Handoffs Technologies as Continuing Care

• NIATx Webinar Series• May 15, 2013

• David Mathews, Ph.D. and Todd Molfenter, Ph.D.

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Keys to Successful Hand Offs:

Communication is Critical

Dilemma: Positive outcomes when confronted by managed care,

short episodes & limited resources.

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• Only 17% of individuals who complete treatment in one level of care successfully access the next recommended level of care (OAS, 2005).

• Linking treatment to recovery supports improves outcomes 20-22% (Dennis, 2007)

• Only 20% of adults and 36% of adolescents receive any professionally-directed post-discharge continuing care. (Godley et al., 2001; McKay, 2001)

Treatment & Recovery

Handoff Defined

The transfer of information (along with authority and responsibility) during transitions in care across the continuum for the purpose of ensuring the continuity and safety of the individual during healthcare.

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Continuing Care Philosophy

• There are no discharges or terminations

• Status change from active to inactive means active with someone else

• All actions involve transferring care to someone else

• Warm Handoffs vs. Cold Handoffs

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Hand-off as a Form of Communication

Types of Handoffs • One provider to another

• Critical reports (discharge, laboratory and pharmacy )

• Facility transfers (home, IOP-OP)

• Other transitions in care (case management)• One Level of Care to another• One Agency to Another 7

TY

PE

S

JCAHO Requirement (2006)

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“Implement a standardized approach to ‘handoff’ communications, including an opportunity to ask and respond to questions.”

Sample Handoff Tools: Choose one and train staff of your agency!!

• SBAR• I-SBAR

• I PASS THE BATON

• 5 P’s• BSTAR

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I - SBARI – introduction

S - ituation (the current issue)

B - ackground (brief, related to the point)

A - ssessment (what you found/think)

R – equest (what you want next) 10

RecoveryManagement Handoff Form

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• The majority of those discharged from treatment do not receive the NIDA (1999) recommended 90 days of continuous care (White, in press).

• 80% of individuals who relapse after treatment do so in the first 90 days (Hubbard et al., 2001).

• The majority of substance dependent individuals only achieve stable recovery after 3-4 treatment episodes over multiple years (Anglin et al., 1997; Dennis et al., 2005).

More about Treatment

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NIATX: Five Principles1. Understand and involve the customer

2. Fix key problems

3. Pick a powerful Change Leader

4. Get ideas from outside the organization

5. Use rapid-cycle testing

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Why a Walk-through?

The walk-through…– Helps understand the customer and organizational

processes– Provides a new perspective

• Allows you to feel what it’s like• Lets you see the process for what it is

– Seeks out and identifies real problems – Generates ideas for improvement– Keeps you asking why?…and why? again

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Making Changes

• PDSA Cycles – Plan the change– Do the plan– Study the results– Act on the new knowledge

• Adapt• Adopt• Abandon

• Two-week-long cycles

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Strategies to Support Long-Term Recovery

Telephone-based continuing care (McKay et al.,

2004)

Recovery Management Checkups (Dennis et al., 2003; Scott et al., 2005)

Assertive Continuing Care (Godley et al.,

2004)

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Handoff Technologies

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Video Introduction to Next Level of Care• Video created to

demystify first visit to outpatient offices

• Video given to Hospital for units

• Case Managers with portable DVD player

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0%

10%

20%

30%

40%

50%

60%

70%

BaselineOctober

May June July August September

Percentage Substance Abuse Continuing Care from ARH- Hospital to KRCC Outpatient from Dual Units Versus Baseline

Appointments Kept Dual Unit Clients Only

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Video Handoffs

• Clients at Next Step Recovery Center and Bailey Center Crisis Stabilization Units had video meetings with next level of care.

• Clients in the Hospital Have had video handoffs with community counselor.

Offender Re-entry Cook Co.

• Correctional Drug Treatment to post prison HIV Agency

• Five entities involved with service handoff

• HIV+ cases needing continuing care

• NIATx Change Team found barriers, created handoffs – 80% success

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ACHESS Smartphones

• Using specially designed apps clients receive support from each other and Recovery Coaches and Recovery Managers 24/7/365

• Pregnant clients in IOP/OP

• Technological Innovations helps communication during stressful transitions

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Thanks for your attention!

• For more information contact:

Todd Molfenter todd.molfenter@gmail.comDavid Mathews wdmathews@aol.com