Central Rockies Newsletter - June 2013

IN THIS ISSUE:

Contact Us

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ADDICTION CENTER WELCOMES ATTC

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get to know the Central Rockies Addiction Technology Transfer Center (ATTC) PHONE 801.581.8216 (Toll-free: 855.801.4237) FAX

801.587.7858

E-MAIL abbie.paxman@hsc.utah.edu

420 Chipeta Way Annex Suite 1900 Salt Lake City, Utah 84108

WEB

http://healthsciences.utah.edu/utahaddictioncenter/

NIDA AND SAMHSA BLENDING INITIATIVES working to reduce the impact of substance abuse and mental illness on America’s communities

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INTEGRATED HEALTHCARE the Weber-Midtown Wellness Clinic’s novel approach to treating substance abuse

SUBSTANCE

The Utah Addiction Center Report Volume 1 . Issue 1 . July 2013

UNIVERSITY OF UTAH

HEALTH SCIENCES

About the Utah Addiction Center The Utah Addiction Center is dedicated to the prevention, early intervention and treatment of chemical addiction and improvement of health-care related education and patient care through interdisciplinary research, student education, and health care clinical training. Staff divide their time between developing program/policy at the local, state, and nation levels; teaching and training within Utah and throughout the U.S.; and conducting applied and clinical substance use disorder research.

Abuse is PREVENTABLE Addiction is TREATABLE Recovery is POSSIBLE Non-profit Organization U.S. POSTAGE PAID Salt Lake City, Utah Permit No. 1529

420 Chipeta Way Annex Suite 1900 Salt Lake City, Utah 84108

INSTITUTIONAL ADVISORY BOARD Vivian Lee M.D., Ph.D., MBA Louis H. Callister, J.D. Edward B. Clark, M.D. M. David Rudd, PhD, ABPP Patrick Fleming, LSAC, MPA Raymond Gesteland, Ph.D. Jay Graves Ph.D. John R. Hoidal, M.D. Glen W. Hanson Ph.D, D.D.S, Maureen Keefe, RN, Ph.D Jannah Mather, Ph.D. Chris Ireland, Ph.D. John McDonnell, Ph.D. Barbara N. Sullivan, Ph.D. Ross VanVranken, ACSW Kim Wirthlin, MPA The Utah Addiction Center is based in the office of the University of Utah Senior Vice President for Health Sciences

The Central Rockies (Region 8) Addiction Technology Transfer Center (ATTC) The past few months have been exciting and challenging as the Utah Addiction Center (UAC) has assumed responsibility for administering the new Central Rockies (Region 8) Addiction Technology Transfer Center (ATTC) in partnership with the University of Iowa and the Center for the Application of Substance Abuse Technologies (CASAT) at the University of Nevada, Reno.

Our ATTC was selected to receive financial and technical support from SAMHSA and NIDA to elevate the quality of addiction treatment and recovery services by providing state-of-the-art training and academic programming activities.

Specifically, the ATTC mission is to improve throughout our region the addiction treatment workforce and their ability to address the needs of clients with substance abuse problems within their respective areas.

Collaborating with the Universities of Iowa and Nevada, Reno, our ATTC has been conducting needs assessments for the states of Colorado, Montana, North Dakota, South Dakota, Utah and Wyoming and has been working with the respective state agencies to develop and implement training sessions that help each state address its unique drug abuse issues.

surrounding institutions to help enhance strategies for addressing drug-related problems at both the personal and community levels.

While we recognize that as a new ATTC there will be frustrations and disappointments, under the leadership of Dr. Barbara Sullivan (new director of the Central Rockies ATTC), we find ourselves energized and excited about the potential of this new opportunity and look forward to partnering with the outstanding professionals who work in the substance abuse field in order to better relieve the suffering of those within Region 8 who wrestle with substance abuse disorders.

As is implied by the name, the ATTC program is about identifying important and relevant research findings that are ready to be translated into clinical practice to improve treatment outcomes. This ATTC mission integrates well with the objectives of the UAC and takes advantage of the strong drug abuse-related research at the University of Utah and Glen W. Hanson, Ph.D, D.D.S Director, Utah Addiction Center

The Central Rockies ATTC facilitates workforce development for treatment professionals by providing consultation and training on: • Evidence-based practices

NEW AT THE UTAH ADDICTION CENTER

The “Central Rockies Addiction Technology Transfer Center (ATTC)” Marjean Searcy, B.A., S.S.W.

Project Manager Central Rockies ATTC The Addiction Technology Transfer Center (ATTC) Network was established in 1993 by the Substance Abuse and Mental Health Services Administration (SAMHSA) to assist practitioners in accomplishing this goal. The ATTC Network improves the quality of addictions treatment and recovery services by connecting practitioners and other stakeholders to the latest research information.

predominantly white, female and over the age of 45. The lack of gender and age diversity is a challenge. Additionally, the survey identified the need to expand the SUD treatment professionals over the next five years. It is anticipated that the implementation of the Affordable Care Act in 2014 will result in a significant increase in the need for professionals who are able to care for individuals with SUDs in a variety of managed healthcare settings. The Bureau of Labor Research information Statistics projects that SUD comes from the National and the behavioral disorder Institute on Drug Abuse The goal of every addiction treatment treatment workforce will need (NIDA) and SAMHSA to expand by 27% nationally practitioner is to transform the lives of Blending Initiative Products by 2020. Region 8 would that were developed by people who suffer from substance abuse benefit from an increase in blending the resources providers who, themselves, disorders through prevention, intervention and talent of researchers are in recovery. Additional and community treatment and recovery. issues for the Central Rockies providers from NIDA’s Region include: inadequate Clinical Trials Network wages, benefits and promotion (CTN) and staff from opportunities; limited or inadequate clinical supervision; and SAMHSA’s Center for Substance Abuse Treatment (CSAT) loss of expertise/leadership as clinicians retire or take other ATTC Network. These materials promote the understanding jobs. and adoption of evidence-based treatment interventions by professionals in the treatment field.

As of October 1, 2012 the Addiction Technology Transfer Center (ATTC) Network Regions were realigned to better fit the current U.S. Department of Health and Human Service (HHS) Regions. Thus, the Central Rockies ATTC was created to serve HHS Region 8 – “Colorado, Montana, South Dakota, North Dakota, Utah and Wyoming.”

Region 8: Central Rockies ATTC has significant workforce development activities to accomplish. The ATTC Network Workforce Study published in 2012, “Vital Signs Taking the Pulse of the Addiction Treatment Profession,” identified the need to diversify the current workforce that is

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The Utah Addiction Center, at the University of Utah Health Science Center, received funding from SAMHSA to administer the Central Rockies ATTC. In partnership with the University of Iowa and the Center for the Application of Substance Abuse Technologies (CASAT) at the University of Nevada, Reno, the Central Rockies ATTC improves the quality of addictions treatment and recovery services by providing state of the art training, technical assistance and academic programming activities to strengthen the addiction treatment workforce and upgrade practice standards.

• NIDA/SAMHSA Blending Initiative Products • SAMHSA Initiatives The Central Rockies ATTC’s first Advisory Board meeting was conducted in February 2013 to review its five year goals. The Region is currently participating in an on-line training needs assessment. Additionally, meetings are being conducted with each Single State Agency (SSA) Director for Substance Abuse Services to develop a collaborative relationship and discuss how the Central Rockies ATTC will assist with state and regional initiatives.

Specifically, the Central Rockies ATTC is slated to deliver over 68 training and technical events to 1,400 participants annually, totaling 340 events serving over 7,000 regional

stakeholders over five years. These activities will promote increased awareness and skill development in evidence-based and promising practice by clinical supervisors and the substance use disorders treatment workforce; increased knowledge and skills among students preparing to enter the addictions treatment field; increased understanding of culturally-competent recovery-oriented systems of care; a better prepared treatment workforce to effectively treat military families and individuals affected by hepatitis, trauma, and non-medical use of prescription drugs; and increased dissemination of research findings that have been synthesized into user-friendly practice resources.

This is an excellent alignment of resources as the Utah Addiction Center is dedicated to the prevention of chemical addiction and the improvement of patient care through research, clinical training and education.

STAY

CONNECTED

Want to receive information about TRAININGS AND PRODUCTS AVAILABLE IN YOUR STATE? Join the Central Rockies ATTC email distribution list by visiting us on the web:

www.attcnetwork.org/ centralrockies or contact Rori Douros: rori.douros@utah.edu Toll free: 855-801-4237 Direct: 801-581-8967

Meet Marjean Searcy Marjean Searcy received her Bachelors of Arts from Southern Utah University and is licensed as a Social Service Worker in Utah. In March of this year, Ms. Searcy was hired by the Utah Addiction Center at the University of Utah Health Sciences as the Project Manager for the Central Rockies Addiction Technology Transfer Center - to improve and strengthen the addiction treatment workforce and upgrade practice standards. In this role, she assists the Principle Investigator by coordinating training and technical assistance events in Colorado, Montana, North Dakota, South Dakota, Utah and Wyoming. To set up an training or technical assistance please contact Marjean Searcy at 801-585-3105 or marjean.searcy@utah.edu.

Ms. Searcy has over fourteen years of experience working for Salt Lake City in the criminal justice field coordinating multi-agency projects focused on methamphetamine and pharmaceutical drug misuse and abuse. The Salt Lake City COPS Methamphetamine Initiative, a thirty agency collaborative, was initiated in 1998 and received national recognition as an effective response to the methamphetamine epidemic. The Utah Pharmaceutical Drug Crime Project, a twenty agency partnership, launched in 2008 focuses its efforts on prevention, public policy, education and enforcement. She served as the Salt Lake

City Police Department’s grant manager providing strategic planning, design, development and project management. She had the opportunity to serve as the Logistic Coordinator for the 2002 Olympics Medals Plaza and the 1999 Tornado Disaster Police Operations Command Center in Salt Lake City.

Ms. Searcy also worked in Salt Lake County’s mental health services for seven years assisting individuals with severe and persistent mental illness to obtain employment, housing and rebuild social networks through a Clubhouse model program.

She currently serves on the Utah Substance Abuse Advisory Council’s Drug Endangered Children and Prevention Committees and was a founder of a non-profit organization, the Utah Alliance for Drug Endangered Children. She is a violinist and enjoys gardening, golfing and hiking with her black lab.

Marjean brings a wealth of expertise and knowledge to the Central Rockies ATTC. Her experience with developing collaborative multiagency partnerships, training, and grant writing will ensure that the goals of the ATTC are met in Utah and throughout the six-state region.

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NIDA & Blending Initiative Products SAMHSA Buprenorphine Treatment

Opioid abuse and addiction (e.g., heroin, OxyContin) remains a critical national public health concern. To address this problem, the Buprenorphine Treatment Blending Team developed a training package to disseminate information and enhance awareness among multi-disciplinary addiction professionals about buprenorphine treatment. Products were completed in 2005.

Short-term Opioid Withdrawal Using Buprenorphine Instructs treatment providers about a unique, 13-day buprenorphine intervention for opioid dependent patients. To test its effectiveness, the NIDA CTN protocol compared this 13day buprenorphine taper intervention to an alternative treatment (clonidine detoxification) in both inpatient and outpatient settings.

In contrast with the clonidine treatment group, patients who received buprenorphine provided more opioid negative urine samples upon completion of the intervention. Products were completed in 2006.

Buprenorphine Treatment for Young Adults

in an outpatient setting. Primary results indicated that young adults in the longer term buprenorphine treatment were less likely to inject drugs or abuse opioids, cocaine, and marijuana, and were more likely to remain in treatment than those young adults who received short-term detoxification. Products were completed in 2010.

HIV Rapid Testing Recent advances in rapid HIV testing technology make HIV testing readily accessible, with fast results. Test results can be obtained onsite in as few as 1 - 20 minutes allowing individuals to receive information about their HIV status right away. This allows them to get the care they need to slow the progression of their disease and to take precautionary measures and medications that help prevent the spread of the HIV virus. This product details the findings of a recent NIDA study of rapid-testing in drug treatment clinics and provides research results, informational videos, and resources for implementing onsite rapid HIV testing. Product was completed in 2012.

Highlights the findings of the NIDA CTN study that compared longer term versus short-term buprenorphine/naloxone treatment

SAMHSA Initiatives Prevention of Substance Recovery Support Abuse and Mental Illness Partnering with people in Creating communities where individuals, families, schools, faith-based organizations, and workplaces take action to promote emotional health and reduce the likelihood of mental illness, substance abuse including tobacco, and suicide. This Initiative will include a focus on the Nation’s high-risk youth, youth in Tribal communities, and military families.

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recovery from mental and substance use disorders to guide the behavioral health system and promote individual-, program, and system-level approaches that foster health and resilience; increase permanent housing, employment, education, and other necessary supports; and reduce barriers to social inclusion.

Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA:STEP) Findings from the NIDA CTN protocol documented that MI resulted in higher retention rates during the first 28 days of treatment compared to standard interventions. This Blending Team designed empirically supported treatment products to enhance the MI skills of treatment providers and supervisory tools to fortify the supervisor’s ability to provide more structured, focused, and effective clinical supervision. Products were completed in 2006.

Prescription Opioid Addiction Treatment Study (POATS) Opioids have been used for decades to treat chronic pain; however, concerns about prescription opioid abuse have increased in recent years. Findings from a study conducted by NIDA’s National Drug Abuse Treatment CTN indicated that prescription opioid–dependent patients are most likely to reduce opioid use during buprenorphine/

naloxone treatment with relatively brief weekly medical management visits. This supports the national trend toward treatment of opioid dependence by physicians in office-based practice. This product offers information to treatment providers aimed at improving outcomes among patients treated for prescription opioid dependence.

Product was released in 2012.

Treatment Planning MATRS The Addiction Severity Index (ASI) is one of the most universally used instruments for the assessment of substance abuse and related problems. This Blending Team has completed products that include a 6-hour continuing education curriculum package addressing how to transform required “paperwork” into clinically useful information.

These products also address the key tenets of treatment objectives and interventions (Measurable, Attainable, Time-limited, Realistic and Specific) referred to as Treatment Planning “M.A.T.R.S.”.

Products were completed in 2005.

Motivational Incentives (MI) Package The MI Package assists practitioners, clinicians, and researchers in utilizing and applying Motivational Incentives for treating substance abuse patients. Products were completed in 2011.

Promoting Awareness of Motivational Incentives (PAMI) This package of tools and training resources introduces the principles behind the clinical use of motivational incentives to help patients abstain from drug use while in a treatment program.

Motivational Incentives: Positive Reinforcers to Enhance Successful Treatment Outcomes (MI:PRESTO) Motivational incentives help patients stay in treatment programs and abstain from drug abuse. MI:PRESTO is a 5-hour, self-paced online course that can help clinical supervisors design a motivational incentives program to reduce drug abuse and promote positive outcomes for patients. This program expands on concepts introduced in PAMI

Motivational Incentives Implementation Software (MIIS) This platform provides the mechanisms to assist researchers, clinicians, and counselors in utilizing and applying motivational incentives for treating patients with substance use disorders, maintaining information about clinic patients, and implementing and calculating incentives based on defined parameters. It can be used as a supplement to the MI:PRESTO program to provide in-depth information on the seven principles of motivational incentives.

SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

Military Families

Trauma and Justice

Supporting America’s service men and women - Active Duty, National Guard, Reserve, and Veteran together with their families and communities by leading efforts to ensure that needed behavioral health services are accessible and that outcomes are positive.

Reducing the pervasive, harmful, and costly health impact of violence and trauma by integrating trauma-informed approaches throughout health, behavioral health, and related systems and addressing the behavioral health needs of people involved in or at risk of involvement in the criminal and juvenile justice systems.

Health Information Technology Ensuring that the behavioral health system, including States, community providers, and peer and prevention specialists, fully participates with the general health care delivery system in the adoption of Health Information Technology (HIT) and interoperable Electronic Health Records (EHR).

Health Reform Broadening health coverage to increase access to appropriate high-quality care and to reduce disparities that currently exist between the availability of services for substance abuse, mental disorders, and other medical conditions such as HIV/AIDS.

Data, Outcomes, and Quality

Public Awareness and Support

Realizing an integrated data strategy and a national framework for quality improvement in behavioral health care that will inform policy, measure program impact, and lead to improved quality of services and outcomes for individuals, families, and communities.

Increasing the understanding of mental and substance use disorders to achieve the full potential of prevention, help people recognize mental and substance use disorders and seek assistance with the same urgency as any other health condition, and make recovery the expectation.

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highlight in INTEGRATED HEALTH CARE

OUTCOME DATA

Weber-Midtown Wellness Clinic The Weber-Midtown Wellness Clinic has improved access to preventative and physical healthcare services, promoted an on-going relationship with primary care providers, coordinated care across the system through a care coordinator, and provided wellness services and activities for clients with behavioral health disorder.

The Weber-Midtown Wellness Clinic is moving towards a certified patient-centered medical home made possible through a Primary and Behavioral Health Care Integration (PBHCI) Program grant awarded by Substance Abuse and Mental Health Services Administration (SAMHSA) on September 2010.

SAMHSA provided funding to Weber Human Services (WHS) in partnership with Midtown Community Health Center (the local Federally Qualified Health Clinic), to coordinate and integrate primary care services into their community-based behavioral health setting. Located in a wing of WHS, the newly integrated service provides seamless medical and behavioral health care to clients.

The facility is equipped with a waiting room, laboratory, and pharmacy. An Advanced Practice Registered Nurse (APRN) and clinician are available to address the behavioral health needs of the uninsured population. Additionally, peer support specialists and customer care staff are available for specialized client services.

Primary care doctors, physician assistants, a care coordinator and clinical manager provide and facilitate health and preventative screenings, immunizations, treatment for acute and chronic illness, medication management, prescription assistance, and sexually transmitted disease testing and treatment. Primary care doctors encourage their patients to set self-management goals.

Behavioral health clinicians provide daily skills development, case management, medication management, housing support and

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peer support services through evidence-based practice to include motivational interviewing, psycho-educational multi-family group therapy, dialectical behavioral therapy, and illness management and recovery.

SUCCESS STORY Andrea was exhibiting inappropriate and bizarre behaviors in the community. These behaviors resulted in exclusion by her religious congregation, which she felt to be a very important part of her life. Andrea was committed and transferred to the state hospital but experienced minimal resolution of her psychiatric symptoms.

When discharged from the state hospital, Andrea received a referral to the Weber-Midtown Wellness Clinic where she received a neurology consultation.

As of March 30, 2013, sixty-four percent (64%) of participants reported that they were healthy overall.

Seventy-one percent (71%) reported that they were not experiencing serious psychological distress – this is a twenty-seven percent (27%) improvement from baseline.

Program participants also showed the following physical health indicator improvements: A twenty-two percent (22%) improvement in blood pressure, a forty-three percent (43%) improvement with Body Mass Index (BMI), a fifty percent (50%) improvement with fasting Plasma Glucose, and a fifty percent (50%) improvement with cholesterol.

LESSONS learned • Approximately 50% of clients who “noshow” to a first primary care appointment will re-engage if called and offered a second appointment.

• Care managers for inpatient psychiatry are a great referral source.

• Behavioral health staff must “be sold” on the benefits of the clinic and have an easy process to refer clients.

• Monthly reminders/requests for referrals and a referral “cheat sheet” are of key importance.

CONTACT INFORMATION

• A “warm handoff” between the referring clinician and wellness coordinator is of great importance.

As all of our substance abuse and mental health provider’s move into implementing the Affordable Care Act, we will need to develop new ways to integrate primary care and behavioral health services.

• The layout of the clinic with integrated services in one location facilitates communication between the primary care and behavioral healthcare staff.

The Weber-Midtown Wellness Clinic has a wealth of experience that we can all benefit from. For more information about the program, please contact the Project Director Karen W Bassett at karenb@weberhs.org.

• Inexpensive brochures and recruiting materials are effective; there is no need for expensive products.

The neurologist was able to work with her to reduce her seizures and stabilize her physically. Through the collaboration of primary health and behavioral health experts, her psychiatric symptoms also began to improve. Andrea now lives in her own apartment in the community and has a full-time benefited job at a local company.

Andrea is one of many success stories that illustrate the importance of addressing both the physical and behavioral health issues.

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