Impacts of COVID-19 on Fidelity to the Sobriety Treatment and Recovery Teams Model

Background and Purpose: Quick access to substance use treatment is associated with better treatment outcomes. However, few studies have described the impact of COVID-19-related practice changes (e.g., increased use of telehealth) on access and retention in care. Given calls to retain and even expand COVID-related practices changes, there is an urgent need for research on this topic. This study examined the relationship between COVID-19-related practice changes and quick access fidelity outcomes of the Sobriety Treatment and Recovery Teams (START) program.

Methods: This retrospective cohort comparison used data collected by START teams and partnering substance use treatment providers. The sample included families referred (N = 764) to and served (N = 274) by the START program between March 23, 2019 and March 23, 2021. On March 23, 2020, most program services were shifted to a virtual format. Families referred to the program between that date and March 23, 2021 were categorized as served during COVID-19 and were compared to families served the year before (i.e., March 23, 2019 to March 22, 2020). Cohorts were compared across nine program fidelity outcomes (e.g., assessed within 4 days of first contact; first treatment session within 4 days of assessment; four treatment sessions completed in 12 days. Differences were assessed using chi-square tests for categorical variables and independent samples t-tests for continuous variables.

Results: Referrals to START were 14% lower during COVID-19 than in the year prior to COVID-19, though due to program demand exceeding capacity, this did not result in fewer families being served. Four of nine fidelity outcomes were significantly different during the two time periods. In the year prior to COVID-19, a significantly higher percentage of participants were assessed (p = .001), attended a first treatment session (p = .041), and completed four treatment sessions (p = .033) compared to participants entering START during COVID-19. However, a higher percentage of participants referred during COVID-19 completed the full fidelity timeline within the targeted 38 days (p = .040).

Conclusions and Implications: Consistent with previous research on COVID-19 and child welfare reporting, START received fewer referrals during COVID-19 than in the prior year. This is a potentially concerning finding given that hospital-confirmed cases of maltreatment increased during COVID-19. With regard to program fidelity, initial engagement and retention of participants in treatment was lower during COVID-19 than in the year before. However, for those engaged in treatment, quick access was either unaffected, or on one outcome, improved under COVID-19 protocols. Though COVID-19-related practice changes have the potential to facilitate greater achievement of key treatment milestones, additional emphasis may be needed on engagement and pre-treatment services in a largely virtual environment.