Advancing Recovery in

WVFinal Learning Session January 14-15 2010

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Advancing Recovery in WV

Nancy Deming –Valley Health Care System

Jon Kemper- Seneca Health Services, Inc.

Karen Schimmel- Westbrook Health Services

Genise Lalos- Prestera Center for Mental Health Services, Inc.

Merritt Moore- WV Bureau for Behavioral Health and Health Facilities

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Since Tucson Learning Session…

• September 2009 – ARWV Partner, Prestera Center, received a cease and desist order from WV Office of Health Facility Licensure and Certification stating that an Opioid Treatment Program (OTP) license was required to prescribe suboxone.

• 0 ARWV partners hold an Opioid Treatment Program license

• WV currently has a moratorium on licensing any new OTPs

• 9-4-09 Prestera Center stopped admitting new patients into MAT program.

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Potential for Loss• ARWV MAT programs close placing

500 people in a major health crisis without a means to get treatment and medication.

• Some people would have relapsed – some may have died.

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Toil and Trouble• Distraught consumers and

their family members stormed (called) the WV Governor’s Office, BBHHF, and the media.

• ARWV CEO’s stayed up all night...for many nights…

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DATA• In the third quarter of Year 2, the % of individuals (11%)

admitted to MAT programs was fairly consistent with second quarter numbers (12%). There was a pronounced drop in admissions during September due to the cease and desist order received by Prestera Center from the WV licensing authority- that prevented them from admitting any new patients into the program-but October numbers substantially increased.Average Percentage of New Clients Receiving Medications - by Month

0%

2%

4%

6%

8%

10%

12%

14%

Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10Months

Ave

. Per

Cen

t

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ACTIVATING LEVERS…

• Much like the Bat signal in the sky, national levers were activated-

• Inter-organizational Levers (organizations working together for the best interest of the desired outcome) as well as Regulatory Levers were consulted.

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Here comes the sun..

• September 29, 2009 Cease and Desist Order was Rescinded

• Through the AR collaborative, Local and National experts answered that bat call and rallied in support of Office Based Buprenorphine.

• Learning was had by all -WV State Leaders, MAT consumers, ARWV partners, and once again…the ARWV CEO’s slept soundly..

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• A number of very positive newspaper articles were written about the ARWV project.• A number of local and statewide talk

radio programs interviewed patients from ARWV MAT programs and their stories gave a much needed human perspective that served to compliment the data that was being discussed.

Positive Outcomes

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Most Useful Lessons• The MAT client demographic differs

from typical clientele and a different approach is needed to engage them:– Younger – More Parental involvement– Have jobs –need non-traditional

treatment hours– Interested in e-services– Pay for services and expect more

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Recipe for Continuation

• Treatment requirements too strict = more drop outs• Treatment requirements too loose= diversion of meds and relapse• Finding the “just right” recipe of tx requirements = continuation and retention

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DATA• West Virginia’s goal is to measure client

retention in their MAT programming.

The third quarter of Year 2 revealed some of the highest retention rates to date for the ARWV project. In October, 67% of the clients received at least 4 treatment services during their first 30 days of treatment. This is the highest retention to date for ARWV. In August, 51% of clients received at least 4 treatment services during 31-60 days of treatment-which was the highest retention

rate of the year for this measure

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30 day continuation

Average % Continuation for 30

0.00%5.00%

10.00%15.00%20.00%25.00%30.00%35.00%40.00%45.00%50.00%55.00%60.00%65.00%70.00%

Feb-09

Mar-09

Apr-09 May-09

Jun-09 Jul-09 Aug-09

Sep-09

Oct-09 Nov-09 Dec-09

Jan-10

Month

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60 day continuation

Average % Continuation for 60

0.00%5.00%

10.00%15.00%20.00%25.00%30.00%35.00%40.00%45.00%50.00%55.00%

Feb-09

Mar-09

Apr-09

May-09

Jun-09

Jul-09 Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Month

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90 day continuation

Average % Continuation for 90

0.00%5.00%

10.00%15.00%20.00%25.00%30.00%35.00%40.00%45.00%50.00%55.00%60.00%65.00%70.00%75.00%80.00%85.00%90.00%

Feb-09 Mar-09

Apr-09 May-09

Jun-09 Jul-09 Aug-09 Sep-09

Oct-09 Nov-09 Dec-09

Jan-10

Month

67% of clients who remained in treatment 61-90 days completed 2 or more treatment services. It appears that every three months there is a surge in client continuation rates. This is illustrated by the increase seen above in the months of April, July, and October. ARWV partners will study this information to determine what factors play a role in this continuation increase during certain months.

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More Lessons…

• AR-WV – State challenges are everyone’s challenges!– KNOW YOUR STATE’S REGULATORY

ENVIRONMENT FOR CHANGE

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SUSTAINING THE MOMENTUM

• Spread the best practice to other agencies throughout the state • Continue to work with state leaders on

process improvements• Get community stakeholders (ie, tx

community, criminal justice system, physicians, judges) invested in the treatment we provide

• Consumers are willing to pay for valuable services- tailor tx to what the consumer tells us they want (evening services, e-therapy options, etc)

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The Human Factor• Over the past two years, WV has

helped over 600 individuals achieve some level of recovery with this program – ARWV has also helped countless parents

regain the son or daughter that they had thought were lost to drugs. I don’t know what is more moving – helping the individual get into a solid recovery program or hearing the parent of that individual, holding back tears and telling you how your program saved their family.

– Wow – that is a powerful thing.

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Helping People• The project has allowed

consumers more of a choice regarding medication assisted treatment – This service had previously only

been offered through for profit opioid treatment programs (on a very limited basis) and through private physicians many of whom were not accepting new patients. 

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Offering Hope• Besides opening up capacity, the

protocol developed by the providers is a very strong one which will give consumers the best opportunity to recover from opioid dependence. – The ARWV team hopes to spread

this EBP throughout the state and extend the reach of this successful program

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Questions/Answers

For further details, contact:

Genise Lalos, M.A., LSW, CCAC-SDirector of Addictions ServicesPrestera Center for Mental Health Services, Inc.1420 Washington AvenueHuntington, WV  25704(304) 525-1522 ext 2532Genise.Lalos@Prestera.org