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