Alcohol & Drug Abuse Programs and 2 more...less...

Substance Use Disorder Treatment Services


Treatment Initiation: Are youth and adults who need help starting treatment? Measured as percent of adolescent and adult Medicaid recipients with a new episode of alcohol or other drug dependence who initiate treatment through an inpatient alcohol or drug admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis.


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Story Behind the Curve

Last Updated: February 2020. Author: Alcohol & Drug Abuse Programs, Vermont Department of Health

People may be identified as potentially needing substance abuse treatment in many different places such as primary care practices substance use disorder treatment providers, hospitals, emergency departments, and mental health practitioners.

The wide variety of places where substance use disorders are identified highlight the importance of coordinating care for those who may need help.

When an individual is identified by a provider as needing treatment for a substance use disorder (addiction), it can be difficult to get the individual to seek treatment. This may be due to a variety of perceived roadblocks such as the time it takes to access treatment, lack of transportation, inability to find childcare, etc. The most frequently cited reason for individuals not initiating treatment is the belief of the lack of a problem so treatment is perceived as unnecessary. Like other chronic diseases such as diabetes or heart disease, the sooner an individual seeks treatment, the more likely the person is to recover. Individuals with substance use disorders need to know where to get help (access), initiate treatment, and stay in treatment for long enough to recover (engagement). Providers can help by offering screening in their offices and talking with patients about substance use.

  • Primary Care Practices
  • Hospital emergency departments and inpatient programs
  • Medicaid beneficiaries and families
  • Community Providers – such as Licensed Alcohol & Drug Counselors (LADCs) and mental health practitioners
  • ADAP Preferred Providers
  • Recovery Centers
  • AHS Departments (Department of Vermont Health Access, Vermont Department of Health Division of Alcohol and Drug Abuse Programs, Department Children and Family, Department of Corrections, Department of Disability, Aging and Independent Living, Department of Mental Health)

What Works

The following list highlights some of the strategies and best practices to improve initiation and engagement of alcohol and other drug treatment in clinical and community settings

  • Strengthen the substance use disorder referral and evaluation systems at the community-level
  • Increase the capacity to treat all substance use disorders in the community
  • Continue expansion of the Rapid Access to Medication Assisted Treatment (RAM) initiative statewide
  • Strengthen partnerships between healthcare and recovery support services, such as the Recovery Coaches in Emergency Departments initiative
  • Build relationships to improve communication and collaboration around referrals
  • Strengthen peer support services and build connections for individuals to access those services
  • Development of workforce with training in alcohol and drug abuse through partnerships with local colleges and universities
  • Establish policies and procedures to assess and treat all clients at risk for or experiencing a substance use disorder that incorporate principles of harm reduction and the social determinants of health
  • Establish and integrate principles of harm reduction and the social determinants of health into all new and existing programs that address substance use across the system (e.g., needle exchange programs, naloxone overdose prevention programs)
Action Plan

ADAP, DVHA, and the Blueprint for Health are collaborating on a performance improvement project (PIP) to address the treatment initiation and engagement performance measures. This process involves community level internal and external stakeholders. A PIP is a concentrated effort on a particular issue; it involves gathering information systematically to clarify issues or problems and intervening for improvements.

This group has compiled evidence-based strategies and best practices to improve initiation and engagement of alcohol and other drug treatment in clinical and community settings. Existing Blueprint community health teams and AHS District Office leadership are leading community stakeholders to implement the strategies that meet the needs of the region.

Notes on Methodology

These rates are based on the Healthcare Effectiveness Data and Information Set (HEDIS) Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) access to care measure. Substance induced mental disorders were not included. The rates exclude beneficiaries with Medicare or other medical insurance due to incomplete Medicaid claims history.

In Vermont Medicaid, medication assisted treatment (MAT) is currently billed as one unit per month. The HEDIS IET specification looks for one service within 14 days of index event to count as initiation and two services within 30 days of initiation for engagement. An adjustment to the IET rate was used to count the multiple visits each week occurring at the MAT opioid treatment programs. Also, VT billing codes for behavioral health residential treatment do not match the IET measure, but for this measure are counted as sub-acute facility visits.

Initiation is the % of Medicaid beneficiaries diagnosed with alcohol and other drug (AOD) dependence who start treatment through an inpatient AOD admission or an outpatient service for AOD abuse or dependence within 14 days.

Please note that treatment services are offered through Community Health Teams and Spoke Staff that may not be reflected in these numbers because the funding mechanism for these teams does not require the generation of a service claim. Since the measure is based on Medicaid claims data, the numbers likely under-represent the rates of initiation and engagement in treatment.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy