For Providers: Understanding CLARO

RAND and the University of New Mexico Health Sciences Center (UNM) are leading the Collaboration Leading to Addiction Treatment and Recovery from Other Stresses, or CLARO study.

The goals of the CLARO project are:

Adapt the collaborative care model to treat co-occurring disorders
Evaluate the impact of collaborative care in treating co-occurring disorders
Understand how other patient or clinic factors influence the effectiveness of collaborative care

This study is evaluating collaborative care as a treatment approach for people with co-occurring mental health and substance use disorders. Specifically, we are recruiting patients that have opioid use disorder (OUD) as well as PTSD and/or depression. We are working with clinics across New Mexico and California to implement collaborative care programs for these patients.

Patients in the study will be randomly assigned to receive collaborative care or usual care. Patients receiving collaborative care will work with a care manager, who will provide patients with additional support and encourage them to remain in care. The research team will evaluate patients’ response to treatment to assess whether collaborative care is beneficial in treating OUD and PTSD/depression.

As we work with patients and clinics, we want to know:

What barriers to care do patients face?
Are there unique characteristics of the patient population that affect how care should be delivered?
How does collaborative care impact clinic staff, and what can we do to help the clinics implement collaborative care?

Understanding the answers to these questions will help us design a collaborative care program that best meets the needs of both patients and clinics.

Providers and CLARO

What role do the partnering clinics play?

Clinics will implement the collaborative care program and help recruit study patients. We will work together to develop procedures to screen and recruit participants and to implement the model. Some clinic staff will receive additional training in treating co-occurring disorders. Equally important, we need staff to tell us about the clinic and its patients: What barriers to care do patients face? Are there unique features of the population that affect how care should be delivered? Understanding the setting and population will help us design the program to best each clinic’s individual needs.

How will the study affect me?

It depends on your role at the clinic. Physicians will get additional training on how to deliver pharmacotherapy for opioid use, depression and/or PTSD. Behavioral health providers will be supported to provide evidence-based psychotherapy for either depression or PTSD (Problem Solving Therapy and Written Exposure Therapy, respectively).

The care coordinators, who will be community health workers, will be responsible for motivating patients, coordinating care, and encouraging patients to enter and remain in care. Care coordinators will also meet with a mental health expert from the research team to review patients’ progress. Training will be provided for specific roles.

I have a patient enrolled in the CLARO study. What does that mean for me?

You will continue to provide care for CLARO patients as you normally would. A care coordinator will contact you to let you know if you have a patient that is enrolled in the collaborative care condition. Care coordinators will meet with patients in between their regular medical or behavioral health appointments to check in on their treatment progress. If a patient is not responding to treatment or is having other difficulties, the care coordinator may reach out to you to discuss how to adjust the treatment plan.

What is the study’s timeline?

This is a five-year study, and the study began in October 2019. Initially, clinic staff will work with the study team to help develop study procedures. Many clinic staff will also receive specific training. Clinics will help identify patients for the study and provide either usual or collaborative care. By the late 2023, all patients will have completed treatment and final interviews, and clinics' direct participation will end.

How can I learn more?

You can contact one of the study leads directly at any time or contact the CLARO project staff (CLAROProject@rand.org or call 833-634-1532) with any questions or concerns about CLARO.

How will CLARO benefit patients?

All patients should benefit from the additional training that the study will offer providers. We will test whether CLARO improves the health of patients assigned to the collaborative care arm more than patients in regular care. Finally, the study will help us develop more effective models for treating future patients, many of whom have very limited options for care.

I have a patient that I think may benefit from the CLARO program. What should I do?

If you have a patient who might benefit from CLARO please reach out to the CLARO project staff (CLAROProject@rand.org or call 833-634-1532), to assist with next steps.

How can my patients learn more about the study?