Suppor ting the he alth of pe ople who use dr ugs in the pr - - PowerPoint PPT Presentation

Suppor ting the he alth of pe ople who use dr ugs in the pr imar y c ar e se tting

K a re n L a mp, MD, Ma rtha Me za , T

• b in She lto n,

L CSW a nd L e tic ia Ce rva nte s So lis

Our o b je c tive s

 T

• sha re a suc c e ssful mo de l fo r
• I

nte g ra ting SUD tre a tme nt into prima ry c a re

• E

ng a g ing pe rso ns using drug s in the ir re c o ve ry

 T

• sha re le sso ns le a rne d thro ug h the pro c e ss
• Ba rrie rs to la unc hing SU tre a tme nt in a prima ry c a re se tting
• So lutio ns

 T

• disc uss susta ina b ility o f se rvic e s

Ve nic e F a mily Clinic

Ve nic e F a mily Clinic

 VF

C is a n F QHC e sta b lishe d in 1970

 27,000 pts, 84,000 prima ry a nd spe c ia lty c a re

visits

 12 site s, 9 stre e t o utre a c h te a ms

Ho w did we sta rt?

Suc c e ssful I nte g ra tio n o f SU se rvic e s into prima ry c a re

Ste p 1: Asse ss Org a niza tio na l re a dine ss

• Buy-in fro m ke y le a de rship

Se nio r ma na g e me nt Clinic a l le a de rship Bo a rd o f Dire c to rs

• Asse ss a ttitude s a b o ut sub sta nc e use
• Adding SUD se rvic e s te ste d the Clinic ’ s

c ulture a nd a ttitude s

• L

iste n to sta ff to a ddre ss b a rrie rs

Pe rc e ive d Ba rrie rs: he a ring fro m o ur pro vide rs

• SUD tre a tme nt sho uld ha ve a de dic a te d

pro vide r a nd b e se t a side in a spe c ia lty c linic

• T

he re is no t e no ug h sta ff to pro vide SUD tre a tme nt

• T

he re is to o muc h sta ff turno ve r – it’ s ha rd to ke e p e ve ryo ne tra ine d

• T

he re a re b a rrie rs to tre a ting pe rso ns e xpe rie nc ing ho me le ssne ss

Pe rc e ive d Ba rrie rs

• Pa tie nts with me nta l he a lth c o mo rb iditie s ma y

no t b e a ppro pria te

• T

he c linic ma y a ttra c t to o ma ny SUD pa tie nts

• T

he c linic ha s a no -na rc o tic po lic y

• Pro vide rs fe a r SUD tre a tme nt will no t re ma in a

prio rity a mo ng le a de rship

• F

E AR se e me d to b e a c o mmo n de no mina to r la c k o f e xpe rtise , kno wle dg e , to o ls

I mple me nta tio n stra te g ie s

Ste p 2: Ga ve o ur pro g ra m a na me : “SUMMI

T ”

Sub sta nc e use , mo tiva tio n, me dic a tio n, inte g ra te d tre a tme nt

Use o f ne utra l la ng ua g e to ide ntify the pro g ra m a nd its pa rtic ipa nts

Ste p 3: De ve lo pe d a nd a do pte d e vide nc e

b a se d tre a tme nt pro to c o ls:

• use d fo r tra ining MOUD (me dic a tio ns fo r OUD)

pro vide rs a nd SUMMI T BH sta ff

• se ts c o nsiste nt sta nda rd o f c a re

Me dic a l a nd BH pro to c o ls

Ava ila b le fre e a t www.ra nd.o rg

I nte g ra tio n…

Pro vide d to o ls fo r SUD tre a tme nt a t a ll le ve ls

• 1. Pro vide rs: MOUD fo c use d
• 2. BH sta ff: e vide nc e b a se d mo de ls o f c a re
• 3. I

de ntifie d re spe c te d MOUD a nd BH c ha mpio ns a s “g o to ” sta ff fo r he lp

• 4. Co ntinue d c o mmunic a tio n with

sta ke ho lde rs

Ste p 5: Ha rm re duc tio n a nd tra uma info rme d

c a re mo de ls thro ug ho ut the a g e nc y

Who a re we ? – Be ha vio ra l He a lth

• L

CSW – SUMMI T Clinic a l ma na g e r a nd the ra pist

• L

CSW (the ra pist)

• 2 Ca re c o o rdina to rs/ Ca se ma na g e rs
• 3 Ce rtifie d Alc o ho l a nd Drug Co unse lo rs
• SUMMI

T Pro g ra m Ma na g e r

Who a re we ? - Me dic a l Pro vide rs

39 pro vide rs, 13 X-wa ive re d pro vide rs:

21 MD/ DO’ s: 8 a c tive MOUD pre sc rib e rs 13 NPs: 3 a c tive MOUD pre sc rib e rs 5 PA’ s: 2 a c tive MOUD pre sc rib e rs

DAT A: F isc a l ye a r 2018/ 19

651patie nts re c e ive d SUMMI

T BH se rvic e s in 5,000 e nc o unte rs

464 patie nts re c e ive d b upre no rphine

pre sc riptio ns in 1520 e nc o unte rs

Ho w do pa tie nts ma ke it in?

• Sc re e ning a t prima ry c a re visits (NI

DA q uic k sc re e n b i-a nnua lly)

• Wa lk-in
• Wo rd o f mo uth (pa rtne rs, fa milie s,

ne ig hb o rs, fe llo w use r, de a le rs)

• Ho me le ss o utre a c h

Ho w do pa tie nts ma ke it in?

• Ne e dle e xc ha ng e (no ne e d to b e VF

C pa tie nt to a tte nd)

• SUMMI

T Suppo rt g ro ups (no ne e d to b e VF C pa tie nt to a tte nd)

• Ca re c o o rdina to r / fro nt de sk se nds a

ta sk o r c a lls to se e who is a va ila b le . Pre fe ra b ly sa me da y!!!

I nte g ra te d Ca re

Wa rm ha ndo ffs: fro m me dic a l pro vide rs to c a re ma na g e rs to b e ha vio ra l he a lth, o r in a ny o the r

• rde r

Me dic a l Assista nt E xpe rtise

Addre ssing a c c e ss issue s

• Ne xt a va ila b le a ppo intme nt is a ppro xima te ly 6

we e ks fro m to da y

• Pa tie nts o fte n ne e d to b e se e n urg e ntly “strike

while the iro n is ho t”

• Appo intme nt a va ila b ility is ve ry limite d witho ut
• ve rb o o king o ur me dic a l pro vide rs
• Sha re d me dic a l visit

“Refill Group”

Name: Current dose of buprenorphine: Number of strips/ pills used per day: Number of strips left: Any symptoms? Any other drug use? If so, what? How many support groups have you been to since your last refill? Triggers encountered this week: What I did for my recovery this week: How is your physical health? Currently Working? Yes No Need to see the provider individually today? Yes No

50 100 150 200 250 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2018 2019

Number of Encounters Date

Increasing Access to Buprenorphine

Individual Encounter Shared Medical Visit

On average, our shared medical visit has been able to increase the number of buprenorphine encounters by 30%

T re a tme nt linka g e

• Ca re c o o rdina tio n: c ritic a l to a suc c e ssful

pro g ra m

• E

nha nc e s a c c e ss fo r SUMMI T pts to o b ta in a ppts with MOUD pro vide rs

• L

inka g e to BH se rvic e s

• Co nta c t pe rso n fo r Ca ll Ce nte r/ c a re

c o o rdina to rs/ c o mmunity tre a tme nt pro g ra m pa rtne rs

Ca re Co o rdina tio n a nd Ca se Ma na g e r E xpe rtise

Ha rm Re duc tio n

• Ac c e pts, fo r b e tte r a nd o r wo rse , tha t drug use is pa rt o f
• ur wo rld a nd c ho o se s to wo rk to minimize its ha rmful

e ffe c ts ra the r tha n simply ig no re o r c o nde mn the m.

• Unde rsta nds drug use a s a c o mple x phe no me no n tha t

e nc o mpa sse s a c o ntinuum o f b e ha vio rs fro m se ve re a b use to to ta l a b stine nc e , a nd a c kno wle dg e s tha t so me wa ys o f using drug s a re c le a rly sa fe r tha n o the rs.

• E

sta b lishe s qua lity of life a nd we ll-b e ing –no t ne c e ssa rily c e ssa tio n o f a ll drug use –a s the c rite ria fo r suc c e ssful inte rve ntio ns a nd po lic ie s.

Ha rm Re duc tio n

• Ca lls fo r the non- judg me nta l, no n-c o e rc ive pro visio n o f

se rvic e s a nd re so urc e s

• E

nsure s tha t drug use rs a nd tho se with a histo ry o f drug use ha ve a re a l vo ic e in the c re a tio n o f pro g ra ms a nd po lic ie s de sig ne d to se rve the m.

• Affirms drug s use rs the mse lve s a s the prima ry a g e nts o f

re duc ing the ha rms o f the ir drug use , a nd se e ks to e mpo we r use rs to sha re info rma tio n a nd suppo rt e a c h

• the r in stra te g ie s whic h me e t the ir a c tua l c o nditio ns o f

use .

Ha rm Re duc tio n

• Re c o g nize s tha t the re a litie s o f po ve rty, c la ss, ra c ism,

so c ia l iso la tio n, pa st tra uma , se x-b a se d disc rimina tio n a nd o the r so c ia l ine q ua litie s a ffe c t b o th pe o ple ’ s vulne ra b ility to a nd c a pa c ity fo r e ffe c tive ly de a ling with drug -re la te d ha rm.

• Do e s no t a tte mpt to minimize o r ig no re the re a l a nd

tra g ic ha rm a nd da ng e r a sso c ia te d with lic it a nd illic it drug use .

Be ha vio ra l He a lth

• Gro ups a re no t ma nda to ry, b ut stro ng ly

e nc o ura g e d

• L

ike wise , se ssio ns with CADCs a nd the ra pists a re no t ma nda to ry

• All pa tie nts intro duc e d to a ll pa rts o f the

pro g ra m a t the initia l visit, o r if no t po ssib le , ne xt visit, o r c a re c o o rdina to r c a lls to fo llo w-up.

Suppo rt Gro ups

Group Name Day Time Location English Mon. 4:30pm—5:45pm 604 Rose Ave. (Co‐ed) Tue. 4:30pm—5:45pm 604 Rose Ave. Thur. 2:00pm—3:15pm 503 Olympic Blvd. Women’s

• Wed. 10:00am—11:15am

622 Rose Ave. (Bilingual) Spanish

• Thur. 9:00am—10:15am

2509 Pico Blvd. (Co‐ed) All support groups are non 12‐step and medication friendly.

Walk‐in or call for more information: M—F 9:00am to 5:00pm (310) 664‐7970

Services Offered:

Medication Assisted Treatment (MAT)

Psychotherapy

Counseling

Support Group

Case Management

Group Name Day Time Location Inglés (Co‐ed) Lun. Mar. Jue. 4:30pm—5:45pm 4:30pm—5:45pm 2:00pm—3:15pm 604 Rose Ave. 604 Rose Ave. 503 Olympic Blvd. Mujeres

• Mie. 10:00am—11:15am

622 Rose Ave. (Bilingüe) Español Jue. 9:00am—10:15am 2509 Pico Blvd. (Co‐ed) Los grupos de apoyo no son basados en A.A. y reciben a personas en tratamiento con ayuda de medicamentos.

Pase a los grupos o llame para más información: L—V 9:00am a 5:00pm (310) 664‐7970

Servicios Disponibles:

Tratamiento con ayuda de medicamentos

Psicoterapia

Consejería

Grupos de apoyo

Manejo de casos

T

• wa rds Susta ina b ility

HR a nd T I C a s a le ns

• All sta ff sympo sium
• T

a rg e te d wo rksho ps a nd tra ining s

• Re vie w c linic po lic ie s to b e sure the y suppo rt

ha rm re duc tio n a ppro a c he s

• K

no w wha t mo tiva te s yo u

• Struc ture sta ff me e ting s so pe o ple c a n vo ic e

c o nc e rns a nd suc c e sse s

• Be lie ve yo ur c o wo rke rs whe n the y e xpre ss the ir

strug g le - a lwa ys

HR a nd T I C a s a le ns

Wha t is wo rking ?

• A se a c ha ng e in a ttitude s within o ur
• rg a niza tio n
• L

e a de rship de ve lo pme nt a nd c ha mpio ns

• Mo nthly multidisc iplina ry me e ting s to disc uss

c ha lle ng ing pts, wo rk thro ug h lo g istic s

• Stre ng the n/ suppo rt the te a m a c ro ss disc ipline s
• Re duc e s b urn o ut a mo ng st te a m me mb e rs

Wha t is wo rking …

• VF

C pha rma c ie s dispe nse b upre no rphine

• Ne wly hire d pro vide rs e a g e r to pro vide MAT
• Disc uss a ttitude s re : sub sta nc e use during hiring inte rvie ws
• Onb o a rding inc lude s intro duc tio n to o ur pro g ra m
• Re fill c linic s: c re a te s a c c e ss, e nha nc e s

a dhe re nc e , impro ve s pa tie nt e xpe rie nc e

E xpe rts a va ila b le fo r c o nsulta tio n a nd supe rvisio n

• Vo lunte e r a ddic tio n spe c ia lists
• Built in-ho use e xpe rtise
• Utilize BH c o nsulta nts/ c linic a l supe rviso rs

Cha lle ng e s / F uture dire c tio ns

• Ho w ma ny pts c a n we a c c o mmo da te ?
• “Co mpe te s” with prima ry c a re a c c e ss
• Cre a te d Spe c ia lty Co nsult slo ts fo r PCPs to a lle via te

pre ssure

• Gro up visits – g re a t fo r spe a king with pe e rs, suppo rt,

a dvic e

• Sa me da y a ppo intme nts
• Ca se ma na g e me nt: a lwa ys b usy, hig h le ve ls o f ne e d
• CRAF

T (Co mmunity Re info rc e me nt a nd F a mily T ra ining ) Re se a rc h Pro je c t with RAND

• T

e st whe the r inc o rpo ra ting a pa tie nt’ s suppo rt syste m into the ir tre a tme nt with b upre no rphine c a n impro ve

• utc o me s fo r pe rso ns with o pia te de pe nde nc e in

re c o ve ry

• Are we pro viding the rig ht le ve l o f c a re ?

$usta ina b ility

Will MOUD/ a ddic tio n tre a tme nt re ma in a prio rity? (mo ra l impe ra tive vs fina nc ia l mo tiva tio n) Mo ne y re ma ins a drive r until the re a re

• rg a niza tio n c ulture / a ttitude c ha ng e s

SAMHSA: Targeted Capacity Expansion DHCS Hub and Spoke System Program HRSA MAT

Sta y o n to p o f g ra nt o ppo rtunitie s fo r funding a nd tra ining s (T APC)

Questions?

T itle 42 CF R imple me nta tio n

42 CF R is a fe de ra l re g ula tio n pro te c ting the re c o rds o f pts with Sub sta nc e Use Diso rde rs. A pt MUST g ive c o nse nt fo r info rma tio n to b e sha re d inte rna lly a nd e xte rna lly to VF C. We de fine d “SUMMI T ” sta ff = SUMMI T b e ha vio ra l he a lth sta ff o nly (L CSWs, CDACs, c a se ma na g e rs)

• E

xc lude s PCPs pro viding MAT whic h is pa rt o f prima ry c a re

E MR ide ntifie s the se e nc o unte rs with “!” a nd a n AL E RT pla c e d in E MR tha t po ps up w/ e a c h e nc o unte r

42 CF R

E a c h SUMMI T c lie nt sig ns re le a se o f re c o rds so SUMMI T sta ff c a n sha re info with MOUD pro vide r I f c lie nt do e sn’ t sig n c o nse nt, we c a n still pro vide se rvic e s b ut SUMMI T sta ff c a nno t spe a k with MOUD pro vide rs a b o ut the ir pro g re ss