Ayer Concord Drug Court Program Hilary Curtis Ph.D., Program Director Technology & Relapse Prevention Project.

Ayer Concord Drug Court Ayer Concord Drug Court ProgramProgram

Hilary Curtis Ph.D., Program Hilary Curtis Ph.D., Program DirectorDirector

Technology & Relapse Technology & Relapse Prevention ProjectPrevention Project

Post-adjudication outpatient programPost-adjudication outpatient program: evidence : evidence based model of the based model of the “10 Key Components of Drug “10 Key Components of Drug Courts.”Courts.”

Male / female non-violent offenders age 18+ Male / female non-violent offenders age 18+ assessed as having AOD problems.assessed as having AOD problems.

Four phase program 52 weeks in length. Four phase program 52 weeks in length. Core treatment program of group & individual Core treatment program of group & individual

therapy, case management and Drug Court therapy, case management and Drug Court Coordination.Coordination.

Operating since 2004, SAMHSA & BJA grants have Operating since 2004, SAMHSA & BJA grants have enabled ACDCP to expand the number of adults enabled ACDCP to expand the number of adults served, adding Family Treatment, Risk & Needs served, adding Family Treatment, Risk & Needs Assessments, Peer Support Staff, Advocacy & Assessments, Peer Support Staff, Advocacy & Benefits Consultation, and the ACHESS / smart Benefits Consultation, and the ACHESS / smart phone application.phone application.

Ayer Concord Drug CourtAyer Concord Drug Court

Ayer & Concord Mass. – 19 towns within Ayer & Concord Mass. – 19 towns within the two jurisdictions the two jurisdictions

Ayer, Mass.Ayer, Mass.

Concord, Mass.Concord, Mass.

Access to triage and support services in time to Access to triage and support services in time to interrupt the cravings / urge to use substances is interrupt the cravings / urge to use substances is the primary problem for participants skills the primary problem for participants skills (Kreuter and Wray 2003; Strecher et al. 1994). (Kreuter and Wray 2003; Strecher et al. 1994).

Clients have established treatment and criminal Clients have established treatment and criminal

history profiles which highlight their difficulty in history profiles which highlight their difficulty in curbing impulses, managing urges to use alcohol curbing impulses, managing urges to use alcohol and other drugs, and family/employment histories and other drugs, and family/employment histories marred by dysfunctional patterns of behavior. marred by dysfunctional patterns of behavior.

SAMHSA Technology Grant: SAMHSA Technology Grant: Technology and Relapse Prevention Technology and Relapse Prevention

ProjectProject

Addiction - Comprehensive Health Addiction - Comprehensive Health Enhancement Support System (ACHESS) Enhancement Support System (ACHESS) as an Evidence-Based Practiceas an Evidence-Based Practice

ACHESS design is influenced by ACHESS design is influenced by Self Self Determination Theory Determination Theory which builds on and which builds on and integrates a rich tradition of social sciences research integrates a rich tradition of social sciences research related torelated to (1) behavior change(1) behavior change (2) social learning (2) social learning (3) persuasive communication (3) persuasive communication (4) motivational interviewing (4) motivational interviewing (5) behavioral intent(5) behavioral intent (6) stages of change (6) stages of change (7) Self Determination Theory focuses on (7) Self Determination Theory focuses on

developing competence, relatedness and developing competence, relatedness and autonomy. autonomy.

Promising PracticesPromising Practices

Research Question: If we build Research Question: If we build it will they come?it will they come?

Drug Court Pilot TestDrug Court Pilot Test

Triage and feedback are intended to Triage and feedback are intended to derail derail the relapse processthe relapse process by providing people by providing people with with just-in-time, tailored information just-in-time, tailored information about recovery coping skillsabout recovery coping skills (Kreuter and (Kreuter and Wray 2003; Strecher et al. 1994). Wray 2003; Strecher et al. 1994).

For persons who experience problems For persons who experience problems managing BAM protective or risk factors managing BAM protective or risk factors (Brief Addictive Monitor), A-CHESS reminds (Brief Addictive Monitor), A-CHESS reminds them of skills to use. them of skills to use.

It offers relaxation exercises, connections It offers relaxation exercises, connections to online peer support, and links to a to online peer support, and links to a healthy-event newsletter; starts a healthy-event newsletter; starts a diversionary activity; and contacts a diversionary activity; and contacts a counselor.counselor.

Theory into Triage/ FeedbackTheory into Triage/ Feedback

Social support is essential for the Social support is essential for the management of any chronic disease & is management of any chronic disease & is an integral part of A-CHESS. an integral part of A-CHESS.

ACHESS can provide social support ACHESS can provide social support through several means:through several means: PeersPeers StaffStaff Panic button to support networkPanic button to support network AA MeetingsAA Meetings

Support Networking – Support Networking – Peer DrivenPeer Driven

Several participants emerged as Peer Several participants emerged as Peer Leaders using ACHESS, and established Leaders using ACHESS, and established a strong voice in the ACHESS program a strong voice in the ACHESS program which they felt they could not provide which they felt they could not provide in a face to face setting. in a face to face setting.

One of the most reserved and “quiet” One of the most reserved and “quiet” participants found validation and participants found validation and recognition as a peer leader on recognition as a peer leader on discussion boards where his anxiety in discussion boards where his anxiety in social groups was diminished. social groups was diminished.

Peer SupportPeer Support

Fully integrated team members who Fully integrated team members who provide individualized support.provide individualized support.

Promote client self determination and Promote client self determination and decision making through the use of their decision making through the use of their own recovery stories and lived experience. own recovery stories and lived experience.

Provide expertise and consultation to the Provide expertise and consultation to the entire team to help create a culture in entire team to help create a culture in which each client’s point of view and which each client’s point of view and preferences are recognized, understood, preferences are recognized, understood, respected, honored, validated, and respected, honored, validated, and integrated into treatment, rehabilitation integrated into treatment, rehabilitation and community self-help activities. and community self-help activities.

Peer SpecialistsPeer Specialists

Drug Court screening and Drug Court screening and assessment within 7 days of assessment within 7 days of referral to the program. referral to the program.

Phone orientation and Phone orientation and Confidentiality formsConfidentiality forms

““Settling in” period of 1 – 2 weeks Settling in” period of 1 – 2 weeks to establish connections.to establish connections.

Participants may choose to decline Participants may choose to decline the phone, but are welcome to the phone, but are welcome to reconsider as they continue to reconsider as they continue to participate in the programparticipate in the program. .

Project Implementation Project Implementation

Learning Disabilities / LiteracyLearning Disabilities / Literacy Technology familiarityTechnology familiarity Connectivity Connectivity Fragility of TechnologyFragility of Technology Co$tCo$t ConfidentialityConfidentiality Liability & crisis management / Liability & crisis management /

DocumentationDocumentation Human Subjects Protections / protected Human Subjects Protections / protected

populationspopulations

Implementation ChallengesImplementation Challenges

Positive tool to Positive tool to establish and strengthen establish and strengthen treatment relationshipstreatment relationships with participants. with participants.

Enhanced ability to coach, monitor and check Enhanced ability to coach, monitor and check in with new referralsin with new referrals during their orientation during their orientation period and provide a more intensive level of period and provide a more intensive level of support as they entered treatment. support as they entered treatment.

Trust was established sooner with staffTrust was established sooner with staff Staff & peers answer questions about how to Staff & peers answer questions about how to

stay in compliance, remind them about stay in compliance, remind them about groups and drug testing, and groups and drug testing, and help connect help connect them with peer leadersthem with peer leaders in the drug court who in the drug court who could peer mentor them into the program as could peer mentor them into the program as well. well.

Feedback & TrustFeedback & Trust

ACHESS Addiction Comprehensive Health Enhancement System

Marlatt’s Relapse Prevention Marlatt’s Relapse Prevention TheoryTheory

Relapse Prevention TheoryRelapse Prevention Theory

ACHESS Use by Drug Court ACHESS Use by Drug Court Pilot ParticipantsPilot Participants

DCHESS GROUP EXCLUSING OBSERVERS AND DCHESS GROUP EXCLUSING OBSERVERS AND MODERATORSMODERATORS1. Density: 0.3115 (31.15% of possible networks existed)1. Density: 0.3115 (31.15% of possible networks existed)2. Ratio of reciprocal relationship (symmetrical: dash; 2. Ratio of reciprocal relationship (symmetrical: dash; asymmetrical: dot): 164/273 (60.73%) were reciprocal asymmetrical: dot): 164/273 (60.73%) were reciprocal relationship, which represent mutual interaction between relationship, which represent mutual interaction between two memberstwo members3. Ratio of lurkers (10 lurkers in small black circles + 2 3. Ratio of lurkers (10 lurkers in small black circles + 2 isolated users who never used): 12/30 (40.00%)isolated users who never used): 12/30 (40.00%)4. Number of messages: 297 (9.9 per each member)4. Number of messages: 297 (9.9 per each member)5. Number of active participants: 9/30 (30.00%) of 5. Number of active participants: 9/30 (30.00%) of participants wrote at least 5 messagesparticipants wrote at least 5 messages6. Level of activity: each message was read 7.80 times on 6. Level of activity: each message was read 7.80 times on average by other membersaverage by other members

ACHESS Use by Drug Court ACHESS Use by Drug Court Pilot ParticipantsPilot Participants

Recovery Support Applications are Recovery Support Applications are well liked by users.well liked by users.

Communication tools are used more Communication tools are used more than information tools.than information tools.

People will use recovery support People will use recovery support applications even if they are heavily applications even if they are heavily monitored.monitored.

ResultsResults

Long term, smart phones KEEP Long term, smart phones KEEP participants involved - high number participants involved - high number of graduates kept their phones & of graduates kept their phones & remained in touch with current drug remained in touch with current drug court participants. court participants.

An “Alumni” group gained prestige An “Alumni” group gained prestige and respect from other membersand respect from other members

Alumni continued to stay in touch Alumni continued to stay in touch with staff for after care and attended with staff for after care and attended group therapy voluntarily to support group therapy voluntarily to support their recovery and stay in touch with their recovery and stay in touch with peers in the program. peers in the program.

Peer & Alumni groupPeer & Alumni group

Panic ButtonPanic Button

Participants access the weekly symptom Participants access the weekly symptom report check list on ACHESS to report report check list on ACHESS to report their risk level and indicate relapse if their risk level and indicate relapse if necessary. necessary.

These reports are reviewed daily by the These reports are reviewed daily by the designated case manager. designated case manager.

Staff review and respond to participants Staff review and respond to participants as clinically appropriate and help them as clinically appropriate and help them to stay on track with their treatment to stay on track with their treatment plan, relapse prevention plans and plan, relapse prevention plans and safety plans as appropriate. safety plans as appropriate.

Weekly Symptom ReportWeekly Symptom Report

Weekly Report check-inWeekly Report check-in

Clinical Feedback ToolClinical Feedback Tool

Discussion BoardDiscussion Board

ACHESS Data reports

0

15

30

45

60

75

90

105

1/23/12 2/9/12 2/25/12 3/11/12 3/25/12 4/8/12 4/22/12 5/6/12

Num

ber o

f Tim

es A

cces

sed

Days with SmartPhone (2 Week Intervals)

Use of Services Over TimeClient DC1048

Discussions

My Msgs

My Photos

Panic Button

Paul: Engagement & panic buttonPaul: Engagement & panic button

Activity posting & SobrietyActivity posting & Sobriety

0

10

20

30

40

50

60

70

80

90

Num

ber o

f Tim

es A

cces

sed

Days with SmartPhone (2 Week Intervals)

Use of Services Over TimeClient DC1052

Discussions

My Msgs

My Photos

GerryGerry

Success StoriesSuccess Stories