Addiction Services System Update – Delaware County

DELAWARE-MORROW MENTAL HEALTH & RECOVERY SERVICES BOARD

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Delaware Morrow Mental Health and Recovery Services

Board

Boards established in Ohio in 1968

In O.R.C 340

Designed to be the “safety net” for uninsured Ohioans to receive behavioral health care services without regard for ability to pay.

Now plan, fund, monitor and evaluate BH services across the continuum in board area.

“I have insurance…”

Funded by property tax levy and OhioMHAS and…

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What Has Changed

Behavioral Health Re-Design

Managed Care Carve In

Central Ohio Mental Health Center Closing

Addition of Syntero and Southeast to system of care

Focus on triaging of services/expansion of non-core services Urgent

Emergent

Routine

Changing the message

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What Has Changed – Opiate Hub

340.30 County hub program to combat opioid addiction.

(A) There is hereby created the county hub program to combat opioid addiction. The purposes of the program are as follows:

(1) To strengthen county and community efforts to prevent and treat opioid addiction;

(2) To educate youth and adults about the dangers of opioid addiction and the negative effects it has on society;

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What Has Changed – Opiate Hub

(3) To promote family building and workforce development as ways of combatting opioid addiction in communities;

(4) To encourage community engagement in efforts to address the purposes specified in divisions (A)(1) to (3) of this section.

(B) The program shall be administered by each board of alcohol, drug addiction, and mental health services.

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Bringing Help. Bringing Hope. Thank You.

“Week of Appreciation” taking place during the week of April 9-13, 2018.

The goal of this weeklong series of activities is to shine a light on the tremendous work going on in communities throughout Ohio to address the opiate epidemic and to specifically show appreciation to frontline workers.

This is hard work – and we know it – and yet our system has not yet adapted to the changing nature of the work intensity. This is the beginning…

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Our Message – Comprehensive Plan

Treatment is readily available. No “One Size Fits All.” Needs to look different in initial intensity, duration,

structure, form.

Treatment works. Addicted individuals recover and can live productive, healthy lives.

Addiction treatment – LE efforts – Child Protective – EMS – PCP/ED -- criminal justice interventions -- prescription monitoring and limits – harm reduction efforts – post overdose protocols – recovery supports -- all need to be working cooperatively and simultaneously.

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Salience network -- Salience networks are brain circuits that interpret our homeostatic condition. Salience is a major determinant of whether we consider a situation dangerous or not.

The brain network that evaluates internal and external stimuli to determine the urgency of our response.

Salience attribution is regulated by prefrontal cortex.

Addicts may have difficulty envisioning long term impact of their choices. “Cannot see the risk…”

Stop waiting for “Rock Bottom” – engage now

8 What We Know

Overdose Death Data

From 2000 to 2015 more than half a million people in the United States died from drug overdoses.

58,820 US soldiers were killed in the Vietnam War Delaware County

2011 – 2015 -- 77 Overdose deaths

2016 – 11 Overdose deaths

2017 – 25 Unintentional Overdose deaths

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Overdose One

Flood the “keyboard” with substances in one sitting – smoke, snort, intravenous use.

Flood the keyboard with high intensity dosage meant to be ‘extended release’ over time.

Flood the keyboard when the person fails to realize that their tolerance has diminished. After a period of inability to obtain drugs

When increasing ingestion to “chase the high.”

After a period of treatment and sobriety

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Overdose Two

Contamination is the key

No substance is pure

Marijuana has 60 separate components, e.g.

Opiates and other substances are frequently cut with fentanyl or other toxins

Fentanyl and its analogs can be 50 -100 times more powerful than morphine

Significant 2017 increase in cocaine-fentanyl overdose deaths

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The Services Bell Curve

Prevention Treatment Recovery Supports

Service Categories -- History

1 -- Treatment

2 – Recovery Supports

3 -- Prevention

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Legs of the Stool

Prescription Drug Monitoring Programs

Narcan and Naloxone distribution programs

Aggressive LE interdiction

Diversion to treatment

Expansion of Medication Assisted Treatment…

Medication diversion deterrents/Abuse deterrent formulations

Engagement of Employers – Policy, Second Chance

Technology – Recovery Apps, Bridge Devices, etc.

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Medication Assisted Treatment

Methadone

Suboxone, Vivitrol

Meant to be certain range of dose so not diverted

Originally meant to be 2 years or less in the program

Has much higher success rates when paired with counseling.

Has much higher success rates than traditional treatment programs with counseling alone.

Harm reduction?

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The Continuum of Care

Prevention Early Intervention Screening Core Clinical Services – Treatment

Individual, Group, Intensive Group,

M.A.T., WM – Acute and Ambulatory

Residential Aftercare – Recovery Supports Recovery Housing

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What Has Changed

Elevation 2011-2 – Medicaid moved to the state ODM

Expansion – 2013-4 Group 8 – eligibility expanded to the 101-138% of

federal poverty level

Modernization National Correct Coding Initiative

Electronic Records

Integration – Behavioral and Physical Health, Social Determinants of Health

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Provider Network

Helpline

Southeast Healthcare Services/COVA

Del-Mor Dwellings

Syntero

Maryhaven

Recovery & Prevention Resources (RPR)

Safe Harbor Peer Support Services

Turning Point

Jacob’s Way – Recovery Housing

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Local Updates

Assertive Outreach and Engagement

24 Hour Coverage

Location -- Community Based Response when safe and possible – will be the focus intermediate to long term

Warm Hand Offs

ED – PCP – OB -- Providers

Law Enforcement to Providers

Court System to Providers

Schools to Providers

Helpline to Providers

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Local Updates

Triage – Rapid Engagement staff Maryhaven, Southeast, Syntero

Increase in School Based Services Every school district in Delaware County has service

availability

Syntero, Maryhaven, Recovery and Prevention Resources, Helpline

All provide school based programming Delay initiation of substance use

Early intervention and crisis intervention

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Local Updates

Recovery Supports Re-Entry Peer Support

Re-Entry Inreach Services

Jail Based Treatment

Recovery Housing

Supported Employment

Housing

Trauma Competent Care

Family Support – NAMI

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HelpLine

Front Door – the Hub 24-hour crisis/hotline

Information & referral / 2-1-1

Prevention • Suicide prevention

• Sexual assault/violence prevention

• Child abuse prevention

• Too Good for Violence

• TGIF

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Maryhaven

Treatment, Recovery Supports, Prevention – Rapid Engagement Addiction treatment

• Outpatient, detox, & residential • Adults & adolescents • Some mental health services

Specialized services • Inpatient sub-acute detox • Residential treatment services adults & adolescents • MAT (Suboxone) for adults • Stable Cradle

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Recovery & Prevention Resources

Treatment, Recovery Supports, Prevention

Outpatient drug & alcohol services for adults Treatment/recovery supports/prevention Outpatient drug & alcohol services for adolescents Treatment/prevention Prevention services for children Drug Free Delaware Project Coordination

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Syntero

Child/Adolescent/Family Services Counseling

CPST

Pharmacological

Group Treatment

School Based Services

Youth and Family Crisis Intervention

Critical Incident Response Team

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Safe Harbor Peer Support Services

Recovery Supports

Peer run programs & services • Peer support groups and advocacy

• Social & recreational opportunities

• Educational & support groups

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Annie’s Outreach - Delaware

No Limits - Edison

Liberty House/Unity House

Delaware County Recovery Housing Operated by the Jacob’s Way Foundation

10 total beds/5 Men, 5 Women

Unity House for Women Funded by the Community of Grace

Liberty House for Men Funded by the DMMHRSB

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Screening -- 2018

Delaware General Health District and DMMHRSB

Grant from Ohio Department of Health Implement the SBIRT

Screening, Brief Intervention and Referral to Treatment

Billable now

Have already done some outreach into the health systems in Delaware County looking for partnerships to implement screening

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Evidence-Based Practices

Integrated Treatment Trauma Competent Care

MH/SUD/Trauma

M.A.T.

Medical Care

Peer Support

Supported Employment (SE)

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Evidence-Based Practices

Residential with longer term LOS.

Prevention Programs

Peer Supports/Recovery Housing

Permanent Supportive Housing

Housing Supports

Time frames – Rapid Engagement, ED induction of medication post overdose?, ED naloxone distribution

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Service Gaps

Addiction Care Local residential treatment

Residential Capacity

Halfway housing

Increased capacity for Recovery and Sober housing

Increase medication assisted opiate treatment services (Suboxone)

Rapid Engagement Specialists

Wait times for higher levels of care

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“In Development”

Fragmentation

Capacity for higher levels of care – access without capacity is not access

Technology supports to recovery

Crisis Services

ED induction of MAT – post overdose protocols

Collaborative Care with PCP, healthcare systems

Bringing the business community to the table

Alternative to ED/Jail for assessment

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In Closing

“Outreach is everything…”

Care when and where you need it.

All systems have to be involved and on the same page. There is no “One Size Fits All” solution.

Increase access and capacity on the front and back ends of the bell curve.

Change the message.

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