recovery awareness month: integrated substance use
TRANSCRIPT
Recovery Awareness Month:
Integrated Substance Use Disorder Treatment & Lived
Experience Perspectives
September 22, 2021
Quick Notes
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Agenda
12:00 PM Welcome & Introductions
12:05 PM California Correctional Health Care Services –Integrated Substance Use Disorder Treatment
12:25 PM Q&A
12:30 PM Transitions Clinic Network – Lived Experience Perspective
12:45 PM Q&A
12:50 PM Announcements
1:00 PM Thank you!
Integrated Substance Use Disorder Treatment
FROM WITHIN: THE CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION (CDCR)/CALIFORNIA CORRECTIONAL HEALTH CARE SERVICES (CCHCS)
TO COMMUNITY: TRANSITION PLANNING BEFORE, AT AND AFTER THE “GATE”
LISA HEINTZ, ISUDT PROJECT EXECUTIVE JANENE DELMUNDO, ISUDT PROJECT DIRECTORSEPTEMBER 22, 2021
Presentation Overview
Context for Change in CDCR & California
SUD is a Treatable Chronic Disease
Components of an Integrated Substance Use Disorder Treatment Program
Enhanced Pre-Release and Transition Services
Background Information
CDCR’s Institution population: 94,440
CDCR’s Parole Population: 48,045
California’s Post-Release Community Supervision (PRCS): Community Releases to 58 County Probation Departments
CDCR’s Mental Health Populations:Enhanced Outpatient (EOP) and Correctional Clinical Case Management System (CCCMS)
CCHCS ISUDT ResponsibilitiesSeptember 8, 2021
What We KnewAddiction and Trauma
The majority of incarcerated persons:
Committed offenses to meet their drug needs
Were incarcerated for an alcohol or drug violation
Committed offenses under the influence of alcohol/other drugs
Have experienced significant TRAUMA including neglect, and physical, emotional and sexual abuse (often beginning in childhood)
62-87% of incarcerated men
77-90% of incarcerated women
People who have experience trauma are:
What We KnewNationwide Opioid Epidemic
Between 2016 and 2018 overdose death rates involving prescription opioids were declining
Deaths attributable to synthetic opioids (fentanyl) increased:
From 9.0 per 100,000 population in 2017 to 9.9 in 2018, accounting for 67% of opioid-involved deaths
CDC data from 2019 show 50,963 individuals died from an opioid overdose — 70% of the total estimated drug overdose deaths that year
Preliminary CDC data from 2020 show a 29% increase in fatalities or more than 93,000 drug-related deaths - the highest ever recorded in a 12-month period
What We IdentifiedDrug Overdoses In CDCR Were Increasing – Upward Trend
Emergency Department and hospitalization claims show that overdose rates from 2016 to 2018 nearly doubled.
People Released From Prison with SUD are at least 40Times More Likely to Die of an Overdose During the
First Two Weeks after release
Patient Death Rates are Much Higher During Transition to Community asCompared With Age/Sex Matched Controls in the General Population
What We DiscoveredDeath Rates Extremely High During Transition to Community
What We KnewAbout the Science of Addiction Treatment
SUD involves the dysregulation of dopamine in certain parts of the brain.
70% of the carceral populations have a SUD
Almost 100% of those have Adverse Childhood Events (ACEs) or suffer adverse adult events by just being incarcerated over and over again.
We need dopamine to survive. It is our motivation.
Average dopamine levels range from 40 to 100 nanograms per deciliter (spectrum).
We know how much dopamine is required to get out of bed in the morning (15 nanograms per deciliter).
While addiction initially provides elevated levels of dopamine - causing an unnatural “high” - eventually the brain stops producing dopamine.
SUD IS A Treatable Chronic Disease
Dr. Corey Waller, Nationally recognized addiction expert and Chairman of the Legislative Advocacy Committee for the AmericanSociety of Addiction Medicine (ASAM).
What We Now Know at CDCR/CCHCSAbout the Science of Addiction Treatment
ISUDT Program Goals
Reduce overdoses, morbidity and mortality
Reduce recidivism and cycle of incarceration for people with SUDs
Enhance pre-release processes and successful community reintegration
Promote healthy families and communities by reducing homelessness, and enhancing employment opportunities
ISUDT Program Components
Leaving in 15-18 months
Transition to Community
Arriving to CDCR
CDCR High Risk
Initially Focus on 3 Patient Populations at Highest risk of death
From Jail on MAT
ISUDT Focus Populations
Treatment Modalities
Evidence-Based Screening and Assessments
Medication Assisted Treatment
Evidence-Based Cognitive Behavioral Interventions
Supportive Housing
Trauma Informed Care
Enhanced Pre-Release Process Current pre-release processes starting at 210 days prior to release, the ISUDT Enhanced
Pre-Release incorporates the following areas into ISUDT program participant release plans:
180 days prior to release: ASAM assessment tools to clearly define SUD needs; use data to improve programming and treatment during incarceration.
60 days prior to release
Weekly Enhanced Pre-Release Meeting
Resource RN interviews patient to determine additional medical and SUD needs
45-30 days prior to release: Coordination with county services to establish appointments; still requires additional coordination with County Transition Services to improve communication, access to services, and data exchange.
21-7 days prior to release: Resource RN reviews release plan with patient
Day of release: R&R RN provides community resource packet; educates on Naloxone to reduce risk of overdose death within 2 weeks after release, and administers Naloxone if releasing inmate accepts.
Transition Services Quality Management Goals
Patient Population Risk, Needs and Services 90% of all released inmates will receive Naloxone
85% of patients released will have an established appointment with a health care primary care provider
Transition Services Infrastructure
Harm/Risk reduction plans: Food, Clothes, Shelter, Transportation and Employment
85% of patients will have a signed Release of Information prior to release
85% of patients will have Benefit Information on file 30-days prior to release
Counties participate in Data Sharing Warehouse
CDCR/CCHCS Overdose Deaths
0
10
20
30
40
50
60
70
2015 2016 2017 2018 2019 2020
ISUDT Public Facing Dashboard
Integrated Substance Use Disorder Treatment
Bobby CardarelliCommunity Health Worker
Family Health Centers of San Diego
Using Lived Experience of Incarceration to Support Patients
with Complex Health NeedsCCJBH Recovery Awareness Month Presentation
September 22, 2021
Transitions Clinic NetworkTCN has supported 48 primary care clinics in 14 states and Puerto Rico in implementing the evidence-based TCN model of care.
TCN is a national network of communityhealth centers which employ CHWs with histories of incarceration within primary care teams to address the health ofpeople returning from incarceration.
Upcoming Events
SEPTEMBER 2021 CCJBH SUICIDE PREVENTION AND RECOVERY AWARENESS ACTIVITIES
Wednesday, September 29, 2021, 12:00-1:00 PM
FULL COUNCIL MEETINGFriday, October 29, 2021, 2:00-4:30 PM
THANK YOU FOR YOUR PARTICIPATION!