Focused Continuing Care at the Betty Ford Center began as a pilot program in 1997. Every seventh patient was invited to participate. Upon discharge from formal treatment, individuals were contacted by telephone on a regular basis by a counselor, with whom they had met prior to completing primary care.
Based on extremely positive early results, this additional level of care was expanded shortly thereafter to include all patients.
Since 1997, an astonishing 22,500 “check-in and check-up” calls have occurred between Focused Continuing Care counselors and over 4,000 patients.
In early 2005, the Center’s management team decided to engage the services of the Philadelphia-based Treatment Research Institute to examine the Focused Continuing Care program – both operational details and the mountain of data that has been collected thanks to all the information gleaned from all those calls.
Deni Carise, PhD, Director of Treatment Systems Research for TRI, worked closely with Cheryl Wilson, Director of the Focused Continuing Care program, and her team of counselors, throughout 2005 and into 2006.
A progress report on their collaboration and findings was shared with the Center’s Chairman’s Council in early March.
According to Dr. Carise, “It was exciting for me to discover just how much had been accomplished by the Betty Ford Center Focused Continuing Care team even before we arrived on the scene.”
She continued, “It was also exciting to see that the Center’s decision to establish and expand Focused Continuing Care was clinically driven. A few other treatment facilities in the country have FCC-like programs, but their motivation is primarily to monitor outcomes, so they can come up with a ‘success rate.’
“Focused Continuing Care at Betty Ford is viewed as an essential component of the patient’s aftercare program, rather than as a research project to monitor outcomes.
“There’s an important distinction between the two rationales, and I think the Betty Ford approach is focused primarily on serving the person in recovery, versus serving the facility’s need for outcome data.”
In other words, says Dr. Carise, “Research should serve treatment, not the other way around.”
The extensive data analysis performed by TRI yielded a goldmine of valuable findings.
Sponsor Contacts. Sixty-three percent of patients are in contact with their sponsor three months after completing primary treatment. That percent remains remarkably constant at the one-year mark (62%).
12-Step Meeting Attendance. The correlation between regularly attending AA and similar meetings, and ongoing sobriety, is striking. At the three-month mark, 88% of persons who complete treatment at the Betty Ford Center confirm they are attending meetings (93% report ongoing sobriety); that percent declines to 78% at the one-year point. (with 88% reporting ongoing sobriety).
Frequency of 12-Step Meeting Attendance. At the three-month mark, 96% of those attending three or more meetings a week have maintained sobriety. At the one-year mark, 94% of those attending three or more meetings a week have maintained sobriety. [The comparable figures for those attending one or fewer meetings per week are 82% and 80% respectively.]
Dr. Carise says she found the correlation fascinating between patients’ post-primary treatment sobriety at three months and sobriety at one year. “The simple fact is,” she says, “early behaviors are an excellent predictor of future behaviors. If a person makes it through those first three months successfully, they have a much higher likelihood of being successful at the end of one year.”
Dr. Carise also points out that all the data generated via the Focused Continuing Care program makes for a marvelous teaching tool.
“It’s one thing to tell patients in the abstract, ‘If, after discharge, you attend 90 meetings in 90 days, and you get a sponsor, chances are good you’ll stay sober.’ It’s another thing to be able to say with great specificity: ‘If you attend at least three AA meetings a week, your chances of maintaining your sobriety at three months are 96%; at 12 months, 94%.’ That kind of hard data speaks directly to the recovering alcoholic or addict.”
As well as analyzing data, the TRI team also provided lots of “nuts and bolts” services involving the Focused Continuing Care program. Some examples:
Focus Groups. Current BFC patients gathered for guided discussions of key questions, such as “Are there any things about FCC that you don’t understand?” “What could be helpful to you?” “What (if any) concerns or worries do you have about being involved in FCC?” [The most frequently expressed concern: that the patient/person in recovery know the counselor with whom he or she is going to have the monthly phone calls. They do.]
Timing of Calls. The first call is made the first week following discharge. After that, flexibility is the key. According to Dr. Carise, “There needs to be a window – say 21 to 37 days – between calls, rather than attempting to make the one-month call at exactly 30 days post-discharge.”
Wording of Questions. “The way questions are phrased is critical,” says Dr. Carise. “You have to avoid questions that beg an easy, glib response. `You didn’t drink, did you?’ does not encourage candor. `Have you drank any alcohol in the past seven days?’ is better; `How many days in the past seven did you drink any alcohol?’ is best.”
“The FCC team already understood all this,” says Dr. Carise. “What we’ve helped them do is codify it.”
Asked her general response as an “outsider” to the Betty Ford Center, she replied, “Even though the Center is a widely-admired licensed addiction treatment hospital, I still found it remarkable that such a high percentage of clients complete their inpatient treatment stay and then follow precisely the right steps that lead to a life of continued sobriety.
“Bottom line? If an alcoholic or addict receives first-class treatment in a first-class facility, then leaves with both a comprehensive, individualized aftercare plan and a commitment to that plan, the chances for lifetime sobriety are excellent.”
