Leaders with five prominent addiction treatment organizations that are using online communication and other tools to offer extended post-treatment support to patients told a conference audience that facilities can offer meaningful aftercare without breaking the bank.
At a May 19 workshop at the annual conference of the National Association of Addiction Treatment Providers (NAATP) in Charlotte, N.C., these panelists also emphasized that extended support beyond a primary treatment stay is becoming a necessary direction for providers of primary services. “This is really the direction that insurance companies are going in, with disease management,” said Cheryl Knepper, vice president of continuum services at Caron Treatment Centers.
Knepper was joined on the workshop panel by leaders from Hazelden Betty Ford Foundation, CRC Health Group, Origins Recovery Centers and Valley Hope Association. Ironically, although research continues to tie extended patient engagement in treatment and support to better outcomes, a couple of the panelists said some staff members at their facility did not immediately praise the idea of online tools for extended support when it was first suggested in the organization.
Panel moderator Janelle Wesloh, Hazelden Betty Ford's executive director of recovery management, told Addiction Professional after the session that some staff members originally feared these services would replace 12-Step support groups and the work of a sponsor, rather than be the conduit to patients' participation in those activities, which is truly their main purpose.
Deni Carise, PhD, CRC Health's deputy chief clinical officer, told the workshop audience that as addiction treatment centers begin to be asked to demonstrate specific standards of performance as a condition of funding, one likely performance measure for residential facilities will be their success in engaging patients in the next level of care after primary treatment.
CRC's Sierra Tucson facility offers one year of continuing care in its Connections program, at no additional charge from the fee for primary treatment (lower levels of ongoing support are offered in smaller CRC facilities). A consultant to the agency staffs the program, offering the patient and family direct assistance and linkage to other resources in weekly contact for the first three months and less thereafter.
At Sierra Tucson the one year of continuing care is focused directly to the patient's time in the community post-treatment, and the patient is not shortchanged of time if at some point he/she enters a program such as a halfway house. The ongoing support program at Origins Recovery Centers in south Texas does not make that distinction. Origins' 15-month support post-treatment also is free of additional charges, and patients and families are introduced to the concept from day one of treatment.
In terms of the technologies used to maintain post-treatment contact with patients at Origins, executive program director Mandy Baker said, “We use just about whatever works,” from videoconferencing to basic phone check-in. She added, “I don't think you have to have all the resources in the world to extend the continuum of care for your patients.”
Knepper told an anecdote that illustrates the potential power of technology and the influence of peers in post-treatment efforts. On the night before the workshop session, a participant in Caron's My First Year of Recovery online program had posted concerns about not being able to find a sponsor who met his particular needs. By the next morning, she said, four fellow group members had responded online with advice and reassurance.
Several speakers said the ongoing support they are offering in the more enhanced of their efforts is intended to resemble the kind of close post-treatment monitoring that professionals such as pilots and physicians are required to undergo as a condition of return to work. Wesloh said that ongoing self-assessments often signal “red flag” areas that merit a response, such as if a patient answers in the affirmative to the statement, “I think I can use in a controlled way.”
At Valley Hope Association, which largely serves rural communities in the country's heartland, online programming has helped overcome logistical challenges to maintaining ongoing contact. President and CEO Ken Gregoire, PhD, said the three most significant measures of the success of Valley Hope's extended programming are sobriety, the successful placement of individuals in continuing care, and patients' length of stay in these post-treatment services. “All three of these numbers are improving for us,” Gregoire said.
Several panelists added that clinicians who work on this side of the operation in their organizations generally maintain the same caseload size as those who work in traditional primary treatment.