CENTER ON THE CONTINUUM OF CARE (C3 CENTER)
MONITORING AND ADAPTING ADDICTION TREATMENT
Selected Past Projects
Monitoring and Feedback in Substance Abuse Treatment; John Cacciola, Ph.D.In substance abuse treatment, although monitoring and feedback approaches have been recommended and many lines of evidence support their potential value, none has been formally evaluated in standard outpatient treatment. The specific aims of this three-year NIDA grant are to conduct a three-staged study to develop and evaluate a monitoring instrument and associated intervention, using a web-based recovery system, as follows: Stage 1 - Develop and determine the reliability, validity, and sensitivity to change of a brief Multidimensional Monitoring Instrument (MMI) for clients in substance abuse treatment; Stage 2 - Develop a Monitoring and Feedback Intervention (MFI) and treatment manual/training materials that use the MMI, and conduct a feasibility study to refine the intervention; Stage 3 - Conduct a randomized clinical trial to determine the preliminary efficacy of the MFI compared to treatment as usual (TAU). The intervention (MFI) is an approach that counselors can easily incorporate into their usual practice with minimal training. The MFI has the potential to be portable, practical and sustainable. Future work could establish benchmarks and data could be fed back to supervisory personnel as well as to the treating clinician, and quality improvement efforts could be initiated and evaluated. Finally, the monitoring instrument (MMI) could aid evaluators and researchers in evaluating the course of clients' change during treatment and their discharge status across treatment organizations or experimental conditions.
Betty Ford: Focused Continuing Care; Deni Carise, Ph.D. The Focused Continuing Care (FCC) program at the Betty Ford Center (BFC) is an innovative, patient-focused level of care designed to monitor and support patient recovery initiated during residential care at BFC. The FCC program does this through periodic, clinical telephone contacts with patients for one year following their completion of residential care. The FCC counselor-patient interactions provide information to BFC on how patients are doing after discharge in the form of self-reported patient status information at each of the telephone sessions. While the FCC program had been in operation since 1998, there were not formal patient contact procedures, standard training formats for new counselors, or a standardized or tested interview format for the calls. In 2005, TRI was asked to evaluate the FCC program and to suggest ways of improving it. TRI staff performed a thorough review through numerous, collaborative meetings with BFC staff in general and FCC staff in particular. TRI conducted a series of analyses on a large sample of BFC patients who had participated in FCC between 1998 and 2005 in order to examine patient level of involvement in FCC and the outcomes of these patients. The knowledge gained from these activities resulted in several consensus recommendations between the TRI and FCC staff for considerable change in the training and practice of FCC. Implementation of the revised FCC protocol resulted in greater client compliance and more useable and useful data. Additionally, the results from analyses of FCC data collected via the revised protocol, in combination with those from the earlier FCC protocol, suggest that more emphasis on the early post discharge period with less emphasis on more distal time periods may yield a more effective and less costly intervention.
Concurrent Recovery Monitoring, State of Delaware; Deni Carise, Ph.D., Adam Brooks, Ph.D., Amy Mericle, Ph.D., Meghan Love: An exploratory NIDA-funded R21 grant aimed to develop, pilot, and disseminate a series of clinical questions useful for counselors, treatment providers, and payers to monitor the recovery process in the state of Delaware. The Department of Substance Abuse and Mental Health (DSAMH), TRI, and state-funded outpatient substance abuse treatment providers collaborated to complete a systematic evaluation of the “paperwork burden” in each treatment program. Multiple, competing data collection demands were examined with the goal of removing unnecessary and burdensome requirements and consolidating others; a small number of additional performance indicators were selected for regular collection within the existing outpatient performance monitoring/contracting system; data collection, recording, and reporting procedures were pilot tested for these additional concurrent recovery monitoring (CRM) measures to assess their feasibility and their usefulness to the treatment programs. The results of this work have been utilized to submit further proposals (to DSAMH and NIDA) to evaluate evidence-based practices and to further develop the statewide CRM system. Read Research Brief.
