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Addiction Research and Treatment Corporation

Developing and Implementing Patient Advisory Committees in Opioid Dependency

Maintenance Programs

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Presented by:

Robert E. Sage, Ph.D., CASAC

Monica A. Joseph, CSW, M.Phil.

Ralph E. Savarese, M.Ed.

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The Role of Management

in Establishing and Sustaining a

Patient Advisory Committee

Robert E. Sage, Ph.D.Senior Vice PresidentAddiction Research and Treatment Corporation

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Addiction Research & Treatment Corporation (ARTC)

Beny J. Primm, Executive Director

Established in 1969

Seven (7) Opioid Treatment Programs

Manhattan and Brooklyn

3,000 patients/ 95% minority

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ARTC

Three (3) Outpatient Drug Free Programs

Research, Evaluation and Continuous Quality Improvement

CARF Accredited

Comprehensive Care

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Rationale for Establishing a

Patient Advisory Committee

(PAC)

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Identifying the unmet needs of the agency

:Perception of opioid treatment

Perception of program in the community

Building staff-patient alliances

Obtaining patient feed-back

Patient recruitment and retention

Creating a clinic community

Enhancing accreditation outcomes

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Identifying Unmet Needs of Patients

Alternative ways to enhance treatment

Patient input in program policy

(clinic policy vs regulations/ standards

Enhancing initial patient integration and socialization within the program

Outlet for complaints and suggestions

Leadership potential

Pre-vocational activities

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Identifying and Meeting

Your Patient Advisory

Committee (PAC)

Objectives

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Developing Pride in the Treatment Modality

PAC members become mentors

PAC presents positive image to staff and other patients

Patients oriented towards treatment

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Enhancing Program Image in the Community

PAC leaders become spokespersons

Community projects and events

Representatives of the program

Encourage feedback from the community

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Developing Patient Leaders

Organizing and maintaining a component

Developing and organizing clinic activities

Mentors or “buddies” to new patients

Working within a component

Encouraging patients to become “part of the solution”

Enhancing treatment progress

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Enhancing Patient Feedback and Input

Presenting ideas to administration and staff

Assisting with patient complaints/ feedback

Administering Satisfaction Surveys

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Initiating a

Patient Advisory Committee

(PAC) Component

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Support from Executive Staff

Commitment to addressing needs

Perceiving PAC as a positive strategy

Commitment to outcomes

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Support from Program Managers and

Staff

Addressing and reducing concernsIdentifying positive aspectsDeveloping a unified missionAddressing workload issuesBuilding the staff into the process

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Selecting a PAC Coordinator

Central Office

Program Specific

One site vs Multi-Site

Clinical Staff Investment

in Developing and Implementing

Patient Advisory Committees

Monica A. Joseph, CSW, M.Phil.

Vice President of Treatment Services, Addiction Research and Treatment Corporation

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Patient Advisory Committee

(PAC) Development

as a Social Process

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Agency Culture

Each agency has culture of its own, i.e. accepted norms, values (Glisson, 2000), ways of doing

Established by management, but staff must support

Dynamic as agency as a whole must respond to the internal and external environment for survival

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Agency Culture

Individual staff must also grow/ respond for survival

Not all staff equally responsive

Majority will not buy into the value of new initiatives until they see that others are okay with and already participating

Initiatives such as PAC must thus be spread through a social process

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Social Process

Social Process called Diffusion

Diffusion Theory (Rogers, 1995) similar to Social Learning (Bandura, 1977)

Stresses that persons adapt observed behaviors through modeling

Diffusion, however, focuses on the outcome, i.e.

What will staff adopt or reject

What role will staff’s social networks play

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Importance of Clinical StaffMust get clinical staff (supervisors, direct practitioners, medical and non-medical staff, etc.) involved and invested:

Constitute the treatment team Have the most contact with patients (especially direct practitioners)Are in the best position to influence the choices that patients makeAre integral to bridging the gap between patient and programmatic activities

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Facilitating the

Diffusion Process

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Cultivating the Critical Mass

Management must focus on getting a core group of staff to buy into/ adopt the idea of PAC and the underlying philosophy

Psycho-graphic profile of the staff can impact, i.e. the combination of their psychological and social/demographic characteristics (Moore, 1991), which can influence their willingness to invest

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Stages of Diffusion

Must be mindful that staff buy-in will occur in stages:

(i) Early Adoption

(ii) Middle Adoption

(iii) Late Adoption

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Targeting Staff

Must also be mindful based on assessment of staff who will be more likely to be the:

(i) Innovative Staff(ii) Early Adopting Staff(iii) Early Majority Adopting Staff(iv) Late Majority Adopting Staff(v) Laggards (Moore, 1991)

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Early Adoption Strategies Goal:

To get to the critical mass of

staff, who will in turn, encourage

patients and other staff to buy-in to

PAC

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Early Adoption StrategiesStep 1: Senior management must champion PAC sending a meta-communication that staff needs to get on board

Step 2: Select and target Innovative Staff, potential Early Adopters, i.e. supervisors, counselors, etc.

Must demonstrate energy, effective interpersonal skillsMust be willing to act as leaders

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Early Adoption Strategies

Send a clear and direct message to the core group about the value of PACGet group to begin to sell PAC to other staff and patients

PAC Coordinator can act as leader

Create climate for staff to demonstrate creativity, e.g. by allow some flexibility with PAC agendas and activities

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Incentives

Make participation attractive by using tangible and intangible incentives, e.g.:

Reductions in staff workload (even if minimal, can still be effective)Opportunities for staff and patients to share their success with othersTransportation assistanceRefreshment Good old praise

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Remember!

More productive to depend on a smaller core group of motivated staff

Ultimately they hold more influence and can establish stronger critical mass

Once reach critical mass, initial development has taken root

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Middle Adoption Strategies

Goal:

To expand the circle of staff and patients

who are involved and invested in the PAC

implementation and integration process

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Expanding staff investment

Target staff who have the potential to become Early Majority and Late Majority Adopters

Early Majority persons want to know that PAC is working before they buy into them

Late Majority Adopters will get on the PAC bandwagon only when they have to

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InteractivityUtilize critical mass (innovators, early adopters) to influence other staff by creating opportunities for staff interactivity

Interactivity is the degree to which staff in a communication process can exchange roles in, and manage their interaction (Williams, Rice, & Rogers, 1988)

Allows staff to begin to process: (i) How can contribute to PAC; (ii) How can adapt the roles to make easier on selves

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InteractivityFacilitates peer to peer feedback as it allows staff to develop a better understanding of what PAC is, what is positive and what is not positive

More benefits perceived, the greater the likelihood that staff will be convinced to adopt

Allows negative feedback to be dealt with appropriately by the Innovators and Early Adopters (critical mass) as they are already invested

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InteractivityFacilitate interactivity between managerial staff and clinical staff

Management’s role is to continue to shape staff’s perceptions of PAC by indicating that:

This continues to be desirable Its implementation is inevitableA core group of staff/patients (the critical mass) have already bought in to the process

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Patient Benefits

Crucial for staff to connect PAC’s benefits to patients

Disseminate the responsibility for interacting with patients about PAC to as many staff as possible

Facilitate by integrating PAC as a treatment tool

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Patient Benefits

Integrate PAC into the treatment process: Discuss with patients during intake, orientation

Include as part of the strategies for attaining and maintaining abstinence on the treatment plan

Utilize as a natural support system for ongoing case management

Encourage patients who have completed treatment to continue to participate

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Late Adoption Strategies

Goal:

To continue to expand and

strengthen clinical staff’s support for

the viability of the PACs

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Dealing with the LaggardsStill need to deal with clinical staff who are Late Adopters, Laggards

Simply don’t want to be part of the process

Can impact the momentum and cause earlier gains to be lost

Only way would become involved is if have no choice

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Dealing with the Laggards

Integrating PAC as part of treatment planning helps to ensure that these staff make some kind of contribution

Managers must be alert for non-productive messages sent by staff in these groups

Counter these with ongoing interactivity and keeping a high profile for PAC

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Dealing with the Laggards

Use information dissemination, regular updates on PAC progress, i.e. posting bulletins, circulating brochures, etc. to keep the message upfront

PAC must encounter problems with patients, consensus, etc. Address these

Engage both staff and patients in the problem solving process

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Demonstrate PAC is Working

Let patients assume an increasingly dominant role to demonstrate that the underlying philosophy is working, i.e.

That patients have the capacity to contribute meaningfully to their own treatment

That patients can provide valuable feedback to improve the organization

That patients can enhance their civic environment

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Summary

Developing, implementing and integrating PAC is a social process

Diffusion principles provide a framework to facilitate staff adoption of PAC

Getting a critical mass can provide the momentum to integrate PAC across the treatment process

Having a PAC Coordinator can guide and nurture the process

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Role of a PAC Coordinator in

Mobilizing and Sustaining

Patient Advisory Committees

Ralph E. Savarese, M. Ed.Director of Training Addiction Research andTreatment Corporation

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Getting Started

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Building the FoundationSetting the stage:

Support from Senior Vice PresidentSenior Staff LiaisonClinic Staff Liaison

Effective communication

Obtaining cooperation and collaboration for patient selection

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Early ImplementationIdentifying specific themes and agendas

Developing Meeting Protocol and Bye-Laws

Ensuring democracy (elections)

Dealing with power issue

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Making it Work

Integrating the clinic components:

Clinical

Recreational

Cultural

Advocacy

Fund Raising

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PAC Responsibilities

Finding a programmatic niche:

Orientation/ Mentoring

Patient Satisfaction Surveys

Patient Spokesperson to Staff/ Program

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Maintaining a High Program Profile

Information DisseminationDedicated Bulletin Boards NewslettersOrientation ParticipationOnsite patient celebrations, eventsCommunity InvolvementIntegrating into Treatment Plan (productive activity, relapse prevention mechanism)

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Growing Pains

Agenda problems

Misconceptions of rules, functions, roles and responsibilities

Patient burnout

Staff burnout

Power vacuums (patient death, illness, separation from program)

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Addressing Problems

Redefining roles:Clinical DirectorStaff Liaisons/ Staff changes Patients

Elections

Increased patient interaction/ support

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Current Status

Number of PACs

Membership

Activities/ projects

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Future Pursuits

Corporate PAC

Increased funding

New projects/ activites

Increased membership

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Summary

PAC Coordinator serves role of bringing various components together

Instrumental in recruitment, keeping patients focused

Troubleshooter for emerging problems

Anticipates needs of specific sites

Serves as morale booster for patients

Provides timely feedback to management

Reinforces the mission of the agency

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Bibliography

Bandura, A. (1977). General theory: Social Learning Theory. Englewood Cliffs, NJ: Prentice-Hall.

Glisson, C. (2000). Organizational climate and culture. Handbook of Social Welfare Management. D. R.J. Patti. CA: Sage Publications, Inc.

Moore, G. (1991). Crossing the chasm. NY: Harper Row.

Rogers, E. (1995). Diffusion of Innovations. NY: The Free Press.

Williams, F., Rice, R. & E. Rogers (1988). Research Methods and the New Media, New York: The Free Press.