Partnership for Advancing Recovery in Kentucky

Using Technology for Continuing Care: Opening the Cage Door

July 16, 2008By David Mathews, Ph.D.

Will press

lever for drugs!

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Moos & Moos (2007)

• Positive impact on long-term outcomes after treatment through developing or enhancing “protective resources” such as financial resources, better health, and participation in AA.

• Family and social resources were strong predictors of positive outcomes.

• “Maintaining and enhancing individuals’ personal and social resources may contribute more to long-term remission than does treatment oriented toward reducing or eliminating substance use per se.”

New Science About Treatment

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• The majority of those discharged from treatment do not receive the NIDA (1999) recommended 90 days of continuous care (White, in press).

• 80% of individuals who relapse after treatment do so in the first 90 days (Hubbard et al., 2001).

• The majority of substance dependent individuals only achieve stable recovery after 3-4 treatment episodes over multiple years (Anglin et al., 1997; Dennis et al., 2005).

More about Treatment

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• Only 17% of individuals who complete treatment in one level of care successfully access the next recommended level of care (OAS, 2005).

• Linking treatment to recovery supports improves outcomes 20-22% (Dennis, 2007)

• Only 20% of adults and 36% of adolescents receive any professionally-directed post-discharge continuing care. (Godley et al., 2001; McKay, 2001)

Treatment & Recovery

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About Recovery.

• The need for post-treatment check-ups and recovery support services intensifies as problem severity increases and recovery capital decreases (White, 2006)

• Recovery Capital means having access to resources to address situational needs, financial, medical, educational, vocational, etc.

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Recovery Capital – Addiction Severity Matrix

High

Recovery

Capital

High

Problem

Severity/

Complexity

Low

Problem

Severity/

Complexity

Low

Recovery

Capital

Intensive treatment with wraparound

and recovery supports

“Natural Recovery” candidate

Long Term

Customized Care

OP Counseling & Wraparound

Services

(adapted from White, in press)

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Strategies to Support Recovery

Improve the continuity of care

Individuals discharged from intensive levels of addiction treatment should be transferred to outpatient treatment before leaving the treatment system (APA, 1995; ASAM, 2001)

Use a recovery plan (as opposed to a treatment plan) (White & Kurtz, 2006; Scott, Dennis & Foss, 2005)

(Dennis & Scott, 2007)

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Emerging Strategies to Support Long-Term Recovery

Telephone-based continuing care (McKay

et al., 2004)

Recovery Management Checkups (Dennis et al., 2003; Scott et al., 2005)

Assertive Continuing Care (Godley et al., 2004)

Resource Guide access and training for counselors (Carise et al., 2006)

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•PARK AIM: Increase continuation and PARK AIM: Increase continuation and decrease dropouts through a statewide decrease dropouts through a statewide

system of care that embraces system of care that embraces community linkages and collaborative community linkages and collaborative

planning.planning.

Target evidence based Target evidence based categories: categories:

Continuing Care &Wraparound Continuing Care &Wraparound SupportsSupports

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DVD Introduction to Next

Level of Care

Use of TRAIN & Essential Learning

for Training and Tracking

Statewide Video Interest Circles

Targeting Evidence Based

Practices

Regional Video Conferencing for Training & Process

ImprovementUse of

Physicians Portalfor EMR Access &

Internet BasedClient Tracking

Software

Telehealth Network

for Primary and Medical Specialty

Care

Use of HBO Addictions video clips in

treatment groups

In House Video Production

Caney Digital Media

Interactive Video Game

Generation Rx for Prevention

Voicent Auto Reminder Telephone Calls

KTOS Assessments

Using PDAVideo Meetings

between Levels of Care Client & Counselor

Counselor

KRCC & Kentucky Technology Strategies

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Video Introduction to Next Level of Care

• Video created to demystify first visit to outpatient offices

• Video re-shot to better capture desired messages

• Video given to Hospital for units

• Case Managers with portable DVD player

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0%

10%

20%

30%

40%

50%

60%

70%

BaselineOctober

May June July August September

Percentage Substance Abuse Continuing Care from ARH- Hospital to KRCC Outpatient from Dual Units Versus Baseline

Appointments Kept Dual Unit Clients Only

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0% 20% 40% 60% 80% 100%

Baseline

Admit Contact

Admit & Discharge

Daily & Discharge

Daily & Called

Discharge Only

Percent Keeping Follow-up Appointment From Hospital to Outpatient or Residential after initiating Assertive Outreach

Activities to Hospital Showing First Visit Video at Admission, Daily and Admission, and Discharge Only

Percent Keeping Appointment

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Video Handoffs

• Clients at Next Step Recovery Center and Bailey Center Crisis Stabilization Units have video meetings with next level of care counselor

• Clients in the Hospital Have had video handoffs with community counselor- currently discontinued

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Continuation between Next Step and Outpatient Services

• Baseline 30% continuation; Goal 75%

• Change Cycles Used:– Reminder Phone Calls– Video Calls with Counselor– Follow-up Phone Calls– Achieved 80% level follow-ups– Monthly Reports Alerts to Problems

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Resource Guide

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Retained in Treatment after 45 Days

68%

39%

20

40

60

80

Resource Information Given Treatment As Usual

TRIscience

addiction

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Percent Completed Treatment

53%

24%

0%

20%

40%

60%

80%

100%

Completed

Resource Information Given Treatment as Usual

TRIscience

addiction