Continuity of Care in a VA Substance Abuse Treatment Program
Elie M. Francis, MD; Joseph DeBaldo, MBA, MEd; Suzanne E. Shealy, PhD; and Cheryl L. Gonzales-Nolas, MD
Dr. Francis is a staff physician, Mr. DeBaldo is a staff counselor, Dr. Shealy is a staff psychologist, and Dr. Gonzales-Nolas is a program leader, all in the Alcohol and Drug Abuse Treatment Program in the Mental Health and Behavioral Sciences Service at the James A. Haley Veterans' Hospital in Tampa, Florida. In addition, Dr. Francis is an associate professor and Dr. Gonzales-Nolas is an assistant professor, both in the Department of Psychiatry and Behavioral Medicine; and Dr. Shealy is an assistant professor in the Counseling Center for Human Development, all at the University of South Florida in Tampa.
Continuous care is essential to successful substance abuse treatment (SAT). When the VA implemented the Continuity of Care Performance Measure, this facility’s SAT program went the extra mile to exceed the VA’s standards.
The methodology for treating patients who have substance use disorders in the United States shifted in the mid-1990s from an inpatient model, in which, patients were admitted and treated in a hospital setting for 28 days under 24-hour nursing supervision, to an outpatient model, in which, patients were treated in less-supervised residential settings or in their own homes.1 Even with this shift to an outpatient model, however, the emphasis of the treatment community remained on treating patients in an intensive 3- to 4-week program. Various aftercare clinics were made available to patients, but there was never a strong focus on their importance, and patients who did not present for their aftercare groups did not receive follow-up telephone calls. More recently, there has been progress toward adopting a broader approach to substance abuse treatment (SAT), which emphasizes the importance of regular follow-up and integration with other health care services.2