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VA Homeless Programs

 

Telephone Continuing Care and Recovery Support (TCCRS) Model

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Telephone Continuing Care and Recovery Support (TCCRS) Model

Supporting formerly homeless Veterans in their recovery is a high priority for VA Homeless Programs. Staying in touch with them by home or office visits is an important part of all programs. To provide further support in 2013 by launching an evidence-based practice called Telephone Continuing Care and Recovery Support.

Telephone Continuing Care and Recovery Support (TCCRS) was initiated by the VHA's National Center on Homelessness among Veterans (the Center) as a model development initiative in the HUD-VASH Program to test the feasibility of using a model developed at the University of Pennsylvania for providing ongoing coaching, relapse prevention, and recovery support for clients with substance use disorders via regular telephone contact. The application of this model with VA Housing Program clients was to determine its effectiveness in enhancing housing stability, reducing substance use, and improving mental health outcomes. The TCCRS program is designed to augment the routine case management service provided by the program, rather than be a substitute for these services.

TCCRS Fact Sheet (2019)

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TCCRS Program Brochure

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Starting a TCCRS Program Power Point

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The TCCRS Counseling Manual

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TCCRS Coaching Questions

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Effects of automated smartphone mobile recovery support and telephone continuing care in the treatment of alcohol use disorder: study protocol for a randomized controlled trial.
McKay JR, Gustafson DH, Ivey M, McTavish F, Pe-Romashko K, Curtis B, Oslin DA, Polsky D, Quanbeck A, Lynch KG. Trials. 2018 Jan 30;19(1):82. doi: 10.1186/s13063-018-2466-1

Effect of Continuing Care for Cocaine Dependence on HIV Sex-Risk Behaviors. Wimberly AS, Ivey M, Rennert L, McKay JR. AIDS Behav. 2017 Apr;21(4):1082-1090. doi: 10.1007/s10461-016-1434-6

Telephone-based continuing care counseling in substance abuse treatment: Economic analysis of a randomized trial.Shepard DS, Daley MC, Neuman MJ, Blaakman AP, McKay JR.
Drug Alcohol Depend. 2016 Feb 1;159:109-16. doi: 10.1016/j.drugalcdep.2015.11.034. Epub 2015 Dec 12.

Efficacy of automated telephone continuing care following outpatient therapy for alcohol dependence. Rose GL, Skelly JM, Badger GJ, Ferraro TA, Helzer JE. Addict Behav. 2015 Feb;41:223-31. doi: 10.1016/j.addbeh.2014.10.022. Epub 2014 Oct 30.

Social network correlates of participation in telephone continuing care for alcohol dependence. Van Horn DH, Rennert L, Lynch KG, McKay JR. Am J Addict. 2014 Sep-Oct;23(5):447-52. doi: 10.1111/j.1521-0391.2014.12128.x. Epub 2014 Mar 15.

Voucher incentives increase treatment participation in telephone-based continuing care for cocaine dependence.Van Horn DH, Drapkin M, Ivey M, Thomas T, Domis SW, Abdalla O, Herd D, McKay JR. Drug Alcohol Depend. 2011 Apr 1;114(2-3):225-8. doi: 10.1016/j.drugalcdep.2010.09.007. Epub 2010 Nov 1.

Extended telephone-based continuing care for alcohol dependence: 24-month outcomes and subgroup analyses. McKay JR, Van Horn D, Oslin DW, Ivey M, Drapkin ML, Coviello DM, Yu Q, Lynch KG.Addiction. 2011 Oct;106(10):1760-9. doi: 10.1111/j.1360-0443.2011.03483.x. Epub 2011 Aug 8.

McKay, J. R. (2009). Continuing care research: What we have learned and where we are going. Journal of Substance Abuse Treatment, 36(2), 131-145.

McKay, J. R., Lynch, K. G., Shepard, D. S., & Pettinati, H. M. (2005). The effectiveness of telephone-based continuing care for alcohol and cocaine dependence: 24-month outcomes. Archives of general psychiatry, 62(2), 199-207.

McKay, J. R., Lynch, K. G., Shepard, D. S., Ratichek, S., Morrison, R., Koppenhaver, J., & Pettinati, H. M. (2004). The effectiveness of telephone-based continuing care in the clinical management of alcohol and cocaine use disorders: 12-month outcomes. Journal of Consulting and Clinical Psychology, 72(6), 967.

TCCRS also been evaluated in three NIH funded studies in which the telephone continuing care intervention achieved better outcomes than treatment-as-usual control conditions.  In the first study, TCCRS produced higher rates of self-reported abstinence over a 2-year follow-up than standard group continuing care, lower rates of cocaine positive urine samples than cognitive behavioral therapy (CBT) continuing care, and better liver functioning outcomes than standard care and CBT conditions (McKay et al., 2004; 2005).  In another study with 252 alcohol dependent patients, the telephone continuing care intervention produced better alcohol use outcomes than standard care only over 18 months (McKay et al., 2010).  Follow-up analyses showed that the treatment effects were larger in women and those with prior treatments for substance use disorders, and in those with poor social support or low motivation to change after a month of treatment (McKay et al., 2011).  In a third study with 321 cocaine-dependent patients, TCCRS produced significantly better substance use outcomes than standard care only in those patients who were still using cocaine or alcohol when they started treatment or during the first 3 weeks of treatment (McKay et al., 2013). 

Telephone coaching for recovery offers another cost-effective modality for supporting formerly homeless veteran in recovery. Having another professional available on a daily basis has the potential to provide that added support that is needed to help Veterans maintain their recovery.

A typical telephone call to Veterans participating in the program begins with a brief assessment of substance use and current risk and protective factors that either interfere with or support recovery.  This enables the coach and the Veteran to track changes over time and to make sure that the content of each session addresses the Veteran's most critical issues.  The content of the telephone calls consisted of discussions about current and upcoming stressors and other risk factors for relapse, and ways in which the Veteran could cope with these potential relapse triggers in a healthy way.  The calls also focused on how the Veteran could increase positive, recovery-oriented behaviors and experiences. Participation is voluntary and if Veterans experience a significant relapse or drop out of the program the Veteran's case manager is notified to initiate appropriate intervention.

No available resources

Telephone Continuing Care and Recovery Support (TCCRS) Summary (A detailed review of the TCCRS initiative)

Telephone Care and Recovery Support Program: An Implementation Framework (A step by step guide for the TCCRS model using an Implementation Science Framework)

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For more information on this initiative, please contact either Roger Casey PhD roger.casey@va.gov or Paul Smits psmits@usf.edu

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