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This grant funds research into a system called Seva (Seva; the Hindi word for selfless caring). Seva consists of modules of self-education based on cognitive behavior therapy, a program of relapse prevention, and a population health management software system for clinicians' use. The goal of Seva is to reduce the burden on FQHC staff of providing care to patients with substance use disorders. The study will examine the quality, speed, and impact of implementing Seva in three FQHCs.

The Need

Primary care settings such as Federally Qualified Health Centers (FQHCs) have routinely provided prevention, detection, and treatment of a wide range of chronic conditions, such as HIV, pain, and hypertension. Now U.S. policy is requiring that already overburdened primary care providers integrate substance use disorder (SUD) treatment into their practices. Previous attempts to integrate addiction treatment into primary care have relied on labor-intensive solutions (e.g., adding more people or having people do tasks differently), with mixed results.

More than two-thirds of individuals with SUD have had contact with a primary care provider in the previous 6 months for reasons that may or may not relate to their SUD. This puts primary care providers in an excellent position to facilitate SUD treatment. But primary care providers frequently do not assess for or treat SUDs. Recovery support methods can be effectively administered in primary care, but they require support and training, which are uncommon in many primary care settings, partly because of the traditional separation of addiction treatment from primary care. Technology can play a key role in addressing these challenges.


Three FQHCs will be enrolled in the study. After one year of baseline data collection, clinics will be coached to integrate Seva into their workflow, to screen for and identify eligible patients, and to make the tool available to them. Seva (the Hindi word for selfless caring) will deliver cognitive behavioral therapy and recovery support to patients through their smart phones. The software will also ask the patient frequent questions, about topics such as substance use, mood, cravings, and ER visits, and use the patient's responses to recommend appropriate Seva features. Patient responses and system usage patterns will be made available to the clinics through their portal into Seva, which aggregates phone data with relevant health data from the electronic medical record to facilitate population management. The study will provide smart phones and phone plans for each of 100 patients in each clinic for one year. After one year of careful Seva implementation, financial and coaching support will be removed from the clinics, and we will evaluate the extent to which Seva continues to be used by clinic staff and patients.

Partners / Participant Sites

  • Dartmouth Medical School, Dartmouth Psychiatric Research Center
  • Forward Health Group

Funding Period:
July 1, 2012 - June 30, 2017
Principal Investigators:
David Gustafson Sr., Ph.D
Lisa Marsch, Ph.D
Andrew Quanbeck


  • BMC Medical Informatics And Decision Making
    Implementing An MHealth System For Substance Use Disorders In Primary Care: A Mixed Methods Study Of Clinicians' Initial Expectations And First Year Experiences

    Mares ML, Gustafson DH, Glass JE, Quanbeck A, McDowell H, McTavish F, Atwood AK, Marsch LA, Thomas C, Shah D, Brown R, Isham A, Nealon MJ, Ward V

    View Abstract | Cite