Written by William D. Harms & Howard Rosen

As an invaluable aid for the Substance Use (“SU”) population, participants, whether case managers, schedulers, pharmacy, or clinicians are looking to build a ‘virtual relationship’ with their treatment populations.  The ‘anonymous relationship’ is key to success with SU population.  This facilitates a relationship where the client can have multiple interactive conversations with the treatment team, and address issues about recovery without having to deal directly with a clinician. 

The LifeWIRE communication platform assists care professionals in managing both residential and non-residential patients with a number of behavioral and mental health affectations, including SU.  LifeWIRE has been implemented in applications where the SU was comorbid with another affectation such as PTSD or High Risk Suicide. As an organization, we listen carefully to those we serve. The LifeWIRE platform benefits from over 3,500 client and patient insights. We highlight below a few of these key insights directly related to substance use populations.

The ‘anonymous relationship’ idea is particularly effective for SU affectations such as problems with authority or paranoia.  The anonymous element is derived from the patient’s ability to communicate from their ‘safe place’ using ‘safe and familiar media’ where they aren’t required to address the non-verbal reactions of a treatment team member.

Speaking to the insights with the SU population, we have found that providing ‘cool tools’, developed as a result of these insights, has proven effective.  Communications aren’t ‘canned’ interactions or analytics that we argue to be better than those of our competition -door.  Rather, we have found it invaluable to emulate the protocols that the clinicians and treatment team already use with their patients.  We automate these interactions and allow the clinician and patient to respond, interact, change treatment, or initiate a referral all electronically, with our Platform and in the background. 

Analytics are only as good as the data collected. Data insights we have found invaluable include:

• Time – we know that one of the first indicators that a SU patient is decompensating or relapsing is time irresponsibility.  There are a couple of ways to detect this issue before it gets out of hand.
   
  1. No answer – Not answering is, in fact, choosing not to answer.  However, each person is different.  Each patient has multiple independent variables that affect when they can answer.  Any change in a ‘standard’ pattern is worth noting. For this “dialogue” what has been helpful is to be able to respond differently depending on the deviation of the response.  Abnormal affectation triggers can be set to automatically contact the treatment team, and even to cascade through a list-serve if the treatment team doesn’t respond promptly.
  
  
  2. Time out of range – In early stages of decompensation the SU patient often continues to respond, but their responses become erratic.  Time out of range would indicate that they are changing the priority of responding, or putting off responding.  These triggers are often indicative that the client’s attitude is in the process of changing.  By automatically monitoring these responses across time and treatment, deviations can often be identified prior to the client consciously making the decision to ‘make a change’.  


• Chat –By offering patients choice and different ways to communicate such as email, text, IVR or even chat takes away many barriers to engagement.  Chat has been particularly interesting. To the treatment team this looks like a Facebook Chat window in the lower right-hand corner of the screen.  Our clients can use this function interactively to converse with the client, or the function can be automatically triggered based an event or response.  Triggers can be programmed to designate that the treatment team receive immediate notifications any time a client’s responses or answers fall outside a range so ‘staff on-call’ can immediately interact with the patient to work with them, through the crisis.  The instantaneous element of chat empowers both the patient and/or clinician to have a more “personal” discussion than with text yet without the emotion that voice can provide


• Change over Time – This is perhaps one of our strongest tools, and again, we developed them based on client interactions and insights.  This allows an administrative user to monitor any question, or group of questions, graphically over any designated time period.  The Clinical Interface builds on the idea presented above, of tracking a client’s responses against their earlier responses.  Clinicians select one or more ‘questions’ from one or more interactive screening tools or assessments. These questions are then graphically displayed over the time period designated by the administrator to see how/if the answers change. 
  
  It isn’t unusual to have one stressor in a day, but when everything is out of whack something is definitely going on.  The interface can monitor   multiple interactions, and automatically inform the treatment team when several indicators or ‘triggers’ seem to indicate an abnormal condition.In fact, we have a whitepaper on how we used the Clinical Interface for PTS populations where, using SU-specific triggers all of the concepts we describe are applied to SU treatment.  https://www.lifewiregroup.com/portals/0/Clinical-Interface-LifeWIRE-sm.pdf


• Referral to outside resources – treatment protocols indicate that a clinician cannot even address SU symptomology until they have stabilized the respective Biopsychosocial platform.The practical challenge is that most SU treatment facilities don’t have the resources or connections to provide these services. LifeWIRE can help the treatment team resolve these issues by performing external referrals via text, email, or IVR to providers and services outside the SU Treatment Team.  As valuable industry intelligence, Clinicians have wanted to check back with the client and the referring provider to verify if and when the referral was consummated, and then track client satisfaction to make sure these issues don’t negatively affect the SU Treatment.

So, what was supposed to be a few short comments have cascaded to over 1,000 words so we will address other specific insights in future blogs, including:

• Ongoing assessments to determine change in ASAM level;
• Patient follow-up and ongoing relationship reinforcement;
• Patient originated ‘hotline’ where clients can type some keyword, be screened and then referred to the appropriate resource based on their screening score;
• Tracking patient scores (like index scores from an assessment) against their cohort to see how they score.