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A Study of Online Counseling and Internet Use Among Family Drug Court Participants

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Project Summary:

This grant is a supplement to the parent grant, "Reimbursement Policy for Online Substance Abuse Treatment". This study analyzes the effectiveness and reimbursement policies for online treatment of substance abuse. In 1998 the Congress passed H.R. Bill 966 mandating the Health Care Financing Administration (HCFA) to reimburse telemedicine services to rural underserved populations. HCFA excluded reimbursement for substance abuse on the ground that viable reimbursement methods were not available. We would like to fill the gap by providing data on both effectiveness and reimbursement strategies for online treatment. Besides HCFA, the Center for Substance Abuse Treatment and various State courts pay for treatment. When these organizations face treatment shortages, they can rely on findings of the current study to expand treatment capacity in underserved areas. Online treatment has five components, three of which are electronic and two are face-to-face. The first component is frequent, almost daily, online motivational counseling. We have developed and tested detailed protocols for online motivational interviews on 300 recovering patients. The second component is home monitoring of the patient. At weekly intervals, the computer calls the patients and assesses their risk of relapse. If risks are high, the counselor may call the patient, engage family members in care of patient, bring the patient in for a visit, or do other previously agreed upon relapse prevention activities. The third component is peer-to-peer support through electronic discussion groups. The fourth and fifth components of the online treatment are not online at all. The fourth component is routine laboratory testing and the fifth component is occasional face-to-face sessions with a counselor. We will provide clients who do not have access to computers with the I-opener machines. A number of studies, including our own, show that patients are more truthful to a computer than to a clinician. In addition, randomized clinical studies show that computer facilitated counseling increases participation in treatment and reduces cost of care. Because length of time in treatment affects recovery rates, we believe that online treatment could be more effective than face-to-face treatment. Whether it is, remains an empirical question addressed in this study. To test the effectiveness and cost of online treatment we will recruit 75 patients from Newark Family Drug Treatment Court. Patients, predominantly black, poor women are assigned randomly to usual and online groups. At baseline and every four months, we will collect data on recovery rates (as measured through bi-weekly urine tests), cost, mother-child bonding, and key court outcomes (time to permanent decision and family reunification). In addition, we will collect data on a number of independent variables including orientation of social support, depression, utilization of health services and severity of patient drug use. To examine cost, we will collect accounting data from online and face-to-face clinics. To these costs we will add the economic costs of volunteer efforts or goods and subtract costs not related to treatment. For the online and face-to-face group we will report cost per patient and cost per unit of service. We have developed and used a case-mix adjusted method for estimating cost of units of treatment

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