• Memory

    Can you imagine remembering all the details of fifty cases?

    In depth conversations, screening scores and results of a plethora of assessments bring an incredible amount of information into the mix for a single consumer, and in some treatment environments, mental health and addictions professionals can be responsible for the health of fifty consumers. Keeping the details straight seems like an impossible task, which is one reason charts were invented in the first place, and these days, one of the greatest reasons why the Electronic Health Record (EHR) is invaluable in the treatment world. Memory

    Thomas Insel, director of the National Institute of Mental Health tackled Memory in a recent blog, and the first thing that came to my mind was how computers store data and assist in decision-making. This study of human memory indicated there is a period of time where memories are fragile and begin to break down…computer data doesn’t do that. Once you have it stored, you can retrieve it in that condition any old time you want it. Still, I wouldn’t say the computer’s memory is better than a professional’s (some days, perhaps it’s more accurate).

    A computer saves a series of on-off switches onto its hard drive without intuition attached, without feelings associated. I begin to question the type of record that is saved. A simple suicide assessment can be a record of seven to a dozen questions or so, with answers that can be scored…something like “yes” = “1”, “maybe” = “2” and “no” = “3”. Write down the answers and add up the scores, and poof! You have a scorable assessment, and if you string a few iterations of this type of instrument completed over a period of time, you have an “outcomes study”. The next question becomes “How reliable is this?”

    If a patient knows he will be admitted to a facility, and is tired of living in a ward, he may elect to be less than truthful when answering the questions, indicating everything is fine, just fine…when it really isn’t. If the consumer is accustomed to this sort of assessment, he could be sent home because the answers to the assessment indicate he doesn’t need help. The judgment of the seasoned professional increases in value, and relying on a short assessment like this becomes questionable. Naturally, this doesn’t mean the technology is meaningless or valueless, just that it’s a tool, and the trained professional makes the decisions for treatment.

    Based on a discussion with a patient while filling out an assessment, professionals may want to look into matters a little more deeply…other tools are at their disposal, including audio and video recording of filling out the assessment, which should be a collaboration between the consumer and the professional.

    Most EHRs have the ability to attach electronic files to a patient’s record, like an MP3 video recording of a session. This sort of technology can be revealing as a study of non-verbal communication, and the drawback is that it’s cumbersome…once you record a session, the exact spot to be studied needs to be accessed, and locating it could take a while. The up-side to this idea is that it may be more reliable than human memory. According to Insel’s research, when memories are retrieved, they can be changed, decreasing their reliability. An assessment’s answers or a recording won’t change. They are what they are.

    Not long ago, this sort of technology required a substantial investment and a lot of equipment. My Notebook cost $400 and came with a camera that records audio/video in formats that are readable on most PCs.

    The idea of recording sessions is an old one. Perhaps it’s time to re-visit some ideas about the EHR like attaching electronically recorded treatment sessions to the consumer’s record. Reviewing records like this could prove to be a lifesaver.

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  • Anonymous Struggle

    Is this anonymous?

    I ran across a headline sharing the wonderful news for OneRecovery who recently closed a deal with Aetna Insurance. Good for them, the salesperson in me cheers and applauds. For the consumer who is a member of the Aetna EAP involved in this sort of service, it means being attached to a traceable series of numbers to track usage. Before participating in programs like these, look into the security measures offered. Some are good, others may not be so great. SocialNetwork

    An EAP, or Employee Assistance Program, offers a number of services, some of which revolve around mental health and addiction services. Some EAPs offer telephone counseling with a professional, as well as other life-skills services.

    Once again, our health information could be further shared due to insurance companies’ “need to know”…which, incidentally, is legitimate to a certain extent. After all, when an insurance company is paying claims, it’s only good business to know where the money’s going. That said, if I were a consumer just trying to overcome addiction or alcoholism, I may want to guard that information from my employer; if not the fact I was frequenting a site specializing in bearing one’s soul with relationship to the disease of addiction, then certainly to the details about my symptoms, relapses, etc. Recovery is a personal affair that improves lives, creates good workers and helps people become participating members of society who pay their bills. One question becomes “How do we keep recovery on that deeply personal level and still enable insurance/EAP billing without disclosing sensitive treatment details that are nobody’s business but the recovering person?”

    Living up to this sort of ideal can be tough, but not impossible.

    On the back end of social networking for recovery support, if somebody provides a service, whether it’s telephone counseling, monitoring a chat room, writing a social-networking software program or keeping the server up and running, they need to feed the baby and buy shoes. So, statistics, lots of statistics, need to change hands to assure the work’s getting done and the service is proving valuable. Proving that legitimate services were provided becomes an interesting challenge, not because the statistics aren’t available, but because of the details involved that really shouldn’t be shared.

    Many years ago, a company in New York worked with the state to assure anonymity of substance abuse treatment consumers statewide. The state needed to provide and track Medicaid services to consumers in treatment in order to assure professionals got paid and consumers received the treatment they needed without names attached. Maintaining anonymity was a problem. The solution was to hire a third party who was the keeper of the numbers and the names. The state didn’t get the names of consumers, just the numbers. The idea worked fine to guard anonymity of involved consumers. The company that was hired had physical security that made it tough to get into the place. Years ago, the manager of this private, third-party facility protected the identity of a patient, not releasing records to the court and risked jail time. Security was about as good as a consumer could hope for. Every scrap of paper that might remotely be attached to a consumer was shredded, and even computer backup tapes were tightly guarded in a secure environment.

    Private insurance companies aren’t necessarily as concerned with confidentiality. Although they may not release records without a consumer’s permission, how much information needs to pass from party to party? I’d say, just enough to validate that a service was provided by a qualified professional, who follows the rules established to protect consumers and assure treatment helps them recover.

    I think the on line support groups are a good, and there are a number of them available: Here are a few:

  • In The Rooms
  • Cyber Recovery Network
  • Christian Recovery Ministries
  • Online Recovery Support
  • If you’re shopping, I’d suggest you ask about security, and think about how your information, intimate details about a problem that you might discuss in a chat room or on-line with a professional, might be shared with folks like insurance companies, or as de-identified data for research. What safeguards are in place to protect your anonymity?

    Caution on the front end could avoid some trouble down the line.

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