Connecting Concern to Care : Interdisciplinary Teamwork to Address - - PowerPoint PPT Presentation
Connecting Concern to Care : Interdisciplinary Teamwork to Address Substance Use Disorders in Primary Care CAROLYN SWENSON, MSPH, MSN, RN & BRAD SJOSTROM, LCSW, MAC COLORADO STATE INNOVATION MODEL (SIM) COLLABORATIVE LEARNING SESSION
CAROLYN SWENSON, MSPH, MSN, RN & BRAD SJOSTROM, LCSW, MAC COLORADO STATE INNOVATION MODEL (SIM) – COLLABORATIVE LEARNING SESSION FRIDAY, OCTOBER 26TH, 2018 – 10:45AM – 11:45AM BREAKOUT 1
4%
Severe Alcohol Use Disorder Alcohol Misuse Low Risk Use or Abstention Brief Intervention + Referral to Treatment
Brief Intervention + Monitoring and Support Positive Reinforcement + Continued Screening
Adapted from SAMHSA
Fear of stigma is a common reason for not seeking treatment “I should be strong enough to handle it alone.” “I’m too embarrassed to discuss it with anyone.” “I hate answering personal questions.” “I’m concerned that getting treatment might cause my neighbors or community to have a negative
“I’m afraid of a possible negative effect on my job.” Only about 15% of people who meet criteria for a lifetime alcohol use disorder report receiving treatment
Unclear expectations and clarifying language Lack of opportunities to meet either in person or via
Lack of strong referral process and feedback
Limited access to data sharing and documentation Weak referral process, no formal forms Weak understanding of specialty strengths, resources
3-5 drinks most evenings to try to improve
On average, 15-20 beers in a week Symptoms checklist includes experiencing
PCMP identifies a BHP need RN or identified referral specialist at the clinic fills out a referral form with the reason for the referral INCLUDING what was communicated to the patient and if medication management or consultation is being requested. *SUD ROI is obtained from patient for referral to BHP Referral Form given to Point Person at PCMP to fax to Point Person at BHP Form is faxed to BHP at: FAX # BHP Point Person sets up an appointment with the patient; notifies PCMP that the patient has an
ROI is obtained from patient through BHP. After appointment, BHP Point Person will fax form to PCMP (Did patient show up?) Send fax to: FAX # Documentation to be shared:
summary from PCMP
ways), Consider possible medication
BHP Point Person will be given this information to fax to PCMP
Assessment of patient engagement Self-management status update Symptom monitoring Coordination among providers Referral and feedback pathways Anticipate and proactively address
Identify patient strengths Increase knowledge and access to
Discuss patient’s engagement level and
Establish method for communication among
Identify what is most important from the
When possible, both PCMP and BHP meet with
Cognitive Behavioral Therapy (CBT), Solution Focused
12-Step Facilitation and Peer driven support (AA, NA,
Family Behavior Therapy Contingency Management Community Reinforcement Approach Medication Assisted Treatment (MAT) – adult,
Primary Care-Based Treatment Outpatient Treatment Intensive Outpatient Treatment Opioid Treatment Programs Residential/Inpatient Treatment Level I Residential/Inpatient Treatment Level II
Psychiatric Conditions: Depressive, psychotic or manic symptoms that impair
a person’s ability to function, makes them a threat to other people or a threat to themselves, or renders the person unable to care for themselves.
Treatment Types: Locked inpatient psychiatric units, Alternative Treatment
Units (ATU) and Crisis Stabilization Units (CSU). Hospital based medical detoxification programs, withdrawal management centers and residential treatment facilities.
Level of SUD: Grossly acute intoxication, severe withdrawal symptoms from
alcohol or benzodiazepines, and in some instances opioids. Severe substance use disorders.
Assessment venues: Emergency Department, Crisis Walk-in Clinic or
Behavioral health facilities with on-site assessment capability
Many of these conditions can be assessed at the treatment facility, but absent
easy access to a treatment facility and or in the event of an emergency, Emergency Department is the first point of contact.
Psychiatric Conditions: Panic attacks, depressive
Treatment Types: Partial psychiatric hospitalization,
Level of SUD: Mild to moderate substance use disorders
Assessment Venues: These services are typically offered at
Psychiatric Conditions: Adjustment Disorders, Phase of
Treatment Types: Individual and group therapy, mutual
Level of SUD: harmful, hazardous and mild substance
Assessment venues: These services are typically offered
Obtain consent upon intake including SUD Disclosure and
Federal Confidentially Laws – HIPAA, Substance Use
Colorado Specific Laws – Mental health, HIV/AIDS,
CO is a “same as Part 2” state with patient consent and “stricter
than Part 2” without patient consent
The One Degree e app allows anyone nyone to practice conversations with virtual peers who use substances in unhealthy ways:
Hi, I’m Jordan! I enjoy
my drinking ng and smoking g weed have been getting ng in the way way of ke keeping g my my job. Hi, I’m Donna! I'm dealing ng with a l lot these day ays, , and I u use alcoho hol to cope with stress. s.
One Degree: e: Publi lic Awa warenes reness Campaign paign
Conversat sation
s:
ng up concer cerns ns abou
bstan ance ce use witho hout ut upse sett tting ing Jorda dan
instor
ays s to balan lance ce partyin tying g with h life goals ls
Conversat sation
s:
ng up concer cerns ns abou
bstan ance ce use witho hout ut upse sett tting ing Donna na
instor
thier ier ways s to cope pe with h stress ess
Available online and as a mobile app (Apple and Android) at www.shifttheinfluence.org
Screening tools SBIRT pocket cards (mobile and
print)
Reimbursement Adolescent SBIRT Marijuana clinical guidance Patient education materials: Exam
room posters, bilingual fact cards, alcohol wallet cards
use treatment