Bill Wendt, JD, CAC IIICEO/General CounselSignal Behavioral Health Network

BJ Dean, MA, LACProgram Manager Arapahoe House

Ron Gowins, BS, CACIIISubstance Use Disorders Services Team LeaderDenver Health, Outpatient Behavioral Health Services

Presenters

Medication Assisted Therapy: Vivitrol – donation from Alkermes

In-roads with State Medicaid office – helping providers enroll and increase billing

State looking to fund MAT for 1st time

Child welfare contracts willing to add Vivitrol and NRT

Medication Assisted Therapy: Signal and providers now have a relationship with a

pharmacy (ADMHN) and experience with billing, shipping and storage

Signal purchased Vivitrol – 1st time we have reimbursed providers directly for MAT other than Methadone

Piloting collection of data on use of MAT – plan is to add to the State’s data collection system.

Detox Continuation: Daniels’ Fund grant to continue the work of AR Provider Performance Monitoring System (PPMS) pays

detox providers who meet continuation rate requirements Statewide implementation of detox/DUI protocol Culture change regarding role of detox – from just

monitoring intoxication/withdrawal to central point of intervention

Colorado Division of Behavioral Health is developing better reporting on detox continuation.

Social Detox Greatest Accomplishments Most Useful Lessons Mechanisms to Sustain Change Efforts Impact of Your Work in the Communities

BJ Dean, MA, LACProgram Manager Arapahoe House

Colorado funds non-medical detoxification

Providing over 40,000 episodes of care per year

Monitoring mild to moderate withdrawal

Referrals from Law Enforcement, Hospitals and ESP Van (Emergency Services Patrol)

Tripling and even quadrupling continuation rates

Baseline continuation from 1/08 through 10/09 would have resulted in 646 clients entering treatment after detox → Due to AR change project, 2,017 clients have entered treatment through 10/09 (312% increase)

70-80% of clients who leave with an appointment show up for continuing care

Increased referral resources from 20 to 150 (educating staff on options for clients)

Teaching staff to use Motivational Interviewing to help clients to see benefits of ongoing care

Changing the role and perception of what happens in detox to more of a clinical focus

Partnerships with outside providers (warm hand offs, on-line scheduling, coming on site to meet with clients on the WEEKENDS, calling partners and leaving messages so they can follow up with the client)

Staff Incentives (recognition awards, food-pizza party, cash, gift cards)

Cultural shift in detox from clerks to clinicians (the significant role we can play in ongoing care and developing skills to be successful)

Partnerships with DUI providers, State Judicial (Probation), and Division of Behavioral Health around the referral processes

Contractual incentives from Signal

Getting clients into treatment earlier (EBP the closer treatment is to the event the better the outcomes)

Taking continuing care protocol statewide (Spring 2010) @ state’s annual detox training

Incentives initiative → Provides incentives for improved continuation to all detox facilities in Signal network (35 counties)

STARS Project (Strengthening Treatment Access Retention Systems) funded by local foundation → Will bring a change leader academy to Colorado in March 2010

Greatest Accomplishments Most Useful Lessons Mechanisms for Sustainability Human Impact

Ron Gowins, BS, CACIIISubstance Use Disorders Services Team LeaderDenver Health, Outpatient Behavioral Health Services

Baseline was zero use of naltrexone at the 3 participating providers → Increased to average of 20.2 patients receiving naltrexone each month (1/09 – 10/09)

Integration of naltrexone screening into standard assessment → Average of 64 patients screened each month

Culture change – Over 100 staff trained on the efficacy of naltrexone

Patient satisfaction – Over 90% of patients receiving naltrexone reported it being extremely helpful

Following NIATx processes, able to identify and overcome internal barriers

Saw implication of using change process for other areas that need change

Bringing the right players together brings about change

Cost of MAT remains significant barrier

Worked with HCPF to receive Medicaid benefit

Ongoing education of Physicians/Psychiatric Residents – doctors who will continue to use naltrexone in the future

Improved relationship with Child Welfare to support MAT

Worked with DBH to increase likelihood of future MAT availability

Laid foundation for future MAT availability in Colorado Networking of major treatment providers in the Denver

Metro area Case study

Alcohol Dependent/Bipolar Mood Disorder HIV/HCV patient Homelessness Unemployed Using 1-1.5 gallons of whiskey per day Started Vivitrol and decreased use to 4-5 beers per day 3-4

days per month for first few months, now abstinent, compliant with HIV/HCV treatment, transitional housing, employed

Questions/Comments?

For additional information contact:

Ron Gowins, BS, CACIIISubstance Use Disorders Services Team LeaderDenver Health, Outpatient Behavioral Health ServicesEMAIL: ronald.gowins@dhha.orgPHONE: 303-436-6413

BJ Dean, MA, LACProgram Manager Arapahoe HouseEMAIL: bjdean@ahinc.orgPHONE: 303-412-3946

Erik StoneDirector of Compliance and Quality ImprovementSignal Behavioral Health NetworkEMAIL: estone@signalbhn.orgPHONE: 720-263-4853