The best time to plant a tree...

December 18, 2013

Kim Johnson, MSEd, MBA
Deputy Director, NIATx
Co-Director, ATTC Network Coordinating Office

“May you live in interesting times” has been described as a Chinese curse, but when I looked it up, I discovered it was really originated in America. So much for my awesome introduction about the curse of interesting times.

We are living in interesting times when it comes to health care delivery in the U.S. Whether it’s a curse or a blessing depends on your perspective, so maybe I can pull in another Chinese concept: yin/yang. Or maybe I should just stick with the American version of a silver lining to every cloud. Interesting times are when innovators thrive and when people who have even a little bit of vision and energy can turn a new idea into a successful business venture. Just look at the iPod. A failing business creates a new device and suddenly it becomes not a failing business but an industry leader. Another new device later, and it has a market value bigger than any other company in the country. Ah, only in America!

Apple might have quietly sunk into oblivion. With a market share of 3-4% before the iPod came out, it was pretty much irrelevant that they made great computers. So Apple innovated and came up with a solution to a problem no one recognized they had. Instead of sitting around wondering why no one bought their great product, they created a new product that not only built an amazing new business, but also wound up creating a new market of buyers for their old product. The interesting times that they were living in (the ability to pack tons of memory into a tiny device, cloud computing that allowed for the creating of itunes) provided an opportunity that only they took advantage of.


You know where I’m going with this, right?  The old funding mechanisms for treatment are going away. They aren’t gone yet, but the new funding mechanisms are in place now and the most innovative people in our field are already starting to exploit them. Time is running out for the rest of us to come up with our version of the iPod that maybe will become the only thing that we sell, but may also be the thing that drives people to buy the great services we produce now. Because let’s face it. Even if you have a waiting list, it’s not like people are lined up at your door to pay for what you have to offer. Sometimes you can give it away, but even when it’s free, a lot of people say, “No thanks.”


How do you become innovative? You need to take some time to focus. Sometimes you wake up from a dream and say “Eureka!”—but mostly people create new products and services by spending some time looking at market forces, talking to customers, and if you aren’t or haven’t been a customer of the services you offer, imagining what it would be like to be one and what you would want if you were that customer. What would the magic pill do, and is there a way to do that without the magic pill?

So, here is the commercial part of my blog (we are in America, after all). If you’re reading this, you obviously care about treatment improvement. Improving treatment includes improving the business as well as the clinical operations of your agency. It means designing new ways to improve care via new services, new delivery models, and new partnerships. A SAMHSA-funded training opportunity provides the structure and resources that allow you to achieve this, while doing some serious thinking about the future of your organization. It’s called BH Business: Mastering Essential Business Operations. All you need to bring to it is your time and energy, everything else is provided for you.


To quote another probably fake Chinese proverb: “The best time to plant a tree was twenty years ago.” The second best is now.

Kimberly Johnson served for seven years as the director of the Office of Substance Abuse in Maine. She has also served as an executive director for a treatment agency, managed intervention and prevention programs, and has worked as a child and family therapist. She joined NIATx in 2007 to lead the ACTION Campaign, a national initiative to increase access to and retention in treatment. She is currently involved in projects with the ATTC Network and NIATx that focus on increasing implementation of evidence-based practices, testing mobile health applications, and developing distance learning programs for behavioral health professionals.

Integration: The Great Debate

December 6, 2013 

Kimberly Johnson, MS Ed, MBA
Deputy Director, NIATx
Co-Director, ATTC Network Coordinating Office

 

If there's one thing that we seem to be constantly fussing about in addiction treatment, it’s integration.

When I first started in the field, we were still resisting the integration of alcohol and drug abuse treatment. Younger people may be saying “What? That seems silly!”  But it was a big debate at the time. The drug treatment people felt they would be taken over by the bigger, more established alcohol treatment system, and the alcohol treatment system wasn’t sure it wanted to deal with the drug problem.

When I was a student, we kicked people out of treatment for having co-occurring disorders. I think the rationale was that these clients were too sick to focus on their addiction, or something like that. I know I never graduated a single client during my internship because I kept learning they had mental health problems. Toward the end, I started wishing they would be less open with me.

So, when I became the executive director of a treatment agency in the mid-1990s, I was very enthusiastic about trying to figure out how to integrate mental health and substance abuse services for people with co-occurring disorders. It was a big debate because the addiction treatment people were worried about being taken over by the big mental health centers, and the mental health people weren’t sure they wanted to deal with addicts.

Remember what I said earlier about integrating alcohol treatment with other drug treatment?

It was déjà vu all over again.

Now, we’re talking about integrating behavioral health (even though we are still fighting about that term) into primary care. It’s a big debate because the behavioral health providers are worried about being taken over by the big primary care systems, and the primary care systems don’t really want to deal with people with behavioral health disorders.

Maybe I’m just getting old…but I think there’s a pattern here.

What’s funny (or sad, depending on your perspective) is that in many ways alcohol and drug treatment really do remain separate; psychiatric disorders other than substance use disorders are still treated really differently; and very few of us understand the interaction between mind and body at even an elementary level.

But we have to keep trying. And I suppose we have to keep debating, not about whether to do it, but about the best way to do it. We have to debate, we have to experiment, and we have to keep trying to figure out the best ways to integrate, because we still don’t really know.
 
During the next year, The Bridge, the ATTC Network's quarterly e-journal, will be devoted to the topic of integration in healthcare. The discussion starts with the next issue. If you haven’t yet subscribed to The Bridge, please do. We will review the literature, debate what it tells us, and propose next steps based on where our research and discussion leads us. Join us in this debate. It will be fun.
 

I’m trying to imagine what the next big integration debate will be. I’m too blinded by the current controversy to think too far ahead, but maybe you have some ideas.

The SAMHSA-HRSA Center for Integrated Health Solutions  (CIHS) offers a wealth of resources and information dedicated to healthcare integration. (And the images in this post are from the CIHS website--check out their excellent infographic on the benefits of integrated care.)

Kimberly Johnson served for seven years as the director of the Office of Substance Abuse in Maine. She has also served as an executive director for a treatment agency, managed intervention and prevention programs, and has worked as a child and family therapist. She joined NIATx in 2007 to lead the ACTION Campaign, a national initiative to increase access to and retention in treatment. She is currently involved in projects with the ATTC Network and NIATx that focus on increasing implementation of evidence-based practices, testing mobile health applications, and developing distance learning programs for behavioral health professionals.