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Appendix III 

 

Summary of Information on 6 Areas of Detoxification Planning by DASA Providers and Other Stake Holders Work Committee

Information from DASA Providers and Other Stakeholders Work Committee On 4 Topical Areas of Detoxification Services

Section I: Quality Standards for Services Delivery
Section II: Admission Criteria for Detoxification Services
Section III: Diversion to Alternative Service Settings
Section IV: Recovery Support Services

Section – I

Quality Standards for Services Delivery

Work Committee Participants:
Joe Lokaitis, DASA; and Jacome Marco, Healthcare Alternative Systems, Inc.

DHS/DASA Detoxification Quality Standards (Licensure Requirements)

 

Along with licensure standards, organizations who provide detoxification services should also maintain excellence in the following clinical practices:

Section – II

Admission Criteria for Detoxification Services

Work Committee Participants:
Jayne Antonacci, DASA; Seth Eisenberg, Medical Director, DASA; Marco Jacome, Healthcare Alternative Systems, Inc.; David Johnson, Cornell/Abraxas; Kathie Kane-Willis, Roosevelt University; Dan Lustig, The McDermott Center; Brian Shaw, Macon County; Timothy Sheehan, Lutheran Social Services; Bruce Suardini, Prairie Center; and Ronald Vlasaty Jr., Family Guidance Centers

Admission Criteria for Detoxification
(Notes from Work Committee Meeting on 10/30/12)

 

 

 

Section – III

Diversion to Alternative Service Settings

Work Committee Participants:
Margaret Egan, Office of Cook County Sheriff (Tom Dart); Marco Jacome, Healthcare Alternative Systems, Inc.; Kathleen Kane-Willis, Roosevelt University; Marvin Lindsey, Community Behavioral Healthcare Association of Illinois (CBHA); Maureen, McDonnell, TASC; Rick Nance, DASA; Arun Pinto, Human Service Center and White Oaks; Allen Sandusky, South Suburban Council On Alcoholism & Substance Abuse; and Timothy Sheehan, Lutheran Social Services of Illinois

From Detox Cycling to Community Stabilization & Recovery

Recommendations from the Diversion to Alternative Services Group Presented to HFS & DHS/DASA on November 9, 2012

Our Responsibility

Building Systems Solutions

Goals for Patients

Goals for Systems

Understanding the Population

What we see:

Questions to Clarify Patient Needs

Note: The amount of each service needed will depend on greater data/clinical information

What is needed?

Spectrum of Care for Community Stabilization & Recovery

Addressing Behavior Change through Community Substance Abuse Services

Medication-Assisted Treatment (MAT)

Care Coordination

Community Recovery Supports

Effective Hospital Linkage Approaches

Tinley Park EDA - Early Results

Additional Recommendations

Next Steps

Section – IV

Recovery Support Services

Work Committee Participants: Maria Bruni, DASA;Jeffrey Collard, Haymarket Center (McDermott Center); Marvin Lindsey, Community Behavioral Healthcare Association of Illinois (CBHA); and Peter McLenighan, Stepping Stones, Inc.

Information on Recovery Support Services
(HFS/DASA Recovery Support Work Committee)

In May, 2009, the Journal of the American Medical Association (JAMA) published research findings confirming that the costs of providing housing and case management to chronically medically ill homeless individuals are more than offset by the reduced costs of emergency department services, inpatient hospital services, nursing home services, and other social services (Sadowski, et al., 2009). Called the Chicago Housing for Health Partnership (CHHP), the program formed in 2003 to scientifically test the efficacy of a "housing first" treatment model to improve the health of chronically ill homeless individuals. Participants who were provided housing with case management used one-third fewer inpatient hospital stays and one-quarter fewer emergency room visits than their peers who relied on the usual care system.

Research conducted by the Technical Assistance Collaborative found that in Illinois SSI monthly stipends are approximately $650, yet a typical one-bedroom apartment in the Chicago metro area rents for nearly $900 per month. If persons in permanent supported housing pay 30% of their monthly income on rent, the typical SSI recipient would pay $200 per month. Rent subsidies are not only needed, but cost effective, in reducing spending on publicly-funded health and social services.
Cost: Costs for supported housing coupled with other supportive services including case management vary depending upon the housing setting, which may include:

    Cost estimate: Supportive housing subsidies for 100 persons @ $600 per month for 12 months = $720,000.

    The recovery coaching model is an evidence-based, manual-driven, community-based recovery management program for people who have entered substance abuse treatment. The program uses recovery coaches to help people in addiction treatment acquire the resources and skills they need to sustain recovery over time.
    The Manual for Recovery Coaching and Personal Recovery Plan Development (Loveland and Boyle, 2005)--developed in Illinois through funding from the Illinois Division of Alcoholism and Substance Abuse (DASA)—incorporates the evidenced-based practices motivational interviewing, contingency management and strengths based case management which are included in the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration National Registry of Evidence Based Programs and Practices.
    Following the Manual, a recovery coach meets with clients individually at least once a week for six months, which will bridge their transition from treatment into the community, and then at least once a month for an additional six months.
    The recovery coach works individually with clients to develop a written recovery plan that outlines strategies for building recovery capital. The plan contains specific action steps to achieve goals under each domain. For example, in the area of employment and education, the client may state: "I would like a job." The client and Recovery Coach will then develop an action plan with discrete steps necessary to get a job. For each of these steps, the client and Recovery Coach will develop weekly contingency management plans to ensure that each step in the action plan are completed.
    An independent evaluation of a three-year, federally-funded, Recovery Oriented System of Care project conducted at Haymarket Center showed significantly positive outcomes. The project was implemented with 480 adult men who had already relapsed within one year of completing residential substance abuse treatment prior to enrollment in the project. The outcomes included significant decreases in substance use and mental health symptoms, high-risk behaviors for HIV, and crime; and significant increases in recovery supports and overall health. It is recommended that Medicaid reimburse programs for recovery coaching as well as case management services provided to support individuals' long-term recovery.
    Cost: The project as implemented at Haymarket Center cost $2,000 per client for the full year of recovery support. This is slightly more than half of the cost of a typical 28-day residential treatment stay at Haymarket. Estimate: Recovery Coaching for 200 individuals for 12 months ($2,000 x 200) = $400,000.

    There is a well-founded science-base for understanding alcohol and other drug dependence as a chronic, recurring brain disease (NIDA, 2010). An abundance of research has consistently shown that chronic drug use affects the brain in fundamental ways often remaining long after the drug using behavior has stopped. Using brain-imaging technologies, research demonstrates the biological basis for addiction and has provided the basis for a biopsychosocial perspective of chemical dependency. From this knowledge, it is now widely understood that for some addicted persons, medications are critical to treat drug-induced brain deficits in order to help sustain a symptom-free lifestyle and long-term recovery. In much the same way that research provided for medications development used for other chronic diseases such as hypertension, diabetes and asthma, addiction medicine is following the same course. Methadone, Buprenorphine (Suboxone), and Vivitrol are all effective medications found to be instrumental to initiating and sustaining the recovery process among individuals with histories of alcohol and other drug dependence. In terms of the length of time that patients should remain on these medications, the guidance from field of addiction medicine is for physicians to use the same considerations that would be applied to the care of patients with any other chronic disease treated with any other therapeutic regimen. That is, as with all other medications, medications used to treat addiction should be continued as long as they are effective and do not cause side effects, and as long as there is reason to believe that termination would be associated with risks to the patient.
    Cost: The cost of supporting 100 patients on Methadone for 12 months = $443,820; the cost of supporting 100 patients on Suboxone for 12 months = $600,000.