Editor's note: Established in 2001, the James W. West, MD, Quality Improvement Awards recognize member organizations of the National Association of Addiction Treatment Providers (NAATP) that improve the quality and effectiveness of their services and document their results along the way.
The award is named in honor of James W. West, a longtime quality improvement advocate and medical director emeritus at the Betty Ford Center. Award recipients will be honored at the annual NAATP conference, held May 19-22 in Phoenix.
This, the 12th annual award, recognizes three programs whose efforts demonstrate comprehensive approaches to effective, continuous quality improvement. One of three recipients this year, Valley Hope Association was recognized for implementing a professionally staffed and monitored online aftercare program.
For an organization that values the quality of the services it provides, Valley Hope Association had grown concerned a few years back when sobriety and recovery rates for clients just a year out of primary treatment had declined to a level that needed attention.
“We were concerned that we weren’t providing the same quality of care that we had in the past,” explains Juanita Gregoire, PhD, Valley Hope’s clinical director. After taking a closer look, they determined that it wasn’t the quality of care that was the issue. It was the quantity.
More accurately, it was the relatively low attendance for clients participating in continuing care. Not surprisingly, their data indicated that individuals who attended continuing care regularly had better long-term sobriety rates than those who didn’t.
What was somewhat surprising was that even clients who were motivated in primary treatment often dropped out of continuing care after a short period of time. Or, they didn’t show up at all. When Valley Hope started asking why, clients said the meetings didn’t “fit in with their lifestyle.” Explanations included factors such as:
- They had children who could not be left unattended or work hours that did not accommodate continuing care meetings.
- They were unable to drive to meetings due to losing their driver’s license or other transportation problems.
- They had other concerns related to travel. Factors such as car trouble, gas prices and weather conditions were often cited.
In an effort to overcome those barriers, the organization initiated a performance improvement project to find better ways to keep patients involved in continuing care on a more consistent basis. The first step, according to Gregoire, was to reevaluate the manner in which aftercare was being delivered.
“We really looked at how we were delivering treatment,” she says. “We had to consider that the world has changed, and perhaps our traditional way of providing continuing care was not meeting the needs of our patients.”
Eventually, the improvement project led to the creation of a professionally staffed and monitored 24-hour online aftercare program called “Accessible Care/Effective Support Services” (AC/ESS). To make sure the new program could be incorporated into the existing model, a one-year trial was conducted with clients in a rural area that exhibited many of the challenges the program hoped to address.
Feedback from early trials included comments that said the interface was “too complicated” and “not intuitive,” so the entire design was abandoned and the process started again. The bugs were eventually worked out, but there were still reservations about how the service would actually work.
For example, some veteran counselors voiced concern over whether a true “therapeutic relationship” could be maintained online. Others were reluctant to refer patients to the service because they felt it was “inferior” to a live continuing care group.
But when the data started coming back, those misgivings were largely put to rest. Trial data showed promise, with individuals still sober and in touch with Valley Hope six or seven months after treatment.
Now over 18 months after the official launch, clients using the online service continue to show some impressive results when compared to “on ground” services, including:
- 79% completion rate (compared to 63% “on ground”)
- 66% abstinence rate (compared to 46% “on ground”)
- 92% recovery rate (compared to 87% “on ground”)
- 87% follow up rate (compared to 50% “on ground”)
“We’re able to see that patients we’re sending online are staying involved,” Gregoire says. “Not only are we able to keep in touch with them longer, we’re able to find them and gather more valid data.”
According to Dennis Gilhousen, president and CEO of NAATP, Valley Hope has developed “a very sophisticated online aftercare program, which they have measured in terms of the length of time that people stay attached and involved.”
“It’s a good vision of what technology can, will, and maybe must do in our field if we’re to continue to grow and keep pace with the world around us,” Gilhousen adds.
Photo caption: The leaders of Valley Hope’s AC/ESS quality initiative are (back row, l-r) Juanita Gregoire, clinical director; Dr. Ken Gregoire, president/CEO; Dawn Johnson, clinical supervisor; Joshua Robinson, information services programmer; (front row) Jolene Nichols, AC/ESS clinical director (seated); and Dr. Tiffney Yeager, clinical supervisor (standing).
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