Expanding the treatment mission through technology

Even by the standards of an addiction treatment provider community that has been relatively cautious in embracing information technology, the Valley Hope Association arrived slowly on the path to automation. It was not even 10 years ago that the nationally known treatment organization hired its first programmer, who was just approaching age 20 at the time. No one would have foreseen then that Valley Hope today would be entering a realm few other behavioral health provider organizations have even stopped to consider: marketing its homegrown technology products and services to other provider agencies.

As a nonprofit that has staked its national reputation on treatment grounded in 12-Step principles and emphasizing family involvement and continuing care, the Kansas-based Valley Hope by definition does not see the technology business as an avenue to riches. Rather, its leaders describe the uncommon move as a logical extension of ideals the organization has held since it first leased space on the campus of a Kansas state hospital in 1967.

"We believe our product is good enough to share commercially, and we see this as allowing us to pursue our mission, which is to help addicts wherever we can," says John Leipold, Valley Hope's executive vice-president and chief operating officer.

Now that effort has the potential to extend beyond the seven states where Valley Hope operates its own treatment facilities (Arizona, Colorado, Kansas, Missouri, Nebraska, Oklahoma, and Texas). In its effort to market its technology solutions to other providers, Valley Hope will emphasize that with treatment having become more individualized and with clinical and insurance requirements now more burdensome for staff, sound clinical and administrative technology is essential for maintaining counselor productivity with sufficient caseloads.

"The pressures on productivity are massive today. If you can't keep up, you'll fall by the wayside," Leipold says.

Company Experience

Leipold says he wouldn't describe Valley Hope as embarking on a full-fledged, head-to-head competition with the well-performing software vendors in the behavioral health market. Nevertheless, it is clear that the agency can distinguish itself to a degree from that group because of its firsthand experience in clinical addiction care, which has informed the design of its technology solutions from the start.

When the organization began to consider automating systems in the early 1990s, it essentially was starting from scratch because its only computer support was located in accounts receivable. Because of a relatively limited number of off-the-shelf products at the time, and because Leipold believed the combination of Valley Hope's size and his own background in writing program code made an in-house system design possible, the agency proceeded without an outside vendor. Leipold says Valley Hope staff exhibited surprisingly little resistance to automation at that time, and that openness remained consistent over the years.

"Managers prior to 1992 had done a nice job of hiring decent people who were on a mission to help the chemically dependent. Whatever tools were available to help, they were willing to embrace them," Leipold says. "Also, most other organizations had already started this process, so there was a sense that we were behind the times."

Valley Hope's first foray into technology consisted of a series of stand-alone workstations that were not networked. But even from that small step, changes were immediately noticeable: Managers now could readily compose their own documents, which in turn changed the nature of support staff's work. Eventually Leipold spearheaded an effort to automate patient demographic information, and the makings of a patient database appeared.

About five years into the process, executives realized they needed a more standardized network approach, and began to investigate development tools for working in a Windows environment. At that time Valley Hope hired George Boutwell as a programmer. Today he is the organization's software development manager and supervises four programmers—with a larger staff likely on the way as the agency begins to work on contracts with other treatment providers. But in some ways, Boutwell's job has remained remarkably consistent, as the writing of code continues to be the focus of his job.

"It's really hard to manage a team of people who do something as technical as programming if you don't know how to do it yourself," Boutwell says. In fact, even the organization's information systems director, an MBA-trained manager, has proficiency in programming.

The foundation of Valley Hope's tools for improving its clinicians' performance has been the Electronic Clinical Record (ECR), a consolidated group of applications that among its features allows multiple clinicians at different locations to view a clinical record simultaneously. "The computer provides fundamental change in how we handle clients," Leipold says.

The ECR includes modules for electronic progress notes, treatment plans, admissions assessments, and discharge summaries. For treatment planning, Valley Hope's software allows clinicians to create problem statements and interventions, generate multidisciplinary case conference review forms, and research various intervention options through an online treatment planning library. (A full description of the programs and services Valley Hope is making available to others can be found at https://www.vhaimcss.com.)

On the administrative side, technology has eased Valley Hope's processes in areas such as budgeting, project administration, contract management, and payroll. For example, Leipold says, "We do our time cards electronically. I've written every line of code for that software application." Even Leipold, a corporate executive-level manager, believed it was important to learn technology at this level.

Throughout the in-house development of Valley Hope's software, the technology experts have prioritized collecting key information from those on the front lines of treatment. Clinical supervisors' input has been essential to designing assessment modules and other automated features relevant to the counselor-client relationship. In addition, the clinical staff is given broad leeway to make changes to programs without having to seek the IT department's approval.

"The best clinicians in the organization get to manage clinical content in the software, in a way that leverages their clinical skill," Leipold says.

Boutwell adds, "I work at least once a day with the clinical managers. We've written our software with our users giving us the starting point. We have meetings with them before we work one line of code."

Entering the Business

Technology certainly has altered the provision of treatment at Valley Hope, but how does an organization whose business is treatment then decide to make the jump to offering technology solutions to others? Leipold acknowledges that before the agency considered taking its programs to the marketplace, Valley Hope had pondered other options for diversifying its revenue base.

Chief among these, Leipold says, was the possibility of offering treatment for addictions beyond the confines of alcohol and drugs, such as in gambling or sex addiction. But the organization concluded that it could not reasonably provide all services to all people. What is attractive about working with like-minded substance addiction agencies on technology solutions, Leipold says, is the opportunity to extend the organization's reach on behalf of the alcohol and drug addict.

Yet this is not to say that Valley Hope will work only with treatment agencies that espouse the same treatment philosophy. "There is no political agenda. We don't need to run other people's companies," Leipold insists. Agencies will be able to superimpose Valley Hope's software on their own clinical models, he says.

Valley Hope is calling its technology venture "WinPIMS," and the effort is beginning to attract interest. Bayside Marin, an 18-bed residential treatment facility in San Rafael, California, has decided to implement the Valley Hope software and become one of the initial customers in Valley Hope's new venture.

"We believe that the [clinical] innovations we have created transcend our concerns over the difficulty of deploying commercial software," Leipold says. "Our innovations bring competitive advantages to the software."

John Leipold