Refuah Community Health Collaborative Initiation and Engagement of Alcohol and Other Drug Treatment in Orange and Rockland Counties November 8, 2018 2:00 pm – 3:30 pm PAC webinar

Webinar Instructions Webinar is being recorded and will be available on our website www.refuahchc.org Attendees who have called in are muted To ask a question: Type the question into the box on the sidebar At the end of the presentation we will read the questions aloud & provide answers

A Presentation to the Refuah PAC Initiation and Engagement of Alcohol and Other Drug Treatment in Orange and Rockland County A Presentation to the Refuah PAC

About John B. Lent Special Program Manager with Catholic Charities of Orange Sullivan & Ulster Rutgers University alum with BA, MBA, JD Good resource for information about data analytics, DSRIP, Medicaid Managed Care Contracting Email: john.lent@cccsos.org Telephone 845-294-5124 ex 309

What Substance Use Treatment Options are there Orange and Rockland County? Medically Managed Detox Stabilization, Rehabilitation and Reintegration Inpatient Rehabilitation Opioid Outpatient Treatment Outpatient Clinic Outpatient Rehabilitation Supportive Living Community Residential

What Licensed Providers Can You Refer to for SUD Treatment? Orange County Rockland County Medically Managed Detox: Bon Secours Community Hospital Stabilization, Rehabilitation and Reintegration: HONORehg Inpatient Rehabilitation: Bon Secours Community Hospital; Richard C. Ward Addiction Treatment Center Opioid Outpatient Treatment: Cornerstone Family Healthcare Outpatient Clinic: Catholic Charities of Orange, Sullivan & Ulster; Cornerstone Family Healthcare; Orange Regional Medical Center; Restorative Management Corp. Outpatient Rehabilitation: Cornerstone Family Healthcare; Regional Economic Community Action Program (RECAP) Supportive Living: Renwick Recovery Medical Managed Detox: Good Samaritan Hospital, Montefiore Nyack Hospital Inpatient Rehabilitation: Blaisdell Addiction Treatment Center, Good Samaritan Hospital Opioid Outpatient Treatment: Lexington Center for Recovery Outpatient Clinic: Bikur Cholim; Lexington Center for Recovery; MHA of Rockland County; Montefiore Nyack Hospital; Samaritan Daytop Village Outpatient Rehabilitation: Lexington Center for Recovery; Samaritan Daytop Village Community Residential & Supportive Living: Open Arms

What is the Initiation and Engagement of Alcohol and Other Drug Treatment (IET) Measure? IET measures The percentage of people in our population who initiate substance use disorder(SUD) treatment within 14-days of an SUD diagnosis. The percentage of people who initiated treatment who had at least two more SUD treatment visits within 30-days.

What Diagnosis Codes Trigger the Initiation of Treatment Measurement? Drug of Choice ICD Code Alcohol  F10 Opioids F11 Cannabis F12 Sedatives, hypnotics, anxiolytics F13 Cocaine F14 Other stimulants, including caffeine F15 Hallucinogens F16 Nicotine F17 Inhalants F18 Other psychoactive substances and multiple drug use F19

What Billing Codes Count as Treatment Visits?

Treatment Billing Codes Continued

Important Measurement Notes for Engagement The engagement measure ONLY counts services delivered starting the DAY AFTER the initiation visit. For example, if you diagnose someone, enroll them in a treatment program, and get them into a group that same day, you will not get “engagement credit.” The goal is to get the patient to RETURN to treatment after the initial enrollment. Getting a client into his/her first treatment visit on the same day as you complete the clinical assessment is still an effective method for increasing the likelihood the client will continue with treatment. Two engagement visits on the same day can occur, so long as they occur with different providers. For example, a client might receive a Suboxone injection from a Nurse Practitioner affiliated with one provider, and have his/her first inpatient session with a different clinical provider.

What are the IET Performance Benchmarks? Engagement Initiation National: 50th Percentile: 40.72% 75th Percentile: 45.13% New York State:48% Region: 48% Refuah PPS: Actual: 31.5% Goal: 57.14% CCOSU*: 67.77% National: 50th Percentile: 12.36% 75th Percentile: 16.25% New York State: 20% Region: 25% Refuah PPS: Actual: 15.75% Goal: 28.27% CCOSU*: 52.54% * This is the comparable PSYCKES measure; does not have 30/14 day threshold.

IET Best Practices if You are Not an SUD Treatment Provider Screen every client for substance use disorder Establish a Memorandum of Understanding with the licensed SUD Treatment Providers in Your Region; ideally, create a form release so that you can share data with your partners about the SUD treatment they will receive. Every time a patient receives a diagnosis indicating abuse of alcohol or other drugs, schedule a follow-up visit within 14 days. During the second visit, schedule two additional visits and/or schedule the patient to see SUD Treatment Provider within the next 14 days. Involve others who are supportive of the patient to increase participation in treatment. Listen for and work with existing motivation in patients.  Motivational Interviewing training is regularly made available through DSRIP. When making a referral, establish a protocol with the partner agency for a warm handoff. This should include the patient being present with you during the conversation with the SUD provider. The referral should be part of the discharge plan from your level of care. Many SUD providers now have peers on staff who can meet with the client at your facility, and help assure that the client makes it to his/her intake appointment at the SUD facility. Alternatively, you may be able to utilize Health Home Care Managers in to encourage the client to engage.

Using the Screening Brief Intervention and Referral to Treatment (SBIRT) Tool SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders for use in community settings. The SAMHSA SBIRT page also includes curricula, online resources, and publications designed to help implement SBIRT initiatives.  http://www.sbirttraining.com/

Use LOCADTR Tool to Establish the Appropriate Level of Care It is essential that the correct level of care be identified early in the treatment process. A referral to the wrong level of care can become a barrier to effective engagement. OASAS uses the LOCADTR tool to assess the correct level of care. OASAS peers can administer the LOCADTR to a client at your facility or offsite. Orange and Rockland County mobile mental health teams can administer the LOCADTR telephonically. Your agency can get access to the LOCADTR directly through the Health Commerce System https://www.oasas.ny.gov/treatment/health/locadtr/documents/LOCADTRaccess.pdf

IET Best Practices if You ARE an SUD Treatment Provider Focus is on Engagement and Retention! Adopt an Open Access Policy for Intake Visits Reduce Time from Assessment to First Treatment Visit (Preferably Same Day) Use Peers to Provider Reminders, No-Show Followup and Transportation Use Telemedicine Technology to Increase Availability Use Concurrent Documentation “Nothing About Me Without Me” Model Use Centralized Scheduling to Manage Clinical Calendar Integrate MAT into your treatment protocol [Disulfiram, Naltrexone, Acamprosate, Buprenorphine/Naloxone]

Questions? ???