State wants to have "a person-centered approach" to rehabilitation.
Delaware has made considerable progress combating addiction and the opioid crisis impacting the nation, but a goal of the state’s Division of Public Health is to create a system that links everything together and makes it easier for people to navigate the process.
“It is easy to be reactive and just want to handle things piece by piece, but it is really important that we develop a comprehensive approach,” said Dr. Karyl Thomas Rattay, director of the state’s Division of Public Health. “It’s important that people don’t slip through the cracks when they go from one level to another. They need a strong voice to help them say ‘this is what I need for the next step of my treatment.’”
Navigating the system can be a struggle because, in addition to addiction, people might have underlying mental health issues, they may have lost their job or home, or they may be in trouble with the law. Some may need intensive help, while others may need less.
“We want to develop a person-centered approach,” Rattay said. “Where are they in their disease? Are they still working? Where are they philosophically?”
Some people entering treatment programs may need to go to a detox center first. Others might need Medication Assisted Treatment such as methadone. Still others might only need counseling and support. Making sure that people are able to transition from one level of care to the next, and that there are people available to explain the treatment options, is key to helping people recover.
Rattay said reforming the healthcare system is an essential part of creating such a comprehensive approach.
“We have this fee for service approach for services that does not support coordinated care,” she said. “Part of it is reforming the way we pay for care.”
Taking better advantage of opportunities to engage people with substance abuse disorders and get them into treatment is also important. Rattay said the Angel Program and Hero Program, which involve law enforcement guiding people into treatment, are good examples. Healthcare providers can also help.
“We want to engage people during the opportune times when they interface with the criminal justice, healthcare or EMS system,” Rattay said. “We want to capture those opportunities to better engage people into treatment.”
Once people are in treatment, ensuring there are support services to help them with any other issues they are facing can also boost recovery success rates.
“They should have peers on staff that can engage them or help them navigate the system,” Rattay said. And in transitional housing, an area where the state is looking to increase availability, Rattay said it is important that they are “making sure they support vocational skill development and helping people get back on their feet with getting a job.”
In releasing the state’s nine-point plan for moving forward in dealing with the crisis earlier this month, Attorney General Matt Denn suggested using $4 million in economic development funds as an incentive for new treatment centers.
“The state has spent economic development funds on all sorts of initiatives over the past two decades, including the expansion and maintenance of other healthcare facilities,” Denn said at the time. “Now it is time to use economic development funds to create jobs in an area where Delaware desperately needs them: substance abuse treatment.”
Other parts of the plan, including funding of better efforts to transfer people from emergency rooms and law enforcement into longer-term treatment, expanding use of opioid-reversing drug naloxone and expanding insurance coverage for pain remedies other than prescription opioids, are among the health department’s priorities.
For Rattay, changing the culture involves changing how doctors, patients and insurance companies view pain treatment.
The science surrounding pain management has become clear in the last few years, she said.
“Opioids are not effective for long term pain management, yet we prescribe a huge amount. This is going to require a culture change. There are many other approaches that are as effective or more effective. We are working on how can we make sure insurance covers things like exercise therapy, even acupuncture.”
The state has also made it easier for people to carry and administer naloxone.
“Eighty percent of overdoses happen in an individual’s home,” she said. “We want to make sure friends and family members, people living with someone with a substance use disorder, that they have naloxone.”
The state contracts with Brandywine Counseling to provide naloxone training. Classes offered in October include one in Rehoboth and another at the Del Tech Stanton campus.
Lynn Fahey, president and CEO of Brandywine Counseling, said since the program started in July 2015 they have trained more than 4,000 people. They also have a train the trainers program. Those people can then train others. People going through the program will get a two-dose kit of naloxone. Fahey said the doses are good for two years. When they expire, people can bring them back and buy more.
“The reason we collect that funding is because it goes back to the state so they can buy more naloxone,” she said.
As of July, 866 doses had been used this year. In 2015, 1,535 were used.
People who want to schedule a training session can visit Brandywine’s website -- brandywinecounseling.org -- for information. Fahey said they have conducted classes with as many as 50 people and classes with just a few people.
“If we have the staff or I can get someone there you aren’t going to get a ‘no’ out of me,” she said.
Rattay said pharmacies will soon be making naloxone available at the pharmacy counter for individuals who have had naloxone training.
Being able to tie everything together, from getting people into treatment to helping them navigate the system, changing people’s attitudes toward pain management, increasing access to naloxone and providing opportunities for those in recovery to overcome the challenges they face is how the state is looking to move forward. Winning the battle, however, takes input from all involved.
“It has to be a two-way street and we have to create this in a way that works for stakeholders as well as health providers and insurance providers,” Rattay said. “It all needs to be able to support this comprehensive approach.”
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