native center for alcohol research and education (ncare ......webinar series introduction. this...

This research is supported by the National Institute on Alcohol Abuse and Alcoholism under Award Number P60AA026112

Native Center for Alcohol Research and Education

(NCARE)Webinar Series Introduction


Welcome!


• Institute for Research and Education to Advance Community Health (IREACH) and Partnerships for Native Health Overview

• Webinar Presentation: Transitions to Recovery Webinar with Dr. Patricia Valverde, Callie Noomah, and Riley Witte

• Q&A

Agenda


IREACH

Institute for Research and Education to Advance Community Health

We challenge the status quo and advance community health through partnerships and collaboration.


IREACH

Native Hawaiian and Pacific Islander Health

Kaïimi Sinclair (Western Cherokee)

Partnerships forNative Health

Lonnie Nelson (Eastern Band

Cherokee)

Rural Health and Health Networks

Justin Denney

Latino Health

Anna Zamora-Kapoor

Addictions

Michael McDonell

College ofMedicine

College ofNursing

College ofPharmacy

College ofEngineering & Architecture College of

Communication College ofVeterinary Medicine


• Community-based research and education to improve health and reduce health disparities among American Indians, Alaska Natives, Native Hawaiians, and Pacific Islanders

• Achieving health equity• Community outreach and

engagement• Training and education• ~160 partners: tribal colleges,

Native organizations, tribes, and universities

Partnerships for Native Health


The center aims to optimize alcohol intervention research for public health in general and our Native community partners in particular. We accomplish this goal by collaboratively engaging with Research Project teams and the Pilot Projects to conduct research that yields high-quality data while simultaneously meeting the unique needs of our partners.

IREACH.WSU.EDU/NCARE

Native Center for Alcohol Research and Education


Transitions To Recovery (TTR) (RP 3)

NCARE Webinar, October 30, 2019

Presenters:Patricia Valverde PhD MPH, Co-InvestigatorCallie Noomah BA, Study Site Coordinator

Riley Witte BA BS, Patient Navigator


Session Flow

• Snapshot of our participants• Background of the need for patient navigation• Transitions To Recovery (TTR) study

description• Challenges• Lessons Learned• Conclusion


Story

• Johnny is a 43 year old male from rural Alaska who has been experiencing homelessness in Fairbanks. He drinks 2 liters of vodka a day, has high blood pressure and Hepatitis C, as well as experiencing symptoms of depression and anxiety.

• Because of his alcohol use, Johnny has been unable to stay in housing or receive consistent treatment for his medical conditions.

• Johnny's social supports are mainly individuals he camps with; he is unable to return to his home village for legal reasons and is not in touch with his family, although he says that there is so much history of trauma there he "wouldn't want to be in touch anyways."


Transition to Recovery

SignificanceAlcohol Use:• Alaska Native People (20%)

of population, 50% of alcohol treatment admission in state

• Alcohol 4th leading cause of death in the Interior

FNA Detoxification:

• 40% readmitted within a year

• 2% transition to sub-stance abuse treatment yearly



FNA Gateway to Recovery• Medical detoxification for adults• 1 to 10 days, average LOS 3 days • From 2011-2015, 5 years, approximately 1200

unique admissions



FNA Behavioral Health Services• Ralph Purdue Center

• 45 day residential treatment program, 10 bed• Outpatient

• OP/IOP, 8 week, 30 patients• Women and Children Center for Inner

Healing• Long term residential treatment program• Pregnant women or women with children up to

age 7


Aim 2 of 3 study aimsAdapt Transition to Recovery to fit the GTR patient population and test its effectiveness in increasing successful transition to post-detoxification treatment and preventing readmission.

• Everyone receives 1 session of MI to enhance substance abuse treatment entry or readiness

• Half receive patient navigationsto reduce barriers to treatment entry



Transition to Recovery Participant Study Flow



Motivational Interviewing Session

After consenting and administering the surveys the Patient Navigator builds rapport and begins to get an idea of the participant’s goals.

About 10-15 minutes in, the first set of scales (readiness, importance, and confidence) are asked. The session from there is dictated based on whether they are high motivation, ambivalent, low motivation for starting treatment in the next 30 days.

At the end, the scales are asked again.


Begin by asking permission and if the present moment is convenient for the

participant

Revisit study and PN role

Assess status since last visit, support for

any challenges encountered

Assess Treatment Rulers: Readiness,

Importance, and Confidence

Review progress made towards goals

Use MI skills to enhance motivation, provide affirmations, emphasize strengths

and change talk

Make a new Action Plan or revise existing plan;

Reassess Rulers

Make a plan for next follow up

appointment

Patient Navigation Sessions


Consumer Story- Dealing with Burnt Bridges


Scheduling Assessments

IdentifyingResources

Supporting Consumers

Discussing Barriers

Making Action Plans

Examples of Patient Navigation Activities


Patient Navigation In Action

• Cynthia is a 64 year old female who lives in Fairbanks where she has been experiencing homelessness for the past three years.

• She has a history of a stroke 1 year prior and multiple falls where she has hit her head, and has attended residential treatment multiple times.

• Staff at these facilities state that she sits quietly and listens but does not speak or engage in groups and as a result they are unwilling to admit the consumer.


• Develop rapport with Cynthia in MI session and explore intrinsic motivations around drinking. Cynthia says she is concerned about her health as she is aging and she knows that she will “end up six feet under” if she can’t stop drinking.

• Advocate for the consumer with the treatment center and they agree to accept the consumer if she first attends a higher-level (ASAM 3.7) treatment facility where she can get a neurocognitive assessment.

• Arrange travel- learns that Cynthia’s Medicaid has lapsed. PN accompanies Cynthia on her next discharge and they do the Medicaid paperwork and interview together at the Public Assistance Office.

• Communicate with Cynthia’s adult children, who are supportive of her attending treatment although cautious about getting their hopes up. PN supports the consumer calling his children.

• Arrange Medicaid travel and accompany Cynthia to the airport to ensure a “warm hand-off.”

Patient Navigation In Action


Navigating Consumers with Chronic Homelessness

Poor physical and mental

health

HomelessnessSubstance Abuse


Preliminary Data

• Date of launch: June 17th 2019• Data as of October 22nd• Recruitment: 56• Potentially eligible: 168 admissions• Reasons for ineligibility:

• 63 already in study, • 20 left AMA, • 12 too high level co-morbidities, • 11 were enrolled in treatment already, • 2 had a discharge destination of jail.


% to treatment:

25%

% in treatment & return to

detox: 14%

% return to Detox:

43%

% to treatment within 30

days: 16%

MI + PN: 27

Total enrollment

54MI only:

27

Preliminary Data


Challenges

• Challenges with operationalizing eligibility criteria

• Integration into existing staff structure at detox center

• Delineation of PN vs detox staff roles• Scope creep

• Transportation of consumers- value of MI/PN• Inability to compensate consumers at

enrollment (in conflict with local practice)• Enrollment of consumers- often not feeling well

while at detox center


Lessons Learned

• Transitioning communication style from baseline survey mode to motivational interviewing mode

• Explanation of study arms• Staff would prefer all consumers receive navigation• Consumers understand RCT design

• We found it is possible to teach a clinically-trained, non-behavioral health staff to conduct Motivational Interviewing!

• Even when consumer says ‘no’ multiple times, he/she may still enroll later → motivation really does increase and decrease quickly


Conclusion

• Despite the challenges faces, we are successfully implementing an innovative intervention that assists consumers who face daily challenges with substance use and social needs.

• Implementation of a navigation program requires a site champion, constant communication, review of navigation role, and identification of community resources to help reduce the range of barriers faced by this consumer population.

• We must show humility and be cognizant of historical trauma experiences, cultural beliefs and range of cultural identification.


Thank YouQuestions & Answers

Thanks to Spero Manson PhD, Principal Investigator,Ursula Running Bear PhD, Co-Investigator & responsible

for protocol development and implementation, Erin Poole, Study Manager

native center for alcohol research and education (ncare ......webinar series introduction. this...

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