Quick Guide For Administrators Based on TIP 46 Substance Abuse: Administrative Issues in Outpatient Treatment U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment www.samhsa.gov Contents Why a Quick Guide? . . . . . . . . . . . . . . . . . . . . 2 What Is a TIP?. . . . . . . . . . . . . . . . . . . . . . . . . 3 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Management Issues. . . . . . . . . . . . . . . . . . . . 5 Managing Human Resources. . . . . . . . . . . . 12 Preparing a Program To Treat Diverse Clients . . . . . . . . . . . . . . . . . . . . . . . 27 Outpatient Treatment Financing Options and Strategies. . . . . . . . . . . . . . . . . 37 Performance Improvement and Outcomes Monitoring. . . . . . . . . . . . . . . . . . 53 Quick Guide For Administrators Based on TIP 46 Substance Abuse: Administrative Issues in Outpatient Treatment This Quick Guide is based entirely on information contained in TIP 46, published in 2006. No additional research has been conducted to update this topic since publication of TIP 46. 2 Administrative Issues in Outpatient Treatment WHY A QUICK GUIDE? This Quick Guide was developed to accompany Substance Abuse: Administrative Issues in Outpatient Treatment, Number 46 in the Treatment Improvement Protocol (TIP) series published by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA). This Quick Guide is based entirely on TIP 46 and is designed to meet the needs of the busy administrator for concise, easily accessed how-to information. The Quick Guide is divided into eight sections (see Contents) to help readers quickly locate relevant material. It will help administrators operate in the rapidly expanding and increasingly complex field of outpatient treatment. For more information on the topics in this Quick Guide, readers are referred to TIP 46. What Is a TIP? 3 WHAT IS A TIP? The TIP series has been in production since 1991. This series provides the substance abuse treat­ ment and related fields with consensus-based, field-reviewed guidelines on substance abuse treatment topics of vital current interest. TIP 46, Substance Abuse: Administrative Issues in Outpatient Treatment, surveys topics relevant to administrators working in the changing environ­ ment of outpatient treatment: • Strategic planning, starting a program, working with partners, and public relations; • Hiring and retaining staff, continuing education and training, and formulating guidelines and policies for staffing; • Preparing a program to treat diverse clients, assessing the cultural competence of a program, and implementing program changes based on the findings; • Strengthening the financial position of a pro­ gram, working with managed care organizations (MCOs), and understanding contracts; and • Improving performance, monitoring outcomes, and using performance data to promote a program. See the inside back cover for information on how to order TIPs and other related products. 4 Administrative Issues in Outpatient Treatment INTRODUCTION This Quick Guide can help administrators address the following issues: • Financial pressures. Funding limitations and shrinking State budgets require increasing creativity and resourcefulness of outpatient treatment (OT) administrators; • Human resources challenges. Substance abuse counselors have a high rate of turnover, skilled counselors are hard to find, and the scarcity of diverse counselors is acute; • Diverse clients. Improving cultural competence can enhance a program’s services and help it meet funding and accreditation requirements; • Emergence of behavioral health funding. Some entities fund mental health and substance abuse treatment separately from other health care, making strategic alliances necessary; • Emphasis on outcomes. The Federal Government now ties funding to performance outcomes, and program monitoring is increas­ ingly important; and • Community relationships. Accrediting bodies and potential funders look at community outreach and partnerships when evaluating a program. For more detailed information, see TIP 46, pp. 1–6. Management Issues 5 MANAGEMENT ISSUES Strategic Planning Strategic planning includes— • Conducting a community needs assessment • Identifying program strengths • Clarifying program mission • Developing and evaluating goals • Identifying strategies to attain goals. Implementing the strategic plan entails— • Incorporating goals and strategies into an annual operating plan • Assigning personnel and timelines • Developing a marketing plan, based on the community needs assessment. Board of Directors Board members have three main responsibilities. General Responsibilities— • Appoint and evaluate the executive director • Attend all meetings of the board of directors • Set organizational policy • Approve and monitor the budget and plan • Develop a mission statement, and review it periodically • Establish a strategic plan 6 Administrative Issues in Outpatient Treatment • Evaluate effectiveness in accomplishing board-approved objectives • Serve on at least one board committee • Become informed and educated about the program and the industry of which it is a part • Be familiar with the program’s bylaws Fundraising Responsibilities— • Participate in special events sponsored by the program • Raise funds using creative strategies • Optional: Make an annual personal donation Public Relations Responsibilities— • Act as a sounding board for community feedback • Serve as a liaison to community organizations • Support the services of the program, and speak out on its behalf Boards should comprise— • People who have knowledge of or experience with substance abuse treatment • Representatives from the local community, the cli­ ent population, and the program’s referral sources • Men and women of various races, cultural backgrounds, and sexual preferences • People with expertise in State and local politics, insurance, managed care, financial management, legal matters, and nonprofits and foundations. Management Issues 7 Orientation for new board members includes— • Program history, mission, and services • Data on service delivery • Board composition and responsibilities • Board committee structure • Program administrator’s job description • Budget • Bylaws • Short- and long-term plans. Board members should be evaluated at least every 5 years, either by an outside consultant or by self-evaluation. Program Policy Management Licensing and accreditation standards require that programs establish written policies and procedures that govern— • Program mission statement and philosophy • Client care (screening, assessment, and treatment and discharge planning) • Recordkeeping (security of clients’ records) • Organizational structure (governance committees and staff positions) • Personnel (procedures for hiring, evaluating, and termination) • Program structure and staffing • Clients’ rights and the program’s grievance process 8 Administrative Issues in Outpatient Treatment • Performance improvement (setting standards and monitoring performance) • Facility, health, and safety standards (first aid, emergency planning, and disaster management). Suggested steps toward accreditation include— • Forming an alliance with a larger organization that can provide support • Hiring a consultant who has experience with the accreditation process • Visiting www.jcaho.org, www.carf.org, www. ncqa.org, www.coanet.org, or www.ncchc.org for more information. Relationships With Strategic Partners Potential sources of new client referrals include— • Managed care companies • Employers • Mental health treatment providers • Employee assistance programs (EAPs) • Schools • Hospitals • Welfare agencies • Criminal justice agencies • Religious leaders.