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Tom kimball power point presentation iCAAD Stockholm
- 1. Support, Evaluation, Follow-Up Keys to Success Thomas G. Kimball, Ph.D., LMFT February 2019 1Private & Confidential | © 2018 MAP Health Management®, LLC | All Rights Reserved.
- 2. • Introduction— • Education and Background • Collegiate Recovery—Director of “The Center” • President Association of Recovery In Higher Education • Clinical Director • SUD is a Huge Problem • Extending the Continuum of Care • Acute versus Chronic Care • The Power of Peers • Better Clinical Outcomes—engagement • Ongoing Evaluation, Creative Methods of Gathering Data • Reducing Costs Introduction and Story 2
- 3. Severe Substance Use Disorder or Addiction is a Huge Problem 3 Every year SUD claims more than 125,000 lives.1 22.7 million Americans are struggling with addiction and only about 2.5 million are getting treatment at a specialty facility.3 Annual economic impact of substance abuse estimated to be $700 billion2 Emergency room visits have escalated 98.4 percent from 2004 to 2009 for non-medical use of prescription drugs.6 Currently, many treatment programs do not provide sufficient support following acute treatment and lack a standardized means to collect data on long-term treatment program results.4 National Institute of Alcohol Abuse and Alcoholism, Alcohol Facts and Statistics, February 2017: https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics National Institute on Drug Abuse, Trends and Statistics, April 2017: https://www.drugabuse.gov/related-topics/trends-statistics https://www.drugabuse.gov/publications/drugfacts/nationwide-trends National Institute on Drug Abuse, Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition), December 2012: https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based- guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment https://www.samhsa.gov/health-financing/implementation-mental-health-parity-addiction-equity-act “Drug Facts: Drug-Related Hospital Emergency Room Visits.” (2011). National Institute on Drug Abuse. Accessed July 10, 2014. U.S. Department of Health and Human Services (2018, March 6). What is the U.S. opioid epidemic? Retrieved from https://www.hhs.gov/opioids/about-the-epidemic/index.html In the United States alone, it is estimated that 116 people die every day due to opioid drug overdoses (U.S. Department of Health and Human Services, 2018).
- 4. Active Addiction Risk & Protection Active Addiction & Intervention Recovery & Ongoing Support Bio Psycho Social Behavioral Cognitive Behavioral Social Learning Pre Post A Comprehensive Systemic Model of Addiction Formation & Recovery Mild Moderate Severe Recovery Support Assessment & Level of Care Peers Attachment Stressors Sex Mental Health Contextual Factors Peers Genetics Trauma Physical Health Psychotherapy Peer Support Family Therapy MAT Co-occurring Treatment Community Support Self Care Contingency ManagementFamily Functioning Kimball, T.G., Shumway, S.T., Bradshaw, S.D., & Soloski, K.L. (In Press) A Systemic Understanding of Addiction Formation and the Recovery Process. Handbook of Systemic Family Therapy.
- 5. Long-term Peer Recovery Support A Powerful Solution 5Private & Confidential ©2018 MAP Health Management®, LLC All rights reserved. Peer recovery support is a proactive means to support a person in recovery (PIR) from severe substance use disorder. The primary goals of peer recovery support are to detect early risks signs of decompensation, to guide the person at risk back to wellness and healthy recovery, and to gather meaningful data. Peer recovery support is most effective when it includes family members and others (i.e., primary support), in the recovery system. Recovery support is particularly valuable during the first 12-18 months following entry into recovery. During this time, PRSS can assist in decreasing the incidence of decompensations that result in increased healthcare costs generally and residential treatment readmissions specifically.
- 6. Peer Recovery Support Specialist • Highly Trained Peers Can: • Effectively Provide Support from a Strength-Based Approach incorporating Motivational Interviewing Techniques • Evaluate Level of Risk for Relapse • Engage Both Clients and Family Members • Gather Meaningful Data Private & Confidential ©2018 MAP Health Management®, LLC All rights reserved. 6
- 7. • Training and Implementation • Go-live 7Private & Confidential | © 2018 MAP Health Management®, LLC | All Rights Reserved. Deliver Better Outcomes and Client Experience • Detox • Residential (RTC) • Partial Hospitalization (PHP) • Intensive Outpatient (IOP) • Outpatient (OP) Acute Treatment • Substance Use Disorder is a chronic disease, yet structured support and treatment typically end after 30-90 days. • Relapse rates for Substance Use Disorders are up to 40-60% within the first year.1 • MAP extends the care continuum, which reduces the clinical and financial impacts of relapse. • We partner with existing Utilization Management, Case Management, EAP, Managed BH, etc. 0-90 Days 1 week prior to discharge - MAP engages patient to create profile. Conducted by on-site MAP administrator or remotely / telephonically. 90 days to 12 months +: • Member: 2 sessions per month (bi-weekly) or as needed depending on risk level. (can call into MAP 24/7) • Consent/Family: 2 session per month with MAP (can call into MAP 24/7) • Ongoing remote risk assessments (done via telehealth) • Ongoing psychiatric review and medication adjustment sessions based for patients with BH comorbidity (all done via telehealth). First 90 days, post-discharge2: • Member: 4 sessions per month with MAP Peer Recovery Support Specialist. (can call into MAP 24/7) • Consent/Family: 2 session per month with MAP (can call into MAP 24/7) • First 30 days: Recovery planning and full risk assessment for Substance Use Disorder and behavioral health. • Initial remote Psychiatric evaluation session based on behavioral health assessments (all done via telehealth). Discharge Member discharges from acute treatment. 1 - https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment 2 - This is the standard touch schedule for MAP Care Solutions, but touch schedules may be adjusted as needed based on necessity and risk level. Post-acute, tech-enabled peer recovery support
- 8. Engagement Is the Key 74 63 57 40 92 83 73 52 0 10 20 30 40 50 60 70 80 90 100 1-30 Days 31-60 Days 61-90 Days 12 Months Active Engagement Clients Family
- 9. Outcomes • 72% Reduction in Post-Acute Average Cost (Treatment Readmissions and Non-Routine Medical Visits) comparing those who relapsed versus those who did not). • 78% Maintained Recovery (No Relapse) While Engaged in the MAP Recovery Support Program while 22% of the member base relapsed. • 72% Reduction in Readmissions into Treatment Facilities—the collection of readmission and relapse data indicates a 72% reduction in readmissions for the no relapse population. • 48% Reduction in ER Admissions—The collection of ER admission and relapse data indicates a 47.86% reduction in ER admissions for the no relapse population.
- 10. Performance Measures and Outcomes Data 10Private & Confidential ©2018 MAP Health Management®, LLC All rights reserved.
- 11. What Types of Data Can Be Captured Using and Relapse • Active Clients Using at End of Month • Number of Clients Who Returned to Substance Use by Month • Returned to Substance Use for First Timers and Repeaters by Month • Returned to Substance Use by Gender by Month Core Indicators • Quality of Life Indicators • Compliance with Treatment Program • Compliance with Medication • Response to Medication • Medication Side Effects Measures • Engagement with Recovery Support Specialist/Counselor • Development of New Forms of Addictive Behaviors • Living in Secure Environment Involvement in Structured Peer Based Recovery Oriented Activities • Sponsored Others This Month • Attended 3 or More Weekly Meetings This Month • Full Time School or Employed This Month • Did Not Access Non-Routine Medical Services This Month • Was Not Using by Month • Had a Sponsor by Month • Sponsored Others by Month • Attended 3 or More Weekly Meetings by Month • Employed by Month • Did Not Access Non-Routine Medical Services by Month Risk Levels • Risk Levels at Time of Report • Risk Levels by Month Quality of Life • Happiness This Month • Happiness by Month • Stress and Coping • Aggregate Peer Support This Month • Peer Support Categories • Aggregate Relationship Strength This Month • Relationship Categories Demographics • Gender • Race • Age Group • Religious Background • Diagnosed Mental Health Disorder (& Disorders) • Education Level • Occupation • Annual Household Income • Military Service • Criminal Record (& Categories) • Addictions (& Categories) • Drug of Choice • Prescribed Medication • Living Environment • Post Discharge (& Categories) • History of Family Addiction • Family Member in Recovery • Who Proposed Treatment • Clients With Children 11Private & Confidential ©2018 MAP Health Management®, LLC All rights reserved.
- 12. Successful Program Completers • Phenomenology of 5 Peer Recovery Support Specialists • 18 Years of Experience • 55 years of Experience • 2 male, 3 female • Successful Completers • Honesty and Integrity and the way they answer questions. • Gratitude and Humility. • Service • Willingness to engage MAP program and other recovery supports. • Willingness to be vulnerable, listen to feedback and incorporate that into meaningful action.
- 13. Two of the Six Essentials for a Lasting Recovery • Hope – The Reawakening After Despair; to Expect with Greater Confidence • Healthy Coping Skills – The development of Effective Skills to Manage the Pain and Stress of Life Kimball, T.G., Shumway, S.T., Harris, K.S., & Austin-Robillard, H. (2016). Hoping and coping in recovery: A phenomenology of emerging adults in a collegiate recovery program. Alcohol Treatment Quarterly. Shumway, S.T. & Kimball, T.G. (2012). 6 Essentials to a Lasting Recovery. Hazelden Press. Shumway, S.T., Dakin, J.B., Smock-Jordan, S.A., Kimball, T.G., Harris, K.S. & Bradshaw, S. (2014). The development of the hope and coping in recovery measure (HCRM). Journal of Groups in Addiction and Recovery.