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| The Model for Improving Treatment Outcomes Already Exists |
| Columns - Prevention | |
| Written by Marzack B. McAllister | |
| Friday, 13 April 2007 | |
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Traditionally counselors and treatment centers have used modalities and
delivered services based on the fundamental beliefs that factors
affecting outcomes were thought to be: • characteristic of the individuals seeking treatment • the nature and severity of their problems • their treatment process and the services provided • post treatment environment interactions among these factors (Ball & Ross, 1995). This thinking has led many in the industry to believe that the best facilities with the best counselors providing the best level of care will have significantly higher results. Conversely, it is believed that a facility that does not have access to such quality resources will have significantly lower results. Following this line of thought, it is easy for us, as addiction professionals, to believe that the right combination of factors, presented in the right order, will bring greater results. What we have learned from applying these “old” methodologies is:
Patients who suffer from other chronic illnesses, such as asthma, diabetes, and hypertension, do well in hospital settings because consistent monitoring of the application of the care plan. However, according to research, outside of these structured settings, 50 percent of the quality of care is lost in the first year because patients do not take medical direction (Mclellan, Lewis, O’Brien & Kleber, 2000). In fact, 47 percent of chemically dependent persons relapse in the first year of leaving treatment (insert proper reference here). These figures are closely related because clients are not following the aftercare directions of their clinical team. Today there is a paradigm for improving treatment outcomes that is currently being used in treatment centers, facilities and agencies across the United States. The process model is based on an old training format — TELL, SHOW, DO, REVIEW. While training a new employee you “tell” them the process, ”show” them the process, have them “do” the process and then the both of you would “review” what has been accomplished, looking for errors, deviations and/or non-compliance of the process. The medical treatments for illnesses of all kinds follow the same type of process through to a cure. However, when it comes to treating chronic illnesses it is imperative that this process is followed because treatment is ongoing and there is no “cure.” When it comes to diabetes, hypertension or asthma, a specialist would “tell” a patient about his/her condition, “show” them how to care for themselves and follow up with them to see how they “do” and then, “review” with that patient the effectiveness of the treatment. For a person afflicted with the disease of chemical dependency the treatment is too often quite different. In treatment the counselor will “tell” the client what his/her continuing care plan consists of. The clinician will “show” it to the client and give him/her a copy of the plan. However, the clinician’s job stops there, and he/she is unable to monitor that the client “do” what is on the plan or “review” the client’s progress. It is clear that if only 50 percent of the process of continuing care plan administration is completed, that the rate of recovery is exactly the same, 50 percent. While in treatment, the rates of abstinence remain high because the follow-through support is provided. When a client is directly transferred from one level of care to the next, effectiveness remains high as well. This happens because the continuing care plan is being directly reported to the new staff for implementation, monitoring and adjustments if necessary. Data supports that there is little difference between the effectiveness of treatment for chemical dependency or other chronic illnesses inside or outside a clinical setting. An effective transition plan is what is missing when a client discharges from a clinical setting. Recognizing this, we must ask ourselves, “How can we help our chemically dependent clients improve treatment outcomes?” In the case of a diabetic, an endocrinologist will request follow up visits from a patient to see if he/she is following the prescribed recommendation for the treatment of diabetes. The physician may check the history of blood sugar levels on the monitor; he may check the monitor to see if the patient is recording blood sugar levels. He may ask if the patient is following a well balanced diet and exercise regiment. He may ask these questions of the patient or any other reliable source for the purpose of accuracy. After reviewing this information, the physician may report back to the patient his findings with additional recommendations, if necessary. In critical situations, the physician may report the findings and/or concerns to the patient’s loved ones so they may support the patient in adhering to the recommendations. Strict adherence to the continuing care plans is essential in improving treatment outcomes. We know treatment works, we see little to no relapses during this phase of the recovery process. It is accepted that post treatment is where the problem lies because chemical dependency is a chronic illness and should be treated as such. Other chronic illnesses are treated using a disease management model, so why not addiction? Disease management focuses on treating the illness and the management over the course of a lifetime through continuing care. Curable illnesses do not require the same level of care as chronic illnesses. Because chronic illnesses are incurable, it is imperative that there are ongoing treatments that require monitoring. For the purpose of identifying effectiveness of the treatment at the differing stages of the recovery process, post treatment care for every chronic illness is vital. Late last year our addiction consulting firm, Addiction Intervention Resources (AIR), was researching better ways to meet the post-treatment needs of our clients. The result of that research was the development of the Recovery Assistance Program (RAP), which is primarily based on disease management care model and existing port treatment assistance/support programs available for airline pilots and medical personnel. It has been reported that 92 to 95 percent of airline pilots completing these post treatment programs remain sober two years later (Kizilo, 1998). RAP is designed to provide relapse prevention through education, support and monitoring. Monitoring the integration of the continuing care plan, regularly reviewing the recovery process and tracking progress provides: motivation, accountability, responsibility and a personalized, comprehensive recovery plan. The effectiveness of this paradigm is based on the process of: • Application and follow through of professional recommendations • Implementation of the prescribed continuing care plans • Access to appropriate recovery resources • Create a higher level of personal accountability and responsibility • On-going monitoring and reporting • Corrective action, should it be warranted As chemical dependency professionals, we are continuously learning new and better ways to treat our clients and improve long term rates of recovery. Through a disease management model that incorporates all four elements of “tell, do, show, review” we will be better able to facilitate the implementation of the prescribed continuing care plan. Through appropriate follow up and monitoring programs such as RAP we will be able continue to treat chemical dependency as a chronic condition and help more clients maintain their hard won recovery. References Ball & Ross. (1995). Developing State Outcomes Monitoring Systems for Alcohol and Other Drug Abuse Treatment. TIP, Volume 14. U.S. Department of Health and Human Services. Kizilo, P. (1998) Drug Dependence: A Chronic Mental Illness. Hazelden Voice. Volume 3, issue1, 1-2. Mclellan, Lewis, O’Brien & Kleber. (2000). Airlines Pilots Soar to Success in Recovery. Journal of the American Medical Association. 284(13), pp. 1689-1695              |
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