Advancing Recovery in Colorado

1. Advancing Recoveryin Colorado Presenters Bill Wendt, JD, CAC III CEO/General Counsel Signal Behavioral Health Network BJ Dean, MA, LAC Program Manager Arapahoe House Ron Gowins, BS, CACIII Substance Use Disorders Services Team Leader Denver Health, Outpatient Behavioral Health Services

2. Systems Changes 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

3. Systems Changes 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.

4. Systems Changes 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.

5. BJ Dean, MA, LAC Program Manager Arapahoe House Detox Continuing Care • Social Detox • Greatest Accomplishments • Most Useful Lessons • Mechanisms to Sustain Change Efforts • Impact of Your Work in the Communities

6. Social Detox • 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)

7. Greatest Accomplishments • 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)

8. Most Useful Lessons • 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)

9. Mechanisms to Sustain Change Efforts • 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

10. Impact of Your Work in the Communities • 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

11. Ron Gowins, BS, CACIII Substance Use Disorders Services Team Leader Denver Health, Outpatient Behavioral Health Services Medication Assisted Therapy • Greatest Accomplishments • Most Useful Lessons • Mechanisms for Sustainability • Human Impact

12. Greatest Accomplishments • 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

13. Most Useful Lessons • 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

14. Mechanisms for Sustainability • 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

15. Human Impact • 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

16. Questions/Comments? For additional information contact: Ron Gowins, BS, CACIII Substance Use Disorders Services Team Leader Denver Health, Outpatient Behavioral Health Services EMAIL: ronald.gowins@dhha.org PHONE: 303-436-6413 BJ Dean, MA, LAC Program Manager Arapahoe House EMAIL: bjdean@ahinc.org PHONE: 303-412-3946 Erik Stone Director of Compliance and Quality Improvement Signal Behavioral Health Network EMAIL: estone@signalbhn.org PHONE: 720-263-4853