Creating an Evidence Base for Stages of Change Model of Engagement and
Recovery Supports
Project Lead: Jennifer Tuerke, Executive Director
Background
Voices of Hope, Inc. (VOH) is the largest nonprofit recovery community organization in Maryland. VOH provides harm reduction services, treatment navigation, and recovery support 24 hours a day, seven days a week. The agency had nearly 26,000 engagements with people affected by addiction and opioid use disorder in Cecil and Harford Counties in 2022. VOH provides a wide variety of services to help individuals find, enter, and maintain recovery support, serving as a “one-stop shop” for people who often have numerous needs. The agency has structured a “touch point road to wellness” approach based on the Stages of Change Model of Prochaska and DiClemente (see Figure 1). VOH received two rounds of IRIS funds and research support led by Dr. Jay Unick. For this round one project, VOH developed a data-driven system to explore participants’ recovery pathways of engagement aligned with Stages of Change to better understand how such services help people progress along this path.
Methods
Aligned with these research aims and to combat the challenges described above, Aaron Wright and Patrick Tucci of VOH have developed a customized database. VOH has created a personal dashboard for participants using a person’s name, a unique identifier (sequence of unidentified numbers and letters), or a combination of both as the relationship and services grow. This database allows all of the agency’s services to be attached to these personal dashboards for qualitative and quantitative data collection and analysis. For this IRIS supported research project, VOH has taken a snapshot of one year, 1/1/2022 through 12/31/22, examining services received by Safe Syringe Program (SSP) participants and their alignment with the Stages of Change Model. As VOH does not collect data for anonymous fellowship meeting attendance, these numbers were not captured in the results below.
Results
In 2022, VOH had 1,374 unique individuals enrolled in its SSP. All services listed below were for those individuals. Allocating services into the Stages of Change Model can be challenging and not clearly defined as “stops and starts.” The following is how VOH categorized some of its services within those stages. VOH deemed services in precontemplation (active use) as receiving SSP supplies and naloxone; a total of 3,669 services were provided. Progressing through the stages of change, VOH deemed registered nurse wound care (provided 791 times) and peer support interactions (recorded 4,000 times) within a combined category of Contemplation and Preparation Stages (active use but possibly preparing for change), for a total of 4,791 services. VOH deemed treatment coordination (71 referrals) and transportation provided (313 occurrences) as services in the action stage (changing behaviors), totaling 384 services. There were 14 instances of recovery house support recorded, for creating plans and applying for housing and funding, all of which were classified within the maintenance stage.
Discussion
VOH’s unique way of connecting services to Stages of Change, from pre-contemplation (active use) through maintenance (maintaining changed behaviors and sustaining recovery) helps demonstrate how a “one-stop-shop” approach supports individuals seeking, entering, and maintaining recovery. Such an approach helps lessen the burden on not only participants but also healthcare providers and community stakeholders. Within VOH, this research project helped the agency to develop a database to quantify service utilization synched with Stages of Change. Noticing how few services were captured in maintenance, for round two of this project VOH will record data differently to better represent its contributions here. The agency will also chart participants’ movement through Stages of Change to assess how recovery is progressing. Within the field, more research is needed to assess whether this approach reduces costs like health insurance, public transportation, and emergency response. Beyond the monetary value of services, above all, how can we uplift the value of an individual in active use, homeless, alone, or at a crossroads in life? One way to do this is by showing how engagement with VOH and other recovery organizations guides them through the stages of change with dignity and respect. This project helps validate the importance of participants in VOH and other harm reduction organizations joining the recovery community, becoming a productive member of society, and a person living a life of wellness - not a number on an overdose fatality sheet.
Figure 1. Transtheoretical Model of Change (basis for Stages of Change Model described above)
Visual from https://www.therelationshipblog.net/2016/06/the-five-stages-of-change/; based on Prochaska and DiClemente’s (1983) model.
Note
The sixth stage, relapse (which some have reframed as reoccurrence to reduce stigma associated with relapse), acknowledges that this is a common part of the recovery experience and should not be stigmatized. Though the goal of VOH is to help those seeking recovery to maintain it, working with participants through this sixth stage provides the opportunity to learn valuable lessons that can support future change efforts (DiClemente & Crisafulli, 2022).
References
DiClemente, C. C., & Crisafulli, M. A. (2022). Relapse on the Road to Recovery: Learning the Lessons of Failure on the Way to Successful Behavior Change. Journal of health service psychology, 48(2), 59–68. https://doi.org/10.1007/s42843-022-00058-5
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395. https://doi.org/10.1037/0022-006X.51.3.390