Failure vs Success
by Bob Snyder, BA, CADC II, NCAC I

One of the things we’ve been hearing from many different sources in the last couple years is “you have to fail at outpatient treatment before you can get into residential treatment”.

This all came about two years ago when the Affordable Care Act and the Coordinated Care Organizations in Oregon started to reshape/reform the behavioral healthcare system of care. The result of this has become a true outcomes-based model. This means that the outcomes for clients with addiction issues has been proven to have a much better result if they are being referred from an outpatient addiction treatment provider. Clients have an 80% success rate in completing residential treatment if they are entering residential treatment when they are being referred from an outpatient addiction treatment provider, as opposed to a 20% success rate when they aren’t. Subsequently, those that discharge residential treatment are 74% more likely to return to their outpatient provider and remain engaged for 60 days with outpatient treatment. Also, 60% of those that are returning to their outpatient treatment provider are remaining engaged for at least 90 days.

Often, many clients who have started with outpatient treatment do well enough to not require a referral to residential treatment. They are able to remain employed (or continue to seek employment) and participate in a very intensive level of service that involves addiction treatment, MH therapy, 12 step meetings, sponsors, participation with recovery mentors, and participation with their local medical, social service and law enforcement agencies. Residential treatment is really seen more as a booster shot to an already comprehensive array of treatment services.

Too often in the past clients would be sent off to residential treatment with very little coordination of care to ensure that they engaged with any type of outpatient services once they left residential treatment. The outcomes were very poor. Clients often do well in a controlled environment. The true challenge is if they can continue to be successful when they are no longer in that controlled environment. What we know is that a comprehensive treatment plan that involves multiple systems working together in a truly bi-directional integrative method of care is what is required for the long term in order to have good outcomes. We are used to working in our own individual silos where we each work separately from each other. We clearly see now that this is simply not working to provide clients a meaningful chance to have a successful recovery.

BestCare and our local CCO Pacific Source Community Solutions are the first in Oregon to develop and deliver an outcomes-based model with performance metrics. Our outcomes have been very good. We are currently in the second full year of the implementation of this unique and innovative contract. We are proud to be able to help clients have a better chance for a successful outcome.

The message we want to send is one of hope. In addition, we want people to know that we have proof that “failing outpatient” is not the true message that we should be giving. It needs to be one that says that recovery is a long term process that has the best chance for a successful outcome when clients start the process in outpatient.

Bob Snyder, BA, CADC II, NCAC I
Adult and Adolescent Intensive Services Manager for PSCS
Program Director Deschutes County Outpatient
Best Care Treatment Services



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