The design and pilot testing of a toolkit to guide staff in managing unplanned discharge in residential substance use disorder programs.

Objectives: Unplanned discharge is a common concern in residential substance use disorder (SUD) programs and is linked to harm including death by suicide as well as relapse and readmission. Program factors as well as staff behaviours can play a role in unplanned discharge events. There is a lack of guidance, however, regarding what evidence-based steps that staff should take to avoid unplanned discharge and related harm such as suicide. A toolkit of evidence-based approaches was created and piloted at sites to guide staff in how to implement best practices to address unplanned discharge in residential SUD programs.

Methods: An unplanned discharge toolkit was developed over three phases using an evidence-based framework. In the first phase, qualitative interviews were held with staff at 10 residential programs to determine toolkit content. Electronic databases and other sources were also reviewed to identify best practices or policies. In the second phase, usability testing was performed with experts in residential SUD treatment. In the third phase, an unplanned discharge toolkit was developed, and a validated survey was administered to residential staff to measure acceptability, appropriateness, and feasibility of the toolkit. Four residential SUD programs are currently participating in a six-month quality improvement (QI) collaborative to gather additional knowledge about ways to improve the toolkit for routine use.

Results: Surveyed participants (N = 6) completely agreed that the unplanned toolkit is acceptable and generally agreed that it seems feasible. A few participants described additional ways to enhance the toolkit. These suggestions were integrated prior to finalizing the toolkit. Four residential SUD programs are currently enrolled in a QI collaborative where additional information is being gathered on how to improve the toolkit for routine use.These data will be available at the time of presentation.