Using technology to keep clients engaged

When clients achieve the realization—either coerced or otherwise—that they need treatment for a substance use issue, they ideally would enroll immediately in a residential or outpatient treatment program. Real world issues, however, often prevent that ideal scenario from occurring.

Insurance coverage issues and waiting lists pose just two of the common obstacles to treatment on demand for clients attempting to access services. Delays caused by these and other barriers place clients in an incredibly vulnerable position. The insight they have achieved to realize their treatment needs usually amounts to a brief window of opportunity. If that moment is not seized upon, the insidious lure of addiction will pull them back in quickly enough. Treatment agencies are attempting to develop ways to reduce or ease wait times for treatment through innovative strategies and processes. The Network for the Improvement of Addiction Treatment (NIATx), a collaborative that works with treatment organizations to facilitate process improvements, has played a key role in devising and proliferating such strategies. Treatment agencies are reaching out to clients to keep them engaged while they wait for access to a full treatment regimen. Agencies are increasingly turning to technology to enhance this outreach process, conducting what is essentially an online intervention. At Arapahoe House, Inc., a provider of drug, alcohol, and behavioral health treatment services in Thornton, Colorado, treatment leaders have developed a program entitled “E-TREAT,” a technology-assisted modality of care designed to improve the rate of engagement and to enhance retention. The idea is to retain clients long enough to enroll them into treatment if they have to wait for services. The program essentially allows clients to engage in an online intervention while they await admittance into residential or outpatient treatment. The online intervention can be continued after the clients have moved into treatment. The effort is funded by a Substance Abuse and Mental Health Services Administration (SAMHSA) grant. “Right now, the intervention is a blend of human interaction and persuasive technology,” says Catherine Hoich, director of program services at Arapahoe House. Clients calling Arapahoe House seeking admission into residential or outpatient programs are screened for participation in E-TREAT. The screening process elicits whether clients are willing to participate in E-TREAT, as well as their level of computer literacy and access. “We’ll do a full screening, and if they’re willing to participate, we’ll connect them with our research staff and recovery coaches,” says Hoich. A recovery coach meets with each client face-to-face to facilitate paperwork and consents, and to offer instruction on how to navigate the online intervention. “The recovery coach will stay in touch with the clients on a regular basis to help motivate them and keep them engaged until we can get them into treatment,” says Hoich. The recovery coaches are certified addiction counselors trained in Motivational Interviewing, and might stay in touch with clients as often as daily through online communication. Once clients go online, they are encouraged to complete the “Change Gauge.” Clients answer 24 questions that assess their stage of change/motivation to change. Clients communicate the result to their recovery coach, and the recovery coach designs the online intervention based on the assessment’s findings. Clients are able to personalize their home page, which gives them access to public technology resources. Clients can attach “gadgets” that contain information on a specific topic. The individualized home page acts as a vehicle for each client and clinical staff to tailor services and resources to the client’s specific needs. The intervention also includes online groups, e-mail, instant messaging, text messaging, and use of message boards (through Google). The recovery coach gives the clients schedules for the online group sessions. Online sessions include topics such as relapse prevention. “A lot of the interventions for those waiting to get into treatment are about engaging them and helping the client really stick with it until they get into treatment,” says Hoich. The recovery coach develops an online, interactive treatment plan for each client, with feedback from the client. Clients are asked to give ongoing feedback regarding the online treatment plan and their progress. On Arapahoe House’s Google group message board, clients can post questions about drug and alcohol use and about Arapahoe House’s programs, and have access to a description of the programs. Program officials use analytics on Google to identify favorite gadgets that clients use, and then expand and enhance those interventions to help engage clients. “These analytics tell us where our clients go online, which information services they’ve used and read,” says Hoich. “That will give us more detail in the future about what’s working and not working for our clients.” Recovery coaches also help clients address potential barriers to treatment, such as transportation and child care needs. The program started in October 2007, with 33 clients having been served thus far.
Internet videoconferencing
At behavioral health agency Fayette Companies in Peoria, Illinois, counselors are using Internet videoconferencing for long-distance initial assessment and screening. Fayette Companies receives many referrals from probation departments that are up to two hours away. Fayette bought cameras for the departments, and is now conducting screening and assessment via videoconferencing for clients who are being referred for residential treatment. “We need to determine if they’re appropriate for that level of service,” says Fayette CEO Mike Boyle. “Prior to this, a probation officer would have to put someone in a car and bring that person in to be assessed and then drive them back. There is a great level of efficiency with this for everyone involved.” Fayette also uses Internet videoconferencing for assessing clients about to enter its detox unit. The videoconferencing allows counselors to see a client’s face, reactions, body movements, etc., when conducting an assessment. While the videoconferencing has been quite useful, there still are some clients who require a face-to-face assessment, such as those with medical or psychiatric conditions, according to the agency. Fayette also is furnishing its residential facilities with computer labs, allowing clients to access the Internet. The computers are used to develop résumés and access job listings. “Women who have never used computers are being taught by other women on how to use a computer, use a mouse, how to turn it on,” says Boyle. Some clients are pursing a GED online and enrolling in college-level online courses. Others are finding community activities online, such as art shows and concerts, to help fulfill the need for meaningful activities that do not involve substance use. Fayette clients also are set up with e-mail accounts so they can communicate with family members and others. Staff members also are communicating with clients via e-mail as part of follow-up support.
Future directions in technology?
Boyle envisions the use of advanced technological devices to communicate with clients. For instance, he says, Global Positioning System (GPS) technology could be used to identify someone who is in a high-risk geographic location, such as heading to a bar where he used to drink. “A phone goes off, and at that point facility [personnel] could talk to them, give them advice, help them think [it] through.” According to Boyle, David Gustafson, NIATx Director and Professor of Industrial Engineering at the University of Wisconsin, has an application under review at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) for using personal digital assistant (PDA) devices to promote ongoing communication with clients. Boyle also sees recovery groups spawning in virtual online worlds, such as Second Life. “It’s a place where people could go 24 hours a day and access other people in recovery,” he says. Brion P. McAlarney is a freelance writer based in Massachusetts.