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EXCLUSIVE: Promising abstinence outcomes in first year of CRC continuing-care initiative

July 29, 2014
by Gary A. Enos, Editor
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Early returns from a continuing-care initiative that CRC Health Group launched at its Sierra Tucson center around a year ago indicate that the for-profit addiction treatment chain may be shattering some myths about post-treatment support. CRC is attempting to demonstrate that it is not only professional groups such as physicians and pilots who have the incentive to follow through on continuing-care plans and achieve long-term recovery, and it is doing that by taking the uncommon step of having another entity coordinate its one-year post-treatment monitoring activity.

“In Minnesota we had worked with the Northwest Airlines pilots program, and we thought, 'Why can't we make this kind of assistance more widely available?'” says Jaclyn Wainwright, program director at Assistance in Recovery, Inc. (AIR), which provides the master's-level case management staff for the program branded as CRC's Connections initiative. “Every [patient] has something that they're not willing to lose,” which when supplemented with the proper support should give them the motivation to make recovery-affirming decisions in the months following primary treatment.

One obstacle that CRC and other treatment organizations might have trouble overcoming, however, is the difficulty of obtaining reimbursement for continuing-care support activity. “There is no easy way to get reimbursed for these services,” says Phil Herschman, PhD, CRC's chief clinical officer. “The big payers have been on board with the concept, but at the end of the day they couldn't find a way to reimburse for it.”

That presented a challenge for CRC as it sought to integrate a continuing-care model into its overall effort to drive clinical excellence in its family of treatment facilities. It would select Sierra Tucson as the laboratory for its effort because that facility's largely self-pay population allowed CRC to avoid the insurance reimbursement dilemma.

The one year of continuing-care support is simply worked into the base price for treatment at the facility (Herschman would not reveal pricing numbers at Sierra Tucson, but says the increase in price for patients in order to absorb Connections has been minimal given the amount of additional support patients are receiving).

It would choose AIR as a partner because CRC already was spending significant dollars on other clinical initiatives and didn't have the resources to build its own continuing-care apparatus, says Herschman.

“If I had had the option, I would have built the capacity myself,” he says. “That's as much because it's the way I think as anything else.”

Minnesota-based AIR started as an intervention business but developed a recovery assistance initiative after it would routinely hear from individuals it had worked with who were reporting that nothing had really changed in their lives several months after the initial help they received, says Wainwright.

A look at the data

In an exclusive interview, Addiction Professional spoke with Herschman and Wainwright about the origins of Connections at the Sierra Tucson facility and the results that have been achieved in the first year.

Connections is not considered an option for patients; in order for the concept to work, it is introduced early on as part of the treatment process and patients are expected to participate for the full one-year period after their primary treatment stay ends. It is a seamless transition, and the patients identify the entire program as part of Sierra Tucson, even though the case managers with whom they work in continuing care are employed by AIR.

Individual case managers are paired with primary therapists at Sierra Tucson. Shortly before a patient's discharge, the patient has an introductory phone call with the case manager, discussing details of the continuing-care plan and the environment to which the patient is relocating. The patient then will hear from the case manager within 48 hours of discharge, with weekly contact in the first month and subsequent frequency based on patient need.

It is recommended that case managers reach out to patients via phone and Skype, Wainwright says, because those contacts tend to elicit the most reliable information.

The case managers work not only with the patient but with the family as well, and on a broad spectrum of topics related to recovery, from family relationships to education and career issues.

Since the program's start in May 2013, 271 Sierra Tucson patients have been enrolled in Connections. In about half of cases, both the patient and the family have actively participated; in about one-quarter of cases, the patient and/or the family have taken a pause from the services.

Through the first phase of Connections (three months post-discharge), 98% of the 42 patients currently engaged in the program are currently abstinent from substance use, according to internal data provided by CRC. At phase two (nine months), 82% of 110 patients are currently abstinent, and 63% in phase two have maintained continuous abstinence since admission.

In around 80% of overall cases, patients in Connections are following through on ordered toxicology screens.

One Connections patient stated in a testimonial about the program, “I never realized how crucial Connections was to my recovery until I had my first really bad day after leaving Sierra Tucson. I called my case manager instead of using. This program saved my life.”

Wainwright says the period around 90 to 120 days after discharge appears to represent the most risky stage for a potential relapse. “This is where life happens again, and maybe they have their first upset,” she says.

Extending effort

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