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Just for this edition of TIPS and TOPICS, we've added a new "S" category that will substitute this month for the SKILLS section. I think you will enjoy a couple of comments from two readers. In the first, I know Bonnie Malek from Oregon is very supportive of 12 Step programs, so take this in the light-hearted manner it was intended. In the second comment, Bill Garrett from Alabama shares some humorous thoughts on what might be the real purpose of documentation (who would have thought documentation had anything to do with flies?)

Hi David:
It's been a LONG time since we've been in contact and this issue inspired me to touch base. I thought you might get a kick out of the 12 Steps of Evidence Based Practice. Feel free to share it if you're so inclined.


1. We admitted we were powerless over *Senate Bill 267 and that our information technology (IT) needs had become unmanageable.

2. Came to believe that the right set of manuals could restore us to pre-morbid functioning.

3. Made a decision to turn our program development and training resources over to the Substance Abuse and Mental Health Services Administration (SAMHSA) before we understood why.

4. Took the inventories of everyone that voted for this bill (and in some cases their mothers and their dogs).

5. Admitted to the Office of Mental Health and Addiction Services (OMHAS) and the Oregon legislature that for the past 70 years, we've been running on sweat equity, imagination and rubber bands.

5. Admitted to the Office of Mental Health and Addiction Services (OMHAS) and the Oregon legislature that for the past 70 years, we've been running on sweat equity, imagination and rubber bands.

6. Grudgingly agreed to do some reading and to keep an open mind.

7. Swore all the way to the dumpster with our favorite handouts and films.

8. Made a list of all the practices that made sense to us and became willing to check at least some of them out.

9. Agreed to learn one new thing this year as long as it didn't add to our caseloads or paperwork.

10. Continued to work on doing the impossible with no new resources and dreamed of deleting databases when no one was looking.

11. Sought through outcomes data and specific serotonin reuptake inhibitors (SSRIs) medication to improve our conscious contact with the legislature, praying only to prove that treatment works and we're truly not sleeping at our desks.

12. Having had a rude awakening as the result of these steps, we vowed to share our retention data with programs that were still pre-contemplative and to practice fidelity in all of our affairs.

By Bonnie Malek, MS, QMHP III, CDS III
E-mail :

* Overview of Oregon Senate Bill 267

The 2003 Legislature passed ORS 182.525 (Senate Bill 267). This bill requires that increasing amounts of Oregon state funds be focused on Evidence-Based Practices (EBP). For 2005-07, the statute requires that at least 25 percent of state funds used to treat people with substance abuse problems who have a propensity to commit crimes be used for the provision of Evidence-Based Practices. The statute also requires that 25 percent of state fund be used to treat people with mental illness who use or have a propensity to use emergency mental health services. In 2007-09, the percentage of funds to be spent on EBPs increases to 50 percent and in 2009-2011 to 75 percent.

The shift to the delivery of services based on scientific evidence of effectiveness is a major shift for both the mental health and addiction treatment systems. This shift includes a focus on lifelong recovery for person with mental illness as well as those with substance abuse disorders.

As part of an effort to meet requirements outlined in ORS 182.525 (Senate Bill 267) from the 2003 Legislative Session, the Office of Mental Health and Addiction Services (OMHAS) developed an operational definition of evidence-based practices. The definition was developed with broad community input before being officially adopted by the office. shtml


Dr. Mee-Lee:
Your September '07 Tips & Topics focus on rote documentation to please the overseers was dead on. The issue to me seems to be to look at the purpose of any particular paperwork and how is it facilitating patient care. Often in site visits I'll come upon a form or some other sort of spurious documentation and ask "What's it for" and be told, "Don't know. On our last survey they said to do it so we just do it and they don't bother us about that anymore." I started calling this superstitious documentation.

Once on a bike ride I noticed some baggies of water stapled to the rafters of a porch at a rural store. I was staring up at them and the owner came out and I asked, "What are those for?" He replied, "Keeps the flies away." I asked how. He responded: "We don't know, but it works." "Earl has some at his BBQ and they don't never get pestered by 'em, so we put 'em up."

I think putting up baggies of water is what many of us as treatment providers are doing in our documentation in order to keep the flies away, or in our case, not be pestered by surveyors. Hanging baggies of water and filling out meaningless forms both seem to qualify as superstitious behaviors. Then again, maybe not as they are both effective in keeping the flies away.

Bill Garrett, MPH
Shoals Treatment Center
Muscle Shoals, Alabama


I was listening to a report about the Tokyo Auto Show and some of the concept cars Honda, Nissan and others were showing. Nissan featured a car with a little robot on the dashboard which speaks to you and keeps you company. Apparently, people have fewer accidents and are less likely to fall asleep or have other tragic mishaps. The robot uses several video cameras checking the driver's eyes, head movements, body posture etc. to employ "mood recognition technology". The robot processes this data and "senses" whether you are falling asleep at the wheel; or are building up to "road rage" or some other potentially dangerous mood.

I guess this is not all that ridiculous. I just started using one of those Global Positioning System (GPS) gadgets in the car. It calculates and plots out every turn to get you to your destination; and "holds your hand" all the way until you arrive safely. It not only anticipates and alerts you to every turn of the way, but lovingly, without scolding you, adjusts if you make a wrong turn and gets you back on track. None of "I told you so"; or "You just don't listen"; or "Dummy, what do you think you are doing?". No wonder the guy in the funny car rental TV ads tries to date and hook up with the "women" in the GPS dashboard gadget. He is just so impressed with how she is consistently there to guide his every step, calmly speaking to him at every turn.

Perhaps it is a sorry commentary on our lives that we could relate to talking robots and machines even better than to a talking real live human being. But then again, it would really be nice to get a real live person to answer the phone sometimes, especially if an intoxicated and/or psychotic person calls to try to get some help. That "your call is very important to us" message doesn't seem very inviting or genuine.

I don't know what right balance of technology and human contact is best. I would rather use an ATM to deposit and get money than stand in line to complete my transaction with a live bank teller. But then it is really frustrating to have to go through ten voice mail prompts in order to talk to a real person. As I said, I don't know what the right balance is and I don't have time to ponder that any more deeply now---I've got to go and check my voice mail and e-mail.


One more time ---
If you want or need ten hours of continuing education credit, and a permanent inservice DVD training and new staff orientation on the ASAM Patient Placement Criteria, check out the latest offering from Hazelden in their Clinical Innovators Series.

"Applying ASAM Placement Criteria" DVD and 104 page Manual with more detail based on the DVD with Continuing Education test (10 CE hrs), 75 minute DVD
David Mee-Lee (DVD) and Kathyleen M. Tomlin (DVD manual)

Don't miss out. Check it out.

Click here for the Hazelden DVD





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