Hundreds of drug addicts depended on a Tacoma-Pierce County Health Department methadone program last year – many of them in a fight for their lives.
What none of them knew was that the program was in a similar battle.
Two weeks after Christina Abby was hired as the program manager of treatment services, a state auditor stunned her and the health department. The auditor found 25 areas in which the program was in “zero percent compliance.”
The audit was triggered by a complaint submitted to the state about lack of treatment planning at the local methadone program.
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“Plans weren’t done on time, they were late on assessment and individual treatment planning.” said Dennis Malmer, the chief of certification and licensing at the Washington Department of Social and Health Services.
Suddenly, Abby and her colleagues were staring down a deadline.
“At the time I took the job, I didn’t know the program was in trouble,” Abby said. “They found the program had issues — and we had 90 days to improve or face state probation.”
At risk was a treatment program that had been a roadmap out of addiction for thousands of people over the years.
One of those is Raymond Power, a 29-year-old who grew up on the streets, joined a Tacoma gang, was shot at age 17 and addicted to painkillers, then heroin, for years.
“The addiction program gave me a chance. I got to a methadone level where I was comfortable and I’ve gone from there,” Power said. “I got my GED. I enrolled at Bates Technical College. I got a second chance.”
While that audit felt like a nuclear backhand, Abby met with her staff and found they were eager to learn and adjust.
“I saw a passion to improve, not resistance to change. They needed guidance to understand what was expected,” Abby said.
So she asked auditor Mary Testa Smith to return to the health department and, essentially, teach the staff how to correct those 25 areas of deficiency. Smith did.
“She would take a case, show them the issue and how to correct it,” Malmer said.
Abby said her staff of 30, which handles more than 900 addicts a year, embraced the training.
They had to do it — and under the pressure of losing their accreditation. It wasn’t an empty threat.
“Personally, I’ve revoked a number of accreditations in the last six years,” Malmer said. “Generally, agencies score an average of 90-percent compliance. To have zero in that many areas surprised us.”
Part of the problem, Smith believed, was that the program was in administrative transition. Abby was new, hired away from the Washington Corrections Center for Women in Purdy, where she’d been a healthcare manager.
And the staff coordinator, Lori Lienenberger, had been hired only three months before Abby.
“My motto is ‘I’m always up for a challenge.’ Well, I got one,” Lienenberger said. “After our training, every day we came in and asked, ‘What’s the next thing we have to do?’ And we just kept doing it.”
Smith revisited the program after 90 days and found significant improvement. In December, she came back for the full accreditation survey.
“What they found was that in 16 of those 25 areas where we’d had zero compliance, we were at 100-percent compliance,” Abby said. “And none of those areas were lower than 80-percent compliance.”
That got them three years of accreditation, Malmer said, and admiration at the state level.
“Because Christina saw what had happened and was committed to improvement, their improvement was extensive,” Malmer said. “In one area, for instance — patient retention — they went from 78 percent to 91 percent.”
Keeping addicts in treatment is never easy, but it’s a key to success.
“Most of our patients come in on their own, some are referred by a hospital or from jail,” Abby said. “Methadone isn’t a short-term solution. Addiction is addiction, and it’s like trying to quit smoking.
“Sometimes it takes more than one try. The reason we all fought so hard to preserve this program is simple: There’s a need.”