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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!
1/21/082Partnership for Advancing Recovery in Kentucky
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
1/21/083Partnership for Advancing Recovery in Kentucky
• 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
1/21/084Partnership for Advancing Recovery in Kentucky
• 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
1/21/085Partnership for Advancing Recovery in Kentucky
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.
1/21/086Partnership for Advancing Recovery in Kentucky
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)
1/21/087Partnership for Advancing Recovery in Kentucky
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)
1/21/088Partnership for Advancing Recovery in Kentucky
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)
1/21/089Partnership for Advancing Recovery in Kentucky
•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
1/21/0810Partnership for Advancing Recovery in Kentucky
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
1/21/0811Partnership for Advancing Recovery in Kentucky
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
1/21/0812Partnership for Advancing Recovery in Kentucky
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
1/21/0813Partnership for Advancing Recovery in Kentucky
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
1/21/0814Partnership for Advancing Recovery in Kentucky
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
1/21/0815Partnership for Advancing Recovery in Kentucky
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
1/21/0817Partnership for Advancing Recovery in Kentucky
Retained in Treatment after 45 Days
68%
39%
20
40
60
80
Resource Information Given Treatment As Usual
TRIscience
addiction