Hospitals Role in Addressing the Opioid Crisis
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1 Hospitals Role in Addressing the Opioid Crisis Webinar 4: Overdose Survivors Outreach Project October 18, 2017
2 Agenda Overdose Survivors Outreach Project (OSOP) Background Barry Page, Director of Early Intervention & Wellness Services Maryland Department of Health, Behavioral Health Administration Sadie Smith, MSW Senior Health Consultant, Mosaic Group MedStar Harbor Experience Cara S. Miller, RN, BSN Assistant Director of Nursing Emergency Department MedStar Harbor Hospital Anne Arundel Medical Center Experience LaToya Nkongolo, LCSW-C, LCADC, RPS Program Manager-Recovery Support Services, Anne Arundel County Department of Health, Bureau of Behavioral Health Services 2
3 Opioid - Overdose Survivors Outreach Project (OSOP) Behavioral Health Administration In partnership with
4 OSOP 4 A MODEL FOR RESPONDING TO OPIOID OVERDOSES IN MARYLAND HOSPITAL EMERGENCY DEPARTMENTS
5 Maryland Intoxication Deaths 5 Source: CDC, Vital Signs, 2013
6 Intoxication deaths by jurisdiction 6
7 OSOP Currently, OSOP has been implemented by expanding on two different hospital-based Peer led intervention models, one in Anne Arundel County, and the other in hospitals throughout Baltimore City. 7
8 OSOP First implemented in 2016 Anne Arundel Medical Center Bon Secours Baltimore Hospital Mercy Medical Center MedStar Harbor Hospital University of Maryland Medical Center Implemented and managed through the Anne Arundel County Health Department and the Mosaic Group 8
9 Unintentional Deaths 9
10 Intoxication deaths by substance 10 Mosaic Group
11 Comprehensive Hospital Substance Use Response Program SBIRT Screening, Brief Intervention and Referral to Treatment in the Emergency Departments OSOP Opiate Overdose Suvivor s Outreach Program that includes Community Recovery Coaches to conduct inreach/outreach and care management with survivor s while in the hospital and once they are discharged Buprenorphine Administration in the ED initiating medication-assisted treatment while patient is in the ER and referring them for maintenance therapy upon release 11 Mosaic Group
12 OSOP - Baltimore 12 Integrating OSOP in 4 existing hospitals plus 5 additional hospitals Goal: Educate overdose survivors about their risk for additional overdoses and keep them alive Program Components: 1. Brief Intervention from Peer Recovery Coach in ER 2. Overdose prevention education and provision of naloxone 3. Intensive and ongoing outreach from Community Recovery Coach Mosaic Group
13 OSOP FY17 Pilot 4 hospitals & 2 outpatient treatment programs 279 referrals 30% engaged with Community Recovery Coach 64% received referral to treatment 63% linked to care Consent difficult to obtain Communication barriers Care coordination fragmented Limited resources for larger geographic coverage 13 Mosaic Group
14 OSOP FY 18 Model Enhancements 14 Hospital-based Community Recovery Coaches Improved engagement EHR documentation Improved care coordination CRISP utilization Mosaic Group
15 OSOP: MedStar Harbor Hospital Patient population 4300 average ED Visits monthly / 3100 unique patients 450 patients screen positive for risky substance use SBIRT coaches conduct brief interventions on roughly 50% Refer approximately 25% of patients to treatment 50% of patients link to treatment OSOP 67 referrals to Family Health Centers of Baltimore 66% engaged with outreach 41% referred to treatment 56% linked to treatment 15 Mosaic Group
16 Workflow OSOP: MedStar Harbor Hospital Screening completed by RN 16 Brief Intervention performed by Coach with attempt to obtain consent for OSOP Referral Form completed by Coach Referral Form and Consent ed (encrypted) to Family Health Centers of Baltimore and placed in hospital chart Standard follow up care with the patient by in-hospital Coach scheduled Weekly call prescheduled for review of all cases with on-site Coach, ADON and OSOP provider Mosaic Group
17 Successes MedStar Successes & Challenges Improved referrals and linkages to treatment Increased awareness in the community Two coaches following from different avenues Improved communication with closest treatment center 17 Challenges Start up-education for nurses, coaches and OSOP worker Obtaining consent Technology Communication/ Information-sharing Mosaic Group
18 MedStar Lessons Learned Importance of brief intervention and trust formed with SBIRT Peer Recovery Coach Weekly phone meetings improve engagement Aggressive outreach improves patient outcomes Education for coaches assists with the success Communication between SBIRT team and OSOP worker is key 18 Mosaic Group
19 Goals: OSOP: Anne Arundel Medical Center 19 To identify people seen in an ED setting after an overdose OR other opioid-related issue To link them to medication-assisted treatment or other SUD treatment. Program Services Substance Use Disorder screening and referral Medication-assisted treatment screening and referrals Naloxone kit dispensed by hospital pharmacy to each person on discharge (May 2017) Peer support services Twice a month contact for all who are referred (up to 12 months) Case management for those who consent Program Staff 1 FTE nurse coordinator 2 FTE peer support specialists
20 Anne Arundel Medical Center OSOP Services Flow Chart 20
21 OSOP- Anne Arundel Medical Center Began taking patients July 11, 2016 As of October 13, people referred to the program 35 people (9%) readmitted for an overdose 100% receive peer outreach people (12%) admitted into a Medication-Assisted Treatment (MAT) program Highlights: 1. A patient was enrolled in MAT following an overdose. The spouse saw the positive changes happening with the patient as a result of treatment and peer support. She also decided to enroll into an MAT program. With the support of the ODSOS team, both the patient and spouse are doing well in treatment. 2. The peer support specialist developed a healthy, mentoring relationship with a patient to assist him in early recovery as he was adjusting to MAT while also preparing for a cardiac procedure. Procedure was successful and the patient is healthy and drug free!
22 Questions? 22
23 Schedule of Webinars June 28 July 11 September 12 October 18 November 14 New Opioid-Related Requirements Naloxone Prescribing and Dispensing Alcohol and Drug Use Screening Overdose Survivors Outreach Project Buprenorphine in the Emergency Department Materials will be posted at: All webinars are 8:30 9:30 a.m. 23
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