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Time for a change

July 1, 2007
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New technologies and workforce needs will drive transformation in treatment centers

Kevin e. mceneaney

Kevin E. McEneaney

The U.S. alcohol and drug abuse treatment industry in the next few years will face challenges it has never encountered before. The industry will see a significant shift in the way organizations are managed, and in the kinds of corporate structures that will exist. The emergence of new technology will be the driving force behind these changes. Technology will advance the ways in which individuals are assessed, interact in treatment, receive services from counselors, relate with off-site services, and converse when they are back in the community following their treatment experience.

The treatment industry has not seen significant change in more than 50 years, but is now at the edge of major cultural shifts that will force it to change everything from the way it manages programs to its fundamental structure of delivering service. In the coming years, hospitals, residential treatment agencies, outpatient programs, in-prison treatment programs, and even self-help organizations will be most greatly affected by demands from their workforce, driven by skilled workers' desire to see in their working lives some of the same information platforms present in their personal lives.

Counselors will seek alternative working arrangements as technology makes this possible. A large number of workers will look to telecommute, and advances in network platforms will allow workers to be more effective even when they are not on-site. Case conferences, charting, and meetings all will occur online.

Communications based on an intranet will become the norm in treatment organizations, and the flow of vital information will shift from a top-down to a multidirectional system. This will enhance organizations' ability to make decisions, as well as the speed with which employees are able to buy into those decisions. These organizations will have the opportunity to become leaderless and be managed by self-organizing communities whose approaches to workplace activities such as team management, time allocation, and decision making are collaborative.

Technology will deliver opportunities to share information throughout the client's treatment experience among providers, loved ones, and sponsors. Doing so will move the focus away from creating services to clients for reimbursement only and toward tracking progress against behavioral outcomes throughout the treatment process.

Treatment organizations will have to start shifting use of their capital funds from typical infrastructure models toward technological solutions that facilitate networking between employees and other entities. These networks will require constant upgrading. The size of physical plants might change as small workgroups replace traditional operating structures. The need for group space and staff offices might shrink thanks to the use of intranet platforms.

As organizations revolve around these platforms, new forms of management will take hold. The governance of some organizations by “leadership committees” might occur. In short, the alcohol and drug field will be challenged in examining how to incorporate new paradigms into its present structures. Issues of staffing will be particularly vital, as organizations with rigid 9-to-5 days and weekly schedules might find that these approaches work against them.

One of the most important issues is the idea that the way in which productivity is measured will change as the social services community develops more sophisticated ways to track information. Throughout history, health insurers, managed care entities, and government agencies have based their reimbursement schemes on “units of service” models. Units of service measured practitioners' output but not necessarily clients' outcome. The addiction treatment community faces significant challenges as it continues to hold on to units of service models, as data and client tracking will invariably increase outcome-based funding approaches.

How services will change

The way in which addiction treatment services are delivered could see the greatest transformation. The field's future in large part will be determined by its ability to transform the way it works with clients, finding new ways to deliver, manage, and be paid for those services.

Continuums will likely develop to move clients through various stages of recovery. This will require information sharing at the highest, most confidential levels. In an industry that is historically client possessive and often independent, this information sharing poses a major challenge. Organizations that move toward this shift will share information externally and internally in multiple directions.

These developments will change the way we view service delivery. No one organization can or should be responsible for an individual client. Large-scale collaboration will enhance peer-to-peer activities and the power of communities. Interaction facilitated through technology is harvesting ideas about new services and is accessing a large brain trust to solve problems.

These collaborations will clearly push service providers to strengthen their unique skills. Models derived from traditional counseling sessions will need to be evaluated, as client interventions get shorter because of cost and staff becomes more limited in its “teachable moments.” In addition, we see that clinicians with increasing caseloads experience frustration as they find themselves less personally rewarded.