Founded in 1983 and based in Havre de Grace, the nonprofit Ashley Addiction Treatment offers the full range of addiction treatment services, from ambulatory detox services to 60- to 90-day extended care. The facility has treated more than 50,000 patients and their families.
But last year, the pandemic tossed the institute a curveball that took some nimble footwork to accommodate: how to offer its full continuum of care while protecting both its employees and patients from the coronavirus.
“It required us to pivot very quickly,” said Lara Dahl, director of family services for Ashley.
That pivot was to a telehealth system, in which outpatient treatment is offered virtually rather than in-person.
“We’re fighting two wars – addiction and COVID-19,” said Ashley’s Senior Vice President and Chief Medical and Clinical Officer Dr. Gregory Hobelmann at the time the change was made a year ago. “Addiction is an isolating disease, so by removing these familiar support systems it can be detrimental to sobriety since its foundation rests on maintaining a strong connection to others.”
Physical distancing does not mean completely disconnecting from others, Hobelmann noted, adding that his hope was that the new virtual services “preserve a level of comfort and normalcy to people’s lives as we navigate through this pandemic together.”
The hopes seem to have been realized. Patient visits for Ashley increased by 6% for the March-December period of 2020 over the same period in 2019, and successful program completions increased by 11% from March-July 2019 to the same period last year.
The shift was not without challenges. One was learning how to keep patients engaged, which is harder virtually than in person, according to Jennifer Aguglia, Ashley’s vice president of Outpatient Services. People can get distracted easily, especially in group sessions, she said, plus not everyone has access to the needed technology.
To solve the latter problem, she said, Ashley offered patients the option of coming into the office and using an iPad provided by Ashley in a private room.
But virtual treatment also had advantages. It made the treatment both more acceptable and accessible, Aguglia said. Since switching to telehealth, family participation in the treatment, which is considered crucial, has climbed from about 60% before the pandemic to more than 90% now.
“We also have been able to provide services worldwide,” Dahl said. “It removes a lot of barriers to working with these families, which helps assure a successful recovery.”
Patients have applauded the changes, Aguglia said.
“We’ve had patients come back and say, ‘I hope you’re going to offer this after the pandemic.’ They say they’ve never been successful before but they now are because they don’t have to worry about a ride to appointments, about fitting a personal visit into their work schedule.”
Starting this month, the virtual-only restrictions have been eased for some services. Ashley officials are still hoping to continue to offer virtual treatment options, but that depends in part on help from the state of Maryland.
Restrictions on reimbursing providers for telehealth care were lifted because of the state of emergency prompted by the pandemic. But when that ends, the restrictions can return, putting a serious damper on the use of telehealth.
Bills introduced in the Maryland General Assembly would ensure that those services, including those offered by addiction treatment facilities such as Ashley, would be covered and reimbursable.
Ashley’s use of telehealth for addiction treatment during the pandemic is part of a national trend.
In an email response to questions, Dr. Neeraj Gandotra, chief medical officer for the national Substance Abuse and Mental Health Services Administration, said the pandemic has made telehealth services for behavioral health needs much more common. SAMHSA, he said, helped insure that telehealth services would be covered for reimbursement at the federal level, and also provided training for substance use and mental health therapists not used to virtual visits.
“People pursuing recovery for mental and substance use needs benefit from consistent access to a wide range of services,” Gandotra said. While treatment benefits from in-person interaction, he said, “telehealth helps maintain that consistency for patients at a time when in-person interactions can carry a health risk, depending on the circumstances.”