Table 4 Core themes in clinicians’ initial expectations of benefits of implementing Seva

 With few other sobriety resources (6)

Missoula has nothing long term for patients with substance use issues. There’s only one 4-bed share house. Turning Point, the only outpatient program has a long waiting list. There’s nothing else in town. People basically have AA or [the clinic’s] sobriety group. And for people who live further out of town in a small community, or on the reservations? This is something we can offer them.

 As a tool for learning and insight (5)

Their lack of language to talk about emotions is really profound. They can’t explain what happened, don’t know how to tune into different feelings, so they turn to substances. A powerful part of the process is teaching them how to recognize emotions and providing them with options. So just filling out the BAM [Brief Alcohol Monitoring Scale… on Seva] is a powerful tool.

 Who need an alternative to group meetings (5)

Often they want to be alone-they’re often living in shelters that are very chaotic, and they just want peace and quiet…. So Seva would allow them to interact without really being part of a group. They can get their toe in the water.

 To experience constant availability of sobriety support (4)

Often a patient is trying to reach out to me but I’m busy and won’t get the message till five hours later. I really like that in the meantime, the phone can help them with their breathing exercises or he can listen to a podcast to help him figure out why he shouldn’t relapse, and that’s great.

 At key transitions (4)

This has so many positive possibilities. Like being able to help people coming out of rehab, or from mental health inpatient, or coming out of jail and they need that support to help them now they’re back in the community.

 More efficient appointments (10)

If they can be filling out the PHQ [Patient Health Questionnaire] ahead of time on the phone, and if I can see that, that saves me a ton of time. That can make our meetings a lot more efficient.

 Prompt primary care conversations about addiction (6)

Addictions are so often kept secretive in a medical visit, being able to talk about it is really important. If we could give it to the medical provider, it would be really good. It could start the conversation.

 For patients (5)

Having a phone helps them move into housing, they can call the hotline phone number at the homeless shelter, people can be calling in for help with issues.

 For clinic (5)

So many of these patients don’t have voicemail, don’t have a phone system. Now suddenly we can access them. It suddenly lets us have contact… so we could remind them, “oh you’ve got this appointment” or we can reach out, “hey, just checking in.”