Identifying and Treating Substance Abuse in Healthcare Students

1. Identifying, Treating and Providing Aftercare for HealthcareStudents with Substance Abuse American College Health Association University of the Sciences In Philadelphia June 5, 2010

2. Presentation by: • George Downs, PharmD, • Professor and Dean Emeritus • William Cunningham, PhD, • Dean of Students • Paul Furtaw, Psy.D., • Director, Student Health and Counseling • Kathie Simpson, RN, • Executive Director-SARPH • Kevin Knipe, MSW, LSW • Program Manager, Professional Health Monitoring Program Commonweath of Pennsylvania, Department of State

3. “We have NO actual or potential conflict of interest in relation to this educational activity or presentation”

4. GETTING ‘AT RISK’ STUDENTS HELP • Identification of the Student • Substance Abuse Policy Initiation • Evaluation • Post Evaluation Disposition • Aftercare • Return From Leave Actions

5. Identification of the Student • Legal issues • Student arrested • DUI • Licensing (State Board or SARPH learns of student) • Positive drug screen from experiential learning site

6. Identification of the Student • -Academic evaluations • -Behavioral issues (absenteeism, • Interpersonal conflicts, etc) • -Academic conduct violation (i.e. cheating, peer reports) • -Grades

7. Identification of the Student • Classmates and roommates of students • Need to get them more willing to aid friends without the fear of retaliation by student or institution (develop Good Samaritan Policy). • Self referral • Concerned faculty, employers, staff • SARPH initiated referral

8. Identification of the Student • SEIRT (Student Early Intervention Response Team) • Committee of staff/faculty that evaluates students who demonstrates impaired functioning; inquiries can be made to other staff/faculty about a possible problem. • Mission: To improve student retention: not limited to substance abuse; can be health (physical/mental), etc. • Team members of this institutional committee • Student Health and Counseling (SHAC) • Student Affairs (Deans, Residence Life, Conduct, Disability) • Security • Academic Advising • Associate Dean of Pharmacy (or respective college)

9. Substance Abuse Policy Initiation • Level 1 – Low risk use - Alcohol infraction • Action- Online education plus one session of SHAC counseling • Level 2 – Moderate risk use • Action- Online education plus 2-6 sessions at SHAC • If attendance inadequate, refer to Dean of Students for evaluation process • Level 3 – Severe risk use – Severe safety or health risk • Refer to Dean of Students for evaluation process • Meeting with: • Dean of Students • Dean of Pharmacy/ Academic Dean or designee • Substance Abuse Liaison

10. Substance Abuse Policy Initiation • Initiate Substance Abuse Policy • Process to determine abuse, dependency or other conditions • Student provides waiver of confidentiality • SARPH screens and selects evaluation site • Student signs waiver or is dismissed from university

11. Substance Abuse Policy Initiation • Access to confidential information • Academic Dean • Positive or negative results of evaluation • Results returned within 2-3 days • Recommendations for treatment • Confidentiality release for continued student progress and compliance • Dean of Students and Substance Abuse Liaison • Complete evaluation • Recommendation for treatment • Waiver for continued student progress and compliance • Waiver to communicate with treatment providers and SARPH • SARPH • SARPH gets evaluation report if determined as abuse or dependency • SARPH creates contract, presents to student as soon as possible. • Confidentiality release to communicate with treatment program

12. Evaluation • Dean of Students refers to SARPH for initial screen and evaluation site selection • Evaluators chosen from a list prepared by SARPH • Geared toward treatment of healthcare professionals • Drug screen conducted during evaluation • Student is responsible for cost of the initial evaluation. • Insurance usually covers the cost (USP insurance does cover initial evaluation and treatment cost). • If no insurance, student pays out of pocket for initial evaluation.

13. Evaluation • Agency evaluation expectations • Multimodal assessment • Clinical interview • Drug screen • Collateral information (obligated to seek) • Peer references • Family contact • University personnel • Indication of severity, acuity and/or diagnoses • DSM -IV diagnosis • ASAM criteria • Therapy recommendations • Student sets up appointment with Dean of Students to review the report from the evaluation • Meeting conducted within 5 working days

14. Post Evaluation Disposition • No diagnosis of substance abuse or dependency • Exit from substance abuse policy process • Behavioral issues without substance abuse or dependence • Refer to SEIRT as necessary • Confirmed substance abuse or dependency • Substance abuse treatment (i.e. acute detoxification/withdrawal from substances, residential/inpatient substance abuse rehabilitation, intensive outpatient treatment, general outpatient treatment.) • Generate contract for SARPH • Student signs as soon as possible

15. Post Evaluation Disposition • Academic Status: • Short term leave (10 days in term) • Medical leave (1-2 semesters) • Part time status (less than 12 credits) • Full time status

16. Aftercare • Treatment program: approved by SARPH • Aftercare program: SARPH • Complete abstinence • 90/90 • Random Screening • Continuing therapy • Monitoring • Reporting • Sponsor • Single Physician • Notify employer

17. Aftercare • Other issues • USP follows students while in academic program. • Students report periodically to Dean of students, appropriate academic Dean. • University is student’s employer on SARPH contract. Clerkship sites informed about student drug abuse problem or treatment status on per student/per rotation basis. • PAL creates an interface program that allows confidential communication of student progress throughout their time in school? • List of everyone on contract • Once a semester meeting with Academic Dean, Dean of Students to follow up on students • How long is follow up? • Pharmacy Students: 3 years including after graduation. • Others – until graduation. • Campus support group – letter of interest for introductions to each other – mentorship i.e. informal lunch hour – aimed at peer support

18. Return From Leave • Student must receive written approval from treatment provider and SARPH . • Review by Dean of Students/ Academic Dean • Back to school support program developed