(5) Substance Treatment Phone Line Expansion Improves Connection to Treatment and Resources

Background & Introduction:

Denver Health (DH) is an integrated, safety-net health system that annually cares for 220,000 (30%) of Denver’s most vulnerable residents, including 32,000 patients with a substance use disorder (SUD). Navigating SUD treatment options can be overwhelming and discouraging for individuals, their loved ones, and clinicians. But when people receive specialized, compassionate guidance in the moment, the goal of recovery becomes more achievable. One important service to meet this need is the Substance Treatment Line (STL), operated through Denver Health’s Center for Addiction Medicine (CAM). The STL was created in 2017 providing treatment referrals and resources through a voicemail service for people experiencing SUDs and their family and friends. Callers would leave a voicemail and receive a call back to discuss treatment options and/or connect to care. In 2024, the STL was expanded with a regional opioid abatement grant to hire additional Behavioral Health Educators (BHEs) to answer live calls, Monday through Friday 9am-5pm, to help callers identify SUD treatment and resources, with an additional effort to support more Denver-area clinicians. This poster presents the impact of the STL expansion on clinicians, patients, and the community supporting those with SUDs, as well as sharing a model that other organizations could adopt.

Methods:

The STL expansion was evaluated for reach and satisfaction through the tracking of call metrics and a satisfaction survey. Data from each call was input by BHEs into a database, which includes metrics on caller type, primary substance patients are using, and call outcomes (e.g., treatment referral was placed, resource information was provided). Call metrics were compared between a pre period of January-June 2024 and a post period of July-December 2024, which were defined based on two changes to the program in June 2024: 1) the rollout of marketing efforts for the STL in priority geographic areas where drug overdoses are highest in Denver, and 2) hiring and onboarding of additional BHEs. Call metrics between the pre and post periods were compared using z-tests for differences in proportions and chi-square tests (alpha= 0.05). The satisfaction survey assessed the usefulness and reliability of education, resources, screening, referrals, and patient care coordination (clinicians only), as well as overall satisfaction with calls, and if callers would recommend the STL to others. Each caller chose whether they would like to provide feedback on their experience and if so, were emailed a link to the survey.

Results:

The evaluation aimed to assess the impact of the expansion of the STL through describing changes in call volume, caller characteristics, and call outcomes, as well as assessing satisfaction with call experience. The expansion led to the hiring of 3 additional BHEs to answer calls, a new call entry form in REDCap, and the addition of a satisfaction survey. A total of 724 calls were included in this analysis (pre=255, post=469). Patients made up 62% (n=449) and providers made up 19% (n=135) of callers. Referrals made up 40% (n=292) and information provided made up 26% (n=189) of call outcomes. The number of calls the STL received increased significantly between the two periods (pre=255, post=469, increase=84%, p< 0.05). The distribution of caller types (patient, patient friend/family, provider) and patient’s primary substances (i.e., alcohol, opioids, or stimulants) did not differ significantly before and after expansion. In both periods, patients were overwhelmingly the most common caller type (pre=66%, post=63%), followed by an almost equal proportion of providers (pre=19%, post=20%) and patient friend/family (pre=15%, post=18%). Most patients’ primary substances were opioids in both periods (pre=52%, post=50%), followed by alcohol (pre=29%, post=29%). A significant increase in the proportion of referrals placed was observed from pre to post periods (pre=29%, post=71%, increase=143%, p< 0.05), while no significant difference in the proportion of calls where information was provided was seen between the two periods. The proportion of referrals resulting in linkage to outpatient services within 30 days of the referral was similar (pre=45%, post=55%) in both periods.

Of the 290 callers who agreed to receive the satisfaction survey, 31 completed it, resulting in a response rate of 11%. The majority of respondents were patients or family/friends (84%). The majority of non-clinician callers (≥95%) and all clinician callers agreed/strongly agreed that the STL was a reliable resource for education, resources, and referrals for SUD treatment. Additionally, all clinicians agreed that the STL was a useful and reliable resource for patient care coordination. All respondents were satisfied with their experiences, agreeing that calls were answered in a timely manner, staff were able to assist them with the purpose of their call and answer their questions, and that they felt supported. All respondents would recommend the STL to others sharing they are grateful the STL exists, it is helpful for identifying resources, and that BHEs go above and beyond to assist callers.

Conclusion & Discussion:

Results suggest the STL expansion was successful in increasing call volume and placing referrals for SUD treatment. Findings also show overwhelming satisfaction with STL call experience. In the first year of expansion, we learned that callers value a direct, live line for personalized support finding SUD treatment and resources. This success occurred despite challenges related to the hiring process of BHE’s taking longer than expected, which delayed the implementation of the expansion.

One limitation of our evaluation is that using discrete pre/post periods does not account for linear trends in the effects of the STL expansion over time. However, observed discrete differences still reflect meaningful shifts in service utilization. Another limitation is the low response rate for the satisfaction survey despite an incentive. While this does not impact positive findings, it does mean the data are not representative of all callers.

The STL is a replicable approach for assisting in navigating substance treatment options and patient care coordination that can be adapted for different institutions. We have identified key elements through the expansion that others can build upon to improve treatment navigation and patient care coordination within other communities, which will be described in greater detail should we be accepted.

References:

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Garner BR, Godley MD, Passetti LL, Funk RR, White WL. Recovery support for adolescents with substance use disorders: The impact of recovery support telephone calls provided by pre-professional volunteers. Journal of substance abuse and alcoholism. 2014 Apr;2(2):1010.