Imagine you’re thrown into the middle of an emergency room, in charge of too many people, responsible for too many patients, having piles of paperwork. And you haven’t been trained for any of it. This is the reality for most social workers. The internship, residency, fellowship, attending structure we all know from Grey’s Anatomy doesn’t exist in the realm of addiction therapy. Recent graduates don’t have clinics to practice in or resources on the level of students in medicine, psychiatry and even dentistry. They get thrown into an underfunded and chaotic system, which has only been exacerbated by the pandemic.
Dr. David Patterson Silver Wolf, associate professor at the Brown School and director of the Community Academic Partnership on Addiction (CAPA) is working towards dissolving this problem. As chief research officer, he has developed a clinic in which interns receive supervised patient interaction and are paid for time and billed for services, like in medical models. This initiative increased patient completion rates by 11% over six months. Patterson Silver Wolf compares this to graduating high school, where just the act of finishing the program leads to better health outcomes.
Therapists have unsustainable caseloads of 75-100 people and struggle to answer basic questions about both open and closed cases. When a patient walks into a clinic, they are often assigned the therapist that is “up next”—the one who has the lightest caseload or is free at that moment.
Furthermore, there are patient biases inherent in the treatment system. When looking for therapists, patients don’t have access to information about their education, experience or other factors that are available when choosing a doctor. According to Patterson Silver Wolf, therapists aren’t necessarily rewarded for excellence and many times mediocre treatment is the norm.
Social workers are taught that every patient has an equal chance at recovery, but there is evidence behind opposing claims. According to Patterson Silver Wolf, the field needs to consider that patient completion rates are at least partially dependent on the therapist’s demographic profile. In one study, white male therapists have statistically significant success rates in every race and gender match compared to other genders and demographics, while non-white male therapists had no female patients (1). This brings up concerns about what is defined as “success” in therapy, as nobody would recommend to only employ white male therapists. This relates to the importance of more accountability in therapy with higher standards, as well as matching patients with therapists based on demographics and other valuable data instead of random assignment.
A study by Dr. Lisa A. Marsch explains the benefits of technology-based therapeutic tools such as computerized assessments, behavior therapies, prevention interventions and recovery support programs (2). She suggests that tools can be used in addition to traditional treatment methods or to replace pieces of their patient interaction. This would allow clinicians to treat more clients and have more time to manage specific crises for those with the greatest needs. Another possibility is the implementation of technology as stand-alone intervention, benefiting those with limited access to care, such as residents of rural areas.
“Services are based on therapists’ good intentions and bad intuitions. Therapists and the organizations they work, have no real-time and real-world data on the performance of their own services or on the health improvements of their patients,” according to Patterson Silver Wolf.
Patterson Silver Wolf incorporates technology to address many of the biases and lack of transparency in therapy with his St. Louis-based startup Takoda.
Takoda recognizes that recovery happens in the community, not in clinics. Their user interface includes patient questionnaires, remote check-ins and access to schedules and trends over past sessions. Essentially, this quantitative and qualitative data can be sent to their therapist to better assess their day-to-day activities. The data includes the location of relapses, real-time measurements of anxiety and cravings, as well as demographics and retention rates.
This constant contact helps with intervention and retention in Substance Use Disorder (SUD) outpatient programs. After the initial dropouts after weeks 1 and 2, there is another spike after weeks 4 and 5 because patients feel like they’ve received all the new information they can about therapy. don’t hear much new information. There are also racial disparities, as non-white individuals spend an average of 65.99 days in the program compared to 115.45 days for white individuals. According to Patterson Silver Wolf, innovations in technology serve to “replace intuition and gut feelings with science, data and technology.”
This new system has become even more relevant with the pandemic. From a physiological perspective, individuals with SUDs are more likely to have suppressed immune systems and have a greater risk of respiratory infections and lung and heart diseases (3). On top of that, they are often stigmatized and underserved by the healthcare system, experience housing instability and higher incarceration rates and may have difficulty accessing medication or therapy (4). Furthermore, from a social perspective, isolation negatively affects recovery from substance use disorders, increasing risk for relapse, withdrawal and suicide (5). Takoda has added a video-based telehealth service to their platform and encouraged distribution of their technology as a response to the pandemic.
“Social distancing and lack of face to face contact presents unique challenges and [we need] accelerated digital and telehealth communications in this industry that historically is behind the tech adoption curve,” Patterson Silver Wolf elaborated.
With the new technology developed for contact tracing and other online platforms during the pandemic, there is hope for application in the field of social work to address systemic problems in the future.
Edited by Daniel Berkovich
Illustrated by Annie Liu