Continuing Care Recovery Oriented Systems of Care

Principle  Health care professionals should remain involved and available to those they serve until long term recovery can be self-managed by the patient, family, and extended support network  Community is the ultimate healing agent, not treatment

Recovery Stability  Stability of recovery not reached until 4-5 years of sustained remission  Post-treatment monitoring and support can significantly elevate long-term recovery outcomes

Recovery Stability  Extended period of check-ups and support rather than longer periods in primary treatment  Emotional support and mental health service needs that were not present during initial treatment may present during post-treatment monitoring

Critical Elements of Continuing Care  For a five year period:  post stabilization monitoring,  stage-appropriate recovery education,  active recovery coaching, and  re-intervention when needed

RM Continuing Care 1.Provided to all clients, not just those who “graduate” 2. Responsibility for contact shifts from client to the treatment agency

RM Continuing Care 3.Timing: Capitalizes on critical windows of vulnerability (first days following treatment) and power of sustained monitoring (Recovery Checkups)

RM Continuing Care 4.Intensity: Ability to individualize frequency and intensity of contact based on clinical data 5.Duration: Continuity of contact over time with a primary recovery support specialist

RM Continuing Care 6.Location: Community-based vs. clinic-based 7.Staffing: May be provided in a professional or peer-based delivery format 8.Technology: Increased use of phone & Internet-based support services

Evidence Based Practice  The Effectiveness of Telephone-Based Continuing Care for Alcohol and Cocaine Dependence.  James R. McKay, PhD; Kevin G. Lynch, PhD; Donald S. Shepard, PhD; Helen M. Pettinati, PhD

Telephone Based Continuing Care Research  Intensive Outpatient completion  12-week continuing care protocol  weekly telephone-based monitoring and brief counseling contacts combined with weekly supportive group sessions in the first 4 weeks

Telephone Based Continuing Care Research  Telephone-based continuing care appears to be an effective form of step-down treatment for most patients with alcohol and cocaine dependence who complete an initial stabilization treatment, compared with more intensive face-to-face interventions  However, high risk patients may have better outcomes if they first receive group counseling continuing care after completing intensive outpatient programs

Phone Contact  Initial face to face session to orient client  One 15 minute phone call per week  Began with brief review of progress toward one to two goals identified in prior session  Plans for achieving goals over next week were then discussed, along with any other pressing issues

References  Recovery Management and Recovery-Oriented Systems of Care: Scientific Rationale and Promising Practices. White, 2008.