Presentation on theme: "How Behavioral Health Organizations Can Positively Impact Communities Effected by Prescription Drug Abuse Doug Leonardo, LCSW Executive Director Tracey."— Presentation transcript:
1 How Behavioral Health Organizations Can Positively Impact Communities Effected by Prescription Drug AbuseDoug Leonardo, LCSWExecutive DirectorTracey Kaly, LMHCClinical Services Manager
2 Learning ObjectivesLearn about state/local prescription drug abuse data related to mortality rates, neonatal abstinence syndrome and pain clinic monitoring.Learn a minimum of 3 ways a behavioral health center can support their local community.Learn some of the steps needed to develop an integrated care model to provide behavioral health services onsite in specialty care sites (e.g.; pain management clinics, health clinics, primary care offices and hospitals).
3 Agenda Who We Are State and Local Data Trends Supporting Your Local CommunityBuilding an Integrated Care Model
4 Who We AreBayCare - large community-based non profit health care system in FloridaLocated in Tampa Bay RegionNetwork of hospitals and outpatient facilities22,000 team membersWe are the behavioral health service provider for the BayCare Health SystemFull continuum of adult and children's behavioral health servicesServices provided in 5 counties in Tampa Bay area
5 Addiction…a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing the development and manifestations. It is characterized by behaviors that include one or more of the following:Impaired control over drug useCompulsive useContinued use despite harmCraving(American Society of Addiction Medicine, 2001)
6 State Data 10 Year Trend Upward in Prescription Drug Abuse
7 Overdoses – Opiates and Benzo’s State DataOverdoses – Opiates and Benzo’sFloridacounties with high rates of opiateoverdosesFloridacounties with high rates of benzodiazepineoverdoses
8 State Data Hospitalizations and Emergency Department Visits for Unintentional Rx Drug Poisonings Source: Agency for Health Care Administration Emergency Department and Inpatient Hospital Datasets
9 Oxycodone Suspected Suicides 326%IncreaseJanuary 20, 2011Florida Poison Information Center Tampa
10 Oxycodone Cases 264% Increase January 20, 2011 Florida Poison Information Center Tampa
11 State Data Drug Overdose Deaths 2003 - 2009 Death rates for all substances increased with the exceptionof heroin and cocaine.Heroin decreased 62.2%Cocaine decreased 10.8%Death rates for prescription drugs increased 84.2%.7.3 to 13.4 per 100,000Substance specific death rates.Oxycodone rose %Alprazolam rose %Methadone rose %Ethanol rose %Source : MMWR July 8, 2011/60 (26);
12 Prescription Drug Monitoring Program (PDMP) Florida lacked a system for monitoring drug prescriptions until Governor Scott signed a bill into law on June 3, 2011;The law strengthens reporting requirements to a prescription drug database, increases penalties for overprescribing, tracks wholesale distribution of specific controlled substances, bans most doctors who prescribe narcotics from dispensing them and provides funding to support law enforcement and state prosecutor efforts;Attorney General Pam Bondi has made prescription drug abuse her top priority;98 of the top 100 doctors dispensing Oxycodone nationally are in Florida – concentrated in the Miami, Tampa and Orlando regions.
13 Prescription Drug Monitoring Program (PDMP) The state of Florida has established a program that will improve patient quality of care and reduce controlled prescription drug abuse and diversion.The PDMP will reduce the chances for patients to repeatedly and illegally divert prescription drugs.Overall the program will dramatically reduce doctor and pharmacy shopping.
14 Local Data - Pasco County Prescription Drug Abuse Becomes Priority Parents began calling local substance abuse coalition (ASAP) to get involved;Legislators asking for community members to get involved;Law enforcement was highlighting the prescription drug related crimes: (impaired driving, stolen property, drug trafficking, pill mills, etc.);Detoxification unit seeing unprecedented number of admissions for prescription drug dependency (specifically females aged 18 to 40);FYSAS indicated increase in prescription drug use by students;Pill mills and drug trafficking arrests increased significantly in Pasco County;Pain Management practitioner reached out to local provider and coalition to become part of the solution.
15 Local Data - Pasco County Lethal Level of Drug Present at Death According to the Medical Examiner, there were 103 deaths from Oxycodone alone in District 6, which consists of both Pasco and Pinellas Counties identified higher amounts of prescription drugs tracked by the Medical Examiner at the time of death then any other district in the State of Florida. Primary drug of choice is Oxycontin (30 mg), followed by Xanax.Pasco County is higher than Pinellas County in per capita drug-related deaths.Primary route of delivery; crushing and inhaling, followed by an equal amount of oral and injection.Approximately 80% obtain from “friends” who sell off the streets and approximately 20% steal from a parent or family member who is prescribed.
16 Local Data Pasco County Pasco County has the Highest Rates of Diagnoses of Newborn withdrawal per 1000 live births in the State of Florida. Source: DCFPinellas and Pasco Counties ranked 1 and 2 respectively in the state of Florida for the number of substance exposed newborns. Pasco saw a 2,840% increase from 5 in 2005 to 147 in 2010 and nearly doubled the from 2009 to 2010 (75 to 147 respectively). Data obtained from the Florida Agency for Health Care Administration (AHCA)
17 Local Data - Pasco County 63.2% of the 399 women ages (child bearing age) that entered treatment, reported a prescription drug as their primary drug of choice in Pasco County (BayCare Behavioral Health ).4.1% of Pasco County high school students report past 30-day use of prescription pain relievers (2010, Florida Youth Substance Abuse Survey).In 2008 in Pasco County, there were 159 ER visits for an Opioid related incident. There were 86 overdoses of Benzodiazepine and 20 overdoses involving other tranquilizers (2008 Agency for Healthcare Administration).The number of female inmates in Pasco Sheriff’s County jails that are pregnant and have substance abuse problems with prescription drugs is increasing.59% of Pasco residents feel that there is not enough enforcement of prescription drugs (2010 Pasco Alcohol Policy and Prescription Drug Use Survey).
18 Supporting Your Local Community: What Can I Do As a Provider? Gather data to prioritize the public health problem related to prescription drugs;Start a local Initiative with rapid action planning;Join learning collaboratives and list serves;Leverage grants and other funding initiatives;Educate policy makers, funders, providers, individuals, families and communities about the public health issue and advocate for policies to reduce morbidity and mortality rates;Explore with local community the recovery supports for supportive housing, activities of daily living, phone outreach, peer mentors, recovery coaches wellness centers, etc.;Focus on what happens BEFORE and AFTER primary treatment with greater emphasis on the physical, social and cultural environment in which recovery succeeds or fails;
19 Supporting Your Local Community: What We Did as a Provider Leverage collaborative initiatives to combat epidemic (coalition’s, stakeholders, specialty clinics, legislators, law enforcement, etc.).Frame your system of care with a focus on integrated care partnerships (FQHC, health clinics, primary care, specialty care clinics, hospitals, emergency departments, etc.);
20 Collaborative Initiatives In 2010 we created a Prescription Drug Initiative to address the growing number of individuals seeking treatment for prescription drug use, increased deaths related to prescription drug use, increased substance exposed newborns and the increased number of unauthorized pain management clinics in Pasco County.Focus was to review, research and make recommendations on how to address the increasing prescription drug problems within our community.Committee was composed of law enforcement, treatment providers, parents, judiciary, pain clinics and community partners.One of the recommendations from that effort was the development of a proposed innovative project to assist Pasco County in the epidemic fight against prescription drug use.The proposed project would harness six environmental strategies that would bring about community change that was adopted as a useful framework by the Community Anti-Drug Coalitions of America (CADCA).Provide Information - Enhance Skills - Provide Support - Change ConsequencesChange Physical Design - Enhance Access
22 Collaborative Initiatives Sample Description of ActivitiesProvide InformationCommunity Forums, Marchman Act training, prescription drug tool kits and social norms marketing campaign, etc.Enhance SkillsPrescriber training, parent and youth summit, student and faculty training, motivational interview training, screening and intervention training, community education, etc.Provide SupportPrescription drug information line, medication disposal pill drop boxes, Rx drug safes, etc.Change ConsequencesPain clinic best practices, pain clinic compliance, pain clinic drug screenings, enhance drug court Ambassador Program, etc.Change Physical DesignIntelligence Led Policing enforcement activities, Take Back events, etc.Enhance AccessOutreach, care management, community education, substance abuse screening tools, expanded treatment capacity, etc.
23 Integrated Care Partnerships “Integrated care is a service that combines medical and behavioral health services to more fully address the spectrum of problems that patients bring to their medical care providers.”“It allows patients to feel that, for almost anyproblem, they have come to the right place.”Alexander Blount, Ed.D.
24 Why do Integrated Care?To strengthen collaboration between behavioral health andhealth care;To reduce cost and utilization factors;To improve outcomes, access to care and engagement;To integrate population based care into system redesign;To prepare for payment reform and overall system redesign;Because with reform primary care and behavioral healthservices must be available in all clinical settings;Because behavioral health settings must have streamlinedaccess to medical services;Because all healthcare settings must have care coordinationcapability in the continuum based on case mix and severity;Because it is the right thing to do.
25 How do I get started? Building an Integrated Model Establish administrative and clinical leadership “buy-in”;Create a sense of urgency;Establish an Integrated Care Initiative;Complete an environmental scan - readiness assessment;Benchmark the perception of healthcare professionals regarding integration;Design and deploy strategically (PCP, FQHC, Hospitals, ED, Pain Clinics, etc.);Identify and address funding/financial barriers;Develop and revise business modeling/practices;Seek partners who bring needed expertise or consultation;Commit on transformation from volume to value.
26 Qualities of an Integrated Model Culturally competentStepped care approachShortened sessionsCondensed treatment pathwaysMultiple delivery formats
27 Benefits of an Integrated Model More likely to keep appointmentsTreat person where they feel comfortableFocus on preventative careOffset medical costOn site behavioral services availableBetter communicationBetter outcomesMind/body connectionWhole person approach
29 Key Findings and Challenges of Integrated Care Not one size fits all (cultural tailoring, developing common language, variance in population based needs, training, etc.);Quality outcomes and measurement are vital (future pay structure, integrated record, reliable data, etc.);Care management/coordination imperative (break down silos, use skills with care management, cross train, home based practice, patient education coaching, focus on raising health of population, etc.);Payment alignment and reimbursement is challenging (transforming from fee for service model to delivering model of brief care, internal and external barriers, minimal current state flexibility, minimal consultation reimbursement/care management/ telephone contact, pursuit of cost offset not immediate, etc.);Access and the ability to ramp immediately based on the unmet demand by primary care is urgent (physician demands, access to care, multiple primary sites, psychiatric evaluation requests, etc.);Changing the system of care is essential (finding the right staff, brief stepped care approach, pathway driven model, limited short sessions with focus on triage, group preventive care with focus on at risk patient, linkage to specialty care clinics for diversion of high risk patients, emphasis on early identification, etc.);
30 Key Findings and Challenges of Integrated Care Cultural competencies are critical (recognizing differences, assessments/screenings/interventions are appropriate, linkage to community support services, etc.);Sustainability is crucial.Data and Outcomes (integrated electronic health record, measurement moving from encounters to overall health outcomes, increased productivity for physicians, patient/family satisfaction will be driver of long term market differentiation, change in care being based on managing health of population. physician satisfaction, quality of life increased, identifying and documenting added values, payment for those of us that deliver, etc.).
31 Four Level Integration Model Staff ModelIntegrationLevel 4Deep IntegrationCo-LocatedLevel 3Basic IntegrationCo-LocatedLevel 2Basic CollaborationAt-a-DistanceLevel 1
32 ACCESS Staff Model Integration Deep Integration Co-Located Single SiteOne ReceptionOne Visit for All NeedsSpecialty Care ReferralsDeep IntegrationCo-LocatedSingle SiteSame ReceptionWarm Handoff ReferralSpecialty Care ReferralsBasic IntegrationCo-LocatedSingle SiteSeparate ReceptionOn Site Paper ReferralBasic CollaborationAt-a-DistanceSeparate Sites2 Front DoorsReferral to BH Clinic
33 SERVICES Staff Model Integration Deep Integration Co-Located 1 Prescriber1 Treatment Plan Fully IntegratedLicensed Clinician in Staff Model1 Treatment TeamPatient Prevention - Wellness GroupsIntegrated Care Manager On SiteIn Home Clinical Services AvailableIntegrated Appointment with PCDeep IntegrationCo-Located2 Prescribers with On Site Psych. Consult2 Treatment Plans with Integrated GoalsLicensed Clinician On SiteMulti Disciplinary Treatment Team StaffingPatient Prevention GroupsSame Day Appt. as Primary AppointmentReferrals Made to Case ManagementBasic IntegrationCo-LocatedBasic CollaborationAt-a-Distance2 Prescribers with Psych. Phone Consult2 Treatment Plans with Information SharingLicensed Clinician On SiteInformal On Site StaffingPatient Prevention Materials DistributedScheduled Appointments for BH On Site2 Prescribers2 Separate Treatment PlansLicensed Clinician At A DistancePhone Consultation for Staffing
34 VALUE ADDED PRACTICES Staff Model Integration Deep Integration Integrated Clinical/Critical PathwaysBrief Therapy Model and SBIRT ModelMotivational InterviewingCare Management ModelCare Manager Conducts ScreeningsTeam Monitoring Health ConditionsPsychiatric TrainingPatient Centered Medical HomeManage Multiple Chronic ConditionsDeep IntegrationCo-LocatedBasic IntegrationCo-LocatedIntegrated Clinical PathwaysBrief Therapy and SBIRT Model (4-8 sessions)Motivational InterviewingOn Site Clinician Conducts ScreeningsJoint Monitoring Health ConditionsPsychiatric TrainingBasic CollaborationAt-a-DistanceSpecialized Clinical PathwaysBrief Therapy Model ( minute sessions)Motivational InterviewingScreening Tools On Site (e.g. PHQ9, CAGE)Traditional Clinical PathwaysTraditional Therapy ModelsMotivational Interviewing