BY DEBBIE PAGE
debbiepage.iredellfreenews@gmail.com

Partners Health Management showcased two area programs during its recent Community Cafe to raise awareness of available substance use disorder treatment options.

EMS COMMUNITY SUPPORT RESPONSE TEAM

Community Peer Support Specialist Terri Blankenship said the Iredell County EMS Community Support Response Team is a group of three (soon to be four) peer support specialists, two community paramedics, and administrative support staff who offer support and referral services to people who have recently overdosed, are facing addiction, have a chronic disease like diabetes, or have had more than four EMS encounters in a year due to falls or other problems.

The team contacts referred persons within 24 to 72 hours after an overdose or referral. The community paramedic (CP) attempts to visit the home to offer services. After taking patient information, the CP may conduct a home safety assessment, wellness evaluation, check vitals, and perform other screening procedures.

The team also serves people who may not have had a recent EMS encounter but who have been referred by a family member, friend, or community member because of addiction, chronic disease, or fall dangers.

The CP helps those who have frequent falls with in-home safety assessments, fall mitigation measures, and prevention education and services. For those with chronic disease, they provide nutritional and disease management education and help with them with medication management to reduce unnecessary EMS calls and ER visits.

The community paramedics also work with frequent EMS callers by providing education and connecting these patients with primary care resources available in their area to improve their overall health.

The CP also coordinates community resources such as addiction treatment or other medical care, provides prevention education and harm reduction, assists with disease management, provides wound care, administers medication, monitors vitals, and other service needs as identified.

The peer support specialist (PSS) provides support, empowerment and connections to resources to individuals to reduce harm and lead to recovery. The PSS also educates parents on proper medication storage and the warning signs of teen substance use.

The PSS also provides family support, education and connection to community resources and grief support after a substance-related loss.

In the community, the PSS offers education and resources, builds partnerships with other agencies and organizations, participates in awareness events, offers trainings, and supports medication take-back events.

After an overdose or substance use related call, a peer support specialist attempts to contact the patient to offer support, treatment options, and other resources. They then try to set up an in-person meeting time at a comfortable location for the patient.

At the meeting, they discuss wellness and economic and social goals. The PSS, who is a person in recovery, uses his or her own personal experience with substance use disorder to build rapport and trust.

The PSS then connects the client with community resources, assists with any application processes for services or assistance, and helps clients overcome any barriers to care, including transportation, healthcare, and identification issues.

Specialists continue client follow-up for a minimum of three months, unless discontinued by the client. The PSS continuously revises the recovery plan and strategies as needed, connects the person to resources, and provides recovery support.

Before the creation of the innovative Community Support Response Team, Blankenship said one of several things happened with a drug overdose patient: EMS took the person to the ER and were offered treatment, but most declined; law enforcement administered Narcan and the person refused EMS transport; or the survived and continue using or died.

With the CSRT, patients receive in-person individual visits and support, get resources for stable housing, transportation, health care and insurance, and receive treatment options to get them on the path to recovery.

PERSONAL STORY

Blankenship shared the story of a 26 year-old mother of two children in an unsafe housing situation and with no transportation. She took opiates three to four times per day.

Her medical history revealed that she was born with a rare medical condition that necessitated multiple surgeries before age 5, and she was prescribed opiates for her medical issues. She also had family members with addiction issues.

More difficulties followed. The young girl was bullied in school, became a teen mother, and tragically lost her own mother in a car accident. She was then prescribed tranquilizers to cope with her emotional pain and anxiety.

Nine months later, she found her dad dead from an overdose after he began taking drugs to cope with his wife’s loss. She increasingly used drugs as a coping mechanism, leading to an unstable home situation, the inability to hold a job, and incarceration.

When she tried to get treatment, she faced several barriers, including no insurance. She also could not find outpatient care openings and could not enter in-patient rehab because she had to care for her children.

Her breaking point came when she lost custody of her oldest child and lost all of her possessions and her parents’ belongings, including photos and mementos of her parents.

Blankenship then revealed this journey was her own story. She is now eight years in recovery and in a great place with her family.

She said that if the Community Support Response Team had then been available, her story would be much different. They would have connected her to a primary healthcare provider, gotten her medicated assisted treatment (MAT) and peer support, provided her transportation vouchers to get to doctor and treatment appointments and run errands, and gotten her grief support.

They would have also helped her to get food, gas cards, employment, safe housing, childcare, and legal assistance. For long term help, they would have assisted her with applications for Supplemental Nutrition Assistance Program (SNAP) and Medicaid to get regular health care for herself and children.

HARM REDUCTION/JUSTICE INVOLVED INDIVIDUALS

Blankenship also touched on the CSRT’s efforts with harm reduction for those who are not ready to seek treatment and recovery.

Offers of harm reduction helps the team engage with people and open the door to plant a seed about seeking treatment options for substance use disorder. Harm reduction measures, such as needle exchange and Narcan distribution, also shows compassion and helps prevent overdose deaths and the spread of infectious diseases like hepatitis and HIV.

The CSRT’s new Medically Assisted Treatment (MAT) Bridge Program is also going to save lives. This program allows the CRST to provide suboxone, which works by binding to the same receptors in the brain as opiates and prevents cravings for drugs, to clients while waiting for the first treatment appointment.

MAT medications are safe to use for months, years, or even a lifetime in conjunction with counseling and recovery support groups.

Blankenship said those on MAT have higher treatment retention rates and are as much as
59 percent less likely to die from opioid use disorder or overdose.

MAT also helps the person to focus on their families, employment, and housing needs and reduces the spread of infectious diseases and violent crime related to those feeding their substance use disorder.

The CRST also supports justice-involved individuals as they re-enter society. Their services can help reduce recidivism rates by helping clients identify and address the issues that led to incarceration, such as lack of income and addiction.

The team can also connect the person with resources and support to lead to a happy, healthy life and empower them with employment and skills to become a contributor to the community rather than a consumer of resources.

Other supports include educating the person’s partners, children, families, and employers
on crime, substance use, and reentry challenges.

The team also supports first responders by providing 40-hour Crisis Intervention Team training to 70 paramedics so they can be an additional resource for first responders

For more information on how the Community Response Support Team can help you or someone you care for, contact Blankenship at terri.blankenship@co.iredell.nc.us.

THE SUN PROJECT

The SUN (Substance Use Project) Project is a cross-sector, collaborative system of compassionate care using best practices to support the health, safety, well-being and addiction recovery of pregnant patients battling a substance use disorder to improve both maternal and infant outcomes.

SUN is not a clinical care provider; rather it coordinates, institutes prevention measures, and provides support services through partnerships at no cost across multiple sectors and agencies to families impacted by substance use disorder.

These compassionate, non-stigmatizing, state-of-the-art prenatal care, behavioral health, and social support services help the mother in achieving optimal health outcomes and overall well-being.

Gina Hofert of the Cabarrus Partnership for Children said the SUN Project’s care coordination and support helps prevent provider stress, frustration, and burnout when caring for pregnant women with substance use disorder and minimizes duplication of services and reduces overall care costs since all care partners work jointly on collective goals.

Hofert said the project works to keep the mom in a healthy environment through a collaborative system of care with providers, the Department of Social Services, and other helping agencies through the Cabarrus Health Alliance.

Services include prenatal care by an OB/GYN with specialized training in addictions, ultrasounds, laboratory tests, and fetal monitoring, Medication Assisted Treatment (MAT) with buprenorphine, mental health and substance use therapy services provided by licensed providers, nutritional counseling, case management services, recovery supports, peer support specialist services, Women, Infants, and Children (WIC) nutrition assistance, and dental and newborn care.

To be successful, Hofert said the care must wrap around the client, addressing all the social determinants of health, including income and social status, social support, employment working conditions, physical environments, education, healthy child development, biology and genetic factors, availability of health services, and personal health practices and coping skills.

Modifying the adverse environment that contributed to the substance use disorder greatly increases the client’s chances of successful treatment and recovery for both her and the child. The team works together to provide food, safe housing, employment, and supportive services to remove other stressors and place the client’s focus on health and recovery.

The project team is made up of representatives from healthcare, children’s, public safety, and addiction and recovery services, the health department, and social services representatives that serve Cabarrus County, the totality of which can treat the needs of the whole person.

Hofert said that before the SUN Project, patients were overwhelmed navigating providers who did not necessarily collaborate and who sometimes left the patient out of communication or collaboration as well.

“Now all the providers communicate because they meet in the same space to discuss the patient’s care plan together in a patient-centered approach,” said Hofert.

The group worked with the UNC School of Government to work out legal issues concerning HIPPA regulations to allow this collaborative process.

The project has treated 40 patients so far, with no deaths and a 91 percent delivery rate at 35-plus weeks. Patient retention rate is over 95 percent, and MAT compliance is at 81 percent. Babies reached an average gestational age of just over 38 weeks.

The SUN Project program is expanding into Rowan and Stanley Counties, and Iredell County agencies also are expressing interest in the program as well. Hofert said that they are glad to share their care model with other counties to spread the success.

For more information, contact Hofert at gina@cabarruspartnership.org or visit https://www.cabarruspartnership.org/family-programs/sun-clinic.