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The Use of Motivational Interviewing in Behavioral Health

The BestNotes blog has been exploring different types of therapy used by addiction treatment and behavioral health providers. This time, we’re looking at motivational interviewing (MI).

Motivational Interviewing Overview
MI is a type of counseling that helps individuals resolve conflicting beliefs or feelings that have prevented healthy behavioral changes. It can be applied to individuals who are unmotivated, unwilling, or unprepared to make necessary changes in their lives.

Rather than trying to compel or direct clients toward changing their behavior, a therapist or counselor uses MI to guide a patient or client through their feelings and help them examine the need for change. Clinical psychologists William R. Miller and Stephen Rollnick are often credited for helping to develop this approach.

Who Motivational Interviewing Is For
According to some sources, MI was originally developed to address people struggling with alcohol problems. However, MI can help many other individuals who struggle to make necessary changes in their lives, including those with:

Addiction and substance abuse
Behavioral and mental health concerns
Chronic physical conditions, such as diabetes or asthma, that often require lifestyle changes

What Motivational Interviewing Involves
MI counseling involves a few basic ideas and assumptions:

Ambivalence toward one’s substance use, or changing substance use, is normal and common
Counselors can help individuals resolve their ambivalence by exploring and addressing their individual, inner motivations and values
The counselor and the patient are allies and equal collaborators in the counseling process
Change is most likely when the counselor is empathic, supportive, and yet directive, without arguing or confronting aggressively, which may make patients defensive and so hinder their progress

In their book, Motivational Interviewing: Preparing People To Change Addictive Behavior, Miller and Rollnick note that MI should involve persuasion and support, not coercion and arguments. They write, “The motivational interviewer must proceed with a strong sense of purpose, clear strategies and skills for pursuing that purpose, and a sense of timing to intervene in particular ways at incisive moments.”

During MI sessions, the counselor or motivational interviewer will encourage the patient to talk about their need to change their behavior and why they want to change. An MI clinician should take care to use reflective listening and empathy to help the patient see the discrepancy between their goals or values and their current behavior.

How Motivational Interviewing Works

MI aims to help increase a person’s motivation to change, and then encourage them to commit to change. By helping a patient explore their conflicting feelings and the necessity for change, MI can help encourage self-efficacy and optimism.

While the effectiveness of MI therapy needs more research, existing studies have shown positive results. One study of MI found that it “outperforms traditional advice giving” for several diseases and behavioral health issues.

While it can be combined with other types of therapies, including cognitive therapy and support groups, MI is usually short-term. In many cases, only one or two sessions may be needed.

Does Your EHR Work With Your Treatment Approach?

No two patients, clinicians, or treatment approaches are exactly alike. That’s why BestNotes EHR solutions offer many customization options to help you work more effectively and improve profitability. Contact us today to learn more or schedule a d

date:  Nov 19, 2019
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Could Artificial Intelligence Supplement Behavioral Health Treatment?

As awareness increases and stigma decreases, more people in need are seeking behavioral health services. At the same time, the number of behavioral health clinicians and other resources have not been keeping up with demand. Many areas of the country, especially rural locations, continue to be underserved.

The healthcare industry has been leveraging newer technologies, like artificial intelligence (AI) and machine learning, to help streamline many tasks. AI has been used to manage and analyze large numbers of patient data, or help providers take notes with speech recognition capabilities.

So could AI also be used to supplement behavioral health services?

Using artificial intelligence (AI) in healthcare

We’ve previously talked about AI on the BestNotes blog. This term usually applies to computers and software that can imitate the “intelligent” functions of humans, such as learning and problem solving.

When used in healthcare, AI often helps analyze large amounts of complicated data to help with predictions and diagnostics. It is also used with virtual assistants (VAs) that understand voice commands and even “learn” the user’s habits or preferences.

Using AI in behavioral health and addiction treatment

Despite the personal nature of behavioral health, it has not been immune to digitization. In recent years, funding for mental health tech startups has grown from nearly $100 million in 2014 to more than $500 million in 2018.

As AI technology advances, researchers are finding more ways to apply it within the healthcare industry. Researchers with the World Well-Being Project wrote in the journal PNAS how they incorporated language from the Facebook posts of consenting individuals to create an AI algorithm. This algorithm accurately predicted depression recorded in electronic health records.

AI may even help supplement the “soft skills” of communication, problem-solving, and conflict resolution that are vital for behavioral health. At the University of Waterloo in Ontario, computer scientists developed a new method for VAs that could be used to help people with mental illness. SMERTI (pronounced “Smarty”) takes a text response from a VA and adjusts its “personality” so that it uses natural language and emotional cues based on the relationship and situations involved. This allows the technology to better “connect” with users.

This follows the general trend of a growing number of Americans using technology to influence their health decisions. That also includes increasing popularity for virtual therapy options, which include chatbots, text-based messaging, and video counseling sessions.

By creating technology that responds to users’ needs with more emotional intelligence, researchers and developers may make behavioral health solutions more accessible. While this tech may not be a fully adequate substitute for working directly, in person with a behavioral health clinician, it may still help reduce the burden for providers and improve patient outcomes.

Stay up-to-date with your behavioral health EHR

BestNotes EHR and CRM solutions were designed with the behavioral health and addiction treatment provider in mind. BestNotes’ many features offer peace of mind for both providers and patients, allowing you to provide better care and streamline your office operations. Contact us today to learn more or schedule a free demo.

date:  Nov 12, 2019
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Medication-Assisted Treatment Works for Opioid Addiction, But Isn’t Used Enough

While medication-assisted treatment (MAT) has been found effective for opioid addiction, new research also shows that it continues to be underused.

Medication-Assisted Treatment Works for Opioid Misuse and Addiction
The FDA has approved the drugs naltrexone, buprenorphine, and methadone for use in MAT. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), MAT has been shown to:

Improve patient survival
Help individuals stay in addiction treatment
Help reduce criminal activity among people with substance use disorders
Increase a patient’s ability to get and keep a job
Improve birth outcomes in pregnant women with substance use disorders

Recent Findings on MAT Underutilization

In the October issue of Mayo Clinic Proceedings, researchers reported that MAT drugs are effective, but are not applied as frequently as they should be. Their findings were based on a review of data from the available medical literature about MAT.

The researchers, led by Tyler Oesterle, MD, medical director of Mayo Clinic Health System’s Fountain Centers drug and alcohol treatment programs, pointed out that each drug has strengths and weaknesses. Clinicians should weigh the risks and benefits of each drug for each patient suffering from an opioid use disorder.

Why MAT Is Underutilized
Despite its effectiveness, there are persistent barriers to widespread MAT use in the United States.

Critics of MAT often say that the technique simply substitutes one drug for another. However, MAT actually helps relieve withdrawal symptoms and psychological cravings associated with opioid misuse. With MAT medications, patients have a safe, managed way to overcome opioid abuse.

Research indicates that, at the appropriate dose, MAT does not adversely affect a patient’s mental or physical functioning. This can help patients lead fulfilling, productive lives without opioid dependence.

However, this misinformation leads to stigma that may prevent people from getting the help they need through MAT. For example, many drug courts do not allow patients to be referred to this type of treatment for substance abuse.

Limited Access

Patients struggling with opioid misuse may not have access to an MAT provider. The three drugs used in MAT can only be dispensed through an Opioid Treatment Program (OTP) certified by the SAMHSA and accredited by a SAMHSA-approved accrediting body.

Federal, state, and local regulations also limit the number of MAT providers. Practitioners must receive a waiver to practice opioid dependency treatment with approved medications, which requires an application and training process. Under the SUPPORT Act, non-physician practitioners have received greater flexibility in providing MAT, though this still requires them to receive a waiver and fulfill other requirements.

Treatment providers and behavioral health organizations also may lack the funding to begin prescribing MAT or launch an MAT program. One study from 2009-2010 found that many funding policies “are unsupportive of the implementation of MAT,” which limits availability.
The National Council offers a variety of resources for behavioral health and addiction treatment organizations and other healthcare providers that are considering incorporating MAT into their practices.

Serving Addiction Treatment and Behavioral Health Clients

Whether you offer MAT, talk therapy, or a combination of treatments for substance misuse, your EHR system should help, not hinder, your practice. Contact BestNotes today to get started with EHR and CRM solutions tailored to your specific needs.

date:  Nov 04, 2019
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News Roundup: Ohio’s Opioid Settlement

In response to the national opioid crisis, more than two thousand U.S. states, counties, and cities have filed lawsuits against companies that manufacture or distribute opioid medications.

This year has seen several rulings and settlements related to these lawsuits, with several major developments occurring in Ohio. Let’s take a look at a few of the particular stories centered around these lawsuits.

More Than $23 Billion Could Go Toward Addiction Treatment After Settlements
Ohio’s Cuyahoga and Summit counties have reached a settlement with pharmaceutical firm Teva and drug distributors AmerisourceBergen, Cardinal Health, and McKesson. These companies, along with pharmacy company Walgreens, had been accused of recklessly prescribing and distributing medications that contained oxycodone and fentanyl.

Originally, the lawsuit was expected to lead to an important trial in holding drugmakers responsible for allegedly contributing to the nation’s opioid epidemic. However, on October 21, the companies reached a $260 million settlement with the two counties.

The drug distributors have agreed to pay $215 million to the two counties. According to the distributors, they expect their portion of the settlement to fund addiction treatment, rehabilitation programs, and behavioral health services. Teva will pay $20 million in cash and supply $25 million worth of Suboxone, distributed over three years.

Statement From Drugmaker Teva Discloses Global Settlement Framework

In an October 21 statement, Israel-based pharmaceutical company Teva announced not only its settlement with the Ohio counties, but “an agreement in principle” with attorneys general from North Carolina, Pennsylvania, Tennessee, and Texas to reach “a global settlement framework.”

Under the agreement, which is not an admission of liability, Teva would donate up to 10 years’ worth of buprenorphine naloxone (sublingual tablets) with a total value of approximately $23 billion. This donation of medication used to treat opioid addiction would be used to help individuals and communities that have been significantly impacted by opioid addiction. The agreement would also include a cash payment from Teva of up to $250 million over 10 years.

Ohio Settlement Leaves Questions Unanswered
Within Ohio’s Cuyahoga and Summit counties, communities and families are celebrating the opioid settlement. Many hope that the resulting funding and Suboxone supply can provide vital treatment for individuals impacted by opioid addiction.

Some experts say, however, that reaching a settlement instead of going to trial has left some issues in the opioid crisis unresolved. Some specific concerns include:

Had there been a trial, the jury’s decision could have had a significant impact on future opioid lawsuits, potentially validating future trials.
Without the validation of an Ohio trial, some communities may reach settlements with drug companies, but other communities could miss out on the addiction treatment support they need.
A full trial, rather than a settlement, would have revealed additional information about the business practices of opioid manufacturers and distributors.
Reaching a nationwide or global settlement with drugmakers that are allegedly responsible for the opioid crisis remains uncertain.

Are you ready for increased demand?
With more individuals seeking help for opioid addiction, behavioral health and addiction treatment providers could easily be overwhelmed by the increased demand. BestNotes EHR solutions can help you manage more patients, track outcomes, and bill appropriately, so you can help more people and get paid faster. Contact us to find out more or schedule a free demo.

date:  Oct 28, 2019
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Four Things to Know About the ASAM Criteria Assessment

As a behavioral health provider, you know that addiction treatment is one of the most complex services in your field. Not only do different patients have different needs, but each type of substance can have varying effects. With so many factors involved, it can be hard to determine the best treatment approach for each patient.

Since the 1980s, the American Society of Addiction Medicine (ASAM) has been working to develop criteria for treating addiction. Here’s what you should know about the ASAM Criteria and how it can help your addiction treatment practice.

1. The ASAM Criteria uses a holistic approach.

ASAM’s assessment for addiction treatment looks at six dimensions that include biology, psychology, and socio-environmental factors. This creates a fuller, more accurate picture of the individual patient.

Dimension 1 examines the patient’s past and current substance use and/or withdrawal
Dimension 2 examines the patient’s current and past physical health status
Dimension 3 examines the patient’s current and past mental health status
Dimension 4 examines whether the patient is willing or ready to change their substance use
Dimension 5 examines the patient’s individual risks of relapse or other continued substance use issues
Dimension 6 examines the patient’s living situation and whether it will contribute to recovery

2. The ASAM Criteria has authority and staying power.

This ASAM Criteria has become the most widely used set of guidelines for placing, treating, and discharging patients with addiction and co-occurring conditions. In fact, ASAM’s criteria are required in over 30 states. Also, many insurers and other payers require some form of ASAM assessment for patients receiving addiction treatment.

ASAM Criteria is continually reviewed and revised through collaboration between ASAM leadership and the Steering Committee of the Coalition for National Clinical Criteria. This coalition has been meeting regularly since 1991 to ensure that the Criteria adequately serves and supports both public and private payers, providers, and patients.

3. ASAM provides several products based on its Criteria.

Using its Criteria, ASAM developed a family of products known as ASAM Continuum® to help clinicians assess patients with substance misuse and co-occurring conditions. Using ASAM Continuum, a treatment team can conduct computer-guided, standardized patient interviews.

These tools include all six dimensions of the ASAM Criteria, as well as research-quality questions and assessments to create a comprehensive patient report that includes a recommended level of care.

Within the Continuum family, ASAM also provides CO-Triage® for referring patients with alcohol and substance problems. Using questions in the CO-Triage tool, clinicians can recommended the ASAM Level of Care to which a patient should be referred.

4. BestNotes is adding ASAM-based assessment.

BestNotes has been working with ASAM to secure copyright permission to build and implement our own ASAM assessment. This new feature will be added to the Documentation section of the BestNotes EHR software by mid-2020.

If you’re a behavioral health or addiction treatment provider seeking a better way to assess and refer patients, BestNotes EHR is here for you. Created specifically for behavioral health and addiction treatment organizations, BestNotes helps you ask the right questions, take better notes, track outcomes, and provide better care so you can make your practice more efficient and improve revenue. Contact us today to learn more, and even schedule a free demo.

date:  Oct 24, 2019
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