When Rehab Software Solutions Forget the Humans
I recently read an article that states, “2016 was the year tech seemed to forget about the humans: the way we work, what makes us tick, and that we’re all, actually, fragile and complex beings."
It explains that people are attempting to cure all the ails of the world with tech. People swipe for a date, have items delivered to their door by drone and attempt to solve life and death problems via the Internet.
Thought leader Steve Millette has a different idea. He wants to put humans back at the center of technology—specifically the software and tools used in the rehab and recovery industry.
The trend is to take humans out of the digital equation
“Patient-physician communication is an integral part of clinical practice. When done well, such communication produces a therapeutic effect for the patient, as has been validated in controlled studies.”
Mike Strazzella, a federal government healthcare attorney, explains that while tech can help save costs to the healthcare system and patient, those services also remove much of the interaction.
The Journal of the American Osteopathic Association has been warning physicians for more than a decade about the dangers of losing this communication. “Patient-physician communication is an integral part of clinical practice. When done well, such communication produces a therapeutic effect for the patient, as has been validated in controlled studies.” They go on to list the barriers in effective communication, which include “time, language and technology.”
Steve Millette believes the right engagement technologies and platform models can innovate, support and speed the advances of needed solutions. He’s working with Gloo to develop these platforms in the areas of recovery and rehab.
The Centers for Disease Control estimate that over 100 people a day die because of drugs and over 6500 will be sent to hospital emergency rooms for treatment. While addiction and substance abuse are undoubtedly major problems in the US, a survey conducted by the Substance Abuse and Mental Health Services Administration found that as many as 90 percent of people who most need drug rehab do not receive it.
With such a desperate need for solutions, why is the system so broken?
Steve explains how the current system does not work in these important ways:
- The value equation is upside down—it’s profit-driven instead of patient outcome-driven
- Drug treatment has turned into a big business—private firms and publicly-traded companies look for ways to profit from the growing rates of addiction
Steve believes what the industry really needs is human connection. “People and relationships are central to success,” he says. For people to grow, they need more than just content. They need encouragement, support and real human connections.
Steve explains the struggles in rehab & recovery tech today
Steve’s been involved in the recovery healthcare field for decades. First as a survivor, then as a mentor. He’s worked as an administrator and even a program director. It’s his passion to bring the systemic change required to solve addiction and behavioral problems in our society through human-based solutions.
As he works to create the digital platforms to make this a possibility, he has noticed two main struggles that affect the recovery industry. These struggles are directly related to patient outcomes, which must be addressed by treatment centers, in order to improve future programs.
1. Patient engagement needs to happen sooner, be stronger and last longer.
Sooner: Currently, the industry only gets involved when patients or their friends and family are desperate. ACCESS states that only 10% of those who need treatment receive it. We need to identify and reach the people in need sooner, before they hit rock bottom.
Stronger: We need to engage in the gap, between face-to-face meetings, and with various comprehensive offerings tailored to meet the patient’s needs. The need for support can arise when patients are at home, in social gatherings or in the workplace. Engaging in the gap opens communication for support whenever it’s needed.
Longer: We need to provide follow up services and support after the patient leaves. Right now the patient is considered “recovered” once leaving the program, and is only heard from again if they relapse.
2. Data-based evidence is missing.
Measurement-based care and decision making is scarce because engagement is missing before, during and after an episode of care. With little ongoing engagement, follow-up data and outcome measurement is hard to obtain and report. With a scarcity of data to measure outcomes and understand what works, many go unserved, underserved or poorly served in our current system. Since data can lead to better decision making, why is it so scarce?
1. Differences in the definitions of important terms such as “addiction,” “treatment” and “recovery,” according to Spontaneous Recovery Studies.
2. Sample sizes in outcome-data are often too small to be representative. They struggle to be larger than 30% of the intended study group, often smaller. This doesn’t allow for accurate measurement of the group as a whole.
3. The accepted duration of “healthy” behavior for recovery to be called successful is missing. Studies that look at 2-5 years out are rare. Most at best look within the first year of the designated “graduation from treatment,” while centers often only study outcomes around the the duration of their program which is necessary but not sufficient.
4. The widely used 12 Step Program is not a treatment model, although many believe it to be. It also does not collect data.
Medically-assisted treatment is considered the gold standard for treating severe opiate/opioid addiction. However, treatment centers are much slower to adapt to these methods. At a recovery industry convention in 2016, American treatment centers discussed “their core faith in abstinence-based treatment … which forswears the use of medications such as methadone or Suboxone.”
Scientific American also looked at the often-cited problem with formalized treatment programs: so many people who attend them suffer relapses. They found that data just doesn’t support that the formalized 12 Step programs are successful.
An Americanaddictioncenters.org “Rehab Success Rates and Statistics” study points out that studies don’t support the notion that willpower is the answer, nor that rehab doesn’t work. It does add support to the notion that successful recovery can vary widely from one individual to the next. This is echoed by Bankole Johnson, professor of neuroscience at the University of Virginia School of Medicine and editor of Addiction Medicine. He suggests that the treatment emphasis should be on the best treatment for the individual and the situation.
Introducing the Recovery Oriented Model of Care
When I sat down with Steve at Gloo, we discussed how treatment facilities and technology companies must work together to put people back into digital communication and software solutions.
He calls his solution the Recovery Oriented Model of Care — ROMC.
What ROMC looks like
ROMC turns the focus of care from the disease to the patients and their recovery outcomes. This can be done by embracing models of recovery management nested within larger recovery-oriented systems of care. If we think about recovery as a person’s experience of improved functioning in the domains of health, home, purpose and community and collect data on these domains over a 5 year period following care, then we start to define “success” in a much more comprehensive and meaningful way.
These systems of care can look like:
- Pre-covery outreach services
- Sustained post-treatment recovery checkups
- Support services for families in long-term recovery
ROMC practices with these action guidelines:
- An individual and family-centered treatment approach
- Increased involvement of professionals in pre and post-treatment stages of recovery
- Expanding array of service settings
- Continuum of professional/clinical and peer-based interventions
- Lowered barriers between treatment setting and the indigenous recovery supports
ROMC puts people first
Let’s look closer at two ways the practices of ROMC are putting people back into the equation of recovery.
1. Recovery Focus
Full and partial recoveries from severe behavioral health disorders are living realities of hundreds of thousands of individuals. Where complete and sustained remission is not attainable, individuals can actively manage these conditions in ways that transcend the limitations of these disorders. This allows for a fulfilled and contributing life.
The ROMC model emphasizes recovery processes over disease processes by affirming the hope of such full and partial recoveries. It emphasizes client strengths and resiliency rather than client deficits. Recovery re-introduces the notion that any and all life goals are possible for people with severe behavioral health disorders.
2. Client Empowerment
The client, rather than the professional, is at the center of the ROMC model. The goal is the assumption of responsibility by each client for the management of their long-term recovery process. The goal is the achievement of a self-determined and self-fulfilling life.
Client empowerment involves not just self-direction of one's own recovery, but opportunities for involvement in the design, delivery and evaluation of services provided by behavioral health organizations. It also means the involvement in shaping public attitudes and public policies regarding behavioral health disorders.
Going forward in the recovery industry
Steve distilled his model of recovery into ways we can look at this problem and work to solve it. We know we can’t have evidence-based without a measurement-based practice.
“That doesn’t mean you’re always practicing with high fidelity, but if you measure your practice, you can at least have that to guide you,” says Steve.
Steve realizes that no system is perfect, but good technology is flexible and responsive to correction. You can fix tech problems as they arise.
And finally, that the core solution is people helping people. We must put people back into the recovery technology if we want to help more people.
“We need to harness the latent energy of Champions. And never forget the core solution is people helping people.”
Reorient Our View of Addiction and Recovery
The solution of a ROMC is one model that is having a dramatic impact. It works to reorient our view of addiction and recovery. Any effective solution to addiction will increase access to new products and services not currently available in our system of care but needed by the consumers. With the right architecture and design, the platform model of ROMC can solve many of the problems we have endured for too long in our system.