Partnership for Advancing Recovery in Kentucky Using Technology for Continuing Care: Opening the Cage Door July 16, 2008 By David Mathews, Ph.D. Will press lever for drugs!

Partnership for Advancing Recovery in Kentucky 1/21/08 2 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

Partnership for Advancing Recovery in Kentucky 1/21/08 3 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

Partnership for Advancing Recovery in Kentucky 1/21/08 4 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

Partnership for Advancing Recovery in Kentucky 1/21/08 5 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.

Partnership for Advancing Recovery in Kentucky 1/21/08 6 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)

Partnership for Advancing Recovery in Kentucky 1/21/08 7 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)

Partnership for Advancing Recovery in Kentucky 1/21/08 8 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)

Partnership for Advancing Recovery in Kentucky 1/21/08 9 PARK AIM: Increase continuation and decrease dropouts through a statewide system of care that embraces community linkages and collaborative planning.PARK AIM: Increase continuation and decrease dropouts through a statewide system of care that embraces community linkages and collaborative planning. Target evidence based categories: Continuing Care &Wraparound Supports

Partnership for Advancing Recovery in Kentucky 1/21/08 10 KRCC & Kentucky Technology Strategies Video Meetings between Levels of Care Client & Counselor Counselor KTOS Assessments Using PDA Voicent Auto Reminder Telephone Calls Interactive Video Game Generation Rx for Prevention In House Video Production Caney Digital Media Use of HBO Addictions video clips in treatment groups Telehealth Network for Primary and Medical Specialty Care Use of Physicians Portal for EMR Access & Internet Based Client Tracking Software Regional Video Conferencing for Training & Process Improvement Statewide Video Interest Circles Targeting Evidence Based Practices Use of TRAIN & Essential Learning for Training and Tracking DVD Introduction to Next Level of Care

Partnership for Advancing Recovery in Kentucky 1/21/08 11 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

Partnership for Advancing Recovery in Kentucky 1/21/08 12

Partnership for Advancing Recovery in Kentucky 1/21/08 13

Partnership for Advancing Recovery in Kentucky 1/21/08 14 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

Partnership for Advancing Recovery in Kentucky 1/21/08 15 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

Partnership for Advancing Recovery in Kentucky 1/21/08 16 Resource Guide

Partnership for Advancing Recovery in Kentucky 1/21/08 17 Retained in Treatment after 45 Days TRI science addiction

Partnership for Advancing Recovery in Kentucky 1/21/08 18 Percent Completed Treatment TRI science addiction