The National Association of Community Health Centers NHCAC working with Provider Clinical Support System PCSS , launched a pilot study on how to best address intake, billing and coding procedures in community healthcare centers, critical aspects in positive patient outcomes. which and summarized with a blueprint for a successful OUD/MAT practice. Peer Support is one distinct and specific recommendation to bolster effectiveness in a practice and so are the CCAR trainings we deliver. Here is an excerpt from that report:
PURPOSE: If a health center’s goal is to expand access to MAT Program services for individuals suffering from opioid addiction, or at risk of becoming addicted, facilitating community outreach efforts targeting shelters, soup kitchens, and similar locations
can be a valuable process.
Here is a re-posting of Appendix A-2 in that report.
RECOVERY COACH (PEER) MODEL
Successfully expanding community outreach efforts requires finding the right individual(s) to serve in this capacity. A “recovery coach” may be a good fit for this function, as these individuals commonly possess the following attributes:
Typically is in recovery (i.e. a peer)
Have acquired knowledge about how to successfully sustain recovery
Non-clinical role – this person is not diagnosing or treating addiction or mental health issues
Able to remain engaged with patients throughout the recovery process
The recovery coach can be valuable in a case management role and in assisting patients with sustaining their recovery.
Below are some examples of specific roles a recovery coach can fulfill as a MAT Program resource.
Spends time at shelters & soup kitchens engaging with individuals, eating meals with them, etc.
Establishes rapport as a peer over time
Facilitates scheduling willing patients for an assessment at the health center
Stays engaged with individuals on a waiting list for the MAT Program
Communicates regularly with the MAT Program team Helps develop the recovery plan
PATIENT LIAISON/ MENTOR
Helps to initiate and sustain an individual/family in recovery from substance use
Helps client find transportation, housing, clothes, employment, child care, etc.
Promotes recovery by removing barriers
Serves as a personal mentor for people seeking recovery assistance
Works with individuals beyond the recovery phase through stabilization and into maintenance
RECOVERY COACH ACADEMY
Specific training for individuals serving as a recovery coach are available, including through the Center for Addiction Recovery Training (CCAR Recovery Coach Academy): CCAR (or)
With the federal passage of the FIRST STEP Act, we finally see action on criminal justice reform. Closer to home, the Vice Chair of the Colorado House Judiciary Committee has introduced a bill titled Colorado Chance to Compete — House Bill-1025 — (sometimes referred to as “ban the box”). As a step for Colorado, Vice-Chair Leslie Herod writes: “A question in particular that appears on most, if not all, job applications is this: ‘have you ever been arrested, charged or convicted of a crime?’ If you answer yes to this question, the likely result is your application will be disregarded. You won’t be interviewed. You simply won’t be considered for the job. The bill addresses this issue and does so in a moderate and measured way. It simply says that businesses cannot ask this question on the application but can do so later in the interview process. This bill is an important criminal justice reform initiative and makes good economic sense.” The good new is that Approximately 25 states and hundreds of municipalities across the country have passed similar laws and the outcomes have been positive. Simply stated, work and contributing to community reduces recidivism. Here’s another significant Herod statistic: “96 percent of ex-offenders when trained into skilled jobs succeed. They don’t re-offend. The greatest influence on reducing recidivism is employment”. Think of the current situation where there are more jobs than workers to fill them. Beyond the application, an interview may reveal a hidden treasure developed from a lived experience that serves to enhance potential worth of an individual. In an interview, skills may be revealed that fit the employer’s needs.
The Colorado bill is important to communities and to justice reform. In the early nineties, I lived in Southern California and served as administrator for a program that provided alternatives to incarceration. A pioneer is such matters, Nancy Clark, began the Alternative Sentencing Program—A.S.P. Not at public expense, but at the court’s direction, individuals were allowed to become a part of a community of recovery centers for a determinate length of time, depending on the nature of the misdemeanor. Generally, the misuse of drugs may have been involved, particularly alcohol. Individuals experienced a loss of freedom through administration of the expectations and direction of the Judges. They also experienced financial responsibility and accountability. The program provided reason and resources to reduce recidivism. It provides education and information to guide positive, life-changing behaviors. I refer to it as a truly teachable time on a tether. Employment or community service is required. Individuals were employed by firms willing to take a chance and give a chance. Though there was no “jail time” completion of the program allowed re-entry into social norms and restoration of freedom. Thankfully, we were assisted through the advent of a drug court. Drug Courts now serve the justice department, offenders, and families in counties and states across the nation. A completion of a court program can result in expunging of a record of offense.
It has been said that the wheels of justice turn slowly, but grind exceedingly fine. We might restate it to read, the wheels of legislation turn slowly, but grind exceedingly. Fair Lady Eliza Doolittle states in the song “Show Me,” Words, words, words, I’m so sick of words. I get words all day through. Finally, in the last decade we have gotten action. Faces and Voices of Recovery has extensive experience working on criminal justice and substance abuse policy issues at the federal level, including the Second Chance Act. —SCA. Since 2009, more than one out of three Second Chance Act awards have gone directly to county governments that have received $95 million over the past nine years. These grants provide financial assistance for programs such as employment training, mentoring, substance abuse, mental health treatment, and other family-based services to assist formerly incarcerated individuals as they reenter society.
The Second Chance Act reauthorization was recently included in the compromise criminal justice reform bill titled the FIRST STEP Act. The reauthorization of the Second Chance Act also includes changes to address inadequacies in the program. The FIRST STEP Act recently passed and was signed by the President. This was historical. For years, Congress had attempted to pass criminal justice reform legislation, such as the Sentencing Reform and Corrections Act (SRCA) introduced in 2015 by Senators Chuck Grassley (R-Iowa) and Dick Durbin (D-Ill.). But the SRCA failed to pass in 2016 despite overwhelming bipartisan support, The FIRST STEP Act is consequential because it includes provisions for meaningful sentencing reform that would reduce the number of people in prison and is part of the starting point of any legislative justice reform. Sentencing laws played a central role in the rise of mass incarceration in recent decades.
The Colorado Chance to Compete bill—House Bill 1025— is a significant step as a criminal justice reform initiative. Herod says, “Simply stated, work and contributing to community reduces recidivism.”
We believe that in order to address the scourge we face, it is becoming necessary to arm ourselves with new artillery for battle. Tough love and incarceration are not working. Recovery is what we need.
We nod to Malden Massachusetts. We nod to you. If you have questions email us at email@example.com
Nicole O’Donnell has experienced two opioid overdoses. She has never forgotten the way she was treated at the hospital emergency room.
“They were awful,” the Philadelphia area woman says. “They were mean, just very cold.”
Once she was stable, she says, “I was just told to leave. I didn’t even have a ride.”
More than a decade later, O’Donnell, 39, is making sure others have a different experience – and that at least one hospital system’s emergency department is a possible gateway to recovery.
O’Donnell is a certified recovery specialist serving three Philadelphia hospitals run by the University of Pennsylvania.
Her job: To counsel people dealing with the same struggles she has faced with opioid addiction and recovery.
While she talks to patients in many settings, she says, some of her most important work happens in the emergency department.
As part of a program that began with a state grant in 2018 and will expand with federal funds this year, O’Donnell is on call to respond any time emergency staffers treat a patient for an opioid overdose.
She’s also called when patients show up with illnesses or injuries related to opioid misuse.
Her mission: to let people in crisis know that treatment and other help is available AND that someone cares.
“I just introduce myself and explain that I understand why they are there and that I’ve been there myself,” O’Donnell says. “I just want to get the conversation started about how I can help them not die.”
O’Donnell, who is training to be a psychologist, is backed by a medical staff ready to offer an immediate dose of buprenorphine. That’s a medication that can prevent withdrawal symptoms and cravings and, when used for a longer time, can help people recover from an opioid use disorder.
In years past, emergency physicians rarely offered the drug, or other nudges toward treatment. But “we have really pivoted 180 degrees,” says Jeanmarie Perrone, a professor of emergency medicine based at the Hospital of the University of Pennsylvania.
Perrone led a committee that recently updated opioid guidelines for emergency departments statewide.
The new philosophy, she says, is that “treatment is our business.”
Starting this year, hospitals that establish practices that guide addicted patients toward treatment will get cash incentives from the state.
The guidelines encourage emergency staffs to offer initial doses of buprenorphine. Providers also are urged to arrange “warm hand-offs” for patients ready to enter treatment.
In practice, that can mean having someone like O’Donnell available to talk with patients and, if desired, accompany them to treatment center doors.
A second counselor joined O’Donnell on the job this month, with the goal of providing round-the-clock coverage.
Still, Perrone says, “not everyone who is post-overdose is ready for treatment.” Those who decline it are given supplies of the overdose antidote naloxone and encouraged to keep in touch.
“We say, ‘You aren’t thinking about treatment today, but we want you to know that when you are ready, we are here,'” Perrone says. “‘When you are ready, please, please come back and bring your friends.’”
“Success is when the people stay engaged no matter what,” O’Donnell says. “A lot of them do in stay in contact with me.”
This year PCA EMBARKed on an effort with CCAR to empower our Colorado Recovery Communities. It seems clear that our systems are overburdened with all the issues confronting our state. The opioid epidemic with the catastrophic numbers of overdoses with family supports being left in the wind. Alcohol remains a huge and costly issue, not to mention the side effects of legal cannabis being seen in our youth. Embark specifically provides access to a network of recovery coach training delivered locally.
Essentially, we have come to accept that 9 out of 10 individuals with a diagnosable substance use disorder will not get help. Ostensibly we have come to accept that these individuals will keep showing up at our emergency rooms, physician offices and our intensive care units driving the cost of healthcare through the roof.
If we could engage even 20% more of this group, we could dramatically reduce costs. It has been clearly established that healthcare costs drop by as much as 40% when individuals with substance use disorders are receiving some type of specialty AOD “help”
The second area of great impact would be intervening with the “risky” group described above. Through evidence-based interventions and a new health coaching model, we could identify and engage this population and promote a healthy lifestyle. This could be thought of as tertiary prevention rather than treatment and the return on investment would be substantial. Much can be done with this group through strategic and brief interventions. For example, in a federal study, a group of at-risk alcohol users who received brief coaching recorded 20 percent fewer emergency department visits and 37 percent fewer days of hospitalization.
Although contemporary medicine has made many breakthroughs and powerful advances, it still remains primarily a disease management system. A focus on acute care and discrete periods of treatment have proven to be insufficient. However, there is a new paradigm emerging with an emphasis on wellness, prevention, and ongoing care. The discipline of health coaching is a growing reality within the continuum of care. Duke University describes health coaching in the following ways:
Health coaching is the missing link in our current health care system.
Health coaching is a new paradigm of care that defines success not as more procedures and tests, but as better patient engagement and outcomes
Health coaching empowers clients to make lasting health behavior changes that are the cornerstones of lifelong well-being
Health coaching bridges the gap between medical recommendations and patients’ abilities to successfully implement those recommendations into their complex lives.
The seasonal carols on the radio have served our communities to bring good tidings. We Hark!—and sing along. We repeat and repeat the sounding joy. Of course, many stories and carols focus on the news of old, proclaiming, “unto us a child is born.” Faith in the veracity of stories of Christmas is a matter of personal choice. We might recall the words of that grown up child who, it is written, said, “if you don’t believe in me, believe in what I teach.” Of course, the radio also brings snooze news, commercials galore, and talk shows. Beyond the nativity is the negativity.
Not all good tidings: There many Christmas stories. Interesting is one that suggests the attitudes of many today. It’s a nativity story called the “Grumpy Sheep.” Among the shepherd’s flock is a grumpy sheep who is not only cross but lazy as well, and has the wrong idea of what the big deal is about not joining other sheep to see this new arrival. The grumpy sheep does discover that it is a big deal when she finally goes to the manger. We now celebrate that “big deal” of long ago as Christmas. Grinch is grumpy. Scrooge is grumpy. Now, in spite of many reasons for joy and contentment, there are millions of grumpy sheep following grumps. They are caroling, do you fear what we fear, say the grumps to the fearful sheep. Baa baa, humbug. Offsetting this was the celebration of the life of George H.W. Bush, who gave us words to remember. “Hate corrodes the container it’s carried in.” Living in a kinder, gentler nation is a valid notion that will serve us well in any season
Good tidings. The drug crisis presents opportunity. The positive state of the economy allows increased resources to find solutions and overcome the present and any future crisis. The recovery movement is strong and growing. Holiday season is very much about children. Unto families, children are born. It has been written that it takes a village to raise a child. For our children and all of us, all the nation’s villages must face and overcome the crisis of the evil that is drug misuse and addiction. In the Betty Ford Children’s Program, with a Colorado presence, illustrated books for children portray, in cartoon style, addiction as a villainous character that destroys families. In the program, boys and girls, seven to twelve years old, learn about alcoholism and drug abuse and how to separate the person they love from the disorder that consumes them. Even at very low or no cost, there is resistance to assistance driven by stigma, shame, and guilt held by parents and family members. Needed is the courage and hope provided by lived experience of family peer support.
Not so good tidings: In the face of the devastating news about opiates, we forget that there are other drugs like alcohol, nicotine, and marijuana. These remain threats to families. Alcohol remains the #1 killer. It is cheap, legal, and accessible. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) notes that holiday celebrations feature alcohol and consequences. They provide a Navigator to show the way to safety and sobriety. Vaping is the new delivery system for nicotine and marijuana. It is a growing threat to our young people in Colorado. Surveys showing growing use by the very young are alarming. The real threat will be impaired brain development and addiction. There is little joy when Individuals and families are living in quiet desperation due to alcohol and other drug mis-use and addiction.
Good tidings. There is hope for families. Over the past few years, “systems of care” have been developed. There are frameworks that involve collaboration across government and private agencies, providers, families, and youth. Community reinforcement and family training (CRAFT) in Colorado and communities around the country, has been shown to have success in getting substance abusers, perhaps with medical assistance to be motivated to get into treatment. CRAFT is a set of therapeutic techniques taken from community reinforcement approach (CRA) and applied to the substance abusing population. Rather than target the person with addiction directly, CRAFT works with the concerned significant others (CSOs) so that they can assist the identified patients (IPs). Congress has taken action in the passage of the SUPPORT for Patients and Communities Act. It includes policies and resources that support individuals and families. The act provides for building communities of recovery. Our Colorado communities need to take advantage of funding and resources that are newly available.
Timely Tidings: William White, author and recovery advocate writes abbout“Family Recovery 101” He writes: “Knowledge about the effects of addiction on families and the family recovery process has grown exponentially as a result of scientific studies and cumulative clinical experience. He outlines 12 important conclusions from this knowledge.” He states, “It is time—no, past time—that the basic unit of service within recovery support service settings shifted from the individual to families and kinship networks. Making that shift will require substantive changes across the addiction treatment and recovery support service continuum.”
Very Good Tidings: May all seek and find the joy of hope, help, and holiday spirit and together let’s repeat and repeat the sounding joy,
CCAR Core Trainer, Rod Rushing founded Peer Coach Academy (PCA) in 2014 with the mission of providing recovery support and services to many in Colorado. With over 10 years of experience in the field, Rod has been a mentor and advocate for individuals seeking to enter or maintain long term recovery. With the CART Collaborative PCA continues to be a driving force for EMBARK, which is Colorado’s effort to develop a network of recovery coaching entities in the state. Through these initiatives PCA and EMBARK are able to offer the complete CART recovery coaching curricula regionally, while eliminating barriers that is sometimes experienced by those who wish to be trained as a recovery coach. CCAR/CART welcomes Rod Rushing to the team!
PCA has added 4 additional trainers to their team. Allison Harden-co-founder of Beyond Betty, Corinthia Brown founder of Don’t Look Back Center, and Rica Rodriguez -Promotura for Rocky Mountain Health Programs, and Jess Norwood- founder of Sober Chick Video Blog. Our team affords us the opportunity to have a larger reach statewide.
Currently, we are collaborating with Sandstone Care Denver and Crossroads Turning Point Pueblo to deliver trainings in 2019. We hope to find partners in Colorado Springs, Glenwood Springs/Grand Junction, and Fort Collins/Greeley.