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SUD System of Care Enhancement Project-Stakeholder Input

Substance Use Disorder System of Care Enhancement Project

Overview
The Vermont Department of Health, Division of Alcohol and Drug Programs (ADAP) recognizes that the need for high-quality services delivered to individuals with or at risk of substance use disorder continues to expand across the entire continuum of prevention, intervention, treatment and recovery. Although the State has a dedicated array of service providers that serve individuals across the continuum of care, there are still gaps in service. Many of these gaps can be attributed to the geographic landscape of the state (large rural areas as well as some larger-population centers) and the existing workforce available in the state to deliver services. In looking at the opportunities for continuous improvement, ADAP has been working on what is known as the Substance Use Disorder System of Care Enhancements Project (Project). ADAP envisions that the work of the Project will support the following high-level goals: Ensure all Vermonters will have access to a core set of evidence-based treatment and recovery services. Design and implement one substance use disorder (SUD) continuum of care, agnostic of substance, that is able to meet individual needs and that is seamless for individuals to access and navigate. Enhance care coordination, including the physical health care system, co-occurring conditions, and recovery services. Develop a value-based payment structure to incentivize a higher quality of care and outcomes for Vermonters. Recruit and retain high-quality staff through competitive wages/benefits and staff development career ladders to ensure capacity across the service continuum. Reduce duplicative efforts on behalf of the client (e.g., multiple assessments, multiple case managers, etc.). Reduce administrative functions performed by the State to enable the State to increase its quality-based activities geared towards improving care for Vermonters. At this time, no specific model for the design, organization and/or provision of services has been pre-determined. ADAP is open to how services are defined, how services are delivered, which providers will deliver the services, how services will be paid for, and how services will be effectively and efficiently coordinated. As a result, some or all of the components mentioned may change in whole or in part from the system in place today. ADAP is providing this survey as an additional format and opportunity for stakeholders to provide feedback to the Project team, with a specific focus on the themes identified in the recent Request for Information (RFI) responses.
1. Please provide the general category that best describes your role in the current substance use disorder system of care. Please check all that apply. *This question is required.
As a part of the stakeholder input described above, ADAP identified overarching themes from the stakeholders, which informed the development of the Request for Information (RFI). These themes included the following: One size does not fit all – services need to meet the need of the individual, Ensure coordination of services/ “breakdown silos”, Access to the continuum of services is not the same statewide, Continue to build on existing community relationships and linkages, Existing workforce is aging, Recruitment and retention of staff is challenging and system must address this issue, Need to move beyond the fee-for-service model, Blending funding can be challenging, Reporting with a focus on outcomes, quality measures, must meet federal requirements, Reduce administrative burden to increase focus on quality oversite, More focus needed on co-occurring conditions, Integration with mental health system, Integration with physical healthcare system, Need to include social determinants of health (e.g., housing, access to transportation), Need to make it easier to access services (e.g., co-location, “no wrong door”), Need to make it easier for the individual to navigate the system, The full continuum of services needs to be included (intervention, treatment, and recovery), Need to include health equity and cultural competence lens, Ensure minimum standards for training/skill of staff, quality of care.
The Request for Information (RFI), developed based on the goals of the project and the stakeholder input summarized above, was posted on February 26th, 2021 and 13 responses were received and reviewed by a team from ADAP and the Department of Mental Health. The team identified key themes and opportunities identified in the RFI responses. The themes identified from the RFI responses were sorted into 4 categories: Overarching themes, Experience of the Client, Workforce and Administration. Overall the RFI responses were validating and affirming that there are a lot of strengths in our system and opportunities to make enhancements and improvements. The responses identified that there are models/examples we could look to and demonstrated agreement that enhancements are needed. Respondents identified room for improvement in coordination and collaboration and were in agreement that co-occurring care is an important focus.
2. How would you prioritize the themes identified in the area of the experience of the client? 1 = highest priority 7 = lowest priority Note: for the following table each column is restricted to a single answer across all rows.
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4. How would you prioritize the themes identified in the area of workforce? 1 = highest priority 4 = lowest priority Note: for the following table each column is restricted to a single answer across all rows.
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6. How would you prioritize the themes identified in the area of administration? 1 = highest priority 5 = lowest priority Note: for the following table each column is restricted to a single answer across all rows.
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