The National Association of Addiction Treatment Providers (NAATP) started the official phase of its outcomes research project last month when Institutional Review Board (IRB) approval was granted. And last week, the first patient participants were enrolled in the study.
This Outcomes Pilot Program is significant for NAATP, whose members comprise mainly residential treatment providers, and for the field. As NAATP Executive Director Marvin Ventrell said in announcing the IRB approval last month, “We have not done enough to authenticate our treatment outcomes and our value in general.”
An IRB is a committee that has been designated to approve, monitor and review biomedical and behavioral human subjects research. It protects the rights and welfare of human subjects, and it also ensures fidelity of data, important to the credibility of any study.
“We really do see this as a historic study,” Ventrell told ADAW last week. “The instrument itself is very progressive in its understanding of what treatment and recovery look like — it’s not judgmental or ideological, and it neither undervalues nor overvalues abstinence as a measure.” It’s also significant that NAATP and not individual programs or payers are sponsoring the study. Finally, the study is rigorous, with IRB oversight.
Ventrell said there is some self-doubt in the profession. “They’re asking themselves, ‘Are we doing the right thing? Does this work?’” It’s not that they go to work every day and question the value of their services, he said. “But it’s deeply ingrained in us that we don’t know the answers — it’s not just our ability to articulate what the benefits of treatment are, but it’s our ability to understand it.”
There is no debate within the field that addiction is a chronic, not an acute, disorder, said Ventrell. It needs to be treated on a long-term, chronic basis, he said. “That doesn’t mean that we don’t get stuck in a moment of time,” he said. “If somebody needs detox, that’s acute treatment. You can even say that 28 days is an acute period.”
But what needs to change is the question being asked. “Do people recover after 28 days of care?” is the wrong question, he said. “The question should be, ‘Do people enter lifelong recovery after 28 days of care?’” Even the Big Book of Alcoholics Anonymous is confused on the definition, in one place calling people “recovered,” and in another saying “it’s a never-ending battle,” noted Ventrell. But among NAATP providers there is no confusion: addiction is a chronic disorder requiring long-term attention.
How the study is set up
All nine organizations will use the same data-collection tools, and administer the three surveys in the same way using a common data-collection system. While each provider may be offering different kinds of care — some may offer opioid substitution medication and some may not, for example — those different types of treatment will also be measured.
The NAATP provider model has inpatient treatment in common, with inpatient treatment being measured from the date of intake at 30-day, 90-day, 6-month, 9-month and 1-year follow-ups. Main variations will be in the length of stay, explained Jessica Swan, outcomes manager for NAATP. Some patients will have the option of a longer length of stay, or may be recommended for a longer length of stay, she said. The baseline and the first 30 days will be similar across all nine programs, she said.
NAATP has also secured a Certificate of Confidentiality from the National Institutes of Health for the project, which gives an additional layer of confidentiality to the participating patients/subjects over and above 42 CFR Part 2. “This allows researchers to refuse to disclose names or identifiers,” said Swan. Participants will also receive Target gift cards.
The pilot sites
There are nine NAATP members who are serving as the pilot sites: Addiction Recovery Resources (Metairie, Louisiana), Ashley Addiction Treatment (Havre de Grace, Maryland), Caron Treatment Centers (Wernersville, Pennsylvania), Hazelden Betty Ford Foundation (Center City, Minnesota), Jaywalker Lodge (Carbondale, Colorado), New Directions for Women (Costa Mesa, California), Seabrook House (Bridgeton, New Jersey), Sundown M Ranch (Selah, Washington) and Tully Hill Chemical Dependency Treatment Center (Tully, New York).
The project was first presented at the NAATP annual leadership meeting in 2015, and last fall about 20 sites had expressed interest in participating. NAATP narrowed the number down to 12, said Swan, “and when it came to contract, we got 9.”
Now that the project is under way, many more members want to participate, said Ventrell. “There were organizations who stepped forward and saw the need for this, for the industry,” he said. “These folks have a broader industry view, not just a purely provincial view.” Since the launch, however, many more requests to participate have come in. “Now everybody wants to do this,” he said.
At the annual leadership meeting in Fort Lauderdale, Florida, this spring, a session on the outcomes project prompted some impatience from members, who want the results out as soon as possible (see ADAW, June 6).
Providers will be enrolling participants through the end of 2017. Then the OMNI Institute, an independent research firm, will analyze the data. NAATP hopes to publish the findings in a journal by mid-2018. “We plan to provide periodic reports on our progress, in terms of what’s working, and to provide educational tools for our membership,” said Swan.
“I wish we could get something out sooner, but there’s nothing that’s taking too long about this study,” said Ventrell, noting that he made the outcomes project top priority as soon as he took the helm at NAATP. “What may have taken too long was for the study to be conceptualized,” he said. “But the new NAATP administration had this project operational within six months of our taking over. Our time line was very fast.”
The new NAATP
While NAATP and these centers know that treatment works, because they see it every day, they need to be able to demonstrate this value to the press, public, policymakers and health care industry at large, said Ventrell.
Some providers are worried that the data won’t be good, and criticized NAATP for conducting research that could damage marketing efforts. But this is not a marketing study, said Ventrell. Rather, it is designed to evaluate service, and if the data show there are problems, NAATP and its members want to improve.
This outcomes project is a centerpiece of the “new NAATP,” which is represented by a completely new structure — and by Ventrell. Last spring, the organization released a 30-page strategic plan outlining the organization’s vision for the next three years (see ADAW, May 16). The focus was clearly on ethics, outcomes and accountability.
This focus may not be welcome to some treatment providers who do not want to abide by transparency and ethics rules, and indeed, many of the treatment providers in the country are not members. But the view of the NAATP board and Ventrell is that these providers make a focus on quality even more important, because if profits are put before the welfare of patients, patients will suffer. But so, ultimately, will the industry if it can’t prove that quality pays.
“As the industry evolves and as new players come in, we can’t immediately determine what values an operator is using,” he said. “There are good providers coming in, and there are providers who are only selfishly motivated coming in.” The outcomes study will favor the good providers, he said. “If what you want is an anecdotal marketing study, this is not going to appeal to you. There are folks coming in who are probably not going to be here five years from now. NAATP is playing the long game, which is hard to do if you are losing the short game. But we are confident that this is a long-term process.” The outcomes study will benefit providers “whether you are an altruistic thinker or a long-time capitalist.” It won’t benefit the get-rich-quick providers — and it isn’t supposed to.
“We are interested in driving our industry,” said Swan. “Rather than being reactive to marketing or selfish business practices, we want to drive the health and well-being of the patients we serve.”
For more information, go to https://www.naatp.org/resources/treatment-outcomes-surveys.
The nine providers in NAATP’s outcomes project started enrolling patients last week in what will be the field’s most rigorous study of what works in residential addiction treatment.