ADOM Implementation Project

Presentation

Cutting Edge Conference

6 – 8 September, 2012

Partnerships & Collaboration

Te Pou Research, Information and

Matua Raki

The Ministry of Health contracted Te Pou to lead the ADOM Implementation project. Te Pou and Matua Raki acknowledge the ADOM Advisory Group comprising addiction sector leaders, clinicians and consumer representatives, MOH representation and ADOM co-author Dr Daryle Deering.

Special thanks to the six addiction services who participated

in the ADOM Implementation Project Test Site phase

ADOM Implementation Project

Purpose 1. To develop an information collection protocol, training package and

data collection & reporting system requirements that supports

consistent implementation and collection of ADOM across services

Three draft resources have been developed to achieve this purpose:

• ADOM Guide for Addiction Clinicians – including the ADOM collection form

• ADOM Trainer Resource Manual - aligned to the Guide

• ADOM Training Powerpoint presentation - aligned to the Guide

Feedback from six ADOM test sites is being used to finalise these documents

over the next weeks.

2. To refine „Part B‟ questions - Section 2 questions are currently

being refined – testing for possible improvement in the current

validation scores

Presentation Content 1. About ADOM

2. ADOM collection protocols – how it works

3. ADOM data collection & reporting systems – Test phase demo

4. ADOM Test Site Experience – Midcentral DHB Addictions services –

„Testing the implementation of ADOM in a clinical setting’

5. ADOM Key Points - Summary

ADOM information available at Cutting Edge Conference

• ADOM Implementation Guide - outlines key considerations and

resource implications for services considering voluntary

implementation of ADOM

1. About ADOM

The ADOM (Alcohol and Drug Outcome Measure) consists of three

parts:

• Section 1 – contains eleven questions related to type and

frequency of substance use

• Section 2 – includes seven questions about lifestyle and wellbeing

• Section 3 contains one recovery focused question.

The ADOM is completed in collaboration between the clinician and

tangata whaiora. It is a client rated measure.

About ADOM cont.

Design and intent:

• For use in adult community based outpatient addiction services /

programmes

• Collaborative process – clinician and client/ tangata whaiora

• Provides a snapshot of the tangata whaiora‟s treatment journey

• Demonstrates change over time…….

• It is NOT a clinical tool for assessment/ review

Some benefits of collecting ADOM

• Assists clients/tangata whaiora to review their treatment journey –

changes made over time

• Provides clinicians with a means of reviewing treatment goals with

clients / tangata whaiora and their family and whanau

At a team and service level, outcome information can also add value,

for example it can:

• assist organisations to recognise the impact of service models,

service delivery and interventions

• assist in identifying case complexity through clinically significant

items or index of severity reporting.

ADOM limitations The ADOM is not valid where it cannot be collected in an ongoing

way.

◦ It is most relevant and validated for adult community based outpatient

addiction services which are non-residential in nature.

◦ It is not suitable for very brief interventions, drop in, inpatient and custody

settings……

• It‟s not an audit tool, not designed nor intended for use as a

measure of service or clinician performance.

• It is not designed nor intended for use as a measure of service or

clinician performance

2. ADOM collection protocol The ADOM Guide for Addiction Clinicians provides a comprehensive

guide to using ADOM in a clinical setting. It contains:

◦ Purpose of collecting ADOM

◦ Benefits and limitations of ADOM

◦ Who can collect ADOM – eligible services

◦ Who can complete ADOM – eligible clients/ tangata whaiora

◦ Facilitating completion of the ADOM by the client

◦ Understanding the intent of the ADOM questions

◦ Collection Protocol - when to collect ADOM during treatment journey

◦ ADOM collection form and clinician prompt sheet

◦ ADOM information for clients/ tangata whaiora – handout

◦ FAQ about ADOM – clinical and technical answers to frequently asked

questions

ADOM eligibility criteria

Eligible services – are community based outpatient addiction service

/ programmes – includes OST and after /continuing care programmes

Eligible clients - all clients / tangata whaiora 18 yrs + who are

enrolled with a community based addiction treatment service or

programme

3. ADOM data collection and

reporting systems

One of the most important strategies for successful

implementation of outcome measures is having an ‘easy to use’

‘rapid turn around & feedback’ information systems in place.. (Pirkis

et al., 2005; Fonagy et al., 2005; OHE Commission, 2008; Ministry of Health, 2008)

3 of the 6 ADOM test sites volunteered to trial entering their ADOM

data into a data collection system -

• 2 sites used the test phase option of Recordbase – Wild Bamboo

provided this option free of charge for Te Pou during the test phase

• 1 site (DHB) set up an ADOM data collection system within their

DHB patient management system.

ADOM data - visual interpretation

using ‘feedback wheel’

• Clinicians also tested the use of a „feedback wheel‟ (an excel

graph) - that could be used either manually or printed off from

data entered. This allows clients/ tangata whaiora to view their

data in a meaningful / visual format to see their progress and

change over time while in treatment

• Visual ADOM acknowledgment

• Wild Bamboo supported the ADOM project by developing an ADOM data

collection and reporting system for use in the test site phase. This

included a „feedback wheel‟ showing up to 3 ADOM collection occasions

ADOM data

collection and

feedback wheel

• Collect new ADOM information

• View existing ADOM interviews

• Compare up to 3 interviews using the feedback wheel

• Information can be saved and sent electronically, and is

printable in black and white

Interview 1

Interview 1

and 2

Interviews

1-3

ADOM in Recordbase

Kelsey Doughty

Relationship Manager

07 857 1216

Kelsey@wildbamboo.co.nz

www.wildbamboo.co.nz

4. ADOM Test Site Experience

MidCentral DHB AoD Service

ADOM Test Site Process

• High interest in measures to inform tx model outcomes

• Face validity for consumers – reinforces active

engagement in recovery

• Clinicians felt ADOM emerges easily from existing tx

practices – “pity about the paperwork though”

Train the trainers

• Valuable: rationale, how to, well resourced, evidence

based – no problems

MidCentral test site experience cont

Training Clinicians

• Whole team, scenarios & practice made staff „ready,

willing and able‟

Using the ADOM Form in a clinical setting

• Visual prompt, consumer pamphlet, timing, give client

the wheel

ADOM Data Collection

• Systematise, dedicate time to embed,

• Recordbase or skilled data analyst [PRIMHD]

• Timely feedback – we‟re getting there!

MidCentral experience:

What‟s important for successful implementation??

• Leadership - outcomes champions

• Making outcomes measurement part of quality/everyday clin prac

• IT systems that support front line work – client feedback graph

• Use the information collected – R E S P E C T

• Pacing / phasing of implementation – beware of overload

• Training and education – danger of Form vs Outcome measurement

• National support for trainers through Te Pou

What I learned/ recommend • Understand it, be the joy germ

• Check out the HoNOS for parallel process

• Include your administrator in training

• Act out the process whoa to go/ interview in team tg

• Make it easy e.g. placement, colour

• Check completed form initially –

• Follow-up tg 1x month later

• Input data once a week – generates bring up for staff

• Make 2nd ADOM collection happen – value apparent then

• Staff want this to be therapeutic – timing impt

• Seek consumer feedback

5. ADOM Key Points - Summary

• Services may register for voluntary implementation of ADOM from

September 2012 onwards through Te Pou website or through a link on

Matua Raki web site

This will start the process of preparing for implementation including

access to:

◦ ADOM implementation - information seminars for addiction managers

/ clinical leaders - facilitated by Te Pou and Matua Raki

◦ Technical support in determining addiction service options for

implementing ADOM data collection and reporting systems – Te Pou

Information team

◦ ADOM Train the Trainer workshops for addiction clinicians nominated

by services implementing ADOM – facilitated by Te Pou and Matua Raki

ADOM Key Points – summary cont.

• The ADOM Implementation Guide provides information for

services about the considerations and resource implications of

implementing ADOM

• The Ministry of Health has indicated it intends to mandate ADOM as

part of the PRIMHD national collection within the next few years.

Contacts: Te Pou and Matua Raki websites

Research on ADOM - Te Pou Outcomes Information webpage

THANK YOU