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Using New Technologies to Support Treatment and Recovery Addiction - Comprehensive Health Enhancement Support System (ACHESS) Michael Boyle and David Moore Using New Technologies to Support Treatment and Recovery Addiction - Comprehensive Health Enhancement Support System (ACHESS) Michael Boyle and David Moore The use of technology within behavioral health has predominately been limited to administrative functions such as service reporting and billing procedures or adopting electronic medical records. Virtually all treatment is delivered face-to-face by practitioners. In behavioral health care organizations, labor costs typically account for the vast majority of total expenses. Funding restraints and typically low salaries may contribute to the high turnover in staff members and difficulty in attracting new clinicians to the field. Using technologies delivered through web-based application, stand alone computer software, or smart phones are all components of a new approach termed E-Health. NIDA-funded studies have demonstrated that evidence-based clinical treatments can be effectively delivered through computerized applications. These studies have shown outcomes that are equal or superior to the same treatment delivered solely by clinicians (NIDA Notes). David Gustafson, Director of NIATx at the University of Wisconsin-Madison, initiated a project, Innovations for Recovery, to identify and research technologies that may improve addiction treatment and recovery support. The first research project of I4R is a NIAAA random clinical trial using smart phones to provide recovery supports following residential alcoholism treatment. The system is an extension of web-based cancer support systems that were developed by Dr. Gustafson. Background Next Steps in Smart Phone Research Clinical algorithms are being developed that are trigged by the responses to the weekly BAM survey. These will be tailored to individuals and much of the content will be delivered through the smart phones. This will allow implementation of adaptive continuing care (McKay, 2009) with “just in time” interventions. A second NIAAA proposal has been submitted that expands the smart phone support services to family members and concerned significant others. An ACHESS research consortium being formed through the University of Wisconsin will allow other treatment organizations to access the technology. The methods by which the technologies are disseminated and utilized by members will be studied to guide future dissemination of technologies. Hypothesized Implications for Behavioral Health Practice, Policy, and/or Research Over 50% of treatment currently delivered by clinical staff could be provided electronically. The potential cost savings are significant. Savings could be utilized to attract and retain highly skilled clinicians and add needed professional services including more physician and nursing services. A portion of the savings would be redirected to support the technology and purchase required equipment. A percentage of the savings could be utilized to increase access to treatment. Current barriers to access could be removed. Services can be delivered anytime/anywhere. Continuing care, a key component of a recovery management approach can be efficiently delivered with rapid response as needed by the patient or family. The cost for obtaining and aggregating outcome data can also be significantly reduced. Cost of addiction treatment per individual treated may also be reduced. Cost/benefit studies are needed to determine if outcomes can be improved at potentially lower costs. New payment methodologies such as case rates or episode of care rates will be required to support technology delivered care. Reasons Research May Be Considered a Disruptive Innovation The technology supports “facilitated networks” allowing people with a chronic condition to interact with “someone like me” The solutions are taken to the problem rather than current system wherein the problem must be taken to the solution The reliability of quality treatments can be increased by standard approaches while simultaneously increasing convenience and responsiveness May be a key component in an integrated fixed-fee payment system Support Team: Study participants are connected to each other (in a manner similar to Facebook). Participants can post pictures, personal interests etc. to share with other participants (they can be as open or as private as they want with their profile), write messages to one another and post on each other’s walls. Discussion groups: Participants can post questions, ideas or comments to share with others on the project. This is helpful for getting feedback from other peers or support in a time of crisis. High Risk Locations: Study participants can choose to add locations to their phone that are risky (e.g. old hang-out or bar, or drug dealer locale). When the participant gets near the location, the phone will beep, when the participant views the phone, they will get a message letting them know they are near a high risk location and the phone will ask if they feel like drinking. The participant can then choose to use other activities on their phone (such as listening to a relaxation exercise or pressing their panic button to try and curb their urge). Panic Button: Participants can elect to place support people (e.g. friends, family members, sponsor) on their panic button. If the individual has an urge to drink or is in a high risk situation, they can press the panic button. A text message is sent to the people they have chosen asking for their help and support. Weekly Survey: Study participants receive an electronic notification through a text message one time per week asking them to complete a recovery based survey. Participants can elect to have the results of the survey sent to their study counselor – these surveys serve as a indicators for risk versus recovery factors. ACHESS ServicesNumber of Users Number of ACHESS Pages Requested MeanStandard Deviation My Messages91554361 Home Pages91379297 My Profile89329365 Discussion90188218 Weekly Survey8713260 My Team908182 Team Feed873967 Events & Meetings862328 My Settings842226 Recovery Information772028 Ask an Expert781121 Panic Button7376 Easing Distress6067 Our Stories7655 News7754 Number of Pages Used in ACHESS Services (Data reflects 92 participants on ACHESS for more than 4 months) Study Demographics (through 2/11/11) Randomization Control GroupExperimental Group 122127 Location Fayette - Peoria, ILCAB - Boston, MA 16980 Gender FemaleMale 31.7% (79)68.3% (170) Age Range 18-64Mean - 38.45 Race/Ethnicity AsianNative AmericanHispanic Black/African AmericanWhite.04% (1)2.4% (6)4.4% (11)13.7% (34)82.7% (206) Copyright © 2009–2011, CHESS by the Board of Regents of the University of Wisconsin System. All rights reserved. Events: Participants can view a calendar of healthy and inexpensive events in their city they can participate in. Ask an Expert:: Allows participants to request information and advice and receive a response within 24 hours. Responses to questions of general interest are rendered anonymous and placed in Open Expert for all users to see. References: Gustafson, D.H., Shaw, B.R., Isham, A., Baker, T., Boyle, M.G., & Levy, M. (2011). Explicating an evidenced-based, theoretically informed, mobile technology-based system to improve outcomes for people in recovery for alcohol dependence. Substance Use & Misuse, 46, 96-111. McKay, J.A. (2009). Treating Substance Use Disorders with Adaptive Continuing Care. Washington, DC: American Psychological Association. Whitten, L. (Nov, 2009). Computer-based interventions promote drug abstinence. NIDA Notes, 22 (5), pp.1, 14-16. Methods Persons with an alcohol dependency are randomly assigned to receive smart phone access to the resources or treatment as usual prior to discharge from residential treatment. The phones have unlimited internet access and call time and are linked to the web based services for eight months. Follow-up evaluations are conducted at 4, 8 and 12 months. A key outcome factor is number of risky drinking days during the past 30 days for each evaluation period. A survey measuring 5 protection and 5 risk factors for recovery is pushed through the phones to participants weekly.
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