The Road to Recovery Initiative (R2R) is an innovative model of care that aims to transform the way substance use treatment is coordinated and delivered in BC. Co-developed by the Providence Health Care (PHC) Division of Addiction and the BC Centre on Substance (BCCSU), it will focus on providing a full continuum of substance use care, to help patients access the right support when they need it.
In parallel to the rollout of the R2R’s clinical services, an extensive program of research will be conducted to evaluate how the program is working and to understand patients’ experiences with it. The knowledge gained through this research will be used in real time to improve the program and inform how the R2R can be successfully implemented in other regions of the province.
Addressing gaps in the addiction treatment system
Accessing safe and appropriate recovery services can be a major challenge for people with a substance use disorder. Through the R2R, people seeking addiction treatment will be able to access a comprehensive range of treatments, including acute stabilization and withdrawal management, transitional housing, and long-term recovery services.
“Under one umbrella, individuals can access harm reduction services, inpatient detox, transitional or short-term stay beds, inpatient recovery, and longitudinal follow-up through our outpatient clinics,” says Dr. Seonaid Nolan, clinician scientist with the BCCSU and Division Head of PHC’s Interdepartmental Division of Addiction. Dr. Nolan co-created the Road to Recovery program along with the BCCSU’s Executive Director, Cheyenne Johnson.
“It was really born out of our front-line experience, recognizing that there are numerous gaps and fractures in our addiction treatment system. We wanted to put pen to paper to sketch out what a functioning addiction treatment system would look like,” says Dr. Nolan.
The R2R will expand treatment capacity with the creation of ninety-five new addiction treatment beds. The first fourteen-bed stabilization and withdrawal management unit opened at St. Paul’s Hospital in September 2023, and twenty transitional care beds located in the community opened in October. Over the next several years, this continuum of services will be scaled up to meet the demand for care.
The program will collaborate with partners including PHC, the Ministry of Mental Health and Addiction, Vancouver Coastal Health (VCH), and PHC and VCH’s Regional Addiction Program to centralize and coordinate access to detox and recovery programs, as well as referral pathways between treatment providers. This will help ensure that the system is streamlined, easy to navigate – for administrators and patients, and provides the appropriate type and level of support that patients need at the exact moment that they are looking to access it.
Parallel research to improve the program
Dr. Nolan is leading the comprehensive health services evaluation and observational study that will follow individuals receiving care through this new service model. This research aims to evaluate the implementation of R2R services and the outcomes of people who access them, capture patient experience and satisfaction with these services, and identify opportunities for improvement.
“Any new model of care, intervention, or medication – pretty much any change in a system of care or how you treat patients – requires a thoughtful research evaluation to occur in parallel, so that we can continue to inform our evidence base and ensure that the new approaches to care are based in science,” says Dr. Brittany Dennis.
Dr. Dennis, a clinician scientist with the BCCSU and physician with PHC’s Interdisciplinary Division of Addiction Medicine, will be co-leading the prospective cohort study of the R2R, which is a major component of the research evaluation. She received the 2023 Michael Smith Health Research BC Scholar Award and the Carraresi Foundation Early Career Clinician Investigator Award to support her role.
The prospective cohort study will recruit patients who are accessing care through R2R services in order to explore the impact of this care on health, substance use trajectories, and social outcomes. It will draw on data from multiple sources, including qualitative and quantitative data from patient interviews and questionnaires and system-level data administrative data.
Given the chronic nature of substance use, researchers will follow patients who access R2R services over time, capturing detailed information about socio-demographic characteristics, physical and mental health conditions, substance use behaviors as well as harms caused by substance use. As time passes, researchers will reassess this information to establish patterns of interaction and connection with R2R services and determine how these services impact health and substance use outcomes. They will also employ novel methods of data linkage through several administrative databases, allowing researchers to see how participants are managing years out from accessing R2R services.
The program of research also includes a qualitative evaluation, where patients will be asked to participate in interviews focused on their experience with the R2R and how access to this model of addiction treatment may have impacted their health or substance use trajectories, and overall quality of life. These interviews will also gather suggestions on how to improve the service to better address the needs of patients seeking care.
This evaluation has made intentional efforts to identify and measure outcomes that reflect patient values and preferences, and the team is committed to better understanding patient-important outcomes. Capturing both outcomes that are traditionally used to establish program effectiveness, like treatment retention and substance use behaviors, as well as those considered important to patients, such as employment, access to housing, and reestablishing family connections, is prioritized in both the quantitative and qualitative streams of the evaluation.
The final aspect of this program of research includes a comprehensive health services evaluation which will use system-level data to help researchers understand service needs and factors impacting capacity while also characterizing the populations accessing R2R services, with specific attention to how patients migrate through the substance use system of care.
In total, this program of research will operate over a ten-year span. Participants will be recruited over the course of five years, and their outcomes will be tracked for another five years beyond that. Research and data will be emerging throughout this period as the program continues to evolve.
Research will help understand program’s impact on patient outcomes
Evidence on how to best treat patients with a substance use disorder is still growing, and in light of BC’s substance use crisis, it is an especially important area of study.
“The overarching aim here is to demonstrate that, through data collection and in an evidence-based fashion, if we can better coordinate service delivery for people who use substances, they will do better over time,” says Dr. Nolan.
This research program aims to understand the impact of offering comprehensive, coordinated addiction care on patients’ health, social, and substance use outcomes. The information and data collected through this research will be used to ensure this new model of care is operating as efficiently and seamlessly as possible, and will allow the researchers to make improvements for patients in real time.
“In the end, this is a program of research developed by patients, for patients, to answer big questions about how we can best improve and evaluate our standard of substance use care,” says Dr. Dennis.
Story by Grace Jenkins, Providence Research.