opioid use disorder response in windham county, vt...an initiative of the windham county consortium...

An Initiative of the Windham County Consortium on Substance Use (COSU)

Opioid Use Disorder Response in Windham County, VT

10/24/2019 SVTAHEC, COSU Workforce Workgroup Lead 1

Living through an Epidemic

In 2007, the number of deaths from illicit drugs and prescription opioids in the U.S. exceeded the number of persons killed annually in the U.S. in car crashes.

By 2017, drug overdose deaths had doubled, accounting for 70,200 deaths—more than all the U.S. soldiers who were killed in the entire duration of the Vietnam War.

SVTAHEC, COSU Workforce Workgroup Lead 10/24/2019 2

Living through an Epidemic

• Between 2007 and 2017, the number of opioid-related deaths in the U.S. increased by over 150%

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Opioid Crisis in Windham

County

10/24/2019

SVTAHEC, COSU Workforce Workgroup Lead

In 2018, 21 Windham County residents died from opioid-related causes, equating to 49 deaths per 100,000. This represented by far the highest rate of such deaths among all Vermont Counties statewide—Chittenden had 14 such deaths (8.6 per 100,000).

Rate of EMS calls in Windham County involving naloxone administration per 10,000 residents was 20.6—highest in the state (VT-wide = 8.9/10,000)

Most Windham County drug-related deaths involved fentanyl, heroin, or both, along with some prescription-related fatalities

A $5 bag of heroin in NYC can sell for $10-$15 in VT; I-91 corridor provides easy access to the County for drug trafficking from MA, CT and NYC.

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Opioid Crisis in Windham

County

10/24/2019

SVTAHEC, COSU Workforce Workgroup Lead

Windham County is one of 220 counties in the U.S. identified by the CDC as being vulnerable to experiencing increases in hepatitis infection or an HIV outbreak due to injection drug use.

Windham County Syringe Services Program reported 40,000+ syringes returned, 50,000+ distributed, along with 250+ naloxone kits in 2018.

The Brattleboro Retreat reported 1,521 inpatient hospitalizations with SUD as a primary or secondary diagnosis; 331 were people with a primary or secondary opioid dependence diagnosis.

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Windham County Consortium on Substance Use (COSU)

10/24/2019 SVTAHEC, COSU Workforce Workgroup Lead

A county-wide collaboration that works across the continuum of substance use prevention, harm reduction, treatment and recovery to address the impacts of opioid and other substance use.

12 organizations and agencies—all the key players

Formed summer 2018

All members sign MOU – commit to common mission

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Windham County Consortium on Substance Use (COSU)

• HCRS: DA

• Brattleboro Retreat: MAT HUB

• HabitOpCo: MAT HUB

• Turning Point: recovery supports

• Regional Prevention Partnership: Youth Services + 4 area substance abuse prevention coalitions

• VDH Brattleboro: prevention consultant, public health

• Brattleboro Hospital and Grace Cottage Hospital: EDs, Spoke providers in practices

• Groundworks Collaborative: Supportive housing

• AIDS Project of SVT: Syringe services, prevention

• SVTAHEC: Healthcare workforce development

• VT State Police: law enforcement

SVTAHEC, COSU Workforce Workgroup Lead 7

Planning Initiative Fall

2018-Summer 2019

10/24/2019

• HRSA Rural Communities Opioid Response Program (RCORP) planning grant to carry out planning and assessment efforts:

• Strengthen organizational and infrastructure capacity of multi-sectoral consortiums

• Address death and disease associated with opioid overdoes in high-risk rural communities

• $200,000

• HCRS applicant for COSU, fiscal agent, houses project manager

SVTAHEC, COSU Workforce Workgroup Lead8

Extensive Community Assessment

• Form 6 workgroups: prevention, treatment, recovery, justice, harm reduction, workforce

• Workgroups meet monthly (weeds work)

• Research data, best practices, innovative approaches

• Workgroup leads design focus groups, surveys, community forums

• COSU meets monthly (report outs, strategy, direction)

• Voices of those most affected by SUD/OUD in forefront of conversation

10/24/2019


The root of addiction is isolation and the antidote is connection

• Many of the best practices and effective approaches prioritize connection and vulnerability.

• These approaches build trust, reduce judgement and shame and connect people with services and supports they need when they need them.

• Community conversations

• Peer recovery

• Trauma-informed practices

• Supporting families, children

• Support for first responders and providers

• Supportive housing

• Multi-sectoral approach


Focus Groups, primarily in 6 groupings

• People eligible for treatment but not currently in treatment

• People in recovery and their families

• Community supports and agencies providing justice-related programs/services (e.g. law enforcement, restorative justice)

• First responders (EMT/Rescue, Fire)

• Providers (Hub/Spoke providers, LADCs, mental health counselors, recovery coaches, etc.)

• School staff and administration (elementary school: grades 4-6)

10/24/2019


Some focus group comments…..


Families of People in Recovery: “We’re trying not to trip over hoops we have to jump through….but getting into programs can feel dehumanizing—staff are judgmental, rude, dismissive…..”

Elementary School Staff/Admin: “Home life is greatly affecting these students’ broader sense of safety. They are growing up too fast….they’re not open to wonder and kindness”

First Responders: “A person being revived with Narcan—they were sound and making judgements and chose NOT to go to treatment. This is a frequent situation…”

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Some community forum comments…..


“I hit rock bottom and went into rehab for three months. I would not have made it without my mother—she looked after my three kids, she visited me regularly in rehab…I am so much closer to her now.”

“There is so much fear out there…the public needs to understand the effects of drugs and that it’s a disease….If you’re genetically prone to addiction you can start abusing with an opiate prescription.”

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Gaps and Unmet Needs (as of May 2019)

• 99 licensed social workers in County, only 14 serve areas outside Brattleboro

• 36 drug and alcohol counselors, only half serve areas outside Brattleboro

Number and location of

substance use counselors

• 20 identified; but just 12 prescribing, 8 w/under 10 Medicaid patients fails to meet threshold for Spoke RN, LADC

• Lack of structure increases risk, liability in rural areas; stigma in community still a challenge

Number of practitioners w/DATA 2000

waiver to provide MAT

• Small providers don’t have capacity for SUD/OUD screening, care coordination

• EMR system integration cost prohibitive

Barriers to primary care-

behavioral health integration in

rural areas

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Gaps and Unmet Needs Continued…

• ED to Hub treatment; Spoke treatment to community recovery supports

Need to improve care transitions for

those with OUD

• Addressing stigma a priority for families, schools, communities, EMT, providers

Lack of compassion and support for

those experiencing SUD/OUD

• Access to naloxone, syringe services, transportation to MAT

SUD/OUD services and support

lacking in the most rural areas

• Affordable housing, food security, childcare, support from employers

People in early recovery lack

essential support

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Some potential strategies to address needs


PREVENTION:

Increase naloxone distribution sites, expand trainings

Provide community education on SUD/OUD-related stigma

Expand Mental Health Health First Aid to front-line HC staff, providers

Provide mental health and addiction care ed to medical providers

Training for allied health providers on SUD and co-occurring disorders

Embed social worker at GCH to provider mental health/addiction screening, care

Establish a new syringe service program in a rural town

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TREATMENT

MAT education and stigma reduction curriculum to 20 targeted medical providers; X-waiver training to 10 targeted providers

Embed LMHC in BMH ED to facilitate seamless transition from rapid-access MAT to Hub treatment program

Launch internship program to support students enrolled in SUD/OUD certification and/or licensure programs in VT College/Univ System

CE program for SUD/OUD providers to address gaps in local offerings

Expand peer recovery coaching, integrating treatment and recovery

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RECOVERY Expand peer recovery coaching in rural communities to allow for better access recovery support

Launch recovery doulas program to support pregnant and post-partum families in recovery

Support housing stability for at-risk households in rural affordable housing with intensive case management

Expand peer recovery coaching to support those leaving inpatient treatment

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COSU has already led to valuable collaborations

SVTAHEC, COSU Workforce Workgroup Lead 10/24/2019

Project CARE: Brattleboro Police-HCRS-Retreat-Turning Point and other agencies; social worker embedded with police to co-respond to mental health and substance abuse emergencies, make referral and supportive counseling, provide follow up

Recovery coaches embedded in BMH ED: build relationships with hospital staff, help facilitate rapid access to MAT when those with OUD are most vulnerable

Post Partum Recovery Doula Training: VDH Brattleboro-Turning Point-Winston Prouty Center for Child and Family Development pilot to support new parents affected by SUD/OUD after a birth

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What’s Next?spring 2019

Complete focus groups and assessments

summer 2019

Write OUD Response Plan, outreach to public

summer 2019

OUD Response activities with HRSA Supplemental funds

2019–2022

HRSA RCORP Implementation – fall 2019- fall 2022 (application pending)

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HRSA Supplemental Funds Targeted to Rural Windham County (April – August 2019)

• Work with community prevention coalitions in Deerfield Valley, West River Valley, Londonderry area to implement trainings for families and community members supporting recovery—e.g. understanding addiction, trauma-informed response, ACES, social determinates of health….

• Work with Turning Point to sponsor training and job shadowing for pilot “On-Call” Peer Worker initiative w/rescue in Wilmington and Londonderry areas

• Plan and implement “train-the-trainers” motivational interviewing and debriefing program for rural first responders

• Establish Pharmacists-MD dialogues in Londonderry and Deerfield Valley areas, create RAP teams and sustainability plan for groups, update Windham Rx (web site linked to resources for practitioners)

10/24/2019


opioid use disorder response in windham county, vt...an initiative of the windham county consortium...

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