Department of Psychiatry
Penn Behavioral Health

Center on the Continuum of Care

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About the Center

In the addictions, the term "continuum of care" refers to an approach to treatment in which patients are initially placed in the type and intensity of care that is appropriate, given the current severity of their substance use disorder and co-occurring problems. As their condition subsequently improves or deteriorates, patients are then either "stepped down" or "stepped up" to lower or higher levels of care, as needed. Although the concept of a continuum of care holds considerable promise for improving the long-term management of substance use disorders, there are a number of major challenges to the implementation and effectiveness of this model in community settings. These include resistance among those with addictive disorders to entering traditional specialty care chemical dependency programs, high rates of dropout from these programs, considerable variation in response among patients who do become engaged in treatment, failure to monitor patient progress with standardized instruments and procedures, lack of treatment options for patients who either do not like or do not do well in traditional 12-step models, and lack of availability of extended low intensity interventions, which are needed for a full continuum of care.

Recent work done by researchers at Penn and other institutions suggests that adaptive treatment models may provide a solution to many of the problems that interfere with the successful implementation of a continuum of care in addiction treatment. These models are designed to increase participation in treatment by providing flexible care that is adjusted over time on the basis of patient response to treatment, according to clearly operationalized, empirically derived decision rules. Adaptive approaches also seek to maximize participation by specifying lower intensity treatment whenever possible, and considering patient preference when designing treatment algorithms.

The Center on the Continuum of Care in the Addictions was established in 2005 to further work on the development and evaluation of adaptive approaches to the delivery of treatment across the continuum of care. This new Center represents a collaboration between the Department of Psychiatry at the University of Pennsylvania, the Philadelphia Veterans Affairs Medical Center, and the Treatment Research Institute (TRI), in order to take advantage of complementary strengths in these groups. The Center stresses the importance of:

  • Developing improved methods to foster sustained participation in treatment, regardless of modality or setting
  • Collaborating with "real world" programs and systems at the local and state level, as well as with the VA treatment system
  • Developing alternative service delivery systems (e.g., primary care)
  • Collaborating with top researchers in other Schools, Centers, Units, and Departments at Penn, as well as those from other institutions
  • Evaluating economic and feasibility issues
  • Working with investigators from other areas of behavioral health and behavioral medicine to promote cross-fertilization of ideas and approaches to disease management.