Testimony before State Representative Angel Cruz's Public Hearing Related to Drug Treatment Services to Citizens of Puerto Rico "Air Bridge"

Transcription

1 Testimony before State Representative Angel Cruz's Public Hearing Related to Drug Treatment Services to Citizens of Puerto Rico "Air Bridge" April, 0 Testimony of Catherine Williams, PH.D., LSW Associate Director of Behavior Health Philadelphia Department of Behavioral Health & Intellectual disability Services (DBHIDS) Good morning Honorable State Representative Cruz. Thank you for the opportunity to provide testimony regarding drug treatment to citizens of Puerto Rico unofficially known as "Air Bridge". My name is Dr. Catherine Williams and I am the Associate Director of Behavioral Health with the Philadelphia Department of Behavioral Health and Intellectual disability Services (DBHIDS). DBHIDS coordinates the provision of prevention, early intervention, treatment and untimatly recovery services to those challenged by mental health, substance use and intellectual disabilities. As such, through its Office of Addiction Services (OAS) and the Office of Mental Health {OMH), the DBHIDS has been working with many stakeholders in the community, the field, and across systems to address the consequences of chronic drug use in general and heroin use in partilar as well as their associated mental health challenges. Regarding housing, mental health and/or drug treatment services, as well as a range of support services for U.S. citizens receiving services in the City of Philadelphia, DBHIDS has implemented many activities to address the needs of this population. Community Behavioral Health (CBH) is our Medicaid managed care entity. CBH's medicaid-funded behavioral health service utilization by race and ethnicity for calendar year 06 reflects that Hispanics received some significant services. Please note that CBH does not collect data by Country or Territory of origin, but by race and ethnicity of Philadelphia residency. From January, 06 to December, 06,668 Hispanic adults received a variety of services including detoxification, drug and alcohol case management, residential rehabilitation, partial drug and alcohol (i.e. intensive outpatient and medicated assisted treatment), and outpatient drug and alcohol. The most utilized services by this population were outpatient drug and alcohol, partial drug and alcohol, and residential rehabilitation services respectively. Please see Bar Chart Below:

2 Medicaid-Funded D&A Service Utilization among Hispanic Adults, January, 06 - December, 06 (n=,668) u ~ J: tlo c 'iii :I.. c... u a. 00% 90% 80% - 0% 60% 50% 40% 0% - 0% 0% 0% 8.% DETOX (n=6} D&A CASE Residential Rehab PARTIAL D&A (i.e.: OUTPATIENT D&A MANAGEMENT (n=l,05) IOP, MAT; n=,506) (n=,80) (n=446) Medicaid-Funded D&A Service There were,66 adult Hispanic CBH members utilizing drug and alcohol services in calendar year 06 regardless of diagnosis residing in specifically in 95, 9 or 94 zip codes. The majority of them received outpatient drug and alcohol services and partial drug and alcohol services respectively. The below bar chart reflects the percentage of actual services received. Medicaid-Funded D&A Service Utilization among Hispanic Adults Residing in 95, 9 or 94, January, 06 - December, 06 (n=l,66) 00% u -~ 80% ' 60% c 'iii :I 40%... c... u a. 0% 0% 0.5% DETOX (n=s) D&A CASE Residential Rehab PARTIAL D&A (i.e.: OUTPATIENT D&A MANAGEMENT (n=49) IOP, MAT; n=l,4) (n=l,) (n=4l Medicaid-Funded D&A Service

3 Below is a table of drug and alcohol service providers (n=58) providing drug and alcohol services to,668 adult Hispanics in calendar year 06 regardless of diagnosis or zip code. -. O&A Service Providers Unique Members Served A&O T~ANSPORT ANO RECOVERY SEIWlCES, INC. ADDICTION MEDICINE AND HEALTH ADVOCATES, INC. ASOCIACION PUERTORRIQUENOS EN MARCHA, INC. Belmont Behavioral Hospital, LLC. CASA DE <;QNSf~ERIA Y SALUD INTEGRj\L, INC.. CENTRALIZED COMPREHENSIVE HUMAN SERVICES, INC. COMMUNITY SPECIALIST CORPORATION{) CORA SERVICES, INC. (00) CORECARE BEHAVIORAL HEAL TH MANAGEMENT, INC.(0) Crisis Management Services Inc (8) DREXEL UNWERSffY (4) EAGLEVILLE HOSPITAL FIRETREE, LTD GAUDENZIA GAUDENZIA INC. GEORGE JUNIOR REPUBLIC IN PENNSYLVANIA GOOD FRIENDS, INC. GREATER PHILADELPHIA ASIAN SOCIAL SERVICES CENTER. GREATER PHILADELPHIA HEALTH ACTION, INC. HORIZON HOUSE REHABILITATION SERVICES, INC. lntercommunity Action, Inc. INTERIM HOUSE, INC. JEFFERSON MEDlCAL COLLEGE JEVS HUMAN SERVICES KENSINGTON HOSPITAL LIBERTAE, INC. MEN AND WOMEN FOR HUMAN EXCELLENCE, INC. MERCY CATHOLIC MEDICAL CENTER OF SE.PA MINSEC COMPANIES MINSEC TREATMENT NEW JOURNEYS IN RECOVERY NHS PARKSIDE RECOVERY NORTH PHILADELPHIA HEAL TH SYSTEM NORTHEAST CMH/MR CENTER NORTHEAST TREATMENT CENTER, INC. Path Inc. PHILADELPHIA FIGHT

4 PMHCC, Inc. PUBLIC HEALTH MANAGEMENT CORPORATION RE-ENTER, INC. RESOURCES FOR HUMAN DEVELOPMENT, INC. SELF HELP MOVEMENT SOAR SOBRIETY THROUGH OUTPATIENT, INC. Southwest Nu-Stop Philadelphia Inc.. - Spanish American Civic Association For Equality, Inc.._ STOP & ~URRENDER,INC. SUMMIT ACADEMY THE THERAPEUTIC CENTER AT FOX CHASE THE WEDGE MEDICAL CENTER, INC Thomas Jefferson University UHS OF FAIRMOUNT, INC. UHS Recovery Foundation Inc. UNIVERSITY OF PA MEDICAL CENTER AND HEALTH SYSTEMS VALLEY FORGE MEDICAL CENTER AND HOSPITAL, INC. WES HEALTH CENTERS, INC. WEST PHILADELPHA COMMUNITY MENTAL HEALTH CONSORTIUM INC. WOMEN'S INSTITUTE FOR FAMILY HEALTH Unique Members Total ,668 Below is a table of drug and alcohol service providers (n=49) providing drug and alcohol services to,66 adult Hispanics residing in zip codes 95, 9, or 94 ("Air Bridge area) at the time of service in calendar year 06 regardless of diagnosis.... ~. - - ~ D&A Service Providers. A&O TRANSPORT _AND RECOVERY SERVICES, INC.(50) ADDICTION MEDICINE AND HEALTH ADVOCATES, INC.(0} ASOCIACION PUERTORRIQUENOS EN MARCHA, INC..(04, CASA DE CONSEJERIA Y SALUD INTEGRAL, INC.(4) CENTRALIZED COMPREHENSIVE HUMAN SERVICES, INC.(005) CORECARE BEHAVIORAL HEALTH MANAGEMENT, INC.(0) Crisis Man'!Sement Servkes Inc (8) DREXEL UNIVERSITY (4) EAGLEVILLE HOSPITAL (06) FIRETREE, LTD (0} GAUDENZIA (04) GAUDENZIA INC. (50) GREATER PHILADELPHIA AS_IAN SOCIAL SERVICES CENTER(65) ,...- ~ - Unique Members Served (Gurney St Zip Codes)

5 GREATER PHILADELPHIA HEALTH ACTION, INC.(0) HORIZON HOUSE REHABILITATION SERVICES, INC.(5) JEFFERSON MEDICAL COLLEGE (50) JEVS HUMAN SERViCES (009) KENSINGTON HOSPITAL (06) MEN AND 'f'omen FOR HU~AN EXCELLENCE, IN({) MERCY CATHOLIC MEDICAL CENTER OF SE.PA(069) MINSEC COMPANIES (68) MINSEC TREATMENT (64) NEW JOURNEYS IN RECOVERY (0) NHS PARKSIDE RECOVERY (48) NORTH PHILADELPHIA HEALTH SYSTEM(0) NORTHEAST CMH/MR CENTER (0) NORTHEAST TREATMENT CENTER, INC.() Path Inc. (00) PM HCC, tnc. (85) PUBLIC HEALTH MANAGEMENT CORPORATION(6) RE-ENTER, INC. (088) RESOURCES FOR HUMAN DEVELOPMENT, INC. (RHD)(090) SELF HELP MOVEMENT (09) SOAR (69) SOBRIETY THROUGH OUTPATIENT, INC.(094) Southwest Nu-Stop Philadelphia lnc.(96) Spanish American Civic Association Fo~ Equality, lnc.(4) STOP & SURRENDER,INC. (66) SUMMIT ACADEMY (540) THE THERAPEUTIC CENTER AT FOX CHASE(65) THE WEDGE MEDICAL CENTER, INC (09) Thomas Jefferson University (00) UHS OF FAIRMOUNi:, INC. (96) UHS Rec9very Foundation Inc. (60) UNIVERS'ITY OF PA MEDICAL CENTER ANO HEALTH SYSTEMS{lOBS) VALLEY FORGE MEDICAL CENTER AND HOSPITAL, INC.(06) WES HEALTH CENTERS, INC. (05) WEST PHILADELPHIA COMMUNITY MENTAL HEALTH CONSORTIUM INC.(09) WOMEN'S INSTITUTE FOR FAMILY HEALTH(09) Unique Members Total ,66 In addition to the aforementioned services, as you are aware, regarding the Pennsylvania budget, we have not heard specifically how much will be allocated in detail for Philadelphia and for which specific purposes. The main infusion of dollars thus far has been for the development of the opioid use 5

6 disorders centers of excellence, $500,000 for each (6). Some dollars were given to the SCA and others to the PH-MCOs. City-wide, we have made a concerted effort to increase the availability of Medication Assisted Treatments (MAT) including methadone, buprenorphine (Suboxone) and naltrexone Xr (Vivitrol) o MAT is considered as first line evidenced based treatment by numerous national professional organizations, including: the National Institute on Drug Abuse, Substance Abuse and Mental Health Services Administration, the National Institute on Alcohol Abuse and Alcoholism, Centers for Disease Control and Prevention, the American Academy of Addiction Psychiatry, the American Medical Association and the National Council. o Numerous studies have demonstrated superior outcomes for MAT versus detox followed by "drug free" treatment in terms of reducing morbidity and mortality from opioid use disorder, as well as improving treatment retention, reducing recidivism, reducing illicit substance use, reducing cost. Detox can actually put someone at risk for overdose if utilized in isolation. we are linking individuals to MAT treatment providers through our care management and member services departments, to align with best practice and out of concern that we are seeing numerous individuals cycling through detox and residential treatment. o We have increased methadone treatment capacity by 500 o We have increased the availability of buprenorphine from approximately 00 slots to over,000 at the present time. There is treatment capacity, as all ~ur buprenorphine providers have treatment availability at this time. If someone calls members services, he/she can be directed to one of our sites. o We also have three residential sites offering buprenorphine inductions at this time o Vivitrol is now available in 4 outpatient treatment sites and 4 residential sites o We added a partial hospitalization program for individuals with substance use and significant co-ocrring mental health challenges, which also includes the provision of MAT o We are worki,ng with the PH-MCOs and the state to further develop the Opioid Use disorder Centers of Excellence, and expect this MAT treatment capacity to expand in the upcoming months o We are collaborating with the PH-MCOs to help direct members identified by the PH-MCOs who need substance use treatment to one of our network treatment providers o We are working to incorporate buprenorphine in the Philadelphia Department of Public Health PDPH) Health Centers o We are holding free buprenorphine waiver trainings for all physicians in Philadelphia (both psychiatry and all other medical specialties) to get buprenorphine waivered in order to further increase access in all treatment settings, including Emergency Departments, CRCS, inpatient medical and psychiatric, as.well as primary care settings. We are also creating a physician 6

7 o mentoring program so that those who are new to prescribing can receive technical assistance We developed buprenorphine standards of care for the network to make sure the buprenorphine is being prescribed in alignment with national practice guidelines developed by the American Society of Addiction Medicine Our staff are assisting providers daily who are having challenges getting members into the rrent detox or rehab beds. In cases where there are any significant or potential medical co- morbidities, we are authorizing higher levels of care so that these individuals do not have to wait. We are requiring all halfway houses to accept individuals on MAT and psychiatric medications as of June, 0. This will dramatically increase access to this level of care for individuals stabilized in detox and rehab. 50 of these beds will become available for this population. As of now, the majority of the halfway houses do not accept these individuals. This creates an access issue for step down, as well as keeps many unnecessarily in rehab beds that could otherwise be made available to individuals who need this more intensive treatment service. We are developing a web based portal domenting treatment capacity. We are requiring all residential providers to enter this availability. This is being piloted now. We are working with one of our providers to develop a 4/ walk in center at 5th and Spring Garden where individuals can receive immediate stabilization in the outpatient setting and linked to further treatment. They will take individuals from the Emergency Rooms once they are medically cleared. This should be operational by rd quarter 0. DBHIDS has been working closely with Prevention Point Philadelphia (PPP). PPP is a multi-service public health organization serving the most vulnerable and hard-to-reach populations of Philadelphia for many years to provide access to treatment for those high risk individuals in the "Air Bridge: area that is between Tuslum and Garney streets. Several years ago the Consolidated Response to Addiction by Facilitating Treatment (CRAFT) Project was started at the Prevention Point Harm Reductions Center. Staff members from the DBHIDS are on-site three days a week engaging and screening individuals and authorizing immediate treatment access including detoxification. Approximately 0 people a week use this mechanism to get into treatment. Currently, there are approximatly providers of mental health, drug and alcohol outpatient, drug and alcohol inpatient, and prevention services serving the Latino community. In addition, DBHIDS is sponsoring and funding overdose training to providers, community groups, family members, and individuals. Funding is being allocated to PPP for the purchase of narcan kits to those at high risk and their family members, as well as support to the Philadelphia Police Department to support their purchases of narcan. Regarding housing, there is a process to connect individuals to shelters, safe havens or recovery housing based on availability. For those not yet ready to accept behavioral health treatment, they are still offered social services, medical support, and meals at the Harm Reduction Center and individuals can accept treatment at a later date.

8 The Department also supports two Latino peer mentors who work with Spanish speaking people in the "Air Bridge" area and link them with services including treatment. The department has funded two additional outreach workers to engage individuals and connect them with services. For people who do not initially agree to accept help, the approach is to continually offer help over time. Our experience with this population is that you never lose hope. People can and do change. Working with a related population in the streets of Center City, we found that even people who were on the street for years, when offered consistent outreach and our ability to respond quickly, eventually agree to come into services. In partnership with PPP, we commenced collecting data specifically in the "Air Bridge" area from July, 06 through December, 06 (first quarters) and are able to extrapolate services specifically domenting whether a participant came to Philadelphia under the pretense of getting sound substance use treatment, and /or only had identification and doments from Puerto Rico. The following are rough numbers regarding individuals PPP served that came from the "Air Bridge": Time Frame: //6-//6 Clinica Bienestar: This provider has a total of 8 patients and of that total; are from the "Air Bridge (/8 total patients) Medicated Assisted Treatment (Buphenorphine and Vivitrol only; no Methadone Maintenance.): 6 of all 4 new enrollees are rrently on Buphenorphine (6/4) Winter Safe Haven: of 4 (/4) shelter residents are from the "Air Bridge", ( recently moved to permanent housing) and 6 were living on Gurney Street ~ PPP Homeless Outreach: 6 toal participants received homeless outreach. PPP did not ask about "Air Bridge" but 0 individuals out of 6 (0/6) were Latino, and were from Puerto Rico rrently residing at the railroad tracks Syringe Exchange Program: Between September, 06 and December, 06, of 88 new registrants, 59 were Latino, and 6 had only identification from Puerto Rico PPP will continue to collect specific data to this target population and provide services or referrals as deemed appropriate or accepted by the individuals. DBHIDS will continue to engage this target population and will provide behavioral health services to all eligible citizens of Philadelphia. The DBHIDS has also partnered with Mural Arts to set up a hub on the Kensington Avenue corridor providing further oureach to those in the community and empower the community to be more engaged in addressing the issues plaguing it. Representative Cruz, again, thank you for the opportunity to provide testimony regarding behavioral health services to citizens of Puerto Rico. I respectfully submit this testimony and await any questions you may have. Catherine Williams, Ph.D., LSW Associate Director of Behavioral Health Department of Behavioral Health and Intellectual disability Services 8