Technology Assisted Care: Preparation for Pandemic?

How does this fit into what we do? For many, embarking on a new endeavor can be fraught with trepidation, wariness, and outright obstinacy.  Encountering innovation at work is often a recipe for stress. So, when the Massachusetts Probation Service Office of Community Corrections (OCC) sought to innovate through the introduction of Technology Assisted Care (TAC) they partnered with the New England Addiction Technology Transfer Center (NEATTC) based at Brown University on a demonstration project that deployed new practices in a way that addressed the concerns of staff and clients. As a result, the Commonwealth’s network of 18 community corrections centers (CCC), which provide treatment interventions to those at high risk for recidivism, were able to quickly adapt to the devastating operational circumstances presented by COVID-19, including physical isolation from clients and reduced staffing patterns.

In February 2017, the OCC worked with the NEATTC on a demonstration project to deploy TAC.  Staff participated  in a one-day training on the NIDA/SAMHSA Blending Initiative “Technology Assisted Care for Substance Use Disorders” presented by Senior Technology Transfer Specialist Michael Torch, MA, LADC.  Upon completion of the training, CCC were issued login credentials for ten participants to enroll in a web-based program called Computer Based Training for Cognitive Behavioral Therapy, branded CBT4CBT. 

CBT4CBT, created by Yale University Professor of PsychiatryKathleen Carrol, PhD and programmer Geoffrey White, PhD, contains seven video modules in which students are taught various skills to address substance use disorder.  According to the company’s website, two National Institutes of Health funded studies, conducted at Yale, have shown that the program, coupled with traditional treatment, reduces substance use more than traditional methods alone.

Still, at the outset of the project, many CCC staff expressed concerns and sought further explanation.  How does this fit into what we do? Do we expect a computer to provide empathy to clients? How will we know that clients are learning?  To answer these questions Torch held periodic forums with staff and visited them at their offices to watch them work the programs with clients. 

“People have to understand the role of the technology.  It is not there to replace the counselor.  It is technology assisted care.  It is designed to support the counselor,” said Torch of the NEATTC.  “I can only do so much explanation.  The way to prove the concept is to let the practitioners use it to see how it works for them.  We want them to be successful so we start with a product that is concise, only seven modules, so that they are not overwhelmed trying to implement it.” 

"CBT4CBT, created by Yale University Professor of PsychiatryKathleen Carrol, PhD and programmer Geoffrey White, PhD, contains seven video modules in which students are taught various skills to address substance use disorder" 

Benefits of TAC, noted by NIDA/SAMSHA, include allowing on-demand access to therapeutic support, removing geographical limitations, increasing receptivity to treatment and even enhancing the treatment experience by enabling anonymity.  These benefits became vital over the last year when face-to-face meetings were severely limited. 

Eric Dorman, LADC CCDP, a Program Manager for Adcare Criminal Justice Services, Inc., who managed the Dartmouth Community Corrections Center, saw success, “The program brought great excitement to the participants.  The interaction amongst the group was a higher level than the posturing that previously existed.  The program worked great with the manualized CBT that we do for substance abuse and it can help us manage, and increase, dosage hours.”

“I really like how interactive the program is.  I really like computer work and it helps keep my attention, “said Annalise a client in Dartmouth.  Another client, Janice,stated, “It’s my favorite group of the week.  I look forward to it on my schedule.”

Because CCC had integrated TAC into their practice before the pandemic hit, stakeholders found that the CCC were rapidly able to pivot to using video conferencing and other technology to deliver services to clients.

“Once things shut down there was literally nothing available to support our clients.  Very quickly, maybe within a week, the Fitchburg CCC was online engaging with clients.  It was really life-saving because they were just about the only place in town that was able to get back so quickly,” said Hon. Christopher P. LoConto, First Justice at the Fitchburg Division of the District Court Department.