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Practical Solutions to Prescribing Medication Assisted Treatment

MAT & Centers of Excellence—Making theRight Connections For Client Success

Jaime Bernard, MS, LCDP Linda Mahoney, CAADC, CCS Associate Administrator, Substance Abuse & Administrator, Behavioral Health &Program Development Substance Use Disorder ProgramsProject Director, Federal MAT-PDOA Grant Department of Behavioral Healthcare, Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH)Developmental Disabilities and Hospitals State of Rhode Island | Cranston, RIState of Rhode Island | Cranston, RI RI State Opioid Treatment Authority

Rhode Island Department of Health Academic Center

Jointly Provided By

Rhode Island Department of Health Academic Center Public Health Grand Rounds

Supported by the CDC Prescription Drug Overdose Prevention for States Grant Academic

Center

Program Release: December 18, 2019Expiration Date: December 18, 2021Estimated time to complete: 30 Minutes There are no prerequisites for participation.

Method of Participation and How to Receive CME CreditThere are no fees for participating in and receiving credit for this activity.• Review the activity objectives, faculty information, and CME information prior to participating in the

activity.• View the CME presentations• Complete the CME activity evaluation and post-test at the conclusion of the activity. • A passing score of 75% must be achieved in order to receive a credit certificate.

Target AudiencePhysicians, Physician Assistants, Nurse Practitioners and other Healthcare Professionals

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Privacy Policy: The Office of Continuing Medical Education (CME) and its educational partners protect theprivacy of personal and other information regarding participants and educational collaborators. The CME Office maintains its Internet site as an information resource and service for physicians, other health professionals, and the public. The CME Office will keep your personal information confidential when you participate in a CME Internet-based program. CME collects only the information necessary to provide you with the services that you request.

Disclaimer: This educational program is designed to present scientific information and opinion to healthprofessionals, to stimulate thought, and further investigation.

Disclaimer and Privacy Policy

MAT & Centers of Excellence—Making the Right Connections For Client Success

This activity has been planned and implemented in accordance with the accreditation requirements andpolicies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Warren Alpert Medical School of Brown University and the Rhode Island Department of Health Academic Center. The Warren Alpert Medical School is accredited by the ACCME to provide continuing medical education for physicians.

Credit DesignationPhysicians: The Warren Alpert Medical School of Brown University designates this live activity for a maximum of 0.5 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Rhode Island Specific: This program qualifies for 0.5 hour CME Credit in Opioid Pain Management / Chronic Pain Management, one of the

required areas of section 6.0; 6.2.1 Rhode Island CME re-licensure requirements. This training meets the requirements set forth in RI Regulation 3.14 Prescriber Training Requirement for Best

Practices Regarding Opioid Prescribing. This specific training requirement is required only once & must be completed before renewal of controlled substance registration or two (2) years (whichever is longer).

Other Health Professionals: Participants will receive a Certificate of Attendance stating this program is designated for 0.5 hour AMA PRA Category 1 CreditTM. This credit is accepted by the AANP, AAPA, and RI Pharmacy re-licensure.

CME Accreditation

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In accordance with the disclosure policy of the Brown University CME Office as well as standards set forthby the Accreditation Council on Continuing Medical Education (ACCME), speakers have been asked todisclose any relevant financial relationship with the manufacturers of any commercial products and/orprovider of commercial services discussed in any educational presentation and with any commercialsupporters or exhibitors of this activity

The intent of this policy is not to prevent a speaker with a potential conflict of interest from making apresentation but to identified openly so that the listener may form his/her own opinion. Any potentialconflicts of interest have been resolved prior to this presentation.

This activity may include discussion of off-label or investigative drugs uses. Speakers are aware that it istheir responsibility to disclose to the audience this information. Individual Faculty Disclosure informationmay be found in the conference handouts.

Faculty Disclosure

MAT & Centers of Excellence—Making the Right Connections For Client Success

Faculty Disclosure/Conflict of InterestThe following Speakers* and Planning Committee members have indicated that they have no relevant financial relationships to disclose:

MAT & Centers of Excellence—Making the Right Connections For Client Success

Jaime Bernard, MS, LCDP*

Associate AdministratorSubstance Abuse & Program DevelopmentProject Director, Federal MAT-PDOA GrantDepartment of Behavioral Healthcare, Developmental Disabilities and HospitalsState of Rhode Island | Cranston, RI

Lauren Conkey, MPH

Overdose Prevention Outreach ManagerRhode Island Department of Health | Providence, RI

Jennifer Koziol, MPH

Drug Overdose Prevention Program AdministratorRhode Island Department of Health | Providence, RI

Linda Mahoney, CAADC, CCS*

AdministratorBehavioral Health & Substance Use Disorder ProgramsDepartment of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH)State of Rhode Island | Cranston, RIRI State Opioid Treatment Authority

James V. McDonald, MD, MPH (Course Director)*

Chief Administrative OfficerBoard of Medical Licensure and DisciplineRhode Island Department of Health (RIDOH) | Providence, RI

Maria Sullivan, BS

Director, Continuing Medical EducationWarren Alpert Medical School of Brown UniversityProvidence, RI

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Obtain Credits/Certificate

MAT & Centers of Excellence—Making the Right Connections For Client Success

Please complete the Post-Test and Survey upon conclusion.

A passing score of 75% is required for credit.

If you have any questions regarding this activity, contact the Office of Continuing Medical Education at 401-863-2871 or CME@brown.edu

At the conclusion of this session, attendees should be able to:

1. Access information to professional & community resources for individuals and family members effected by opioid use disorders

2. Find easy access to Recovery Support services, including how to hire and bill for peer recovery specialist to assist with engagement and retention issues

3. Identify RI “Centers of Excellences” and how they can assist in handling complex opioid disorder cases

Learning Objectives

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RI Department of Behavioral Healthcare, Development Disabilities & Hospitals

Division of Behavioral Healthcare

Linda Mahoney Administrator II

State Opioid Treatment Authority

Jaime Bernard, MS COE Project Manager

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Practical Solutions to Prescribing Medications To Assist with Treatment & Recovery

Rhode Island Department of Health Academic Center Public Health

Grand Rounds Event

September 26, 2019

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Goals

1. Learning ways to utilizing Certified Peer Recovery Specialist to support your practice

2. “Centers of Excellences”, a referral support system designed for the complex specialty cases

3. BH LINK- Emergency Behavioral Health Crisis support-Mental Health & SUD

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Certified Peer Recovery Specialists

What is a CPRS?

A CPRS is a trained & certified individual or family member who has lived experience with mental illness and/or addiction, who provides strengths based support to people in recovery.

How do you become a CPRS?

Step 1: Complete 46 Hours of peer specialized Training

Step 2: Complete 500 Hour/Supervised Internship Program

Step 3: Pass the International Certification & Reciprocity Consortium (IC&RC) Peer Recovery (PRS) Exam

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2007 2020

Today

2007 2009 2011 2013 2015 2017 2019

First SUD PRS Training by CCAR

First Mental Health PRS Training by Yale/Mead

BHDDH Begins Certifying Mental Health Peer Recovery Specialists

RI Certification Board Begins Certifying SUD PRS

BHDDH ends Mental Health PRS Certification

BHDDH Begins Integrated MH and SUD PRS Training through PSN

RI Certification Board changes SUD PRS Certification to certify MH and SUD PRS

BHDDH delivers first PRS Supervisor Training through PSN

PRS Supervisor Training Goes Online!

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Baseline surveys from individuals being assisted by Peer Recovery Specialist

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76.62%

63.10%

83.17%

71.43%

65.32%

57.76%59.74%

46.88%

40.46%

79.59%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Percentage of Responses which show an improvement from Baseline Survery to Followup

Currently Employed Decrease in Arrests Anchor Helped in Recovery Decrease in Alcohol Use Decrease in Drug Use

Living Arrangement Decrease in MH Hospitalizations Decrease in Medical Hospitalizations Anchor Helped with Abstaining Recovery Coaching Utilized

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Rhode Island Peer Based Recovery Support Services

1) Are all clients eligible to receive peer recovery services?

2) What exactly will Medicaid pay for?

3) How do Primary Care offices become paid providers of Peer Based Recovery Support Services?

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Who is eligible for the service?

18 years of age or older

Medicaid eligible and has a need for recovery support services

Has a Mental Health or Substance Use Disorder Diagnosis

The individual is not enrolled in any service in which CPRS is already provided as part of a bundled rate

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What exactly will Medicaid reimburse for?

Peer Recovery Services

Individual services $13.50 per 15 mins

Group- Per Member/Per Group

Evidence Based Structure group ( Life skills etc..)

Recovery activity group ( Building Recovery Capital event)

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How do Primary Care sites become certified to offer peer based recovery support services?

Agency has to apply for a BHDDH certification & approval to be reimbursed for peer services.

BHDDH staff to assist each agency in the process.

Standards and Medicaid Peer Based Recovery Billing Manual:

www.eohhs.ri.gov/ProvidersPartners/ProviderManualsGuidelines/MedicaidProviderManual/PeerRecoveryServices.aspx

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Centers of Excellence19

This Photo by Unknown Author is licensed under CC BY

“Long-Term Treatment

with medication, in

combination with

counseling, is without a

doubt the most effective

treatment available for

Opioid Use Disorder”

Dr Adam Bisaga, M.D. Professor of

Psychiatry, Columbia University

Medical Center

On August 4, 2015, Governor Raimondo

issued Executive Order 15-14 to

established a task force to create a strategic plan.

A Center of Excellence (COE) is a specialty referral center that utilizes evidence-based practices to provide treatment and coordinate care for individuals with moderate to severe Opioid Use Disorder that utilizes a multidisciplinary team, including peer recovery supports.

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COE Standards

A Coe must offer at least 2 of the 3 FDA approved medications: Methadone, Buprenorphine (Suboxone) and Naltrexone (Vivitrol) for the treatment of OUD.

Ensure timely access within no more than 48 hours.

Provide access to all support services for example, psychiatry, counseling, smoking cessation, pain management, and case management.

Referral capacity must be ongoing, coordinated and build collaboration between provider and COE.

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COE Standards (Cont.)

A COE shall provide a referral back to community based providers within 6 months.

A COE can continue outpatient and recovery support services to individuals, transferred to the community or continuing with office based Buprenorphine treatment or Health Home services.

A COE must support readmission and re-stabilization of individuals who have relapsed or are experiencing crisis.

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Example:“ CODAC’s” 12 week Pain Solutions

Strategic approaches to the treatment of chronic painDeveloped to meet the needs of individuals with chronic pain, pain that has

persisted for over six months.

Program consists of:Biopsychosocial assessmentGroup meetings that focus on patients relationship with painPain assessment/education about chronic pain & SUD by Dr Frank SporadeoBody Therapy including therapeutic massage, acupuncture and chiropracticMental Health Counseling & Psychiatric evaluations, relapse prevention plans

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Goals

Continue to grow reciprocating relationships with community, DATA-waivered providers and other treatment providers

Continue to grow relationships with Emergency Departments (EDs)

Provide community education about the utilization of MAT in OUD treatment and how it benefits the recovery process.

Engage provider communities in addressing stigma, the primary barrier to treatment intervention and care.

Engage families/partners in the process of Medication assisted recovery.

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Center Of Excellence Locations

• CODAC - (401) 461-5056~

• Community Care Alliance – (401) 235-7120 ~

• Care New England Recovery Center - (844) 401-0111

• The Journey to Hope, Health & Healing Center - (877) 400-4673 ~

• Lifespan Recovery Center – A Program of RI Hospital Center of Excellence ~ (401) 606-8530

BH Link (414-LINK)Hotline and Triage Center

BH Link - Mental health or substance use crisis

Emergency Department Diversion

18 years or older

24/7 access (call, walk-in, drop-off)

Services

Crisis management and stabilization, psychiatric consultation, clinical assessment, peer support, mobile crisis response, care management, emergency medication prescribing, skilled nursing

System navigation, connections to treatment and recovery support, connections to recovery housing, continued engagement and connection to follow-up services,

975 Waterman AveEast Providence, RI 02914

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BH Link Services

Behavioral Health crisis response by (BHDDH) Horizon Health Partners with three major components:

Physical location triage facility: • 24/7 face-to-face assessments, phone screening and triage• Nursing and psychiatric assessments• Recovery support (provided by peers) and case management• Transportation and linkage related to post-stabilization services• Recovery house eligibility and application

Hotlines: Suicide hotline: (800-273-8255) State warm line: (942-STOP)Mobile capacity: Two vans

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Quality of service is priority at BH LINK!Services include: nursing assessments, psychiatric

assessments, medications, stabilization, connection

to treatment, and access to peer services and case

management.

These percentages are

consistent with historical

trends at BHDDH. Many

individuals may have

cooccurring conditions.

All of these individuals would have

utilized the emergency

department. A proportion of these

individuals may have been

admitted into an in patient level of

care. Through BH LINK, individuals

are diverted from the emergency

department and receive person-

centered care.

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Continued Resources…

www.preventoverdoseri.org

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Obtain Credits/CertificatePlease complete the Post-Test and Survey upon conclusion.

A passing score of 75% is required for credit.

If you have any questions regarding this activity, contact the Office of Continuing Medical Education at 401-863-2871 or CME@brown.edu