Use of Recovery Support Navigators and Client Incentives to Improve Care and Outcomes for Repeat Detoxification Clients

Purpose: Public payers for treatment of substance use disorders (SUD) face major challenges in terms of clients’ repeated utilization of detoxification services and failure to link with community-based SUD care.  Detox is necessary for many individuals with SUD but is not sufficient for ensuring their path to recovery. 

To address this issue, the Massachusetts Behavioral Health Partnership (MBHP) partnered with Brandeis University and providers statewide on a study that explores the influence of recovery support navigators (RSNs) and client incentives on reducing detox readmissions, reducing costs, improving continuity of care after detox, and improving outcomes among Medicaid clients who are repeat detox users.

 

Methods: The study consists of three groups where clients receive either (1) treatment as usual (TAU), (2) support services from a recovery support navigator (RSN), or (3) support services from a recovery support navigator and financial incentives for meeting each of a specified set of recovery goals (RSN +I). Since the launch of the study in March 2013, MBHP and Brandeis have trained and deployed 54 recovery support navigators (RSNs), a specially trained cadre of personnel who offer flexible support to repeat detox clients in the community.  In the RSN+ I group, members are offered similar services as the RSN group but in addition, they receive contingency management-style incentives, during the 90-days after leaving detox, to encourage participation in recovery-oriented activities such as prompt entry into substance abuse treatment after discharge from detox.   RSNs track their work with clients via a weekly log. Among data collected on the RSN log is the number of RSN encounters per month, the content area of their work with the client, and for the RSN+I group, the incentives clients earned for meeting behavioral health targets.  Using descriptive statistics we assess differences in number of encounters by intervention group, as well as analysis of the incentives earned.

 

Results: Using four quarters of RSN log data, preliminary findings show that the mean number of RSN encounters is 5.6 for the RSN group and 6.6 for the RSN+I group during their time in the study. Preliminary results show that among clients enrolled in the RSN+I condition, about half (48.5%) receive at least one incentive beyond the initial recruitment incentive. On average, clients earned 2.5 incentives each thus far. Clients were most likely to earn incentives for meeting with the RSN before discharge from detox (93.9%), meeting with the RSN within 7 days of discharge (41.2%), attending substance use disorder treatment within 14 days of discharge (29.7%), meeting with the RSN in the second month after discharge (24.2%) and developing a recovery plan within 30 days of discharge (20.0%).  Data will be updated in advance of conference. Later, this study will examine the influence of the interventions on treatment initiation and engagement after detox, as well as treatment costs, using claims data.

Implications: Integrated care is a key aspect of improving care for individuals with complex needs. Recovery navigators bring a consumer focus to help clients as they move toward recovery and become engaged consumers.