Addressing Unhealthy Substance Use with Older Adults Dawn Matchett,LICSW Hearth, Inc. October 20, 2014

Project Description Implementation of an evidence-based practice called SBIRT (Screening, Brief Intervention and Referral to Treatment) for reducing and preventing substance misuse. Within Hearth Housing sites With the Hearth Outreach client population

Project Significance While SBIRT has been successfully used in community health centers and primary practices, it has never been implemented in affordable older adult housing settings or targeted for the older adult homeless/previously homeless population.

Goals and Objectives of the Project 1.Increase competency/skills of Hearth outreach and direct care staff in identifying potential substance misuse/risk in clients and tenants 2.Evaluate existing agency SA assessment tools and change as needed 3.Fewer instances of eviction/tenancy loss/homelessness 4.Improved overall health of the older adults we serve 5.Enhance support systems for tenants/clients in need of ongoing substance abuse services and supports

Hearth’s mission is to end older adult homelessness. Hearth’s Mission Hearth, Inc. Outreach Program 1,600 elders placed 3,500 served (capacity to help 325 elders annually) Housing & Services 7 sites, 188 units of permanent supportive housing in Greater Boston Advocacy The National Leadership to End Elder Homelessness raises awareness about the issue

About Hearth: Outreach Program 7 food income insurance health care mental health substance abuse financial assistance legal socialization stress management crisis services food income insurance health care mental health HOUSING SEARCH and CASE MANAGEMENT PLACEMENT and STABILIZATION OUTREACH OPERATING MODEL CONNECTION Homeless Elders Safe, Affordable Permanent Housing The Hearth Outreach program has case managers who can assist homeless older adults in locating affordable housing opportunities and the social services critical to their long term housing success.

Subsidized Units Multidisciplinary Support Team Biopsychosocial Assessments and Treatment Planning Care Coordination Medication Management Crisis Management Mental Health support Relapse Support Representative Payee About Hearth: Service Enriched Supported Housing

Hearth’s Study Data In June of 2008, elderly residents of Hearth housing were surveyed to document their pathways to homelessness, their challenges and needs, and their experiences in Hearth’s service-enriched housing. 9 HEARTH Ending Elder Homelessness

Prevalence of Substance Abuse 40% of Hearth residents report a history of alcohol problems 14% name it as the key reason for their homelessness 65% of the homeless and at-risk seniors served by Hearth’s outreach team experience or have experienced substance abuse Substance misuse can lead to risk of homelessness, poor health outcomes, and affects the safety and wellness of other residents.

A Challenge for Hearth… People who work with older adults can be crucial in identifying those in need of treatment and providing appropriate interventions based on clinical need. --Kristen L. Berry, Ph.D. Research Associate Professor, University of Michigan Department of Psychiatry & Associate Director, Department of Veterans Affairs National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC)

What is SBIRT? A comprehensive, low-cost, integrated, public health approach to the delivery of early interventions and treatment services for persons with unhealthy substance use, as well as those who are at risk of developing substance use issues.

SBIRT S creening Universal, annual, 2-3 initial questions that identify unhealthy substance use – For those who screen positive, further assessment is needed to determine level of risk

SBIRT B rief I ntervention Provides feedback about unhealthy substance use. It also focuses on education, increasing patient insight and awareness about risks related to unhealthy substance use, and enhances motivation toward healthy behavioral change.

SBIRT R eferral to T reatment Helps facilitate access to addiction assessment and treatment for those with more serious problems.

The Project to Date 1.Hearth reviewed current SA assessment tools and made some revisions to simplify the questions asked. – CAGE-AID and single question alcohol screening assessment tools were added to our current assessment forms to allow staff to better assess tenant/client risk for substance misuse 2.Provided 9.5 hours of training to 24 Hearth staff on the use of Motivational Interviewing – Staff attend one 1.5 hour introductory MI training and SBIRT overview and four 2 hour MI trainings

The Project to Date cont. 3.Staff have been provided with an SBIRT training guide: SBIRT: A Step-By-Step Guide published by the Massachusetts Bureau of Substance Abuse Services

18 What we have learned so far…

Successes 1.Staff found the Motivational Interviewing trainings to be helpful. – They feel they have new skills to have more effective conversations with residents/clients about changing unhealthy substance use behaviors – They feel equipped to have conversations with clients/residents to increase their motivation to change unhealthy behaviors

Motivational Interviewing Not a Wrestling Match …

Motivational Interviewing … But a Dance

Successes cont. 2.Staff have found clients/residents more receptive to having conversations about substance misuse. 3.Staff have been able to connect residents/clients with SA supports to reduce the risk of negative consequences related to unhealthy substance use.

Learning Experiences 1.Cultural and Language barriers 2.Lack of age appropriate treatment referrals 3.Motivating staff to approach conversations differently with residents and clients and to use the new “tools” they have been given 4.SBIRT doesn’t work for everyone – Individuals with cognitive decline – Individuals with certain mental health diagnoses

Learning Experiences cont. 5. Challenges within the organization - Staff turnover - Staff time

Where Do We Go From Here 1. Sustainability is a key objective to this project – Hearth staff continue to work with the SBIRT training staff to provide on going “booster” trainings to staff in house and in the community – Hearth clinical staff are in the process of developing a Hearth specific SBIRT training/resource manual

Where Do We Go From Here… 2. Redesign Substance Awareness Group (SAG) at Hearth – Secure funding to support a substance abuse specialist position 3. Have conversations with the Massachusetts Bureau of Substance Abuse Services regarding lack of services

Contact Information Dawn Matchett, LICSW Director of Behavioral Health T: Hearth, Inc Washington Street Boston, MA