Homewood Research Institute 1 The Development and Implementation of a Recovery Monitoring System: In...

Homewood Research Institute

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The Development and Implementation of a Recovery Monitoring System:

In the Addiction Medicine Service, Homewood Health Centre

2015 Addictions & Mental Health ConferenceToronto, Ontario

Monday, May 25th, 2015

Presented byJean Costello, PhD

Research & Evaluation ScientistHomewood Research Institute


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The Partnership: HRI & Homewood Health


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About Homewood Health

Homewood Health Centre (HHC) Inpatient Programs:• Addiction Medicine• Traumatic Stress

Recovery• Integrated Mood and

Anxiety• Eating Disorders• Others…


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Why Recovery Monitoring at HHC?

• Commitment to evidence-based practice and client-centered treatment

• measuring & monitoring patient-level outcomes

• Demonstrate accountability to patients, family members, payers/insurers, etc.

• Few other facilities routinely measure outcomes post-discharge

• Research value – better understanding of the effectiveness of MHA services


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Our Vision

• To create a learning system where one can learn from practice to improve practice, by…

• enabling routine evaluation and monitoring of patient outcomes post-discharge;

• facilitating applied or clinical research (within and across organizations); and,

• aligning with provincial-level efforts to facilitate comparisons across populations and contribute to system change.


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Our Approach

• Build upon best practices and align with larger efforts• Hazelden (Dr. Valerie Slaymaker) – U.S. Leader• Ontario (Dr. Brian Rush) – Canadian & International Leader

• Participatory / Consultative• Administrative-level• Program-level• Patient-level• Other external experts: Drs. Brian Rush; Valerie Slaymaker;

James MacKillop; Don Meichenbaum


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STEP 2: Develop data

collection tools and protocols

STEP 3:Pre-test

tools and protocols

STEP 4:Implement recovery

monitoring system

STEP 5:Evaluate

and refine tools and protocols

STEP 1:Develop a program

logic modelManage routine operations of the

system

Our Process


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Manage routine operations of the

system



STEP 3:Pre-test

tools and protocols


monitoring system

STEP 5:Evaluate



logic model

Our Process: Step 1


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Step 1: AMS Logic Model


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Step 1: Program Outcomes

Outcome Domain Example Outcome(s)

Substance Use Behaviours Abstinence from alcohol and/or drugs

Mental Health Status Improved mental health status

Aftercare Involvement Adherence to aftercare plan; Engagement in AA/NA/CA

Life Functioning

Psychological Greater sense of hope; meaning; self-efficacy

Physical health Improved physical health status

Social roles & responsibility Greater fulfilment of social roles (e.g., parent, spouse)

Activities of daily living (ADL) Improved ability to perform ADL

Occupational/vocational Improved performance at work

Quality of life/life satisfaction Improved quality of life/satisfaction with life

Use of Health & Social Services Decreased use of emergency room services


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system



STEP 3:Pre-test

tools and protocols


monitoring system

STEP 5:Evaluate



logic model

Our Process: Step 2


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Step 2: System & Tool Development

• Reviewed existing protocols and tools/sub-scales

• Adopted, refined, and created new protocols/items where appropriate with internal and external stakeholder feedback

• Created an infrastructure: • Staff• Software (i.e., data capture, participant tracking)• Equipment (i.e., tablets, phones & headsets)


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Step 2: Data Collection Protocol

Admission Discharge1-month

post-discharge

3-months post-

discharge

6-months post-

discharge

12-months post-

discharge

Self-administered, in-person, group-based

via tablets

Primary recruitment

Re-recruitment opportunity

Telephone via trained research assistant OR

email via electronic questionnaire


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system



STEP 3:Pre-test

tools and protocols


monitoring system

STEP 5:Evaluate



logic model

Our Process: Step 3


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• Pre-tested with former AMS patients• Group 1, n=21: self-completed, in-person via tablets• Group 2, n=25: completed over phone w/ a trained interviewer

• All followed up 3-7 days later by phone and asked to complete the questionnaire again (Group 1, n=17; Group 2, n=21)

• Informed revisions to question wording, instructions, and administration protocols

• Test-retest reliability analysis

Step 3: Pre-testing System & Tools


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system



STEP 3:Pre-test

tools and protocols


monitoring system

STEP 5:Evaluate



logic model

Our Process: Step 4


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Step 4: Early Implementation

Admission Discharge1-month

post-discharge

3-months post-

discharge

6-months post-

discharge

12-months post-

discharge

Self-administered, in-person, group-based

via tablets

Primary recruitment

Re-recruitment opportunity

Telephone via trained research assistant OR

email via electronic questionnaire

WE ARE HERE


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Reflections on Critical Success Factors and Early Lessons Learned


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Critical Success Factors

• Buy-in at the level of ownership & senior administrators

• Committed resources for developing & testing the system

• HRI is arms length objective data collection & reporting

• Working initially at the program-level (e.g., AMS)

• Not trying to re-invent the wheel; building on/contributing to…

• Engaging expert reviewers and advisors

• Incorporating the lived experience

• Commitment to translating findings back to decision-makers

• Plans to embed outcome monitoring within standard practices


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• Create a system that is meaningful to the participant

• Value in “giving back”; continual engagement

• Start with a good electronic capture product(s) & embrace the

limitations

• Tablets facilitate data collection & entry, but require facilitation

• Move to a tailored product when needs are clear

• Embed data collection within treatment

• Need to balance expectations & multi-uses of outcome data

Early Lessons Learned


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HRI’s Recovery Monitoring Team

Jean Costello, Research & Evaluation Scientist

Courtney Ropp, Research Associate

Sarah Sousa, Research Associate

Kayla Deroux, Research Assistant

Katie Junkin, Research Assistant


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The aim of Homewood Research Institute (HRI) is to improve outcomes of mental health and addictions treatments and services. Initial areas of focus are addictions, PTSD, concurrent treatment and return to work.

HRI is initiating networks to enable researchers, evaluators and practice leaders to collaborate with patients, clients, worksites, clinicians, and donors in work that advances both science and practice. Homewood Health is HRI’s primary practice partner.

www.homewoodresearch.org

Homewood Research Institute 1 The Development and Implementation of a Recovery Monitoring System: In...

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