1. Family Health Center Substance Use Disorder Services
Sheila Weix, MSN, RN, CARN, Director of Substance Abuse Services
Danielle Luther, MPH, PS, Operations Project Manager
Rachel Stankowski, PhD, Operations Project Manager
Family Health Center of Marshfield, Inc.
A member of the Marshfield Clinic Health System

2. Presentation Outline and Objectives
FHC Overview
Describe FHC as a member of the Marshfield Clinic Health System and part of a nationwide network of community health centers.
Focus on Continuum of Care
Emphasize the importance of addressing substance abuse prevention, treatment, and recovery support to make a lasting impact.
Substance Abuse-Related Grants
Provide overview of diverse program funding.
Group Practice Model for Substance Use Disorder Treatment
Review care model designed to standardize care and maximize access to treatment with limited rural workforce.
Other Grant-Funded Programs
Review novel, grant-funded programming in the field of substance abuse.

3. Marshfield Clinic Health System (MCHS)
Serving rural Wisconsin since 1916
1,150 providers serve 328,000 unique patients
Clinical sites
55 clinical locations
34 communities
Integrated delivery system
Hospitals
Skilled nursing facilities
Ambulatory surgery centers
Urgent cares
Pharmacies
Clinical laboratories
Dental clinics
Alcohol and drug recovery centers
Brief description of the Marshfield Clinic Health System service area…
Transition to next: Some of these services are made possible thanks to the unique partnership of MCHS with an embedded federally-qualified health center…

4. Family Health Center of Marshfield, Inc. (FHC)
Partnered with Marshfield Clinic since 1974
Federally Qualified Health Center (FQHC) or Community Health Center (CHC)
Serving rural, underserved communities in central, northern, and western Wisconsin
Shared EHR with Marshfield Clinic
Community majority board prioritizes activities
Dental care – 2002
Substance use disorder treatment – 2016
The CHC within the larger Marshfield Clinic operation ensures, in an egalitarian way, that the wonderful services Marshfield renders to thousands in central Wisconsin and beyond include low income, publically insurance, and uninsured people. It’s remarkable.
- Dan Hawkins, Senior Vice Present for Public Policy and Research, National Association for Community Health Centers
Overlay FHC concept on top of MCHS

5. Long Term Goals and the Continuum of Care
Increase access to substance use disorder treatment across the lifespan.
Reduce the burden substance abuse places on our communities and improve health and well-being for our patients.
New Cases
Not Seeking Treatment
Seeking Treatment
Treatment Available
Treatment Not Available
Relapse
Success
In Progress
Coverage Barriers
Incidence
Prevalence
FHC has established a set of two goals that we intend to address in our work related to substance abuse
We think about the continuum of care (i.e. prevention, treatment, and recovery) in the context of these two goals and how we can impact both incidence and prevalence
As such, we think about prevention, treatment, and recovery as overlapping rather than linear
Prevention
Treatment
Recovery

6. Continuum of Care Continuum of Care Funding Siloes
Unfortunately, the continuum of care is generally thought about in a more linear fashion and as such, funds tend to be targeted for prevention, treatment, OR recovery… philosophically, we prefer not to separate these activities, but we also acknowledge the reality of the support environment and have worked hard to braid together diverse funding streams to support our programming.
Continuum of Care
Funding Siloes

7. Substance Abuse-Related Grants
Activity
Focus
Funding Source(s)
Service Area
HOPE Consortium
Treatment and Recovery
DHS – HOPE 1.0
Vilas, Forest, Iron, Oneida, Price Counties; Lac du Flambeau, Sokaogon Chippewa, Forest County Potawatomi Tribal Nations
FHC Alcohol & Drug Recovery Center – Minocqua
HRSA – Substance Abuse Service Expansion “
Study of Substance Abuse and Recovery in the Northwoods
Prevention, Treatment, and Recovery
MCRI
FHC Alcohol & Drug Recovery Center – Marshfield
HRSA –AIMS Grant
HRSA – SUDS MH Grant
(Pending HRSA – IBHS)
Marshfield Area
FHC Alcohol & Drug Recovery Center – Ladysmith
DHS – HOPE 2.0
Rusk, Barron, and Polk Counties
Comprehensive Models of Care for Women with Opioid Use Disorder
CDC via Wisconsin Association for Perinatal Care
Marshfield and Minocqua Areas
Rural Central Wisconsin Opioid Response Program Planning Project
HRSA – Rural Communities Opioid Responsive Program Planning Grant
Wood and Clark Counties
Diverse funding for robust body of work; of note, three of four HRSA grants are specific to federally qualified health centers.

8. FHC Alcohol & Drug Recovery Centers
Outpatient substance use disorder treatment
Function as group practice
Minocqua (November 2016)
Wisconsin Department of Health Services (DHS) funding to address opioid epidemic
Established HOPE Consortium – 10 partner agencies in 5 counties, 3 tribal communities
Identified lack of treatment resources
CHC-specific HRSA funds for substance use disorder treatment
Marshfield (August 2018)
Additional CHC-specific HRSA funding for substance use disorder treatment (opioid focus) and mental health
MCHS tertiary care location – easy transition between services
Ladysmith (February 2019)
Wisconsin DHS funding to address opioid and methamphetamine use disorder (HOPE 2.0)
Co-located with Indianhead Community Action Agency
109 miles
1 hr 51 min
97 miles
1 hr 47 min
94 miles
1 hr 44 min
Minocqua
Marshfield
Ladysmith

9. Reality of Rural Service Delivery
109 miles
1 hr 51 min
97 miles
1 hr 47 min
94 miles
1 hr 44 min
Minocqua
Marshfield
Ladysmith
… the majority of travel between centers takes place on two lane roads – the four lane exceptions indicated here in black.

10. Group Practice Model
Three free-standing clinics, each with at least one physician or advanced practice provider
Staffed by people from the community with electronic support
Telehealth, , and Lync messaging allow rapid communication between sites
Primary Location
Minocqua
Marshfield
Ladysmith
Satellite
Support Staff:
Appointment Coordinator
Medical Assistant
Registered Nurse(s)
Dually Credentialed Therapist(s)
Substance Abuse Counselor(s)
Care Coordinator(s)
Peer Support Staff
Patient Financial Navigator
Connection to Local Recovering Community
MD (internal medicine)
NP (neurology)
MD (addictionologist)
DNP

11. Group Practice Thrives via Telehealth
AODA Telehealth Volume by Year
2017
296
2018
460
2019 (to date)
213
Total (to date)
969
Opened November 2016
Opened February 2019
Opened August 2018

12. Enabling Services and Recovery Support
Group Practice Model
Capacity not limited to local workforce
Providers can “see” any patient managed by other providers in case of vacation or illness
Care Coordinators
Facilitate rapid intake
Support communication between service providers
Patient Financial Navigator
Reduce, eliminate, and navigate financial barriers to care
Collaborative Regional Support
HOPE Consortium
MCHS Recovery Corps
Perinatal Workgroup
Minocqua
Satellite
Ladysmith
Satellite
Co-located with Indianhead Community Action Agency
Marshfield
Primary Location
Marshfield Medical Center consult service
Perinatal Workgroup
Wood and Clark County Consortium

13. HOPE Consortium Vision Mission
Coordinated treatment and recovery support for those affected by substance use in Northwoods communities.
Mission
Build hope in communities together to overcome substance use disorders and support recovery.
Minocqua
Satellite
Ladysmith
Satellite
Highlights:
Regional TAM (vs. MAT) philosophy
Served 357 patients with 504 affected minor children in 2018
Marshfield
Primary Location
Ten regional partner agencies represent 5 counties and 3 tribes.

14. Study of Substance Abuse and Recovery in the Northwoods
Collaborative research project:
HOPE Consortium
Anthropologist and Public Health Specialist Kate Barnes, MCRI National Farm Medicine Center
Participants in recovery
Minocqua
Satellite
Ladysmith
HOPE Consortium Programming
Satellite
Marshfield
Clinicians
Care Coordinators
Recovery Coaches
Active Substance Users
Recovery Community
Researchers
Primary Location
Community Engaged Research

15. Comprehensive Perinatal Care
Minocqua
Satellite
Ladysmith
Satellite
Marshfield
Primary Location
Grant activities based on six areas of change
Perinatal workgroups in Minocqua and Marshfield
Community-based doulas with additional training in substance abuse and culturally responsive care
Currently accepting training applications
June 18 – 21 in Lac du Flambeau

16. Rural Central Wisconsin Planning Grant
Establish a consortium with multi-sector representation from across the continuum of care, including prevention, treatment, and recovery stakeholders, in the rural central Wisconsin counties of Wood and Clark.
Minocqua
One year planning grant ($200,000)
Planned activities:
Conduct detailed analysis of opportunities and gaps in substance use disorder prevention, treatment, and recovery:
Workforce
Services
Access to care
Develop strategic plans to address workforce and other gaps
Develop plans to sustain consortium and operationalize activities proposed in strategic plans after one year
Satellite
Ladysmith
Satellite
Marshfield
Primary Location

17. Let’s Discuss! Sheila Weix, Director of Substance Abuse Services
Danielle Luther, Operations Project Manager
Rachel Stankowski, Operations Project Manager