Lessons learned for follow-up phone booster counseling calls with substance abusing emergency department patients.
Post-visit “booster” sessions have been recommended to augment the impact of brief interventions delivered in the emergency department (ED). This paper, which focuses on implementation issues, presents descriptive information and interventionists’ qualitative perspectives on providing brief motivational interviewing-based interventions over the phone, challenges, “lessons learned,” and recommendations for others attempting to implement adjunctive booster calls.
In the National Drug Abuse Treatment Clinical Trials Network study, “Screening Motivational Assessment and Referral to Treatment in Emergency Departments” (SMART-ED), attempts were made to complete two 20-minute telephone “booster” calls within a week following a patient’s ED discharge with 425 patients who screened positive for and had recent problematic substance use other than alcohol or nicotine. Over half (56.2%) of participants completed the initial call; 66.9% of those who received the initial call also completed the second call. Median number of attempts to successfully contact participants for the first and second calls was 4 and 3, respectively. Each completed call lasted an average of about 22 minutes. Common challenges/barriers identified by booster callers included unstable housing, limited phone access, unavailability due to additional treatment, lack of compensation for booster calls, and booster calls coming from an area code different than the participants’ locale and from someone other than ED staff, which some participants found confusing and suspicious.
Conclusions: The results of this inquiry demonstrate that a team of booster interventionists and supporting staff can overcome the challenges in implementing a remotely located, centralized booster call center. Specific recommendations are presented with respect to implementing a successful system. Future use of booster calls might be informed by research on contingency management (e.g., incentivizing call completions, which could help address the barrier related to lack of remuneration), smoking cessation quitlines, and phone-based continuing care for substance abuse patients. Future research needs to evaluate the incremental benefit of adjunctive booster calls on outcomes over and above that of brief motivational interventions delivered in the emergency department setting.
Related protocols: CTN-0047