The Shift From Residential: The Changing Addiction Treatment Landscape

Transcription

1 The Shift From Residential: The Changing Addiction Treatment Landscape The 2017 OPEN MINDS Strategy & Innovation Institute Wednesday, June 7, :15am 12:30pm Jim Gargiulo, Senior Associate, OPEN MINDS York Street, Gettysburg, Pennsylvania Phone: info@openminds.com All Rights Reserved.

2 Agenda I. The Emerging Addiction Treatment Continuum II. III. IV. Robert J. Budsock, MS, LCADC, President & CEO, Integrity House Maks Danilin, Strategic Account Executive, Aware Recovery Care, Inc. Amy Gallagher, Psy.D., Vice President, Whole Health, LLC, a subsidiary of Mind Springs Health, Inc. V. Anthony J. Mele, Psy.D., Chief Clinical Officer, Sovereign Health VI. Questions & Discussion All Rights Reserved.

3 The Emerging Addiction Treatment Continuum Prevention, Identification & Early Intervention New Technologies Integration With Medical Care Medication Assisted Treatment Extended Patient Engagement (Recovery Coaching) Whole Family Involvement All Rights Reserved.

4 Integrity House Robert J. Budsock, MS, LCADC, President & CEO, Integrity House

5 Welcome! Robert J. Budsock, MS, LCADC President & CEO, Integrity House

6 Rebuilding lives since 1968 At Integrity House, we re committed to helping individuals and families through comprehensive, integrated addictions treatment and recovery support in a manner that brings about positive, long-term lifestyle change.

7 Our reach In 2016, Integrity House served over 3,000 clients from all 21 counties in New Jersey

8 Our reach Residential Outpatient Residential Outpatient 4% 42.5% 96% 57.5% Data retrieved from the New Jersey Department of Human Services Division of Mental Health and Addiction Services Substance Abuse Treatment Provider Report (7/1/2015 6/30/2016)

9 Treating the whole individual Addiction Treatment Supportive Housing Support Services

10 Partnerships Government Law Enforcement Higher Ed Institutions Human Service Agencies

11 Aware Recovery Care, Inc. Maks Danilin, Strategic Account Executive, Aware Recovery Care, Inc.

12 Recover where you live sm MAKS DANILIN AWARE RECOVERY CARE

13 TRANSFORMING THE HOME INTO THE TREATMENT CENTER THE ONE YEAR CONTINUUM Robust bio-psycho-social education and support with major focus on the family system Successful assimilation into support programs as appropriate (12 step, smart recovery, etc. ) Management of addiction as a chronic illness using a uniquely trained in home multi-disciplinary team led by addiction psychiatrist Integration and utilization of local providers and resources Compliance management using frequent, random urine screens as well as GPS monitoring and innovative technologies Support use of MAT (Medication Assisted Treatment) 13

14 ARC assigns each client a multi-disciplinary team led by an Addiction Psychiatrist, Care Coordinator (Registered Nurse/Social Worker), Certified Recovery Advisor, and a Licensed Marriage and Family Therapist. The team works in consultation with the client s Primary Care Provider and other attending clinicians and a Licensed Therapist. We work with the client at home and in their community for a full year so he/she can build the daily habits and skills that support lifelong recovery, including assimilation into support groups, as indicated. The team meets at the start of care and then at least weekly to confer on the client s care and progress, making adjustments to the treatment planning process of care as indicated. The client signs an accountability contract. In addition to specific agreed-upon guidelines, the client is subject to random supervised urine screens, GPS tracking and innovative technologies such as Soberlink to encourage and verify abstinence. 14

15 ADDICTION PSYCHIATRIST HOLISTIC WELLNESS LICENSED INDIVIDUAL THERAPIST Aware Recovery aaaaaaaaaa Care Client and Family System LICENSED CLINICAL CARE COORDINATOR LMFT / FAMILY SYSTEMS CLINICIAN CRA 15

16 We Develop Long Term Therapeutic Relationships With clients and client families characterized by Empathy and understanding Genuineness and open mindedness Respect Although the client is the identified individual receiving services, the client s family is included in our model of care from the day of admission whenever clinically appropriate 16

17 Treatment Team Relationships- Three (3) Levels A client s primary treatment team is composed of: Psychiatrist Care Coordinator (licensed) Two Certified Recovery Associates Family liaison/therapist The extended treatment team is composed of: Primary Care Physician Dentist Individual Therapist Psycho-pharmacologist Specialty Providers and Institutions

18 Treatment Team Relationships The External Treatment Team is composed of (where applicable) EAP Employers Courts Probation/Parole School

19 The certified recovery advisor (CRA) is unique role Walks through ARC s Proprietary 52-week bio-psychosocial curriculum Guides/Directs clients utilizing evidencebased practices including: CBT DBT Contingency Management Motivational Enhancement Therapy Family Systems Therapy Trained in Motivational Interviewing and to guide clients through the stages of change Assists the client in identifying their personal goals which are used to underpin their recovery Is in long-term recovery Age Matched Gender Matched Trained in AWARE Family Systems Integrated Care 19

20 Aware Recovery Care s Home Based Addiction Treatment The ARC care team therapeutically integrates into the support system. Allows the support system to be intimately involved in the recovery process. Uses family systems therapy provided by an LMFT. Utilizes innovative approaches to assess the family s history of mental illness and substance abuse. Provides an accurate insight into the home that is unique to our model of care. Coordinates access to MAT and other medical necessities when appropriate. Maximizes outcomes with technological innovations. 20

21 ARC fully supports the use of MAT wherever clinically appropriate Care begins with full evaluation by prescriber As indicated, utilization of MAT wherever clinically appropriate ARC Team employs innovative as well as traditional tools to verify medication compliance Provides coordination and transportation to vetted and trusted MAT prescriber as needed ARC is in full support of MAT when used in conjunction with other treatments. The relationships our clients develop with our staff and providers are one of many ways to maximize clinical outcomes. 21

22 TECHNOLOGY ASSISTED MONITORING 22

23 Studies show that the longer the individual remains engaged with a program that implements consistent monitoring, the better the long-term outcome*. Tools designed for monitoring can help promote structure and change behavior. This concept of accountability tools is the basis on which Aware Recovery Care was founded.

24 GPS Tracking and Verification Technology Improves accountability Hot Spots (Alerts full team) Pattern Analysis

25 Our Approach ARC has developed an innovative approach to treat Substance Use Disorder (SUD). The In-Home Addiction Treatment (IHAT) model is a fully integrated, multidisciplinary wrap-around approach. It focuses on components of clients lives that are important influences for recovery. These components can either support or undermine sustained recovery. Examples include, but are not limited to, the following: Living environment Employment and/or education Ongoing, individualized, long-term recovery Family Systems support Referral to or coordination with ongoing medical care Supporting clients with and through legal issues 25

26 Whole Health, LLC Amy Gallagher, Psy.D., Vice President, Whole Health, LLC, a subsidiary of Mind Springs Health, Inc.

27 SUBSTANCE USE DISORDERS: FROM RESIDENTIAL TO RELATIONSHIP Amy C. Gallagher, Psy.D.

28 WHO WE ARE Mind Springs Health CMHC serving 10 counties in northwest CO Full spectrum of outpatient services Crisis services with 11 transitional beds 32-bed inpatient hospital Residential treatment facility for women Whole Health, LLC (formed January 2014) Subsidiary of Mind Springs Health Workforce of Community Health Workers Focus on behavior change

29 HISTORY & OVERVIEW Conceptualization (Western Slope of Colorado) Understanding that behaviors influence health outcomes Focus on the payer plan Identified pain points Collaborative planning Use of global budget Use of logic model Shared financial risk (30%) Focus on community collaboration Meet goals of the Triple Aim

30 ROLE OF CHW Link to appropriate resources Provide transportation Coordinate care Communicate with PCP & other providers Assist with pharmacy Spark behavior change (e.g. ED utilization) Advocate Practice skills Role model appropriate behavior Listen

31 INDIVIDUALS SERVED Complex or challenging High ED utilization Chronic medical conditions Social determinants/correlates of health Mental health Substance abuse Chronic pain

32 LESSONS LEARNED Continued focus on payer s pain points Creating BFFs Buy-in Ongoing communication Contributions from all involved Goodness-of-fit when hiring Rapid-cycle change mentality helpful Bio-psycho-social model of conceptualization Medical practices with integrated behavioral health may understand communication flow quicker

33 OUTCOMES Shared savings successful Year 1: $1.2 million dollar payout Year 2: similar payout ED visits trending downward Increased communication and coordination Western Slope Needs Assessment- individuals getting needs met

34 PATIENT STORIES TJ Dana Molly Jane Cody

35 Sovereign Health Anthony J. Mele, Psy.D., Chief Clinical Officer, Sovereign Health

36 Presenting the Sovereign WHY Clinical Overview Assessment / Mental Health / Substance Use / DD / Eating Disorders / TBI Dr. Anthony J. Mele Chief Clinical Officer 24/7 Admissions Helpline

37 The Sovereign WHY Sovereign Health challenges the behavioral health status quo. Sovereign thinks and acts differently. Our treatment programs reflect our belief that addiction and mental illness are brain diseases that can be remediated. 24/7 Admissions Helpline

38 The Sovereign WHY Sovereign Health is a national system of behavioral health treatment centers that augments theory with empirical data to develop evidence-based interventions that repair brain dysfunction and promote recovery and brain wellness. 24/7 Admissions Helpline

39 The Sovereign Way to Recovery and Wellness Disease model: curative and remove Preventive model: reduction of risk Wellness model: preventive + enhancement Sovereign: Neuroplasticity and Brain Wellness are the foundations of recovery. 24/7 Admissions Helpline

40 Brain Wellness The brain can recover from certain trauma depending on Type of trauma Degenerative, acquired/acute, chronic, Extent and location of the trauma Extent of the trauma and injury Extent and location of unaffected Time between trauma and treatmetn Type of treatment 24/7 Admissions Helpline

41 Levels of Care Primary Mental Health / Trauma / Eating Disorders Residential > PHP > IOP > Outpatient and E-therapy Dual Diagnosis / Pain Recovery Detox > Residential > PHP> IOP > Outpatient and E-therapy 24/7 Admissions Helpline

42 The Sovereign Way of Promoting Wellness and Recovery Connecting personality variables, personal history, recovery. Identifying personality strengths and challenges. Assessing current cognitive functioning and potential. Enhancing brain functioning and wellness: remediation. 24/7 Admissions Helpline

43 Data-driven: Assessments! Our cognitive assessment protocol identifies the presence or absence of the cognitive functions required for successful use of DBT and Motivational Interviewing. This deconstruction helps create more meaningful treatment interventions and better outcomes. Measurement Based Care (MBC): we measure treatment efficacy on a regular basis and modify treatment plans accordingly. Treatment outcomes are measured: admission, T30, T60, discharge. Treatment Response is measured weekly. 24/7 Admissions Helpline

44 Interventions: Cognitive Enhancement Therapy Evidence-based: > EMDR, Schema, Moral Reconation Therapy, DBT / CBT, Motivational Interviewing, Kinetic therapies, MAT, Neurofeedback, TMS Theory and Research-driven > Attachment theories > Social Learning > Neurobiology > Neuroplasticity > Developmental theories Measurable > E-basis Joint Commission Outcomes (admission, T30, T60, Discharge) > Measurement Based Care Protocol (depression, anxiety, trauma, addiction) 24/7 Admissions Helpline

45 Sovereign s Centers of Excellence Promoting recovery and providing hope for individuals with special conditions or situations. Adolescent female Eating Disorder (San Diego, CA) Adolescent transgender support (San Diego, CA) Adult female Eating Disorder (San Clemente, CA) Pain Recovery Program (San Clemente, CA) ROAR: (Rebuilding Our Acceptance and Resilience) DBT Exclusive Trauma, Abuse, and Emotional Dysregulation (Phoenix, AZ) Trauma, Abuse, and Emotional Dysregulation (San Clemente, CA, Fort Myers FL) 24/7 Admissions Helpline

46 Sovereign s Centers of Excellence Promoting recovery and providing hope for individuals with special conditions or situations. PRIME: Personal Recovery Integrating Men s Experiences (men yrs, employed, relationship (Palm Desert, CA) POWER: (Primary Opportunities for Women Experiencing Recovery) (women yrs, employed, relationship (Palm Desert, CA) CROSS (Christian-spirituality recovery approach); Palm Desert, CA ARMOR (Achieving Recovery of Moral Reasoning), men 18-30, (Los Angeles CA) Bi-Lingual DD (Spanish-English), El Paso, TX 24/7 Admissions Helpline

47 Sovereign Health Clinical Program Highlights Joint Commission: Our Joint Commission Outcomes exceed the standards set by TJC on 6 of 7 metrics. 24/7 Admissions Helpline

48 Sovereign Residential (N=340) 4=extreme 3=quite a bit 2=moderate 1=a little 0=none Self-harm Admission Discharge Sovereign s performance exceeds JTC performance guideline meets JTC performance guideline Depression Relationship Emotional LabilityPsychosisSubstance Abuse Overall Comparison Group: Other 50 Different Organisations (N = 29638) 3 Admission 2.5 Discharge 4=extreme 3=quite a 2 bit 1.5 2=moderate 1=a little 1 0=none 0.5 0

49 Sovereign PHP (N=69) 4=extreme 3=quite a bit 2=moderate 1=a little 0=none 3 Comparison Group: Other 50 Different Organisations (N = 29638) Admissio n =extreme 3=quite a bit 2=moderate 1=a little 0=none Admission Discharge Self-harm Depression Relationship Emotional Lability Psychosis Sovereign s performance exceeds JTC performance guideline meets JTC performance guideline Substance Abuse Overall

50 DBT-informed Milieu: Each Sovereign Health community provides extensive cognitive-based interventions including Dialectical Behavior Therapy (DBT) and Motivational Interviewing. Unique to Sovereign is our deconstruction process which identifies the presence/absence of cognitive skills required for successful use of cognitive-based therapies.

51 Cognitive Enhancement Treatment: Sovereign Health s clinical programs are based on the disease process model of addiction and trauma. We believe that addiction is the result of a process of brain changes that can be remediated to promote recovery and healing. Neurobics Brain exercises designed to maintain memory and promote remediation of the cognitive deficits often identified in individuals with addictions including: attention, cognitive flexibility, and social cognition Neurofeedback Therapy (NFT): individualized feedback system that helps the brain reduce the experiences of underarousal, over-arousal, and trauma-related hyper-arousal., and other imbalances. NFT provides visual and auditory feedback that guides the patient toward calmness, focused, and balanced. Many feel more confident, creative and happy. 24/7 Admissions Helpline

52 Scholar-Practitioner Model Applying Theory to Treatment ROAR: Elevated Emotional Dysregulation: Sovereign Health s addiction recovery and trauma program is a fully DBT-informed and trauma-informed program. All staff, from para-professional administrative and clerical support to house managers and residential staff to professional clinical and medical staff, have undergone a 16-week immersion dialectical behavioral therapy and motivational interviewing training program. A licensed clinician supervises evening invivo clinical supervision of the residential staff. PRIME and POWER: age and gender specific recovery programs that apply the developmental stage theories of Piaget, Erikson, Kohlberg to recovery from addiction and mental illness. 24/7 Admissions Helpline

53 E-therapy: A longtime leader in the integration of technology and treatment, Sovereign Health s e-therapy program extends to almost 20 states and provides psychotherapy and ongoing case-management support. Our e-therapy program reduces the relapse and readmission and prevents inpatient hospitalization by maintaining close connection with our patients. 24/7 Admissions Helpline

54 Licensed Mental Health facility: Sovereign Health s treatment communities are licensed as a mental health treatment facility and substance abuse (dual diagnosis). Maintaining a separate mental health license allows Sovereign to treat primary or solely mental health patients. Since 60-80% of substance abuse disorders co-occur with a mental health diagnosis, understanding how a mental health disorder contributes to the onset of addiction or maintains addiction is necessary. Most dual diagnosis programs do not incorporate the level of mental health treatment skill that characterizes the Sovereign Health treatment program. Staff Credentials: Sovereign Health s clinical and medical providers are leaders in their fields and include adult and adolescent psychiatrists and psychiatric doctoral level advanced practice nurses, licensed doctoral level psychologists, EMDR specialists, neurofeedback specialists and a team of licensed masters level clinicians and credentialed behavioral health technicians. Sovereign is a training site for several doctoral psychology internships. 24/7 Admissions Helpline

55 Medication Assisted Treatment (MAT): Sovereign s use of MAT is guided by our commitment to individualized treatment planning. MAT is used on a case by case situation. When contra-indicated, other treatment options are considered including participation in our Pain Recovery program that promotes the use of non-opioid pain recovery interventions. Harm Reduction: In order to promote the traumatized and addicted patient s trust that recovery will be safe, although challenging, patients are admitted to a short-term diagnostic and early treatment service. This type of soft landing has led to a low AMA rate and high program completion rate. 24/7 Admissions Helpline

56 Next Step: Re-entry into the Community Pre-discharge vocational and occupational planning Resource coordination Housing Post-discharge case management Post-discharge e-therapy 24/7 Admissions Helpline

57 Sovereign Health Corporate Office 1211 Puerta Del Sol, Suite 200, San Clemente, CA (949) /7 Admissions Helpline

58 Discussion Questions 1. After the passage of health care reform in 2010, many policymakers, advisors, and CMS officials predicted that the Affordable Care Act would help to improve access to addiction treatment and create a more medically-based, person-centered treatment system for addiction. Seven years later, do you feel that these predictions have come true in any sense? 2. What are the biggest changes you have seen in the addiction treatment market? 3. How has the system wide move to towards value-based care affected your organizations? Do you have any capitated contracts with payers and how has that changed your program model? 4. There is a greater push towards increased care coordination and integration with physical health. Can you give us some examples of partnerships/collaborations where you are working with other provider organizations/health systems? 5. How has the expanded use of MAT affected service delivery? 6. How has the use of technology mobile apps, remote monitoring, brain mapping affected consumers and changed your program models? 7. The use of opioids has become a public health crisis in many areas of America. Have you seen a change in your population or an increase in the need for services related to opioid addiction? Has this issue changed your program models? 8. Has this public health crisis lead to any new partnerships or collaborative efforts with payers, other provider organizations, or local governments? All Rights Reserved.

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