Cell phones

Credit: Judit Klein

In 2012, HealthRIGHT 360 began allowing clients to hold onto their cell phones in residential addiction treatment. This certainly went against the grain: nearly all other residential treatment providers either prohibit mobile phones entirely or only allow their use in very specific time-frames.

It’s been popular among HealthRIGHT 360 staff members and seems to have improved client retention. While results from this two-years-and-running experiment don’t mean every provider should mimic HealthRIGHT 360, the policy may offer some food for thought.

Why do residential facilities tend to confiscate cell phones from the start? In their journal article, researchers Scott Collier and Mardell Gavriel lay out four main reasons: distraction, social network, disruption, and privacy.

Distraction is an obvious one. Perhaps the client won’t pay enough attention while in treatment if she’s fiddling on her phone the whole time. Social networks also make a lot of sense: what if the client texts his drug dealer or his friends who use? Could that undermine his treatment? Disruption might occur in a shared living situation if, for example, one roommate is jabbering on his phone while the other is trying to sleep. And privacy is a biggie. Mobile phones, especially smartphones, seem to have HIPAA violation written all over them. Clients can photograph or videotape their peers and upload the content to social media sites immediately.

So did HealthRIGHT 360 encounter these problems when they allowed clients to hang onto their mobile phones? And if not, how did they avoid them?

The Policy

[Clients] would give their phone number to staff with the understanding that staff would call them if they left treatment early…

From the outset, clients were allowed fairly unrestricted access to their cell phones. But in order to keep their phones, they had to sign a contract with a few stipulations:

– They would not use them during therapeutic sessions

– They would not be rude or disruptive to other residents with their cell phones

– They understood that cell phone access was a privilege that could be lost

– They would give their phone number to staff with the understanding that staff would call them if they left treatment early

The last bullet point was an interesting innovation on Health RIGHT 360’s part and, as we’ll see, seemed to make a difference.

What They Measured

In their research study, Collier and Gavriel primarily focused on the new policy’s impact on retention. They were interested in two types of situations:

1) A client leaving treatment because of a restrictive cell phone policy

2) A client returning from treatment because a staff member had called her phone after she left

Before the new policy, like most other treatment providers, Health RIGHT 360 had not permitted clients to possess cell phones. Collier and Gavriel looked at two year’s-worth of data under the old policy and noticed in 13 out of 613 cases where a client chose to leave early, that decision was specifically connected to the cell phone policy. For example:

“Client was seen with a cell phone outside the facility. Client admitted to having a cell phone; however she did not want to turn it in to staff. Client decided to abandon treatment.”

Pretty straightforward. And not unique to Health RIGHT 360, either.

Gavriel and Collier predicted that with a new policy in place, they would not see anyone walk out of treatment because of the cell phone policy. And after a year under the new policy, they were right. They reasoned that allowing clients to keep cell phones could contribute to client retention.

Even more interesting is the new policy’s effect on “elopement retractions”–that is to say, how a call from staff members impacted a person’s desire to come back to to treatment once she’d already left. During the first year of the new cell phone policy, there were 473 documented elopements (early departures), 26 of which were “retracted” because the client returned within 24 hours. Of those 26 retractions, Collier and Gavriel estimate that eight were directly connected to receiving a phone call from a staff member, about a third of all clients who decided to return to treatment.

Finally, Collier and Gavriel measured the change in reports of loss of confidentiality between the old policy and new the one. Under the old policy–when cell phones had been banned–there were no reports of loss of confidentiality by clients or staff. But under the new policy, there were no reports, either.

Other Data from Staff Members

families

A cell phone may allow a parent to be more predictable for her child. Credit: urs/ula dee

Based on these measures, the researchers were able to conclude, on a preliminary basis, that allowing clients to use cell phones may positively impact treatment retention. This is good for the bottom line. And likely good for client outcomes. The other data they gathered, however, gives us a much clearer picture of what this new policy actually looked like in real-time in the treatment setting. This data comes from qualitative interviews of seven staff  members: five addiction counselors, one social worker, and one clinical psychologist.

100% of those staff members supported the new cell phone policy and thought it should be continued.

Here are a few of their observations:

Banning and policing cell phones is futile and time-consuming. “All in all it has saved a lot of conflict and staff can address clinical issues related to  individual needs and assessments instead of being cell phone police.”

The need to intervene when someone is disruptive with a mobile phone happens all the time, but no more than other problems. “Just like we have to remind them to speak softly when in the house, we have to remind them how to appropriately use their phones.” One staff member pointed out that cell phone use sometimes disrupt staff meetings and trainings, too.

Cell phones are very useful for clients. “It may allow a Child Protective Services involved parent to more predictable in his/her relationship with the child.” “They can call and receive calls related to job searching on their own.” “If a client doesn’t return from a pass, then we can contact them and let them know everything is okay.”

What Have They Learned?

There’s plenty of room for this policy to improve, report the researchers. For example, there are many mobile apps that support recovery that Health RIGHT 360 could encourage clients to download. And rather than calling clients who leave treatment (who wants to check voicemail these days?), the organization is considering sending a text. Most important thus far, according to Collier and Gavriel, has been the use of written guidelines. When clients start out by signing a contract that explicitly outlines appropriate use of cell phones, they are more likely to use cell phones to facilitate recovery, rather than hamper it.

 

Resources

[ABSTRACT] Mobile Phones in Residential Treatment: Implications for Practice (2014)