county of santa cruz - center for care innovations · santa cruz county health services agency...

County of Santa Cruz

HealthServicesAgencyHPHP,Emeline,WHC

Santa Cruz County as Whole

Watsonville

PopulationofEthnicity

ZipCode:95076 CountyofSantaCruz StateofCalifornia

Persons %ofpopulation

Persons %ofpopulation

Persons %percentofpopulation

Hispanic/Latino 63,494 73.38% 95,074 34.17% 15,802,941 39.54%

Non-Hispanic/Latino

23,038 26.62% 183,150 65.83% 24,161,907 60.46%

Santa Cruz County Clinics WeusedtheBostonModelandmanyotherbestpracticesandadaptedittoourclinicsneeds,wedomostlyhomeinductions,withtheexceptionofsomeofficebasedinductionsasneeded.19waiveredprovidersandthecapacitytosee640+patientsandgrowing135patientsreceivingMATintheprevious6months,305patientsservedinlast3yearsPartoftheHubandSpokemodelWorkingincollaborationwithmanyagenciestodevelopbridgesfromtheER,hospitals,jails,etcWehavegivenout1,600nasaldosestoagencies,patients,andindividualsduringoutreach.SSPgivesoutabout2,000dosesofthenasalnaloxoneyearly.

GoalsforATSHparticipation:Ø  Tolearnfromeverybody'sdifferentapproachestoprovidingMATservicesØ  TocontinuetogrowourMATprogramandprovidethebestpatientcarepossible

SantaCruzCountyHealthServicesAgencyPrimaryCareClinics

MAT Team

•  JoeyCrottogini,HealthClinicManagerofHPHP•  JasmineMarozick,MATNurse,•  AngelicaTorres,CADC-CAS,BilingualSUDCM•  5prescribers

HomelessPersonHealthProject(HPHP)

• MarionBrodkey,MATNurse• GregGoldfield,CADC-CAS,SUDCM• MarissaTorres,CADCII,BilingualSUDCM• AdamEchols,RADT,SUDCM• 8prescribers

SantaCruzHealthCenter(EMELINE)

• AlejandroMonroy,CADC-CAS,BilingualSUDCM• Thiscouldbeyou,BilingualSUDCM• Thiscouldbeyou,BilingualMATNurse• 6prescribers

WatsonvilleHealthCenter(WHC)

DannyContreras,SUDCCIII–MATHealthServicesManager

EugeneSantillano,MD–MATChampionProvider

Howdoessomeonegetstarted?

Step1:Setupanintakeappointmentwithoneofour

SUDcounselors.Wewillgooverprogramrequirementsatthis

meeting.Patientwillbeaskedtosubmitspecimensfordrug

screen/bloodtests.

Step:2:PatientwillberequiredtostartattendingaMATgroupweekly.Anappointmentwitha

medicalproviderwillbescheduledafterthepatienthascompletedgroupandlabtest

resultsarereviewed.

MATWorkflow

SUDCMMATintake

LabsPre-InductionvisitwithNurse

Group/1x1Initial

appointmentwithMATprovider

Post-InitialvisitwithNurse

Followuponinductionwith

Nurse

FollowupProviderVisit

ContinueTreatment

determinedbyTier

Electronic Health Record

•  Tiers-MATpatientsareassignedatagintheEHRaccordingtothetieroftreatmentthattheyareon,whichismanagedbytheSUDCaseManager

•  CareTeam-PatientsareassignedaSUDCaseManager,MATPrescriber,PCP,Psychitarist,Therapist,asneeded.

Tagging

•  Templates–CustomtemplateswrittenbyprogrammanagerareusedbyallMATstafftostandardizedocumentation(intake,followup,group,nursevisit,etc)andguidecare.

•  Questionnaires-SBIRT,Audit,DastandPHQ2/9areadministeredanddocumentedinEHR

•  Prescriptions-ePrescribingofControlledSubstances•  Narcan–Documentedasastockmedication

Documenting

•  SUDCaseManagers-ReporttracksthenumberofpatientseachSUDCaseManagerhasandwhentheywerelastseen

•  General-Reportstrackallpatients,theircareteamandtheirBuprenorphine,Vivitrol,andNaltrexoneRx

Reporting

DocumentationinEMR

•  HealthServiceManagerworkedwithallstaffandwiththehelpofEMRsitespecialistcreatedindividualizednotetemplatesandcheatsheetsforeverypositionandvisit.

DocumentationinEMR

Program Requirements: Complete Intake and Labs Attend groups and individual meetings determined by tier and treatment team. Patients graduate from each tier by providing negative urine drug screens and adhering to your group and/or scheduled appointments with IBH Relapse: If during treatment there is a relapse, patient will return to Tier 2 level of care and more support will be provided. Appointments: It is very important that appointments are not missed. If you must miss, please call to reschedule ahead of time. Drug test: Patients will be drug tested at every visit.

Prescription Group/IBHTier1Induction(2weeks)

Weekly Weekly

Tier2EarlyTreatment(12weeks)

Weekly Weekly

Tier3Stabilization(12weeks)

Everyotherweek

Everyotherweek

Tier4Maintenance(6monthsto1year)

Onceamonth Onceamonth

Tier5Maintenance

Onceamonth Onceamonth

Making A

Transformation groups

Day Time Location

MondayMATgroup

2-3pm WHC(atrium)BuildingA

MondayMATgroup

10-11am Emeline(room#109)

TuesdayMATgroup

2-3pm HPHP(SMA)

TuesdayMATgroup

4-5pm Emeline(SMA)(room#109)

WednesdayMATgroup

6-7pm Emeline(room#109)

WednesdaySeekingSafety

5-6pm WHC(atrium)BuildingA

ThursdaySeekingSafetyinSpanish

5-6pm WHC(atrium)BuildingA

MATServices

IBH(Therapy&Psychiatry)

SyringeServiceProgram

ContingencyManagement Acupuncture

Yoga Groups/SMA1x1

PeerMentors

Outreachinthestreets

Capability Assessment: What We Learned

Incompletingtheassessment,weweresurprisedby:

Ourteam’sareasofstrength:

Continuous,fluidcommunicationinpersonandthroughEMR

Flexibilityinschedulingappointmentswithallteammembers

CaseconferencingweeklyAreasfordevelopment:

Contingencymanagement(inpilot)

Stigmainourclinics,patients,andcommunity

Collaborationbetweenhub/spokesandcountyjail,ED

Current State Assessment Weusedthefollowingmethodstolearnmoreaboutourcurrentstate:

Wespoketo:I.   Staff:ConductedduringMATSteeringCommittee,QualityManagementCommittee.Spoketo

MATteam.

II.   Patients:PatientsatisfactionsurveyrelatedtoMATprogramspecifically.

III.   Providersandstaffwelearned:NeedmorestafftrainingonMATworkflow,cultureshiftingaroundharmreduction

IV.  Frompatientswelearned:Needmoreflexiblehourstoaccommodatepatientswhowork.

V.   WereceivedthefollowingfeedbackontheappropriatenessandacceptabilityofusingMATinourclinic:PatientsgaveusveryhighmarksonaccessibilityandcomprehensivenessofourMATprogram.

VI.   Otherinsightswegatheredfromcurrentstateactivities:

Our Team Has Been Wondering . . .

Ourquestionstootherteams:

Groupvisitexperience–Structure,SharedMedicalAppointments(SMA)outcomesandpitfalls,Whatstaffisneeded?

DoyouseparategroupsorstructureforAlcoholicpatients,opiateaddictedpatients,andpatientsthatweretakingopiatesforpainbuthavecrossedovertoaddiction?

Whatareotherprogramsretentionrates?

Officehours(aretheyextended,dotheyhavegroupsafterhours)?

Whenpatientsarenon-compliant,atwhatpointarewedoingthemadisservicebykeepingthem?

Howoftenarenursevisitshappeningvsprovidervisitsandhowdoesthataffectbilling?

Ourquestionsforfaculty:

Whattodoaboutsuccessfulsuboxonepatientsthatcontinuetousemethand/oralcohol)?

Outreachstrategiesfornewpatients?

Weneedsupporttoaccomplish:

MoreAgencies,Peopleinthecommunitytobeeducatedonaddiction,stigma,harmreduction.

Advice/Guidance/Tools For Other Teams

•  Yes,theyweredevelopedoverseveralmonthsandincorporatebestpractices.

•  Needsomechampions,andstafftomakeitwork

Doyouhavepolicies,protocols,toolstoshare

withothers?

• WorkingwithindividualswhoareHomeless,Gangmembers,Re-Entry/probation/parole,Co-Occurring,Disabled,chronichealthcondition,etc.

•  Implementingcontingencymanagement,acupunctureservices,Yoga,etc.

Aretherespecificcontentareasorspecificsubpopulations

whereyourteamhasdevelopeddeepexpertiseandyoumayserveasfacultyordomore

formalsharing?