Clinical Monitoring to Facilitate Continuous Care for Substance Abusing Clients

The goal of the RecoveryTrack Extended Care (RT-E) study is to improve attendance and
extended care treatment during outpatient substance abuse treatment (SAT). One way we hope
to promote and improve retention in outpatient treatment is to allow the primary counselor
to systematically monitor client progress and respond accordingly to enhance the client's
progress in outpatient treatment. We have developed an intervention using RecoveryTrack
software that allows the counselor to monitor the client while s/he is regularly attending
and to helps to guide their treatment; as well as reaching out and monitoring the client
when s/he has missed sessions or appears to have dropped out in order to support
re-engagement in treatment or recovery in other ways. SAT can serve as a gateway to and
provide services for HIV/STI prevention and treatment as well. Thus, monitoring and
responding to HIV/STI risk behavior and treatment compliance throughout SAT, and increasing
attendance in SAT itself, has the potential for additional personal and public health
impact.

Counselors are trained on the RT-E computer application, and learn to implement the clinical
content and procedures of the RT-E intervention. Clients then are asked to use the software
with participants twice within the first month, and once monthly for 8 months. If clients
drop out of treatment or do not show for an appointment, counselors are asked to do
"outreach" with the clients to promote re-entry into treatment. We also ask the counselors
to keep track of any time that they spend on the project and how much of their own resources
to perform outreach. We ask that all sessions be audio recorded and will be rated at a later
time. The TAU counselors also audio record their sessions and document their time on a log
any outreach attempts. The counselors are asked to perform their usual outreach attempts if
a client drops from treatment, and to complete individual sessions without the RT-E computer
application.

In total, 25 counselor-participants will be enrolled in RT-E study. All counselors receive
incentives throughout participation in the study. The incentives are greater in the RT-E
condition reflecting a greater workload than in TAU with payments at the beginning, middle,
and end of research participation. The compensation for counselor participants in each
condition is as follows: RT-E training takes approximately 4-5 hours over a period of
several weeks at the beginning of the study. RT-E counselors are paid $125 upon completing
the entire training sequence. RT-E counselors receive supervision by TRI staff in 30 minute
sessions about once a month during the 1st 6 months of the study and quarterly thereafter,
for a total of approximately 11 sessions. RT-E counselors are paid $15 for each supervision
session attended [maximum total = $165].Two times, midway and near the end of the study,
RT-E counselors complete the Counselor Acceptability Survey and are reimbursed $20 each
time. Each week RT-E counselors completes the Counselor Activity Log and is paid $2 for each
one completed during the course of the study [a maximum of $200 for approximately 104 weeks
].RT-E Counselors are paid $30 for each completed and audio-recorded phone outreach session
($25 if completed but not recorded). Total counselor payment for these activities will vary
based on number of client participants seen as well as client non-attendance and need for
and responsiveness to outreach contact. Two times, midway and near the end of the study, TAU
counselors complete the Counselor Acceptability Survey and are reimbursed $20 each time.

In total, 150 client-participants will be enrolled in the RT-E study. These participants
will complete a baseline research interview and follow-up interviews 3, 6 and 9 months
later, as well as provide urine samples for drug screening (UDSs) at each of the research
assessments. Clients will be contacted at the midpoint of each follow-up interval to remind
them of the upcoming follow-up appointment and obtain updated locator information. Clients
are paid $30 for completing the baseline ASI6, urine drug screen (UDS), and Risk Assessment
Battery (RAB); $35 for the 3-month follow-up ASI6, UDS, and Client Acceptability Interview;
$40 for the 6-month ASI6 & UDS, and $50 for completing the 9-month ASI6, UDS, RAB, & Client
Acceptability Survey. At months 2, 5, and 8, participants receive reminder letters or phone
calls about their upcoming follow-up and can earn $5 each of those months by calling TRI and
updating their Research Locator Form. All payments are be in cash, unless a check or money
order is more practical (e.g., if payment needs to be mailed). Clients are randomly assigned
to groups based on their primary counselors' assignment to condition in the study.

Inclusion Criteria:

- Client enrolled in outpatient treatment at participating facility and assigned to
participating counselor.

- Counselor employed at participating facility.

Exclusion Criteria:

- Client unable to speak English.

- Client too cognitively impaired to give informed consent.

- Clients who do not wish to be audio-recorded during individual sessions.