In Review
2016 marked the 32nd year in which the Addictions Recovery Centers of Indiana, Inc. (ARC) offered services to individuals seeking substance abuse counseling help. A year of change and accomplishment, it marked the first full year without our founder, Jan Noble, Sr. who passed away in June of 2015. Jan Sr. was committed to helping persons afflicted with substance abuse issues obtain a better life through sobriety and freedom from the disease of addiction. He is very much missed throughout the treatment community.
There were numerous accomplishments during the year. None more impactful than the implementation of Indiana’s “Recovery Works” program which saw ARC enroll persons across our five locations in our first year of involvement. The program, which assists current and former felons without insurance or other third party assistance with payment of treatment services, promoted increased substance abuse treatment services for participants, often at no cost to the client.
ARC continued to engage in the communities in which it serves. Advocacy by agency team members for the needs of persons with substance use issues continued. ARC representatives contributed to the Whitley County Drug Free Indiana, Council for Drug Free LaGrange County, the Elkhart County Re-entry Initiative, and the Elkhart County Drug Free Partnership just to name a few.
In other areas, ARC was awarded a four year certification by the Indiana Office of Court Services (IOCS formerly known as Indiana Judicial Center) as the Alcohol and Drug Program contracted agency for LaGrange County. In that same county, a new Drug Court is being created, of which ARC is participating as well.
Use of our “balanced scorecard” approach to performance measurement and improvement continued. Derived from our 2014 Strategic Plan the “scorecard” sets a five year time frame in which various functional areas of our organization set goals and objectives to attain. It acknowledges the interdependence that each area has in the attainment of our mission and vision, through our identified values. A significant remainder of this report provides selected results for 2016 as well as an assessment of our performance. Given the nearly constant changing environment in our state and local communities, additional improvement steps are outlined as well. First, however, some basic data to provide background for our performance assessment will be given.
Who are we Serving?
Operating five offices across four different counties translates into ARC providing services to diverse populations. Identification of cultural differences and needs as part of the treatment process is critical in offering the best experience to our clients.
In 2016, 77% of clients entering services were male and 23% were female. There were no persons that reported being transgender. A steady trend is appearing since 2011 in which only 16% of participants were female.
Participant race breakdown was as follows: 74% white, 15% black, 8% other, 2% were multi racial and 1% American Indian. Observations regarding race are that those of white race are gradually increasing and the number of African American clients served has risen from 8% in 2014 to 15% in 2016. The number indicating “other” which in large part reflects persons of Latino ethnicity has declined from an average of around 11% to 8% in 2016.
This data is provided as a frame of reference for the performance improvement / outcomes that are analyzed next. The “raw” numbers give an overall indicator the quantity of persons getting services and what services are being utilized.
Outcomes
As referred to prior, ARC developed a Strategic Plan in 2014 that utilized the “balanced scorecard” approach. A summary for each area, objective and the 2016 performance measurement (outcome) is given in the following matrix:
Area: Programming and Services
| Objective | Measure | Targets | Results: 1/1/16 to 12/31/16 | Outcome |
| Reduction: Reduction of use of substances | “Over the past 30 days, how many have you used a mood altering substance?” | 25% reduction from beginning to end | Therapy: Pre survey only 1.49 Days average (69 records). POST = .27 days average (aggregate). Education: PRE = .63 (38 responses); POST= .57. |
Therapy: 82% reported reduction Education: 9% reduction for education programs |
| Symptom Reduction: Number of days gainfully employed | “Over the past 30 days, how many have you been gainfully employed?” | 20% improvement | Therapy: PRE: 25.33 days (117) on average (2,964 total days employed) POST – 27.15 (61) days on average (1,656 total days). (Sample taken includes 2014 -2016 to obtain larger sample). |
7.2 % increase or extrapolated to 213 more days worked over 30 day period for 117 people. |
| Effectiveness: Client perception of effectiveness of counseling services |
Measurement of extent to which client perceives services (curriculum and materials) are relevant and helpful to their recovery | 75% | Therapy: POST- 50 of 68 respondents (74%) indicated “very helpful”; 17 (25%) indicated “somewhat helpful” and 1 (1%) stated “of little help”. Education: POST 41 out of 53 (77%) indicated “very helpful”; 10 (19%) said “somewhat helpful”;1 person indicated “neither” and one person “of little help”. |
Therapy 99% of persons surveyed that materials were very or somewhat helpful to them. Education met and exceeded target as 96% felt materials etc. were very or somewhat helpful. |
| Efficiency:
Client perception of ARC staff’s investment in their sobriety |
Client input stating degree to which staff was invested in their sobriety | 75% | Therapy: 59 of 68 (87%) indicated “agree a lot”; 9 of 68 (13%) said “No”. Education: 47 out of 56 (84%) sampled agreed “a lot”; 5 out of 56 (9%) indicated “no”. |
Therapy exceeded target by 12% Education target exceeded by 9% |
| Efficiency:
Perceived value of services by clients |
Did client feel the money paid for the services received were worth it? | 95% affirmative (clients completing a program) | Therapy: 57 out of 67 (85%) felt it was “worth the money paid” for services. Education: POST – 48 out of 53 (91%) indicated “yes” |
Therapy missed target by 10% Education missed target by 4% |
| Effectiveness:
Client perception of what were the most effective parts of services for them |
Clients are asked on the survey what they felt were the most effective tools. | No target , as this is a monitor of “what is working” for our clients. | Therapy: Group received 52 mentions (78%); 14 indicated Lectures (21%) ; 2 indicated “other” (3%); 4 stated “video” (6%) ; 3 indicated “workshops” (4%).
Education: 53 answered. 44 (83%) mentioned Group Time; 13 (25%) mentioned Lectures ; 6 mentioned “Other” ; 3 (6%) mentioned “Videos”. |
|
Area: Customer Satisfaction
|
Client perception on how they were treated by all ARC staff |
Clients surveyed with question: Were you treated in a professional , courteous, respectful manner by ARC personnel | 95% affirmative (clients completing a program) | Therapy: PRE- 111 or 118 (94%) answered “Yes”, POST- 69 answered, 64 (93%) answered “Yes”. |
End of services missed target by 2%. |
| Successful Discharge from Program | Client Receives successful discharge from given program | Improve rate by 5% year over year 2012 @ 69% | Therapy: 227 Successful and 183 Unsuccessful = 55% Success Rate. Education: (Excluding Level I: 111 of 134 Successful (83%). | Combined, 62% successful discharge |
| Family treatment sessions | Accessibility of family sessions to ARC clients | 100% availability to all clients | “Family night” is continuing in Goshen, Elkhart, South Bend, Columbia City and LaGrange offices | TARGET MET |
| Individualized Treatment | Number of individual or family sessions | 35% of all clients | With the advent of Recovery Works, it is estimated that 26% of therapy clients entered in under that program. Individual sessions are offered at no cost to the client. . | ARC’s overall estimate is that 40% of clients had access to individual sessions in 2016 |
| Accessibility | Persons under 200% of poverty (in therapy) will have opportunity for rate reduction | Ongoing | Hoosier Assurance maintained its funding level in 2016, while LCC grants declined. ARC continued to offer a sliding scale for therapy services at all locations. ARC also began participation in the Recovery Works program which is available at all locations. All combined, it is estimated that financial assistance is available to 75% of lower income individuals at all locations. Elkhart and Goshen is higher, while South Bend clients could benefit by more assistance being offered. . | TARGET CONTINUES TO BE MET |
Business Processes
| Real time information on clientele | Availability of client information in database | 2 days | Continued assessment of this objective indicates that the 2 day target is being met or exceeded. Information from management, counseling staff and support staff validate this. Additionally, with increase in support staff, and revised procedures to have information sent to central office, most client information is in the system within the stated 2 day goal. | TARGET BEING MET |
| Efficient methods for treatment planning and progress | Explore feasibility of implementing electronic record keeping | Ongoing | No progress in this area during 2016 | |
| Marketing | Completion of Website | Functional and available by January 1, 2014 | Website was completed in 2014 and is functional. Issues of maintenance and updates continue however and need to be addressed for 2017 | TARGET MET |
Impact: Our Core Values of Quality, Integrity, Ethics and Compassion
It is evident that ARC is a valued member of each community in which it serves. Outcomes strongly indicate that our programming is viewed by most participants as being of good financial value, highly relevant curriculum (quality), and that staff members at ARC are highly concerned about the well being of it’s participants (compassion). Evidence also shows that clients perceive that they are treated with dignity and respect at a very high rate (integrity).
Particularly noteworthy is the extent to which persons in our longer term outpatient programs feel that ARC staff members are invested in their sobriety- an impressive 87% indicated they agreed “a lot” or “somewhat agree”, while on 13% of the sample indicated “No”.
Impact: Our Mission and Vision
Improved sobriety and higher employment rates demonstrated by our clients provide impact well beyond that of the participant (Improving Community Health). Recall that our sample showed that there was an 82% improvement in the average number of days using a substance over the 30 day period at the beginning and at the end of services. This impacts family members and the community at large. Provision of family services within our Strategy acknowledges the importance of recognizing that addiction’s impact goes far beyond the individual that is suffering.
From a community perspective, if one extrapolates the employment data (sample 117 people) to all outpatient enrollees, one would find that there would be 877 more days of gainful employment from the 30 day period prior to starting compared to the 30 day period prior to completing the program.
In order to impact community health, services must be easily available to those in need of our services. Obviously, proper identification of which individuals can reasonably be assisted within our scope of services is a first step. Establishing that, one then see that ARC has continually made efforts to reduce barriers for those seeking treatment. The most oft identified by all stakeholders are the financial costs to obtaining treatment. As outlined in our performance matrix, ARC continued to contract with the Hoosier Assurance Program, local community grants, and in 2016 the newly implemented Recovery Works program. (Providing accessible services).
Participants input also supported the notion our ability to impact behavior through our program “tools” (effective assistance): a strong majority (78%) of those surveyed indicated that “group time” was by far the most effective part of our counseling services. “Group time” received far more mentions than any other tool that either ARC listed or that the client wrote in.
Additionally, it was highly evident that our curriculum and materials were thought to be “relevant, and helpful” to the recovery of the individual (effective assistance). 75% of those surveyed over all programs indicated that “yes” they did believe this to be the case.
The sum total , and the ultimate reason for implementing outcome based programs at ARC that are performance reviewed is to work towards our mission, through our values with an ultimate vision. Failure to monitor the extent to which these are being attained would make them hollow in meaning.
Looking Forward:
A lot of our targets were met, however many were not attained as well. This gives ARC the impetus to continue moving forward. There are many factors that make the environment challenging (as usual). Political decisions regarding healthcare appear to be forthcoming. Criminal Justice entities continue to seek new and more proven methods in working with their clientele which often extends to treatment agencies. New or different drugs become more prevalent, and the response of substance abuse providers is extremely important.
ARC will navigate these and many other areas. Information from a multitude of stakeholders including local, state and federal guidance and requirements, employees, referral sources and of course our clientele is being processed almost non stop. For 2017, our immediate attention includes:
- How to expand services under financial cost pressures
- Improving facilities and the experience our consumers have.
- Improving the environment or setting inside our facilities, including comfort items for clients and staff, lighting, communication devices and as indicated prior materials that are evidence based.
- Considering how to expand into Medicaid and Healthy Indiana Plan and Insurance-
- Reviewing information management systems for effectiveness
- Maintaining services in a financially sustainable manner
- Seeking new markets and service possibilities in existing and new communities
Clearly, there are many more, however these are some that are on the immediate “radar” so to speak. ARC will continue to adapt and change as necessary to work on attaining our mission.