Month: April 2020

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Incentives

In order to keep patients in the study, we will offer an incentive.

The incentive will work on a point based system. Every time a patient completes a step of the study (the opening survey, a follow-up) they will receive points. The point value of each task will be different for example, an in person follow-up will be more points than a self reporting follow-up. Patients will collect points to redeem them for a prize, and the more points they have the more expensive the prize. The prizes can range from a stick of deodorant to various gift cards.

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Meet the Team

The addiction treatment team consists of five Trinity College students.

Jasmine Parras – A freshman planning to major in Public Policy and minor in history or Spanish. “The most exciting element while doing this project was learning about the different types of treatment there are for people.”

Arianna O’Brien – A junior majoring in Public Policy and Law and minoring in Writing, Rhetoric, and Media Studies. “My favorite part of this project was seeing firsthand how passionate InterCommunity Health is about helping those struggling with addiction.”

Nina Montross –

Lauren Mac Master –

Adrian Rivera – A senior majoring in Neuroscience. “I have a strong interest in Public Health and Epidemiology. My favorite part of the Action Lab was working towards ameliorating a very important and intractable crisis: substance abuse.”

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Quasi-Experimental

Assign groups

In this experiment, there will be three groups of treatment that I Can Model has to offer. Since people are allowed to choose the type of treatment they want to admit themselves in, we will go off the groups that have already been made. This study would last for 5 years.

  • Outpatient: The first group would be the patients that are only being prescribed to MAT (medically assisted treatment). Intercommunity health for MAT they use suboxone, which is a prescription opioid used to treat opioid use disorder, it can be used under the tongue, in the cheek, by injection, as a skin patch, or as an implant.  
  • In-Patient + MAT: The second group of people will be the ones who are prescribed to MAT and have entered themselves in a 28-day program or a 90-day program.
  • In-Patient: Then the third will be the ones who are only entering a 28-day program or a 90-day program without using MAT.

This will measure the effectiveness of treating the whole person versus not. I Can is known to have that special element of treating the whole person. Therefore, this experiment will show if treating the whole person will help them with opioid dependence. These three groups will be compared to another treatment facility in which they offer the same type of programs but do not provide the same uniqueness of treating the whole person that the I Can Model has. It will be compared to the United Recovery Project that is also located in Hartford, Connecticut.

 

An image of an example of a Quasi- Experimental Assignment. url:https://methods.sagepub.com/case/quasi-experimental-quantitative-design-effect-of-cooperative-learning
An image of an example of a Quasi-Experimental Assignment. URL: https://methods.sagepub.com/case/quasi-experimental-quantitative-design-effect-of-cooperative-learning

Data Collection

There will be a survey used for the self-reporting aspect. The survey will consist mainly of questions related to the effect the treatment has had on their lives and if any obstacles had occurred since in treatment to remain opioid independent. Some sample questions:

  • When was the last time you had an opioid overdose?
  • How many relapses have there been since your last self-report?
  • What has helped you not misuse opioids?

Secondly, a urine test will be administered to measure if the person is currently using or has used it in the past couple of days. In order to make sure that the patient is truthful in their responses on the self-reporting survey, talking to their families/friends or significant others will help reaffirm how the process has been for those who are outpatients (if they report that they have those relationships). If the patient is in treatment outside family members or significant others can provide information on how the patient is doing after a treatment. Therefore, when contracting a family member or significant other, there will be a short conversation asking what they have seen in the patient’s journey. This component will only be used for patients who have reported these relationships.

Thirdly, looking into hospital records will indicate who has died from an opioid overdose. Hospital reports will provide information on whether someone died or had been admitted to the hospital for an overdose.

Since this study will run for five years there will be self-reported surveys every month. This way we are also able to follow up without the patient forgetting about the study.  In addition, the urine test will happen every four months starting when the patients enter the program. And as for the follow up with the patient’s family members, it will also be every four months. After each year, there will be an interactive interview with the patients. This interview will involve more personal questions to the patient about what has been working for them verse not. This survey will allow us to see the effects of treating the whole person and whether or not it is useful for a patient to fight opioid substance abuse.

Outcomes

Between the three groups will compare the number of relapses, the number of overdoses and deaths. Through all treatments, we do not expect someone to be completely sober as it’s very common to come out of treatment and have a relapse, especially if you do not have a strong support system. The number of relapses that someone has gone will indicate if the treatment helped in decreasing the number of relapses. Furthermore, the number of overdoses, the fewer overdoses someone has will indicate an improvement in having opioid dependence.

Lastly, the number of deaths will indicate which treatment was less successful. Having death from an OD as an outcome will be interesting to look at because of the uprising access to NARCAN, which an opioid antagonist used for the complete or partial reversal of opioid overdose. Therefore the two main outcomes are:

  • Number of overdoses
  • Number of relapses
  • Number of deaths

To measure this, there will be an Opioid-positive urine test result in the initial first month during recovery, then mid-year and the end of the year. This will repeat for the five years of the duration of the study. Opioid positive urine test is invasive; however, this provides evidence if someone is providing false in the self-reporting surveys. We understand the circumstances these individuals are in. Therefore, we suggest providing an incentive which will be determined by InterCommunities budget for the study, when people take the urine test.

Maintaining Involvement Ideas

  • Use a primary survey to address contact information with the patients. Learning different modes to maintain contact with the patient to ensure followup. The survey would consist question of what type form of contacting they prefer the most.
  • Using incentives

Some examples of incentives could be

  • Cash
  • Gift cards
  • Basic necessities that these individuals might not have access to.
  • Offering workshops as in how to be professional in works place or how to prepare for an interview or other workshops that will help them like how to cook. Workshops to get patients interested and involved.
  • More information

We recommend gift cards because they are easier to distribute to a large population. The amount of the incentive that we recommend is either 15 to 20 dollars each time a patient provides a urine test. This will help encourage people to become involved in the study. This process will allow people to see the improvement of someone’s treatment. Long term studies allow a more complex study to see if the treatment is working for patients.  If participants don’t show up to two consecutive drug tests, we will take that as them dropping out of the study.

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Pre-Post Study Proposal

Study Design: Comparing Pre-ICAN Results and Post-ICAN Recovery Model Results 

Another idea for this experiment would be to compare previous patient data from the InterCommunity Health facility before the implementation of their ICAN Recover model with new data from patients after the implementation of the ICAN Recover model. For this experiment one would assign the control group to be patients who participated in InterCommunity Health’s programs prior to the implementation of the ICAN Recover treatment model, (or those undergoing treatments that do not involve ICAN Recover if the data is not available); the treatment group would then consist of any individuals whose treatment has incorporated the ICAN Recover model. With this control group it will allow for direct comparison of the same treatment facility before and after the implementation of the ICAN program to address its effectiveness. Additionally, it is important that each kind of treatment within the InterCommunity Health facility is distinguished from each other so that results from detox are not compared with those of in-patient and out-patient.

 

Assigning Comparison Groups

Comparison groups will be split up into two with one group being any participants who were involved with InterCommunity health before the implementation of the ICAN Recover program. The second group for this study will be the new participants who are receiving the ICAN Recover treatment model in order to see if it is yielding more effective results. It is important to remove any participants for the second group that have received the treatment before ICAN Recover was implemented so that the two groups can be differentiated from each other better. It is  important that any patients who have undergone both treatment models should be left out of this study. The control group should consist just of people who have received treatment from their programs before the implementation while the treatment group should consist of just people who have received treatment from their programs after the implementation.  

 

Data Collection

The data collection for this experiment will consist of both quantitative and qualitative data. The quantitative data will consist of retention rates to assess the percentage of patients going through and maintaining their treatment. On the other hand, the qualitative data will assess treatment success for each patient. In order to obtain this information researchers will obtain old patient records for the control group to assess this information, with complimentary follow up interviews for this group as well when information can’t be found. The data collection for the treatment group will consist of an initial questionnaire with follow up interviews to assess both treatment completion and recovery success as well. These can then be compared in order to compare how treatment at the InterCommunity Health facility before the implementation of ICAN Recover compares to after the implementation of the program. 

For the new data collection initial interviews would be conducted to obtain pertinent information from the patient. After signing a confidentiality agreement and/or consent form, patients would provide information regarding demographics, previous treatments, length of drug or alcohol use/abuse. This longitudinal study would require follow-up interviews to assess retention rates, treatment success, and overall effectiveness. The follow up interviews should be conducted every 6 months in order to assess retention rates and treatment success factors. The duration of this experiment should be at least 5 years to collect comparable to new data that will compliment the records obtained from the control group. This study can therefore hopefully show an increase in treatment effectiveness and success since the implementation of the ICAN Recover program at InterCommunity health, in addition to providing some insight on what parts of the program are the strongest and if there is any room for improvement. 

 

Outcome Measures

This research should ultimately demonstrate the effectiveness of treatment when the ICAN Recover model is implemented versus when it is not. This data could then aid in promoting awareness of this model’s benefits and make it something other facilities can adapt and implement for their own programs. The ideal goal of this study is to show that treatment is more successful with the implementation of the ICAN Recover model. Retention rates pulled from this data should show if the implementation of the ICAN Treatment is increasing the percent of people staying in and going through treatments to their full extent. This quantitative data can be complemented with the follow up surveys to assess their current treatment and substance use status to get more qualitative results as well making this experiment more meaningful. This study design allows for direct comparison as it is looking at data from the same facility just pre and post implementation of the treatment. The goal of this study will be to prove the improvements in treatment that has occured since the implementation of the ICAN Recover model at the InterCommunity Health facilities. 

This research should show higher retention rates seen for people who go through the InterCommunity Health facilities programs after the implementation of ICAN Recover. Also, the follow up questionnaires should yield more successful treatment outcomes than those from before the implementation. This program was created with the goal in mind of improving the quality and consistency of care for their patients and hopefully the results from these study’s help prove that. 

 

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Random Assignment Study Proposal

Random Assignment Procedure

Since randomly assigning a control group that receives no treatment is unethical, the control group will be assigned based on capacity, or, the amount of open beds in the I CAN facility. In this kind of Randomized Control Trial (RCT), the pool of subjects is the amount of people entering the I CAN facility on a given day There are not always enough beds to accommodate the number of people seeking treatment, so I CAN is sometimes forced to turn people away. In this situation, when there is not an available bed for the patient, I CAN will contact other treatment facilities to find out if those facilities have room for the individual. If there is room, I CAN then provides transportation for the individual to get to that treatment center. If all other facilities also have no capacity, patients are referred to their local emergency room department. The patients that are turned away from I CAN and placed into other facilities will act as our control group. Patients who enter I CAN treatment will act as our experimental group. While perhaps more difficult to achieve, a RCT is optimal from a methodological perspective because it allows patients to be assigned to control or experimental groups with as little bias as possible. This, in turn, allows comparisons between treatment groups to be made more effectively. 

In addition, randomization eliminates the ability for individuals to manipulate the control groups. This is due to the fact that an individual is not deciding the control and treatment groups. Rather, the groups are created solely based on capacity of I CAN Recover. Lastly, monetary incentives will be offered to patients in order to encourage participation in the study. The incentives will likely be in the form of a gift card of each patient’s choice. 

There are several addiction treatment services offered in the Hartford area. Three of the facilities patients may be sent to if there is no space at I CAN are CleanSlate, Connecticut Addiction Medicine, LLC, and Root Center for Advanced Recovery. CleanSlate and Root Center for Advanced Recovery both offer MAT and outpatient services. Connecticut Addiction Medicine, LLC is more comparable to I CAN Recover. This model offers a wide range of treatment options including MAT, psychotherapy and counseling, inpatient detox, outpatient detox, intensive outpatient programming, partial hospitalization, and three residential programs – 28 day, 45 day, and 90 day options. This model differs from I CAN because they do not focus on the whole individual, and patients are encouraged to participate in twelve step recovery. 

Data Collection 

Firstly, to demonstrate InterCommunity’s commitment to long-term addiction treatment evaluation, we propose a 5-year outcome measurement. Based on addiction treatment program evaluations discussed in prior literature, programs that evaluate outcomes for longer than one year report more favorable results in terms of abstinence and quality of life. I CAN Recover could benefit greatly from such a treatment model. 

Patients will complete a survey upon their admittance into the treatment facility. The employee at the treatment center that is checking individuals in will first explain the study then ask the individual to sign a form of consent. The survey is the first step of the study which will collect demographic information, substance abuse history, treatment history, family history, as well as determine the best way to contact patients once they leave the facility. We recommend this survey be developed using the Addiction Severity Index (ASI). Once the patient completes their treatment, they will then be followed for five years. The patient will self-report drug use. When possible, they will do in person interviews once every three months and potentially give a urine sample. In addition, patients should report if they have gone back to treatment and if so, what facility and program. These follow-up interviews will help address not only retention rates but also ask questions that will help improve the model as best it can be based on the feedback of participants. 

Outcome Measures

Effectiveness will be measured by:

  • Retention rates for each treatment model 
  • The number of sober days per month

The retention rate of the program (not the retention rate of the study) will show how well the program is able to connect with individuals and keep them engaged and motivated with recovery. To achieve an adequate retention rate, we propose that InterCommunity establish a goal of 70 percent retention. This means that at least 70 percent of study participants remain in treatment throughout its duration. Setting such an ambitious goal will incentivize the InterCommunity staff to find ways to keep participants engaged during treatment over a long-term basis.

In addition, measuring the number of sober days will measure if an individual has increased, decreased, or not changed the amount that they use drugs. This is beneficial because it will show if facilities are reaching their goal of having patients decrease use after leaving treatment. I CAN’s outcomes will then be compared to the outcomes of the other treatment models in the Hartford area in addition to the data derived from InterCommunity health before I CAN was implemented.

 

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Introduction

 

The Liberal Arts Action Lab is a community-based class meaning we work amongst others at Trinity and Capital college as well as with community partners in Hartford. Community partners define problems facing the city and collaborate with teams of students and faculty to create research projects that take place during the semester. The goal of these projects is to strengthen the city, spark social innovation, and support civic engagement. 

I CAN Recover model is a new treatment method for drug and alcohol users, designed to focus on the “whole person” meaning it’s more than just your addiction, they want to treat physical health, mental health, substance abuse and any environmental stressors you could be experiencing. I CAN Recover understands that recovery is a lifelong journey that can’t be done alone. I CAN stands for identity beyond using, gaining core-competencies to achieve and maintain sobriety, practicing healthy actions, and developing a network of support.

The individuals who work under this model want to make sure you are treated as a person, that you know that you are more than your addiction, you deserve choices, and with I CAN they will support and help one learn new skills and behaviors because recovery is not easy. What separates I CAN from other more methods of treatment, this focuses on treating the whole person and their constantly in language across all levels of care; this way it eliminates all the unnecessary confusion. Right now, I CAN offers 5 types of treatment, they have a detox facility where people spend around three to seven days, a short term 25-day inpatient treatment center above the detox facility and then a long-term treatment option like a 90 -day program or an outpatient option who are prescribed to medically assisted treatment (MAT) only.

I CAN Recover is a unique approach to addiction treatment. In the Spring 2020 semester, the Trinity College Addiction Treatment Action Lab Team worked to answer the question “Is I CAN more effective than other treatment models?” Unfortunately, we did not have enough time in the semester to complete this project, and our community partner thought scaling down the scope of our project would be beneficial. We then changed the direction of our study and focused on creating a survey that would collect demographic information and the best way to contact patients once they left treatment. Due to the COVID-19 pandemic, we were not able to collect data in person and changed our project one last time. The team conducted a literature review to determine the most effective research design to prove the effectiveness of I CAN Recover. We decided that this was the best project to move forward with because we could complete it in the time we have left, and it is useful for our community partner, InterCommunity Health, to design a future study that answers the original research question. 

Below are three proposed research plans that consist of a random assignment option, pre-post study, and a quasi-experiment that works to answer the question “is I CAN more effective than other treatment models?”

 


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