Using Peers to Improve ED Patient Engagement and Linkage to Substance Use Disorder (SUD) Services

BACKGROUNDBACKGROUNDBACKGROUND

The prevalence of substance misuse has been a pressing issue for New York State and the

Staten Island community. A high volume of patients with substance use disorders (SUDs) have

presented to Staten Island Emergency Departments (ED), many of whom frequently returned.

While patients received the proper medical care, the challenge of engaging patients to seek

immediate treatment or recovery support still prevailed.

Through the Behavioral Health Infrastructure Project, the ED Warm Handoff Program was

created to introduce peers in the Richmond University Medical Center ED for the first time.

Peers were integrated as hospital staff to engage, educate, and advocate for patients, while

supporting clinicians to connect patients to SUD services. The program served as an

intervention to better engage patients who present with substance use needs and to link them

to an appropriate level of care in a timely manner. This initiative was launched with a six-month

pilot (November 30, 2016 to May 31, 2017) and was also supported by several infrastructural

system-level enhancements, including the expansion of treatment provider hours of operation,

a 24/7 call center and online searchable provider directory, and the growth of the peer

workforce.

PROGRAM MODELPROGRAM MODELPROGRAM MODEL

Establishing

a 24/7

call center

Placing certified recovery

coaches/peer advocates

in the Emergency

Department

Expanding

treatment

providers’

hours of operation

Conducting substance

use disorder level-

of-care in the

Emergency Department

Patient

Crisis Stabilization &

Resource/

Recovery

Recovery Coaches /

Peer Advocates SUD Treatment

Providers

Behavioral Health

Specialists

Staten Island

Connect

844-877-7828

PROGRAM OUTCOMESPROGRAM OUTCOMESPROGRAM OUTCOMES

75% 25%

Male Female

From November 2016 to May 2017,

a 13 % Reduction

in preventable ED utilization for people with

substance use disorders and other behavioral

health diagnoses

3% increase

in the initiation of SUD treatment within

14 days and engagement within

30 days after initiation

Victoria Njoku-Anokam, MPH

Director of Behavioral Health Initiatives,

Staten Island Performing Provider System

Kimberly Lewis, LCSW

Assistant Director of Social Work,

Richmond University Medical Center

Maralie Deprinvil, MPH

Coordinator of Behavioral Health Infrastructure Project,

Staten Island Partnership for Community Wellness

Marianne Howard-Siewers, MS, RN

Clinical Consultant

Staten Island Performing Provider System

Steven Chan, MPH

Coordinator of Evaluation

Staten Island Partnership for Community Wellness

WORKFLOWWORKFLOWWORKFLOW

Patient Arrival & Medical Assessment

Peer Engagement

Psychosocial & Level of Care Assessment

Appointment/Transportation Scheduling

Handoff/Escort

Follow Up

Program Oversight: Staten Island Performing Provider System, Staten Island Partnership for Community

Wellness, the Richmond University Medical Center, and the Resource Training & Counseling Center

Goal .Connect patients with substance use disorder

needs to treatment and support services in a timely manner by:

Transformed

ED Culture

of Managing

Patients with

Substance Use

Disorders and

Reduced Stigma

Among ED Staff

We really needed a

program like this for

a while now and

things are going

well.

Peer ED Medical Leadership

A chance to save a

life is stressful but at

the end of the day

to go home with a

natural smile and

feel good especially

in the emergency

room.

I’m tired of this and

you’re the only one

who's been talking

to me for 2 days

now. I'm putting my

life in your hands -

whatever you think is

best .

Patient

LESSONS LEARNEDLESSONS LEARNEDLESSONS LEARNED

Clearly defining peer’s role and collaborating with

peers as part of the ED interdisciplinary care team is

integral to a successful patient engagement and

handoff

Educating ED staff to combat stigma was necessary

for peer productivity and improved patient

experience

Hospital leadership must constantly improve workflow

and get buy in from all levels in the ED

Hospital leadership & staff should work with treatment

providers and utilize available resources to facilitate

quicker access and confirm handoffs (providers who

responded confirmed 46% of handoffs)

Effective supervision of peers and access to

continuing education is critical to support peer

professional development

Timely planning must occur with community partners

and regulatory agencies to financially sustain peer

services and improved care outcomes

PATIENT PROFILEPATIENT PROFILEPATIENT PROFILE

P4P MEASURES IMPROVEMENTP4P MEASURES IMPROVEMENTP4P MEASURES IMPROVEMENT

709

Engagements

458

Unique Patients

22%

Case Finds

PEER ENGAGEMENTSPEER ENGAGEMENTSPEER ENGAGEMENTS

PATIENT ACCEPTANCEPATIENT ACCEPTANCEPATIENT ACCEPTANCE

591

Refusals

83

Handoffs

15 % higher rate

of people that accepted and were linked

to services compared to SAMHSA*

reported national average

118

Requests

Age

Several patients refused SUD

services at time of peer

engagement but peers

educated patients and their

families about treatment and

support services.

Reasons for refusal:

They did not believe they

had a SUD

Aware of disorder, but not

ready for treatment

Already in treatment

* SAMHSA : https://www.samhsa.gov/data/sites/default/files/sr134-health-insurance-2014/sr134-health-insurance-2014/sr134-health-insurance-2014.htm

Data Sources: RUMC EDIMS Hospital ED Patient Data, RUMC Peer Engagement Logs, RUMC Care Coordination Social Worker Notes and LOCADTR Results, SI Connect Call Reports, Salient NYS Medicaid Enterprise System DSRIP Performance Module

*Based on 6 month pilot—November 30, 2016—May 31, 2017

70% of engaged patients had

alcohol-related issues

Insurance

Substance Type

327

40 19 16 9 5

50