Over the past decade we have seen dramatic changes in the use of digital technology in our field. In fact, when I first wrote about the use of technology in clinical practice for this magazine in 2003, it wasn't uncommon for me to meet practitioners who did not have access to e-mail at work.
Today, our field has begun to realize many of the benefits that the new technology promised. Providers are using the Internet to enhance their knowledge and skills. They are leveraging technology to increase organizational capacity and improve their services. Clients have new options to support their recovery, such as online self-help and support groups or specialized “e-therapy” programs.
Of course, providers today still face many of the same obstacles to adopting new technology that they did seven years ago. The most pressing concerns are perennial: Providers worry about money, time, lack of computer knowledge, confidentiality/security of patient information, and lack of technical support. There also are fears that using computers will depersonalize services and compromise the engagement process. And there are the challenges of training staff to use the new technology and make procedural changes that they might not welcome.
These concerns only have been exacerbated by the economic crisis of the past two years. Many state agency budgets have been cut, and many providers have been seriously challenged to provide the same level of services with fewer resources. To balance the budget, some agencies have chosen to cut programming or reduce staff.
Given these circumstances, it might seem like the worst possible time to explore the use of technology in clinical practice. However, there are several good reasons to reconsider.
First, used judiciously, the right technology could help you avoid program or staff reductions.
Laying off staff or cutting programs can destabilize an agency. When you reduce your capacity to serve clients, you could be vulnerable to further revenue loss.
Fortunately, projects facilitated by NIATx, the pioneering improvement collaborative, have demonstrated that agencies can increase financial stability using a different approach: process improvement.1 The approach entails closely examining an agency's procedures to identify those that block access to treatment, increase wait times, drive up no-shows, or reduce staff productivity. Making even small modifications to these procedures, such as systematically reminding clients of their appointments, can positively affect retention rates and revenue.
Notably, using technology to support key process changes can be a smart, cost-effective strategy. For example, an agency might choose to purchase an automated phone service for reminder calls. While a phone service represents an investment, it could dramatically reduce no-shows. As NIATx co-deputy director Kim Johnson explains, “We have 50 percent no-show rates in this country. If you're paid on a fee-for-service basis, the no-show costs you what your fee is.”2 Most agencies that implement reminder calls, Johnson says, will cut no-show rates in half.
Improving client engagement
Second, by improving your clinical workflow, you might be able to increase client motivation, engagement in treatment, and retention.
In any effort to improve agency services, it is extremely important to consider the clinical workflow. When a provider is able to design a workflow that is evidence-based and consumer-friendly, and that leverages technology in a time- and cost-efficient way, it is possible to increase the quality of care while saving time and money. There are plenty of free and low-cost online resources to help providers learn about and implement evidence-based practices. The Substance Abuse and Mental Health Services Administration's (SAMHSA's) Center for Substance Abuse Treatment (CSAT; http://csat.samhsa.gov) has continued to publish invaluable treatment improvement protocols (TIPs) and technical assistance publications (TAPs). The Addiction Technology Transfer Centers, or ATTCs (http://www.attc network.org), offer extensive learning materials, including a monthly e-newsletter with updates on addiction research, funding and other developments in the field. NIATx (http://www.niatx.net) documents “Promising Practices” on its Web site and offers free online webinars.
The rise of social media in the past few years has also opened up new avenues for learning. Sites such as Facebook (http://www.facebook.com) and LinkedIn (http://www.linkedin.com) allow practitioners to connect directly with one another, share relevant information and work through the practical challenges of translating research to action. On LinkedIn, for example, I have joined a number of useful “groups,” such as Addiction Professionals, Friends of SAMHSA, and the ATTC Network, enabling me to follow threaded discussions, post questions and find resources.
In these conversations, and in my experience consulting with providers to develop and enhance the ASI-MV Connect, a computer program for client self-administration of the Addiction Severity Index, I have observed that agencies benefit most from implementing evidence-based approaches when they are incorporated in a workflow that makes sense for both clinicians and clients.