How to Implement a Sustainable Peer Program into Your Health System November 9, 2016 1-2:30pm EST 1
Introduction of Today s Presenters Mark DeWitt Lanyon, Ph.D., ICADC, ICCDPD, LCDP, LPC Current Role at Christiana Care Health System Peter Booras, CPRS Current Role at Christiana Care Health System 2
LEARNING OBJECTIVES Understand how to develop a peer run program within your institution. Describe how to best work with your leadership team to have them embrace this concept. Learn how Engagement Specialists can provide a positive outcome for hospital based patients and the medical staff working with them. 3
History of Project Engage A need was identified in the Christiana Care Health System A collaboration was formed between Christiana Care Health System and Brandywine Counseling and Community Services Christiana Care Health System is one of the largest health care providers in the US mid-atlantic region. Brandywine Counseling and Community Services is a major provider of addiction treatment in Delaware 4
CHRISTIANA CARE HEALTH SYSTEM Wilmington/Christiana Hospitals 1,100 beds 166,945 ER Visits 52, 884 Admissions [2011 data] 5
Hospitals Aggregate the Highly Disordered Substance use disorders are common and severe* Engaging with patients can be a challenge Poor adherence to care Poor clinical outcomes Over-utilization** Safety concerns Poor staff morale *Saitz, JGIM, 2006; Bertholet, JGIM, 2010 ** Walley. J Addict Med, 2012 6
NEGATIVE IMPACT ON THE HEALTH SYSTEM It is estimated that individuals with SUDs who frequently visit the ED result in 8.9 ED visits annually with average annual charges of $13,000 per patient. It is further estimated that individuals with SUDS result in 1.3 inpatient hospital admissions annually with average annual charges of $45,000 per patient. Reference: CSH, The Source for Housing Solutions. Frequent Users of Health Services Initiative. Available at: www.csh.org/.../frequent-users-ofhealth-services-initiative. 7
Key Component for Successful Peer Program What makes this program unique is having Engagement Specialists who are in recovery from substance use disorders. This helps to break down resistance from hospital patients. Engagement Specialists get interested patients into community-based treatment. The Engagement Specialists work in the ED, inpatient, and in the community. 8
Engagement Specialist A Peer in Recovery from substance use disorders Supports the Interdisciplinary Healthcare Team in Patient Care Collaborates with Social Work Expert in Available Addictions Treatment Uses Evidenced Based Clinical Practices Skilled in Patient Placement 9
Significance of Peer Specialists Historically Effective Method Peers Know the Language of Addiction Patients Feel More at Ease Not Judged Can Elicit a More Accurate Hx of Patient s Use Proven to Effect Health-Related Behavior Changes Concrete Example That Treatment Works 10
Support the Interdisciplinary Healthcare Team Provides a Path for individuals with Substance Use Disorders May Elicit a More Comprehensive History Offer Insight into Patient s Point of View Education on all Aspects of Addiction Translators Between Staff and Patient Discharge Planning and Assistance 11
Treatment Resource Expertise Knowledge of Area Referral Options Relationship Building with Referral Sources Astute at Facility Intake Procedures Working Understanding of Insurance Coverage Gather Info for Pre-Authorizations Relationship with Insurance Case Managers 12
Key Component for Successful Peer Program Project Engage Engagement Specialists are Experientially Credentialed. 13
Project Engage 2008 2009 2010 2011 2012 2013 2014 Phase 1 Phase 2 Phase 3 Phase 4 Phase 1: Wilmington Hospital Pilot Phase 2: Roll Out to Christiana Hospital Phase 3: Roll Out to Emergency Department Phase 4: Community-based 14
Phase 1: Wilmington Hospital Pilot 2008-2011 Embedded Peer Counselor from local drug treatment program Peer-to-peer intervention using Motivational Interviewing 15
Phase 2: Roll Out to Christiana Hospital When Bobby left, Peter took over his position. After Peter began, the need for a dedicated social worker was identified. Shortly thereafter, two inpatient engagement specialists began at Christiana Hospital Project Engage continued to grow to meet the identified needs. 16
Phase 3: Roll Out to Emergency Department Based on the success of the inpatient specialists, the Emergency Department requested specialists as well. Today there are three inpatient specialists, three emergency department specialists, as well as two dedicated social workers. But there was more need identified. 17
Key Component for Successful Peer Program A Dedicated Social Worker who assists Peer Engagement Specialists with the placement of patients into Community Treatment Providers. 18
Project Engage Plus Community-Based Model 19
Phase 4: Community- Based Component Part I Need for warm handoff to Community Providers upon a patient s discharge from the hospital was identified. The Community Engagement Specialist position was added. Need to address women who are pregnant and have an opioid use disorder was also identified. The Maternal Engagement Specialist position was added. 20
Phase 5: Community- Based Component Part II Based on success of Project Engage, the Construction Industry contacted Dr. Horton and requested Project Engage. Over 20 construction companies have participated in funding an Engagement Specialist to work with construction employees with substance use disorders. The Construction Engagement Specialist works with the employee and/or the families of the employees. 21
Case 1 A Success Story 52 y/o white male with 43-year history of continuous chronic alcohol use without any length of sobriety. Typical pattern of use consists of six 24-ounce beers and half a pint of vodka daily. In Spring 2015, he was again admitted to CCHS Hospital. He subsequently met first with the Project Engage Inpatient Engagement Specialist and develops a therapeutic relationship. Prior to discharge from the hospital, a warm handoff occurs and the individual is referred to a Project Engage Community Engagement Specialist. 22
Case 1 A Success Story 10 months prior to entering Project Engage Community Program on in Spring 2015, patient had 2 inpatient and 11 ED episodes. 10 months following working with Community Specialist, there have been no CCHS alcoholrelated hospital visits. There was one ED visit due to a prescription medication interaction. 23
Case 1 A Success Story Patient broke the 43-year cycle of drinking. Personal care and social support improved. Stable on his psychotropic medications. Diabetes and hyper-tension became well controlled. Legal issues resolved. He has been reunified with his estranged family including seeing his grandchild for first time. 24
The Full Story To read the full story about this success, following the Webinar, visit IRETA s Webinar Library to download this article. Lanyon M, Wilson B, Horton T. Example of Coordinated Effort Between Behavioral Health and Primary Health Care. Del Med J. 2016; 88.6: 174-176. 25
QUESTIONS Before moving from what Project Engage is to how Project Engage works, are there any questions? 26
Key Component for Successful Peer Program Project Engage acts as a concierge service to help patients with what they need getting into detox, inpatient, mental health treatment, etc. 27
Addressing Suspected Drug Use in the Hospital Mark Lanyon discusses how this plan developed. A pilot was begun to address suspected drug use in hospital From this pilot came realization of need to address opiate withdrawal in hospital to reduce drug use in hospital. 28
Opioid Withdrawal is a Safety Issue If withdrawal is poorly controlled, patients may: Self treat use illicit drugs in the hospital and/or Leave high rates of AMA and readmission and/or Additionally, staff may experience the following safety concerns: Dealing with excessive demands for pain medications from patients The increased possibility of needle sticks 29
Case 2 Mark Lanyon discusses 21 year old presenting with endocarditis and opioid withdrawal. The experienced Project Engage Engagement Specialist was able to advocate for the patient s needs with the interdisciplinary healthcare team, who prescribed Suboxone. Mark Lanyon discusses how this brought to light need for an opioid withdrawal protocol. 30
Pittsburgh Mentoring Project Peter Booras and Mark Lanyon discuss the Pittsburgh Mentoring Project. Marketing Strategies for the Pittsburgh Peer Navigators provided during training time here. Discussion of barriers Project Engage experienced which were shared with Pittsburgh. Discussion about building relationships with behavioral health providers which were shared with Pittsburgh. 31
Age-Adjusted Rates of Death Related to Prescription Opioids and Heroin Drug Poisoning in the United States, 2000 2014. Compton WM et al. N Engl J Med 2016;374:154-163. 32
Narcan, Christiana ED, and The New Castle County Police Delaware is experiencing the heroin epidemic like many other states. The New Castle County Police (NCCP) approached Dr. Horton about how to best address this need. Project Engage and NCCP are forging a relationship to meet this need. NCCP and ED Engagement Specialists will be working together. 33
Key Component for Successful Peer Program You must develop sustainability. First Brandywine Counseling provided an Engagement Specialist, then there was a generous donation, now hospital funds the inpatient and ED components. Medicaid provides funding for two of the Community Programs. The Construction Program is funded by participating Construction Companies. 34
Project Engage Cost Savings CCHS Finance 2013 * Annualized from 9 months of data 35
OUTCOMES Approximately 2,000 patients seen annually Inpatient and ED 20 followed by community-based program Approximately 25% overall engaged into care 40% receive brief interventions and/or education on addiction and treatment options. 36
QUESTIONS DOES ANYBODY HAVE ANY QUESTIONS AT THIS TIME? 37
CONTACT INFORMATION Mark DeWitt Lanyon, Ph.D. mark.lanyon@christianacare.org Peter Booras, CPRS Pbooras@christianacare.org 38
THANK YOU Thank you for participating in today s webinar. 39