attend, and in addition to name tags, panelists were identified with double-printed signs on the panelist table. Blank name tags were available for those who came without previously notifying staff.                  

Abbreviated summary. A full summary of the meeting is found in Appendix A. Forty individuals took part--twenty-seven in the audience and thirteen on the panel. The meeting focused on four questions related to bringing evidence-based practices to addiction treatment agencies and evaluating best practices. The questions included the following: What helps? What hurts? How can we deal with what hurts? What next? 

The panel and audience created a list of thirty actions and traits which help and thirty actions or traits which hurt agencies when adopting evidence-based practices and best practices. From these, four items were selected from the list of "what hurts" for more in-depth analysis. The subjects included lack of resources, arrogance, complex clients, and lack of motivation. Again, reference should be made to Appendix A for details of the discussion.

In the last part of the discussion, "What next," eight suggestions were made:

1) do not just talk about adopting research to practice providers and payers should partner with researchers, and all should find out what's easily do-able among best practices; 2) start collaborative discussions convene all the parties; 3) use student interns to develop outcome evaluations; 4) use community developed practice guidelines as a focal point to bring people together; 5) use the practice guidelines as the basis for an additional conference to examine evidence-based research; 6) bring researchers and line staff together to recognize the strengths of each other; 7) include supervisors, line staff and clients in future, ongoing dialogues; include also representatives from outside Erie County; and 8) create a list serve so that the dialogue can continue.

The lists that were generated by the audience were written on flip chart paper. In addition, two NSATTC staff members took notes during the discussion so that a more complete record of the meeting would be available. Tape recording the meeting had been discussed during the planning phases of the event, but the NSATTC staff decided that it might serve to stifle an open discussion.

Evaluation. Evaluation took two forms how staff informally evaluated the day, and responses to the formal evaluation sheet (see Appendix C, Handouts). 

Staff evaluated the day as a success. Participation was animated, and conversational comments at the end of the event were positive. Many members of the audience directly suggested to the Director that a continuing dialogue would be welcomed. Several noted that it was the first time that such a discussion had included appropriate individuals from the health organizations (past efforts in the provider community to engage the health organizations had resulted in the provider relations staff members, not behavioral health policy makers, attending particular functions). The setting was considered a plus, and networking opportunities were utilized fully with prolonged conversations among attendees before and after the formal meeting as well as during the break.

The only minus staff found with the event was the change in the planned format. Rather than utilizing the expertise of the panel for a period of time before including the audience, the moderator immediately included the audience in discussion. This was positive in that it led to early and spirited contributions from the audience, but it meant a missed opportunity to hear from individuals and interests not often included in addiction treatment dialogue. The experience and points of view of the panel members were not utilized, and the hoped-for interaction among the panelists did not materialize.

The formal evaluation form created for the audience and panelists consisted of four questions: 1) what was useful about today's program? 2) What was not useful? 3) What changes would you recommend if this type of program were to be repeated in the future? 4) What other activities, programs, or services do you think would be helpful to advance the goal of increasing the use of evidence-based practices and the evaluation of current best practices in addiction treatment and prevention. Responses were positive (see Appendix D, Evaluation by Participants).

Immediate results. Participants left with eight suggestions as to how to proceed toward better integration of practice and research (described above and in Appendix A, Summary). In addition, two individuals offered concrete collaborative invitations to join current activities in their organizations. Also as a result of the meeting and the mention of information available in chapters authored by Dr. Nancy Smyth, nine individuals asked for copies of the chapters, and fourteen participants signed up to be included in a new listserv for interactive discussion.

Follow-up results. Within the week, thank-you letters were sent to the panelists (see Appendix B, Letters) and individuals asking for the information chapters received their copies. Within the month, everyone attending the event received a copy of the summary, and the new listserv for continuing the discussion was created. The listserv has had a slow start, but in time the interactive/discussion aspects of this type of listserv may become popular.

If NSATTC, University at Buffalo, hosts another similar event, the blueprint is here. The areas of interest for future dialogues are identified, the location has had a trial run and the reasons for choosing it still seem valid, drafts of letters are written, and a time-line for phone calls and mailing has been established. Aspects of the event that could be improved have been noted, the guideline for a written summary of the event has been created, and post-event policy is in place to guide follow-up activities such as sending thank-you letters and requested materials.

The NSATTC, University at Buffalo State Office hopes this blueprint will prove useful to others who seek to bring their communities together for a similar event. If we can help in any way, contact us at 716-645-3381, extension 243. 

On October 17, 2000, forty addiction prevention and treatment professionals met in Buffalo at the invitation of the University at Buffalo School of Social Work and the Northeastern States Addiction Technology Transfer Center (ATTC), University at Buffalo. The purpose of the event was to bring together providers, payers, policy makers and researchers involved with addiction treatment and prevention for a dialogue resulting in better application of research to practice. In addition, the purpose was to establish better understanding and more interaction between the parties. At the end of the discussion, participants left the room with eight suggestions as to how to proceed toward better integration of practice and research, including a list serve for continued discussion which was offered to all attendees. In addition, at least two individuals stepped forward with concrete collaborative invitations for current activities in their organizations.

The panel was comprised of thirteen individuals with special knowledge and experience in the areas of addiction treatment/prevention practice, payment systems for treatment, or policy issues relevant to the profession (see attached list of panelists). The audience was intentionally small, and included representatives from some of the community's most progressive and respected service agencies. A list of individuals who attended and were part of the dialogue also is attached to this summary.

The meeting focused on four questions relating to bringing evidence-based practices to addiction treatment agencies and evaluating best practices. The questions were: What helps? What hurts? How can we deal with what hurts? What next?

The panel and the audience began by creating a list of 30 actions and traits (see attached) which help agencies to adopt evidence-based practices and best practices. This was followed by creation of a list of 30 actions, attitudes and traits which hurt the ability of an agency to adopt evidence-based and best practices (list attached). The audience and panel then took on the task of determining how to deal with barriers. Four items were selected for more in-depth analysis from the list of "what hurts," and through the dialogue that followed, most of the items from the "what helps" list became part of the discussion.

First issue: Lack of Resources. The resource discussion quickly became focused on one of the primary areas of concern, i.e., the need for resources to cover the cost of start-up activities associated with making a treatment/prevention change in an agency. Start-up costs specifically mentioned were the cost of training and staff time to learn the new procedure, and the cost of adding additional staff either to implement the new methods or cover existing clients. Additional related factors mentioned included the need for resources to balance multiple approaches as new treatment methods are added, and the need for funding to pay for additional staff time when a better method requires more treatment time.

To deal with start-up expenses, agencies need payment for staff training time and they need flexibility in using existing resources, especially surplus funds. It was stated that start-up needs are comparable to Research & Development (R&D) needs, therefore R&D funding should be available to implement new treatment/prevention methods. Venture funding was another suggested source of start-up funding. Additional suggestions included collaboration with university researchers, implementation of research that has low resource requirements, and policy changes that would allow funding for R&D. It was also noted that some changes to incorporate evidenced-based practices could occur within current funding and staffing patterns.

In discussing lack of resources, the group touched on the following helpful actions and traits identified at the beginning of the meeting: training, coordinating research and practice, collaborative relationships, resources, incentives, relevance to population served, regulatory flexibility, and improving the process. 

Second issue: Arrogance. All parties researchers, practitioners, payers, and policy makers were identified as part of the arrogance problem. Researchers were accused of saying "My research works" when in fact the population samples are restrictive, and placing too much emphasis on the education difference between themselves and many practitioners. Practitioners were accused of arrogance based on their experiences: "I've been doing this many years and it works." Payer arrogance was attributed to control of funds with an attitude summed up as "You've been expensive in the past. Now we'll tell you how to deliver services." Policy makers were described as not always in-the- know about the specific treatment/prevention issues for which they make policy.

The following observations and suggestions were made to begin addressing the arrogance problem. First, it was pointed out that payer decisions are based on position papers, and these papers are available to all agencies. Practitioners were urged to read the position papers. Payers were urged to have researchers involved in reviewing these papers--researchers who can assess the applicability of research findings, from clinical trials to more heterogeneous populations.

Second, regarding the charge that population samples used in many research projects are not representative, researchers were urged to look at broader (more realistic) population samples. It was noted that the National Institute of Drug Abuse now wants a second level of research application where methods are applied to heterogeneous samples. Also addressing researchers arrogance, it was mentioned that researchers (and practitioners) look at meta-analytic research, i.e., look across many studies because it is in everyone's best interest to find the best patient outcomes.

Finally, the often mentioned antidote for arrogance was collaboration: agencies and policy makers working together on credentialing issues and regulations; payers, practitioners, researchers and policy makers working toward practical guidelines for adopting evidence-based research and best practices; all parties working toward best outcomes for clients; and better evaluation tools to illustrate what methods really work (a balance for treatment prejudices and preconceived ideas).

Helpful actions/traits mentioned at the beginning of the meeting were incorporated into solving the problem of arrogance. These actions/traits include evaluation of current practices, coordinating research and practice, working with payers, direct communication between researchers, providers and payers, agreement regarding what constitutes best practices, relevance to the population served.

Third issue: Complex Clients. The observation was made that clients often have a variety of problems and as a result are in multiple systems for treatment. Because of the complexity of their problems, it is "dangerous to apply cookie cutter treatment" to only one problem area. It is important to pay attention to other issues and combine research from other areas in order to address the complexity of most clients. Researchers in attendance were urged to use natural population samples for their research.

The comment was made that addiction treatment practitioners cannot be all things to all people, i.e., they cannot treat broad populations efficiently by themselves. One suggested solution was to continue to cross-train people to address different issues (for example, cross train addictions and mental health staff).

It was further noted that breaking down payments by disorder is problematic. It was suggested that a system is needed where payments/treatment/research address the individual, and special emphasis is given to integrating payment systems.

An additional problem with complex clients is staff qualifications or the lack thereof. It was suggested that in an effort to make all staff qualified, key staff should have credentials designated to the payer (perhaps even require that staff be credentialed with the payer). It would be beneficial to clients and the profession if credentialing were agreed upon between policy makers, payers, and providers and if clear regulations were formulated. 

Helpful actions/traits used to address this issue included coordinating research and practice, understanding limits, collaborative relationships, training, working with payers, and relevance to population that is served.

Fourth issue: Lack of Motivation. Lack of motivation and excitement is apparent at all levels in terms of transferring research into practice. Even researchers are not motivated because of the time and effort required to create relationships with agencies. It was suggested that researchers reframe research as a two way street with greater payback in well designed research done with agency partners helping to plan some research questions. In short, all parties involved should look for people who are "open to the deal" of mutual gain when research is done collaboratively.

From the training perspective, there are several aspects to the lack of motivation: counselors are required to use vacation days for training under current policy, and when they return to their agencies, they often can not implement the techniques they learned. They need support to implement what they learn from training.

It was suggested that all parties need to get beyond the criticism of researchers who are not comfortable training and who do not have good platform skills. Instead, researchers and trainers who are communicators can present and can write for understanding these individuals (translators) can bridge the gap for researchers who are not good at communicating.

Everyone needs to have realistic expectations as to what research can accomplish. One individual suggested "using the passion of those who are passionate." This is especially important when leaders are motivated and excited--they will infuse an organization or research project with the necessary energy and motivation for success.

In terms of specific problems associated with adapting research to practice, it was suggested that researchers work with staff on the design of research projects (a theme addressed earlier). Again it was pointed out that staff time is a resource issue. This could be offset by having funds for the agency written into the grant.

It was pointed out that although new research is interesting, the focus of integrating research into practice should be on existing exemplary models. In addition, the community has models that are working well. What is needed is an effort to document those models.

Individuals agreed that not all agencies are ready to implement research, but some are. Researchers, payers and policy makers should find those who are ready for change. When asked who in the room was ready to implement research, participants asked back: "What's the research?" "What are the incentives?" "Will people get better?"

The last question, "Will people get better?" changes everything arrogance, lack of motivation, the problems associated with complex clients. Many attendees agreed that funding programs on the basis of outcome, while taking client complexity into account, may be the key for bringing people together. As an example of bringing more interested parties to the table, one panelist urged that future events include, perhaps feature, judges.

Helpful activities/actions/traits described earlier in the meeting and included in this part of the discussion included documentation, training, collaborative relationships, resources, expert educators, incentives, involving line staff, and motivation and excitement.

What next? The following suggestions were made: 1) do not just talk about adopting research to practice providers and payers should partner with researchers, and all should find out what's easily do-able among best practices; 2) start collaborative discussions convene all the parties (at this point, one payer asked for a researcher to join an in-house committee, and an agency director asked for a payer and researcher to join in a collaboration with an independent provider organization, CAIN); 3) use student interns to develop outcome evaluations; 4) use community developed practice guidelines as a focal point to bring people together; 5) use the practice guidelines as the basis for an additional conference to examine evidence-based research; 6) bring researchers and line staff together to recognize the strengths of each; 7) include supervisors, line staff and clients in future, ongoing dialogues; include also representatives from outside Erie County; and 8) create a list serve so that the dialogue can continue.

Flip Chart Notes from 10/17/00

Adoption of Evidenced-based Practices and Evaluating Current "Best Practices":

• What helps?
• What hurts?
• How can we deal with what hurts?
• What next?

What Helps?

• Documentation
• Knowledge of research to practice
• Training
• Understanding research
• Coordinating research and practice
• Understanding limits
• Collaborative relationships
• Practice to research
• Working with payers
• Resources

• Expert educators
• Keep it simple
• Motivation & excitement
• Direct communication between researchers, providers and payers
• Incentives
• Waivers
• Involve line staff
• Research that is practical
• Consumer/client acceptance
• Mandates
• Agreement re what is best practices.
• Successful multiple replications
• Good press for successes
• Relevance to population served
• Regulatory flexibility
• If it improves the process
• Benefit redesign
• Cultural sensitivity/socio-economics
• Clarity in expected outcomes
• Learning curve

What Hurts?

• Lack of resources (every)
• Arrogance
• Rigid Regs
• Lack of Understanding
• Resistance and institutional inertia
• Complex research
• Professional/personal inertia
• Complex clients
• Conflicting beliefs
• Benefits (to whom?) not worth cost
• Rise of uninsured
• Workforce problems
• Lack of motivation/excitement re work
• Outdated community standards
• Unrealistic study samples
• Cultural differences between research and practice
• Cultural differences among clients
• Lack of transfer mechanism
• No gain for researcher
• Inadequate technology
• Trust problems
• Overzealous allegiance to theory and ignoring research
• Lack of collaborative relationships
• Inconsistent societal messages
• Lack of mentoring and mentoring implementation
• Insufficient research
• Insufficient foundation for agreement
• Resistance to change
• Ineffective advocacy
• Poorly targeted research

How to Deal with What Hurts?

• Start-up time:
  • payment for training time
  • use surplus/venture dollars
  • have R&D dollars
  • implement research that is low on resource requirements
  • collaborate with university researchers
• Money-- change policy to fund R&D
• Arrogance
  • more collaboration on credentialing and regs; with county and state policymakers
  • common goals best outcome for clients
  • practical evidence-based guidelines collaboration at the table
  • reasonable program evaluation tools
• Non-realistic samples
  • samples in research that reflect real-world samples
  • use summaries of meta-analyses and practice guidelines
• Complex clients
  • natural samples for research
  • integrated payment model
  • make all staff qualified
  • designate key staff/credential to payer (individually license staff with payer)
• Lack of motivation and excitement
  • look for folks who are open to the "deal" --advocacy at state policy level
  • outcome-based funding skill based; accounting for severity of problems
  • researchers include staff/agency questions
  • great training
  • witnessing success
  • permission and support to implement new ideas and training content
  • interpreters with good platform skills
  • realistic expectations of new/evidence-based treatments
  • give feedback to practitioners how implementation is going
  • use their passion
  • involve/empower staff
  • create positive, motivated leaders

Problems Adapting the Research to Practice

• Integrate cost to staff in research proposal
• Researchers consult with staff how to adapt tx and then study it
• Practice informed research
• Researching best practice

What Next?

• Information about what the evidence-based practices are to providers/payers/policymakers
• Collaborative discussion about
• Use students for evaluation
• Include what is missing at all levels
• Dissemination of practice guidelines
• Research to Practice Forum: guidelines; common ground; what's evidence-based
• Discussions between researchers and line staff; ongoing monthly
• Include line practitioners and clients
• Listserve 

Dear 

You are invited to be part of a small invitation-only audience taking part in an open discussion entitled "Advancing Addiction Prevention/Treatment: A Dialogue between Payers, Providers, and Policy Makers." The purpose of this discussion is to identify issues affecting the ability of the addiction prevention and treatment profession to implement research-based treatment methods and best practice models. The event is co-sponsored by the UB School of Social Work and the Northeastern States Addiction Technology Transfer Center, New York State Office, University at Buffalo.

The meeting will begin with a round table discussion between influential individuals representing payers, providers, and policy makers. Participants include, among others, Mike Weiner, Commissioner of Mental Health for Erie County; Jack O'Conner, Director of Managed Care Reform for Erie County; Ann Herron, Treatment Policy & Resource Development Group, OASAS; and Chuck Monson, Upstate Program Review Supervisor, OASAS. In addition, the round table discussion include leaders from the local provider community as well as representatives from managed health care. After the initial discussion, dialogue will be opened to you and other members of the audience.

Place: Butler Mansion (Jacobs Executive Development Center of the

University at Buffalo School of Management)

672 Delaware Avenue, corner of Delaware and North

Time: October 17, 2000

1:00 - 4:00 p.m.

Free parking is available on the grounds use the gated entrance on North Street.

Please RSVP to 645-3381, x 243, by October 11^th

We hope you will be able to attend your input is valued. 
 
 

Sincerely,
 
 
 
 

Nancy J. Smyth, Ph.D., CSW 

Director, Northeastern States Technology Transfer Center, University at Buffalo 

Dear Dr. xxx:

I am writing to you in my capacity as dean of the School of Social Work at the University at Buffalo. We are the host of the Northeastern States Addiction Technology Transfer Center with responsibility for working to bridge the gap between the research and provider communities.

On Tuesday, October 17^th, from 1:00 p.m. to 4:00 p.m. at the Butler Mansion in Buffalo, we are holding a roundtable discussion of people who influence addictions treatment policy to help us identify the issues that affect the ability to adapt empirically based treatment methods and best-practice models. You have been identified as a key player in Erie County and we hope that you will choose to join us at this roundtable along with the following persons:

• Commissioner of Mental Health for Erie County
• Director of Managed Care Reform for Erie County
• Representatives form the New York State Office of Alcoholism and Substance Abuse Central Office
• Executive Directors of a number of key provider organizations
• Addiction treatment researchers from our own University and from the Research Institute on Addictions

The roundtable will be held "fish bowl" style with an invitation only audience of about thirty people. There will be a facilitated roundtable for discussion for about two hours, a brief break and then about forty-five minutes for questions and discussion from the audience. 

We also would be interested in the attendance of whoever in our organization is in charge of setting policy for behavioral health care in the substance abuse and mental health area.
 
 
 
 

Page Two, Appendix B, Letter to Health Organization President/Ceo
 
 
 
 

We understand with your busy schedule you might only be able to attend for a portion of the afternoon or that you may have to delegate this to the behavioral health policy member of your staff. In any event, we do believe it is important that someone from your organization be represented.

I will be calling within the next couple of days to discuss the event with you and to see whether we can look forward to your involvement.

Sincerely,
 
 
 
 

Lawrence Shulman

Dean  

TO: 

FROM: Nancy Smyth, Ph.D.

Director, Northeastern States ATTCSUBJECT: Details of the October 17^th Round Table Discussion 

DATE: October 12, 2000
 
 
 
 

Thank you for agreeing to be part of our special panel on October 17^th. The title of the event is "Advancing Addiction Prevention/Treatment: A Dialogue Between Payers, Providers, and Policy Makers." We plan to begin the session with discussion between you and your fellow panelists (list attached), and we will eventually open the discussion to include the small, invitation-only audience. Listed below are six general questions which may be used to stimulate discussion. 

1. What facilitates adoption of prevention/addiction research based practice models and best practices?
2. What are the barriers to integrating research findings and practice?
3. How might these barriers be addressed?
4. What's already working to further the adoption of prevention/addiction research based practice models and best practices?
5. What barriers affect an agency's ability to evaluate or research its own current practices?
6. What other initiatives are necessary to advance addiction treatment and prevention?

The event will be held from 1:00 p.m. to 4:00 p.m. at the Butler Mansion (the Jacobs Executive Development Center of the University at Buffalo School of Management). The address is 672 Delaware Avenue, at the corner of Delaware Avenue and North Street. The gated entrance to the parking area is located on North Street. 

If you have any questions, please feel free to call me at 645-3381, extension 232, or Nancy Mandell in the NSATTC office at 645-3381, extension 243. Again, thank you for joining our panel and we look forward to seeing you on the 17^th. 

October 23, 2000
 
 
 
 
 
 

Dear 

Thank you so much for the time you gave to the addiction treatment and prevention professional community last Tuesday. Your presence provided the expertise that encouraged a meaningful dialogue between the players. The first steps toward collaborative relationships were taken at the end of the meeting, and we are hopeful that future relationships will be formed as a result of our afternoon together. Again, thank you for your help.

Sincerely,
 
 
 
 

Nancy J. Smyth, Ph.D.

Director, NSATTC, University at Buffalo

PANELISTS AND ATTENDEES

"Advancing Addiction Prevention/Treatment: A Dialogue Between Payers, Providers, and Policy Makers," October 17, 2000

Co-sponsored by the UB School of Social Work and

The Northeastern States Addiction Technology Transfer Center at UB
 
 

Panelists
 
 

Ann Constantino, President/CEO, Horizon Health Services

Dr. William Fals-Stewart, Senior Research Scientist, Research Institute

on Addictions

Sheila Gould, Account Manager, Community Blue

Dr. Phyllis Greenwald, Medical Director, Integra

Anne Herron, Director, Treatment Policy & Resource Development Group, NY

State Office of Alcoholism and Substance Abuse

Assemblyman Sam Hoyt, New York State Assembly

Dr. Barry Loneck, Assoc. Professor, School of Social Welfare, University at Albany

Bill MacVicar, Coordinator of Public Education, Erie County Council for

Alcoholism and Substance Abuse

Chuck Monson, Supervisor, Upstate Program Review, NY State Office of

Alcoholism and Substance Abuse Services

Jack O'Conner, Erie County Medicaid Reform 

JoAnn Paxon, Assist. Director of Behavioral Health, Independent Health

Mike Weiner, Commissioner, Erie County Mental Health

Dr. Robert Whitney, Clinical Director, Division Of Chemical Dependency, Erie

County Medical Center

Moderator

Steve Schwartz, Margaret A. Stutzman Addiction Treatment Center 
  
 

GUESTS IN THE AUDIENCE

Mr. John Bennett, Genesee/Orleans Council on Alcoholism and Substance Abuse 

Dr. Scott Coffey, School of Medicine and Biomedical Sciences, University at Buffalo

Mr. Jerry Erion, Alcohol & Drug Dependency Services, Inc.

Mr. Douglas Fabian, City of Buffalo

Jeanne Figurel, Spectrum Human Services

Ms. Felicidad Frenette, International Institute 

Ms. Rosemarie Goi, Institute for Addictions Studies and Training, University at Buffalo

Ms. Cynthia Gould, Jewish Family Services

Mr. John Grieco, Mid-Erie Counseling and Treatment Services

Dr. Kim Griswold, UB School of Medicine

Mr. John Guyett, Sisters of Charity Hospital

Dr. Howard Hitzel, Behavioral Health

Mr. Don Ingalls, Health Now

Ms. Pamela Kefi, International Institute

Dr. Kathleen Kost, School of Social Work, University at Buffalo

Sonya McCall, Cattaraugus County Council on Alcoholism & Substance Abuse

Ms. Elaine Maccio, Northeastern States Addiction Technology Transfer Center, UB

Dr. Nancy Mandell, Northeastern States Addiction Technology Transfer Center, UB

Ms. Ellen Roche, Alcohol & Drug Dependency Services, Inc.

Dr. Andrew Safyer, School of Social Work, University at Buffalo

Dr. Nancy Smyth, Northeastern States Addiction Technology Transfer Center, UB

Mr. Charles Syms, School of Social Work, University at Buffalo

Ms. Sarlyn Tate, Mid-Erie Counseling and Treatment Services

Dr. Gail Viamonte, Northeastern States Addiction Technology Transfer Center, 

University at Albany

Dr. Shelly Wiechelt, School of Social Work, University at Buffalo

Ms. Maryann Wooley, Bry-Lin Hospitals
 
 

EVALUATION COVER LETTER and

NSATTC, UNIVERSITY AT BUFFALO, EVALUATION FORM
 
 
 
 
 
 

"Advancing Addiction Prevention/Treatment:

A Dialogue Between Payers, Providers, and Policy Makers"

October 17,2000

Co-sponsored by

The School of Social Work, University at Buffalo

and

The Northeastern States Addiction Technology Transfer Center,

New York State Office at the University at Buffalo

Thank you for attending today's discussion. We hope to use this format as a model for raising professional awareness and gathering information from key stakeholders. It would help us if you would return the attached evaluation form for today's event as well as our funders participant data form.
 
 

NSATTC, University at Buffalo

Nancy Smyth

Charles Syms

Nancy Mandell

Elaine Maccio
 
 

Advancing Addiction Prevention &Treatment: 

A Dialogue Between Payers, Providers, and Policy Makers

October 17, 2000

Co-sponsored by

The University at Buffalo School of Social Work

and

The Northeastern States Addiction Technology Transfer Center,

New York State Office, University at Buffalo
 
 

Evaluation Form

1. What was useful about today's program?
    

   
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    

2. What was not useful?
    

   
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    

3. What changes would you recommend if this type of program were repeated in the future?

4) What other activities, programs or services do you think would be helpful to advance the goal of increasing the use evidence-based practice and the evaluation of current best practices in addiction treatment and prevention?                    

1) What was useful about today's program?

• Identifying barriers that affect research to practice
• Want to see this group bring about collaboration when speaking to county government
• Keeping discussion focused (3)
• Variety/cross-section of representation/collaboration (7)
• Quality of moderator (2)
• Hearing payers talk openly about their experience in working with practitioners; more needs to be done to bring the 3 parties together
• The process
• Listening 
• Gathering together a number of articulate, impassioned people addressing the problem from a variety of perspectives
• Important that it happened; questions raised were more useful than the answers
• Meaningful/frank/open dialogue (6)

2) What was not useful?

• Nothing/all useful (9)
• Goals not clear prior to seminar
• Focus on why it won't work
• Time constraints
• All but exclusive emphasis on treatment (e.g., the disease model) to the exclusion of public health/public policy concerns (this was expected to some extent natural but the dominance of treatment was almost total)
• Inner circle/outer darkness! Too much chumminess, joking among old war horses, to exclusion of "outsiders"
• Moderator shut people down too quickly

3) What changes would you recommend if this type of program were to be repeated in the future?

• More time (perhaps a full day)
• Invite someone from the courts
• Include line staff/case workers/more practitioners (3)
• Follow-up will be important
• Payer and policy and research representatives from regional settings beyond Erie County and surrounds
• Develop common ground/theme
• Include consumers
• We should talk more about creating a new type of clinician who appreciates more the roles of research and payment for service
• Brief opening statements by panelists/audience as to the direction they (not moderator) would like discussion to take

4) What other activities, programs or services do you think would be helpful to advance the goal of increasing the use of evidence-based practices and the evaluation of current best practices in addiction treatment and prevention?

• Continue and expand the dialogue
• Have an ongoing committed committee
• Communicate with PRC, CTNs, etc. on additional levels 
• Add front line staffers
• Enhance policy maker attendance
• Discuss current treatment guidelines with researchers and payers to update the guidelines and incorporate best practices
• Hold a monthly forum
• Have a discussion of community best practices
• Meet more often to develop common language and understanding of issues
• Incorporate research representatives in discussions with different levels of service delivery such as public forums, advocacy groups, staff meetings and sessions (therapy) with clients
• Training relating to practice and research