Washburn House is an addiction recovery center located in Worcester, Mass., serving individuals with substance use disorders. We opened a medically monitored withdrawal management (detoxification) program and a clinically managed inpatient program last year, recently expanding to 52 beds. We also operate outpatient levels of care and a 42-bed sober living community. Our care is structured around four overarching goals: evidence-based treatment; well-structured, repeatable processes; engaged clients; and seamless transitions as clients step down and reintegrate.
We believed that if we could incorporate technology into day-to-day treatment and connect clients to it, we could achieve these goals. We would have one treatment approach that we could evolve as we learned and grew. We would have engaged clients, as most are millennials and members of the digital generation. And, with the right technology, we should even be able to smoothly hand off to the next phase of treatment.
Technology introduced at admission
Upon admission to our inpatient program, clients are set up with a laptop, allowing them access only to the online environment that we have built. We start with the TCU Client Evaluation of Self and Treatment surveys, conducting them online. The surveys that we use assess motivation, engagement, psychological and social functioning, and trauma.
We follow TCU's protocol for when to assess the client. We conduct three of the surveys multiple times, the last time being post-discharge. Our implementation of the surveys automatically calculates the client's score, comparing the results with the TCU benchmarks and ultimately against facility-specific data. We are not shy about showing the results to the clients. This helps them see—and believe in—the progress they are making.
Washburn House structures treatment by assigning worksheets tailored to the objective of a client's individualized plan. Clients fill these out (again online), our counselors review and discuss them with the clients, and clients can iterate if need be. Clients can even self-assign worksheets.
Our case managers also plan transitions using the same technique of assigning a series of worksheets. Discharge planning begins immediately, but the client and the case manager develop the plan together over the course of the treatment stay.
Importantly, the clients take these worksheets (both the transition plans and all the therapeutic assignments) with them when they move on from Washburn House and reintegrate into their communities. The goal was not to discharge our clients with a paper portfolio, as it can easily be lost or discarded. Instead, the portfolio lives in their phones and, for those few without a phone, it is accessible via a browser. Being able to reference it later gives clients another way to see how much progress they have made, and it offers reminders if needed.
One dimension of our treatment involves helping clients be more reflective and become less reactive to their triggers. We use daily check-ins to help inculcate this. The daily check-ins offer an inspirational quote and then ask a quick “How do you feel today?” We begin the daily check-ins during the client’s inpatient stay, with the care team receiving alerts when there are problems. We continue them post-discharge, thus providing a little more continuity across each level of step-down. We can monitor ongoing progress, and we are maintaining a lifeline back to us should the client need it.
Interestingly, our biggest challenges have not been in integrating the technology into the treatment itself. Clients have really taken to completing the surveys and assignments online. We were initially concerned whether clients would engage with the daily check-ins, but then one client pointed out, “What's the first thing you do in the morning? Check your phone for messages.” As long as we kept it light, they were all in.
For us, the first challenge was figuring out how to manage the logistics of intake and onboarding (i.e. provisioning laptops for new clients, making the initial set of assignments, etc.). Part of this stemmed from being a new treatment center, but another part was that we have added steps to the process. Medssenger, our platform for all of this, allowed us to structure that into a repeatable workflow once we determined the best way to do it.
The other big challenge involved integrating with other follow-up programs at organizations outside of the Washburn House continuum. Many of these organizations do not use technology as part of care, and most take away the client's phone. We are still working with them on how our clients might continue with the TCU surveys and daily check-ins. If clients stay within the Washburn House continuum, we are able to continue to incorporate use of technology in both our outpatient programs and our sober living community.
A goal for us is to make a client's portfolio available to the downstream care teams, since we know that greater continuity of care improves outcomes. As we grow and develop stronger ties with other programs, we expect to institute this. Medssenger's sharing data across organizations and managing workflow across transitions were key reasons we implemented its system.
At Washburn House, we have built technology into the foundation of our practice. Going forward, we only expect to leverage it more, to see it become integral throughout the cycle of care. Telepresence/video chat for remote counseling, social networking-type technologies for support groups, etc.—these capabilities are certain to boost outcomes further. For, as one of our clients put it: “I like it; it's like you're not alone.”
Neil Gaer is CEO of Washburn House in Worcester, Mass. His past experience includes serving as a vice president and clinical director at Phoenix House.