Lessons learned for follow-up phone booster counseling calls with substance abusing emergency department patients

• Booster calls are being used adjunctively to support brief interventions
• Call completion rates are relatively low but may be increased by use of locators
• Five prominent barriers to call completion were identified
• Once completed, brief motivational sessions can be delivered with high fidelity
• Skilled staff, preparedness, flexibility, and a warm hand off are important
• Future research need to determine boosted call contribution to outcomes
• Future research needed to determine cost benefit of booster calls in SBIRT programs

BackgroundPost-visit “booster” sessions have been recommended to augment the impact of brief interventions delivered in the emergency department (ED). This paper, which focuses on implementation issues, presents descriptive information and interventionists' qualitative perspectives on providing brief interventions over the phone, challenges, “lessons learned”, and recommendations for others attempting to implement adjunctive booster calls.MethodAttempts were made to complete two 20-minute telephone “booster” calls within a week following a patient's ED discharge with 425 patients who screened positive for and had recent problematic substance use other than alcohol or nicotine.ResultsOver half (56.2%) of participants completed the initial call; 66.9% of those who received the initial call also completed the second call. Median number of attempts to successfully contact participants for the first and second calls were 4 and 3, respectively. Each completed call lasted an average of about 22 minutes. Common challenges/barriers identified by booster callers included unstable housing, limited phone access, unavailability due to additional treatment, lack of compensation for booster calls, and booster calls coming from an area code different than the participants' locale and from someone other than ED staff.ConclusionsSpecific recommendations are presented with respect to implementing a successful centralized adjunctive booster call system. Future use of booster calls might be informed by research on contingency management (e.g., incentivizing call completions), smoking cessation quitlines, and phone-based continuing care for substance abuse patients. Future research needs to evaluate the incremental benefit of adjunctive booster calls on outcomes over and above that of brief motivational interventions delivered in the ED setting.