Impact of recovery support navigators on continuity of care after detoxification

Margaret T Lee; Maria Torres; Mary Brolin; Elizabeth L Merrick; Grant A Ritter; Lee Panas; Constance M Horgan; Nancy Lane; Jonna C Hopwood; Natasha De Marco; Andrea Gewirtz

doi:10.1016/j.jsat.2020.01.019

Impact of recovery support navigators on continuity of care after detoxification

J Subst Abuse Treat. 2020 May:112:10-16. doi: 10.1016/j.jsat.2020.01.019. Epub 2020 Jan 31.

Authors

Affiliations

¹ Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02453, USA. Electronic address: mlee@brandeis.edu.
² Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02453, USA; Smith College School for Social Work, 213 Lilly Hall, Northampton, MA 01063, USA.
³ Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02453, USA.
⁴ Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02453, USA; Massachusetts Behavioral Health Partnership, a Beacon Health Options company, 1000 Washington Street, Suite 310, Boston, MA 02118, USA.
⁵ Massachusetts Behavioral Health Partnership, a Beacon Health Options company, 1000 Washington Street, Suite 310, Boston, MA 02118, USA.
⁶ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215, USA.

PMID: 32199540
DOI: 10.1016/j.jsat.2020.01.019

Abstract

Although evidence points to the benefits of continuity of care after detoxification (detox), especially when continuity of care occurs within a short time after discharge from a detox episode, the rate at which clients engage in continued treatment after detox remains low. The goal of the study was to develop and deploy a specially trained workforce, called recovery support navigators (RSNs), to increase the likelihood of clients continuing onto treatment after detox. Continuity of care is defined as receiving any substance use disorder (SUD) treatment service within 14 days of discharge from the index detox. We examined whether clients in the RSN Intervention group were more likely to meet the continuity of care after detox criteria than clients in the treatment-as-usual (TAU) group. A quasi-experimental intervention versus comparison group study was conducted. Data were from the Massachusetts Behavioral Health Partnership (MBHP), a Beacon Health Options company that manages behavioral health benefits for a subset of Medicaid beneficiaries in the state. Inclusion in the analytic sample (N = 4,236) required that the client's index admission to detox was between 3/29/13 and 3/31/15. RSN Intervention versus TAU status was assigned based on provider organization where the index detox occurred. Analyses were conducted on an intent-to-treat basis. Overall, the continuity of care rate across all study groups was 42%. The rate by study group was 38% for the TAU and 45% for the RSN group. Clients who were in the RSN group were significantly more likely to have continuity of care after discharge from detox than those in the TAU (OR = 1.233, p < .05, 95% CI = 1.044, 1.455). Clients who entered detox at a site that provided specialized training to RSN, which included motivational interviewing and educational sessions related to treatment issues, and allowing them to bill with a flexible daily case rate instead of the usual fee-for-service billing, were more likely to have continuity of care after discharge from detox compared to clients in the TAU group.

Keywords: Continuity of care; Detoxification; Recovery support; Substance use disorder.

Publication types

Research Support, U.S. Gov't, P.H.S.

MeSH terms

Continuity of Patient Care
Humans
Massachusetts
Medicaid
Motivation
Patient Discharge
Substance-Related Disorders* / therapy