Keeping Kids in Treatment for Opioid Use Disorder

Adolescents and young adults with opioid use disorder often struggle to stay in treatment that’s not designed for people at their developmental stage. The Medication-Assisted Treatment of Addiction (MATA) Program at Nationwide Children’s Hospital is one of the only pediatric providers for adolescents with opioid use disorder in the country. They provide medication treatment, such as buprenorphine/naloxone or naltrexone with case management for behavioral health treatment.

“We have noted several challenges within our clinic population with coming to clinic visits and continuing to maintain sobriety,” says Erin McKnight, MD, MPH, a member of the Section of Adolescent Medicine at Nationwide Children’s. “Studies we had done in the past showed that coming to appointments and being active in clinic was predictive of long-term sobriety, so we were concerned about our initial dismal numbers.”

To increase early engagement and 6-month retention numbers at the clinic, Dr. McKnight and her colleagues developed a multifaceted quality improvement (QI) program. The team investigated the mitigating factors causing people to not return to clinic and initiated several interventions. These included training staff on motivational interviewing techniques, providing food and transportation vouchers, and using tokens of incentive for treatment and recovery milestones to enhance patient motivation. Their results were published in the journal Pediatric Quality and Safety.

Following these QI interventions, Dr. McKnight and her colleagues saw a significant increase in both second visit return rate and 6-month retention rate.

“Our providers have found it wonderful to see more engagement with the program and feel like they are doing something to help mitigate barriers to treatment,” says Dr. McKnight, who is also an assistant professor of Clinical Pediatrics at The Ohio State University College of Medicine.

The success of QI interventions at the clinic at Nationwide Children’s can be an example to other practices, says Dr. McKnight.

“Using QI methods is a great way to see where you have problems and if there are interventions that you can put into place to help your patient population,” Dr. McKnight says.

“It is also important to be re-evaluating what your patients need at different times. If they are working, continue them, and if they are not working, shift gears and see what else you can do.”

Reference:

Cottrill CB, Lemle S, Matson SC, Bonny AE, and McKnight ER. Multifaceted quality improvement initiative improves retention in treatment for youth with opioid use disorder. Pediatric Quality and Safety. 4(3):e174.

Image credit: Nationwide Children’s