Four Keys to Improving Quality of Care

Addiction treatment providers who want to improve their quality of care can make strides by focusing in on several key areas, Siobhan Morse, MHSA, CRC, CAI, MAC, the divisional director of clinical services-research/special projects in the Behavioral Health Division at UHS, told attendees at a recent webinar presented by the Psychiatry & Behavioral Health Learning Network.

Morse outlined a quartet of critical factors for success in substance use disorder treatment.

Care for the caregiver. Compassion fatigue and secondary trauma are common challenges for staff, especially now because of the increased challenges and pressures that providers are facing in the current climate, Morse said. Relationships, meanwhile, are an integral part of why people change, Morse said, noting that a study of patients at Foundations Recovery Network found that 30 days post-treatment, patients who said they had had a positive interaction with staff had improved relationships in their lives significantly more than other patients.

“When we build relationships with patients—not friendship, but a therapeutic relationship—we are actually impacting their ability to re-create that in their lives, and we know how important that is for patients later,” Morse said.

Treatment organizations can improve morale among staff in a variety of ways, Morse said, from engaging in organization-wide acknowledgement of individual staff members to providing outside grief counselors for staff after crisis events. Constantly looking for ways to provide modalities for self-care and creating ways to care for teams allows staff members to be a better place to be more available to their patients, Morse said.

Caring for family and loved ones. Addiction is a family disease, and caring for loved ones goes beyond involving them in a patient’s treatment plan to addressing their needs as well, Morse said. Several studies have shown that family members of alcohol-addicted individuals or persons with an alcohol or drug disorder have more medical and psychiatric conditions and increased medical cost and utilization compared to family members of persons without, Morse noted.

“One of best things we can do for families is to begin offering them referrals and begin offering them the opportunity to understand the disease better,” she said. “Creating psychoeducation groups so family members can have a better understanding in a medical sense of what’s going on with their loved one.”

Having a recovery-oriented focus. There is a baseline distinction to be made between curative efforts—focusing on treatment as an acute solution to an acute disorder—and recovery-oriented efforts, which consider the long-term and chronic conditions of substance use disorder, Morse said. SAMHSA defines recovery as a process of change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential.

Recovery, Morse said, includes four components:

• Health: Overcoming or managing a disease and making informed, healthy choices that support one’s physical and emotional wellbeing
• Home: Having a stable, safe place to live
• Purpose: Engaging in meaningful daily activities (work, school, volunteering, family caretaking, creative endeavors), and the independence, income and resources to participate in society
• Community: Having relationships and social networks that provide support, friendship, love and hope

Of note: In a State of the Industry assessment conducted by the technology platform firm Gloo in early 2020, more than a third of the 378 respondents from various levels of treatment organizations said they have faced “a significant amount of struggle” to be recovery-oriented.

Measuring outcomes. In the same survey, about half of respondents said their organizations collect minimal data on outcomes, Morse said.

Outcomes data can facilitate decisions at all different levels, from a single patient’s treatment plan to financial decisions to consumer decisions, Morse said. Having data that demonstrates an organization is providing quality care comes down to knowing how to responsibly collect data, Morse said. Among the considerations:

• Being ethical, which includes: following HIPAA requirements, having an institutional review board or other form of patients’ rights/safety oversight, making sure participation is voluntary, having consent to use data beyond the patient’s treatment planning, and protecting privacy/anonymity of data.
• Being reliable by having consistent methods of measurement and offering all patients the same opportunity to participate in outcomes measurement so that the organization isn’t “cherry picking” only ideal outcomes.
• Using standardized, psychometrically sound instruments to improve the probability that the organization is measuring what it intends to measure
• Implementing third-party verification

“As an industry, we need to look at our patients, we need to look at the guidelines SAMHSA has given us and the definition of recovery, and we need to build some consensus on what positive, long-term outcomes are,” Morse said.