Addiction Treatment in Transforming the Behavioral Health System
uh my friend and colleague of long-standing roland lamb so i have a prepared uh remarks here but um we came up together this guy ran when i first met you you were running um let us say a challenged treatment program in west philadelphia and so challenged that they were willing to have the university of pennsylvania come in and do a science project there and uh roland ran it and made very few resources turn into something that was really special for the community and unlike almost any other uh person uh was very interested in using the results from that initial study to actually improve treatment and and make uh care better so this guy has been a collaborator and friend uh since he was uh since he was good looking and that’s a long time ago it’s very long time ago in fact that’s another era another and uh now roland with uh his colleague uh dr arthur evans uh is responsible for uh all community behavioral health and uh the office of substance abuse services probably getting the office of addiction services yeah oh yes like i said yeah be very proud because under arthur and under roland philadelphia was i do believe the first city i guess connecticut was perhaps first state but philadelphia’s first city to really move towards translating that old system into recovery oriented systems of care and that has been an effort that’s been ongoing here for the past what six seven years now i guess and it’s thanks to roland and uh and and and arthur so uh i should first say before uh uh roland begins his talk this is all thanks to a grant gotten for us by abigail woodworth an unrestricted grant to bring speakers in that we think a lot of who have taken research and turned it into something good for people which is really what we’re trying to do as well so without further ado i can’t wait to hear uh roland lamb warning let’s see let’s try that start there start start there um i am especially privileged and proud to be here i am a tri groupie it goes back to when you got on the other side of market street um and uh tom and i have known each other for a long enough time though i can say that i am a tom mclellan groupie i really have enjoyed uh our our collaboration and our working together and and i actually prepared this presentation and as usual i’m long-winded so my presentations are long-winded so if i see finally going through this pretty quickly is to get to the point or the part of this presentation that i actually have designed to intrigue you and and or even say seduce you um because there is a natural synergy between uh tri and addiction services uh this we’re just not kidding each other uh we are also um i’m also very clear about the fact that we need to align coordinate and integrate at every opportunity in fact my staff is tired of hearing me say that for the last you know eight or so years and would like to have me say something else but i had to keep on saying it because we need to find every opportunity to do that so i welcome you to the office of addiction services and this is pretty much a way from for me to say to you we are involved in a lot of things these days whether it’s throughout the city of philadelphia we oversee over 57 programs that are providers that are operating about 117 facilities that are licensed to provide drug and alcohol we also have invested heavily into developing non-licensed community-based services and then we’ll talk about that as well but what’s really important is that we need to begin to figure out how we can improve our approaches to improve outcomes and outcomes i think is a very important piece here because we we are challenged today with a population and populations that are multi-diagnosed and they are diverse we also need to begin to think about what our options are what the solutions are you know for what we have to do so we’ll kind of cover all these topics and you know as we go through this today the office of addiction services pretty much oversees all the activities i said earlier regarding drug and alcohol throughout philadelphia uh the picture you see on the side here is really the leadership of philadelphia and that’s all the people who are in recovery in this city i think the investment the first investment that we make is in the people that are in recovery in philadelphia and the fact is is that it’s those people that begin to drive it i would dare say to you that our transformation and by the way this is the 10th year of our transformation and that 10th year allows us to say we need to take a look at what we have been able to do and and one of the things that pops out to me is that right now we have a number of people who are in recovery who are ahead of the curve they are ahead of where we are they are doing some things that are very you know interesting and challenging um the office of addiction services is pretty much and this is an organizational chart from hell and um uh it’s six core areas we we’ve we come under the department of behavioral health intellectual disabilities um arthur evans is my boss dr herford oversees the behavioral health side which includes the office of addiction services and the office of mental health and under the office of addiction services you see seven uh core you know uh areas uh two of the seven are probably you can say the primary cores uh what i wanna point out to you all and i guess this is these boxes down here the idea is that we wanna make sure that all these services are seen throughout all the core functions so that means as you see service management nia techs the atr the affordable health care act we need to be making sure that all these things are happening across all of these systems and that all these systems are in turn reinforcing all of these initiatives the single county authority which is the first core is where we do our contracts is that we are the city of philadelphia you know uh foremost and we have to do contracts and whatnot but the office of the single county authority has also been the lead as far as the recovery transformation is concerned when you take a look at a lot of things that we do to support the recovery walk and by the way i want to challenge tri to bring researchers to the recovery walk this year um the one thing that we do need is is to expand the community and we had 20 000 last year i’m going for 25 000 this year these are some of the things that we do under the sca we look at grants allocations policy contracts providers and justice and injustice we have a serious uh investment in terms of funding at least eight initiatives throughout the municipal and common pleas courts on the behavioral health side the special initiative side we have a an opportunity and we actually reorganized the single county authority to be the uh conveyor of grants but the behavior special initiatives allows us to take those grants and put them under the umbrella of recovery so we just don’t use one pot of money for one thing we’re using multiple pots of money to fuel uh the idea of recovery in our system so we and as you’ll see bhsi which is the managed care for those who were underinsured or uninsured in philadelphia drug and alcohol case management i’m particularly proud of this after several blood lettings we were able to get drug and alcohol case management included as a supplemental in health choices which means that we know we’re cbh is now paying for drug and alcohol case management and that’s very significant when you consider the fact that who needs case management more than the people that we sing uh we have housing whether people know this or not we spend a great deal of resources in terms of providing recovery housing uh that’s been put in jeopardy uh over the last two years because of the the um two things one the cuts the ga cuts that came out of harrisburg which took adults off of their general assistance and then the fact that we have a state department of drug and alcohol programs that says said to us you can’t use any of our money to directly fund recovery housing for more than 90 days because they haven’t got it in their heads that somehow 90 days is a magical number and we’re but so we’re we’re pushing back and in fact i would give you all a secret the the term directly funding recovery housing has been used by me and i will take my credit for this because if anybody gets in trouble it will be me for now saying okay treatment providers i’m going to come to you and say to you i’m going to pay you for treatment recovery enhanced treatment and recovery enhanced treatments you know should include you being able to bring recovery housing to the table so i’m paying you for treatment i’m not paying for recovery housing i am paying for treatment which is right now sneaking by we have something called you know core services believe it or not we are actually taking uh services like domestic violence uh life skills literacy education training putting it in recovery houses taking it to programs putting it right into the community we’re also providing you know we’re overseeing the treatment of both adolescent adults children for drug and alcohol across the city but when it comes to kids it’s really important that we remember we’re not talking about a drug and alcohol when kids come to the table the kids they are kids that come to the table and they bring a whole host of issues that we have to be cognizant of i would love to have a kids or an adolescent program that never mentioned the term drug and alcohol but was able to provide the services needed for a young person who has drug and alcohol issues in fact we need to do more of that as far as families are concerned and then we have data management and this is the area that i want to you know hopefully intrigue you guys with as we move you know on and that is the community epidemiology work group work that we do uh the data warehouse that we have access to the gipper stuff that we’re doing with the federal government the clinical claims the southeastern pennsylvania household survey and the philadelphia profile we have a number of community-based partnerships the prevention partnership which allows us to to interact with three grassroots organizations in the community prevention point which is our harm reduction initiative the syringe exchange the one day at a time which is a cl um a grassroots uh recovery organization uh community anti-drug coalitions we actually contracted with cadka to uh work with philadelphia’s uh coalitions believe it or not there are 5 000 drug-free communities you know funded drug-free communities across this country guess how many philadelphia has right now zero they had one before and they just lost their you know uh their allocation so we have put together four coalitions we brought in kadka to train those coalitions to give them uh the background they needed in order to apply for the grants and so they’ve all applied for the grants and keep your fingers crossed hopefully we will get at least two of those grants uh we have we also support the pennsylvania association of recovery residences we have to bring standards to recovery houses as long as recovery houses operate without standards you’re going to have to you know too big and extreme programs that run well and those are the 17 houses that we have under contract and then those that are not really really really recovery houses they are flop houses and so we have to be able to create an association that’s going to give us some standards across the board the uh the pas association and recovery residences is now up in harrisburg meeting with uh you should be the philadelphia association of recovery residences is now pa because they’ve now been working with harrisburg on legislation for recovery houses we have new pathways and new pathways for women very good program um the director just got plucked up by some folks in baltimore to go down there but the thing about it is is that this is not a treatment program but it’s a pre-engagement and post-engagement program it is where women can go who have been you know traumatizing their addiction and you know uh be engaged without having to be in a treatment program uh we also have pro-act and that’s our our most prolific partnership um uh with the recovery community center and if you have the opportunity go down to 17th and lehigh and check it out i think it’s it’s a program for people in recovery run by people in recovery one of our other partnerships in the community has been the mural arts program and just wanted to share with you this is the recovery mural that’s at fourth on fourth street and it actually helped us to bring a community and a methadone program together over a thousand people from the community the program uh constituents and and the program staff worked on this mural and this and the surrounding poetry that goes around the wall we also have collaborations and partnerships we’ve collaborated with the pa association recovery residents i said earlier american association for opioid dependence we hosted the conference and by the way just so you know this this conference this year last year was the most successful a todd conference in terms of attendance in terms of workshop evaluation in terms of overall satisfaction we kicked it in philadelphia you guys should be very very proud we have the ddap we are partnering around with secretary tennis in terms of the pennsylvania over overdose rapid response task force we have the regular every two months we meet with all the medication assistant treatment providers the dea and the state around you know looking at ways that we can improve service delivery and we can bring in the quote unquote regulators so that they can own part of this we also have quarterly prevention provider meetings we’re meeting with all everybody who’s doing prevention in the city of philadelphia we’re very much concerned that our philadelphia school system did not participate in the pennsylvania um youth survey which allowed which would have allowed us to have much more you know much more qualitative data around kids uh only 21 i think um charter schools are participating none of our public schools are so we’re now bringing doing a back door where anybody that’s in the schools that’s in our system we’re bringing in and we’re actually doing information gathering information through them uh we also have you know uh monthly meetings with the justice system in terms of the da’s office the public defenders the adult probation and parole of those recovery houses that i talked to you about 70 are used for criminal justice reentry last but not least we participated and we were actually the instigators of a collaboration that allowed us to bring together community care out west ireta samsa the university of pittsburgh medical center uh department of drug and alcohol programs and people in recovery and programs to create the management of benzodiazepines in medication assisted treatment this is out now you can go to the ireta website you can download it i would suggest that you do these these are guidelines and we know i think some very good information that providers can use even though we still have not gotten beyond the risk management issues that come up we have four domains of practice many of you may have heard of this uh the practice guidelines were produced three years ago i sent out to the community primarily looking at four particular areas that we’re supporting and sort of outreach and initial engagement screening assessment service planning and delivery continuing support and early reintervention and community connections and mobilization these are the priorities that we have identified these are the system goals and i’m not going to go through those but these are the goals that we as as the the department have identified but the office of addiction services has focused in on six uh essential transformation points first of all we look at vision and values if you’re not if you’re not clear if we’re not clear about our vision and values then who is going to be clear about our vision and values and and we’re actually about influencing and infecting wherever we go now regarding you know vision and values we have high performing collaborations and partnerships think about that guys we’re invested in community integration focused interventions integrated health care and and wherever we go finding health care champions or in this case recovery champions uh one of the things initiatives that we talked to you saw earlier in those boxes is niatex which used to be the network for the improvement of addiction treatment is that it’s now just niatex we’ve been at since 2007 we have now the idea is giving providers giving systems the tools in order to get better the idea for us is to reduce waited times reduce no-shows increase admissions and increase continuation between the first and fourth session where we’ve gone beyond that now the idea is now to how do we improve paperwork how do we improve uh communications how do we you know enhance the provider give the provider the tools for added value since the 2070 we have approximately 90 provider agencies and 25 units in the dba dbh ids trained in niatex tools and principles the system has trained approximately 30 niatix coaches 25 agencies and fiber from the provider agencies telephonic outreach saw a good idea and by the way ladies and gentlemen i’m not above you know jumping on good ideas i i don’t believe anything is you know it’s new i don’t create anything so the thing about it is is that jim mckay over the university of pennsylvania was doing you know a study around telephonic outreach he was doing it in a clinical setting with master’s level folks and he was having some great some pretty good outcomes so the light bulb went off what about putting telephonic outreach in a managed care entity and have it staffed with people who are in recovery telephonic outreach trip and trip is you know um telefinding recovery initiative project uh first of all we actually you know brought in the folks from uh the university of pennsylvania to actually you know orient the staff to uh telephonic outreach we then uh spread telephonic outreach not only and we put it in bhsi that’s the funding for the uninsured we then moved telephonic outreach to atr and we’ll talk a little bit about what atr is and we also put it in case management the id is at any place that we have in our system right now with the uninsured or underinsured are we want to stay connected our feeling is that the longer we stay connected the better the person stays engaged and that’s why it’s a bottom line issue and i think we’re seeing some results now come come from that after you know the last four years office of a journey of hope my personal pride six years ago in philadelphia we had a burgeoning or we really had a chronic homeless crisis and what we noticed was that a lot of the folks in the who are chronically homeless were drug and alcohol dependent and in fact met criteria for what we call long-term residential most of them met criteria for long-term which is habilitation but the thing about is they weren’t going the other piece was if they went they didn’t stay and in actuality what we found was that there was a war going on between quote unquote therapeutic communities and people who live out in the street give you an example i live out in the street i’m chronically homeless i’ve been out in the street for 10 20 years i come i decided to come into treatment the first thing you hit me with is a whole bunch of rules and regulations about what i can do and what i can’t do and then you tell me that if i don’t follow these rules you’re going to kick me out what do i say to you bye what we did was we actually shut down initially three providers we paid them to close down we paid them to retrain themselves and their staffs to number one lower the threshold for admission number two to be able to take a person back no matter how many times they came back and welcomed them and number three make it open-ended which was a uh another bloodletting with cbh but i’ll get into that later the idea though is that we wanted to create you know a programs that that addressed the needs of a chronically homeless culture now as i said earlier six years ago nobody was coming to these programs since we installed these programs and opened them up they stayed full you should also know that the end product for these programs is to get people independent housing we have gotten almost several hundred people uh and you know 150 ads of 211 um 2011 but we have now several hundred people at least i think it’s almost 300 people who have transitioned into supported housing with case management with telephonic outreach and you see that you know uh one of the things that we have is that we have a 53 percent uh success rate or completion rate uh whereas nationally we sing about 39 percent so you know we’re very proud of the journey of hope project in fact we actually have expanded it from through the original three to now seven uh agencies and if we could and if they would let me i would actually have turned the whole system the whole you know residential treatment system into this model ira one of the things that we found early on when we came when i first became director of the office of addiction services was that there was a lot of conflict between the criminal justice system the managed care system and the persons who were in treatment and the problems stemmed from the fact that people who did assessments behind the walls were oftentimes dismissed in terms of a person’s need around treatment they’ve been in jail for a year or maybe or maybe less so why they need to be in treatment so that that partially came from a number of folks who weren’t really educated about addiction and that in that people’s addiction doesn’t stop in their minds because they’ve been in jail and in fact one of the things that i have been you know particularly attuned to is the issue of stress and looking at stress in the community and how people cope with stress as being a a very good indicator of about you know success around addiction and what we’ve looked at now is the fact that you know one of the things was that we got three four three providers who were willing to work with us to take people directly out of incarceration from two to four weeks and do what we thought was a good comprehensive assessment it has resulted in our initial findings that has resulted in better placement of those folks not everybody got long-term residential but the idea is that we we got people into a level of care and a dosage of care that was more appropriate and we see less recidivism in this in this population atr uh now four years ago we were able to get the grant the access to recovery grant from the federal government four years we’re averaging a little over a million syringes a year now that says to me that if you say that whom that the usual person who was shooting dope probably takes off about a thousand times a year three times a day 365 days a year so that means that we have at least a thousand people out there that we don’t that we’re not seeing in treatment but are probably shooting you know um uh actively shooting dope or heroin so the issue for us is how fast can we get them engaged and into treatment it’s a slam dunk why weren’t we doing this all along because the situation was that we we had to make some choices about what we were going to fund and where we were going to fund it but the reality is is that we put folks from cbh and from bhsi on the largest syringe exchange site and on their day for for exchanging and said okay we’re going to give people a get out of jail free card or get into treatment free card and the person met criteria for residential or detox or whatever they were going to get it and so this program is up and running now and we’re looking and we’re seeing some interesting you know in fact i think we’re going to end up having to figure out how to get more staff over there because the demand is now growing so this is this is the good part for you guys this is the data initiatives this is where i want to try to get you guys intrigued in terms of looking at what we’re doing we are involved with the community epidemiology work group we are one of 26 sites just so you know this the funding for the cewg has been cut we don’t know if they’re going to continue we would like to figure out a way if they’re not going to continue that we continue this so we’re looking at how we can do that we’re also looking at data that we can we’re using uh in terms of the public health public health uh management corporation uh in terms of their southeastern pennsylvania survey and we’re also doing something called the philadelphia profile just so you know based upon uh the uh uh uh the stats that have come out of the you know philadelphia camden wilmington area we use the 9.5 against the 1.5 million people in philadelphia to estimate that we have about 145 000 people that need to be in treatment this is a conservative estimate is done and that’s not really scientific but this is our best guesstimate about the numbers of people that we have in philadelphia if you were to ask me i would tell you that i would triple this number and the reason why i would triple this number is because of what you’re going to see you know coming up next and that is the amount of folks that we’re seeing who are getting arrested the increase in the number of overdose deaths in the city of philadelphia and some of the increases around the presence of drugs and and deaths just so you know over since 2004 this gives you an idea of the number of folks that have been served by both cbh and bhsi and this gives you all the way through you know through to 2013 and you see that pretty much we’re you know seeing about 37 000 uh you know 271 which by the way which would indicate that we are at a higher uh percentage than the national for in terms of people who get into treatment that again as i said before is relative to the fact of how who you’re counting is needing to be in treatment this is bhsi this is the behavioral health special initiative is the uninsured or underinsured we’re using this as a proxy because i have better access to this data on demand and we can pretty much see the services that we provided over the course of the year and the the increase in presence you know intensive outpatient services uh and the fluctuation in the uh drug and alcohol residential the fluctuation in drug and alcohol residential is largely due to the uh our ability to get people on assistance and that’s the biggest issue for us right now bhsi has been cut average a million dollars a year for the last five years and so we’re see we see ourselves as needing to now find a different way to to to maximize our dollars that way right now is get them on cbh and so we’re moving you know uh to get them on and when you see the lowest numbers as far as um residential is concerned that’s when we got to expedited plus plus the state was working with us in terms of actually you know going back and doing retroactive enrollment but since the ga cuts the state has stopped doing that so you see this in this steady increase uh back up again in in terms of residential treatment is concerned this is our cwg data just so you know again we’re a city of about 1.5 million and this is very important here this is the philadelphia is in the red has averaged almost 20 points higher than the national average of children who are living in poverty that kind of stress is consistent with you know the the high risk factors for people who are engaged in in high-risk behaviors including drug use we pretty much are much like the national average however we have a lot of opiates and by the way if you are a flyers fan if you are a phillies fan and eagles fan or a sixers fan you don’t worry you know you philadelphia can lay claim to the fact that for the last 25 years we’ve had the best dope at the lowest prices in the country get a big finger with a joint sticking up out of it you know go from there primary drug of choice you pretty much see it still in terms of treatment it’s still alcohol uh but now heroin has surpassed marijuana age profile we’re still seeing that for for the most part a lot of the drug use is going on between 18 and 34. we’re also seeing that in terms of admission treatment admissions there’s still men but in this area when you see the you know the heroin and the opiates these numbers are growing for women the race profile is you know it’s pretty much about the same as it has been where african americans are are still excuse me still predominant as far as alcohol crack cocaine and marijuana are concerned uh uh whites are pretty much predominant in terms of heroin and other opiates these are the emergency visits in philadelphia and by the way this is over a six-month period and this little sliver right here almost 3 000 people between this july of 220 of 2012 and december of 2012 where for opiate i mean for over for overdose poisoning this is for drugs so you know the total number of uh you have 141 000 you know emergency responses uh you have a good number that are drugs in mortality cases the drugs most frequently uh detected with the presence of drugs are you know the top ten five of the top ten are opiates the most common you take the drug classes in terms of cases with the presence of drugs bingo take a look at this there’s no drug that’s had a better i think you might not better i should say but a more a faster climb an escalation in terms of of uh being detected than prescription opiates 10 most frequently detected drugs among alcohol or drug intoxication deaths and these are this is uh these are uh drugs that are involved directly involved or identified in the death of someone and again out of the top 10 you see five opiates we’re you know we’re also looking looking look at this in terms of you know the the fact this is actually jumped on the scene over the last four years diphenhydramine this is a this is a very interesting stat of the 972 meo cases of of death with the presence of drugs 497 were alcohol and drug intoxication deaths but then take a look at this number in terms of the average number of drugs found in a person you know in terms of death you have seven almost eight drugs that are being found so we we we’re not a monolithic society we are very eclectic in terms of how we use drugs and especially here in philadelphia just so you know because one of the ways we measure how we how we are doing as a system we saw from 1970 through 2006 a steady increase in the uh in the presence of mortality or mortality with the presence of drugs this is an outlier because this is the fentanyl epidemic in 2006. from since 2007 we’ve seen a downward trend but these ups and downs are primarily due to opiates now this may be a little bit difficult for you to see this is our philly profile we’ve broken the city into by zip code into demographics to take a look at you know each each area of the city in terms of looking at uh where the popular where the biggest populations are we also taking a look at in terms of density to figure out you know what’s what’s going on in the city of philadelphia this is again the demographics and the red lines that i’ve drew where we have the highest you know populations in the city this is this is where treatment occurs in terms of uh zip codes and this is also where you see and it’s not too uh unnatural to find that where you have the highest number of people you have the highest number of folks that are being referred into treatment same thing now this is the same thing is true here this is just a part of the city but these are the retailers by the way in the city but only listed one the one in center city has the most liquor licenses and whatnot and by the way that’s going to change once they ever uh uh commercialize or make the you know the the uh the alcohol industry you know private type everything they ever privatize it this number is going to be is really going to explode uh and and i can tell that also not by this but by the fact that they the number of of actual applications you know has uh you know blown up they said they can’t even process them all okay so you now have uh retailers so now this is the crimes in these areas and again taking a look at at all these areas that we we highlighted in red you see an interesting you know piece in terms of the numbers of people uh property crime where i’m looking at here are the sales of narcotics i’m also looking here at the ems calls for overdose deaths and i’m also looking at where in the city we’re seeing most of our drug intoxication deaths by use of opiates and again you know we’re looking at you know the same sections of the city where they have high populations and if we were to go and dig a little deeper into those demographics you would also take a look at you know the number of the house value uh begin taking a look at the number of um people who are working in these communities and you’re beginning to see that there’s there there are some indicators that for us take a deeper look at these kinds of things now arthur talks about four building blocks and i sort of built them you know from top down but i’m gonna go through this really quickly uh four building blocks to our approach to care and for us right now it’s you know again as i said before vision and values and and and collaborations and the like uh under recovery supports we’re looking at recovery oriented systems of care uh people in recovery families and communities evidence-based practices and and i’ll talk a little bit about epic in a second alignment coordination integration of health care and then at every level and modality of care promoting advocates under physical administrative policy a lot in concept with practice we have to continue to move our providers and ourselves more towards a closer um relationship between what we’re saying and what we’re doing and i think that this is going to you know be of interest to you guys we need to have better ways and kathy bolton has been doing a report card we’re doing you know performance-based contracting but we need to now have standards that we can clearly identify to the state and i mean not just to the state but also to our providers the reason being is this we are living with a plethora of state regs that are minimal and in fact if you look at the state regs it really doesn’t have anything to do with qua outcomes or whether or not a person gets better or not just are you doing these things and the question is is that are there certain things that are going on in providers i’m gonna jump right down to this for instance do we have organizations that celebrate the people that they work with and celebrate their staffs do we have organizations that invest in the relationship i mean one of the things that tom and i spoke about early on when he was doing that study over at the clinic that i was running was the fact that you know the importance of the relationship that a person had was probably mattered more than anything in terms of being able to deliver quality care building esteem uh transformative and you know uh relationships is roland behaving the same way three months from the day that he came in the door am i treating role in the same way that you know three months later because if i am then something something is not happening here there has to be something on at every level that we can talk about that’s transformative and if i can’t say to you that i’m treating you differently than when the day i first met you then there’s something you know inherently bad and i’m going to say bad and difficult putting a value on something about the way i’m relating to you and then last but not least you know is the organization building culture are they producing people who are uh making a difference not both in their staff and the people that they’re working with and most of all are they serving people and the reason why i’m saying serving as opposed to helping is because when you serve someone the first thing you have to do is listen to them and part of the issue that we have in our system is that we still don’t listen to them or to each other in many cases so now in the future what am i doing for time by the way am i okay with the time okay well we’re okay um for the last two years the office of addiction services has been funding what i call recovery enhanced treatment um we have providers in our system that we’re getting you know our program-funded allocations and by the way we brought them in and asked them what they were getting for they couldn’t tell us because they were they were getting for the last 30 years and you know since that time cbh has happened uh bhsi has happened there’s no need for additional funding or for a separate pool of funding for the uninsured you have a higher rates of of payment from the managed care entity so why are we paying you this money and in fact you know even though you know we we got rid of the term program funding we said we’re going to try and experiment we’re you know we we’re seeing that recovery enhanced services bring added value to treatment and so what we’re saying to you is this we want you 21 providers to now we’re going to pay you five dollars every 15 minutes for telephonic outreach 10 for every 15 minutes for peers and 15 for every 15 minutes for recovery management for one of a better term could be case management now those 21 providers we had about eight that adopted this and ran with it we had believe it or not we had providers that never called anybody never hired a peer and couldn’t tell you today what recovery management is and i hate to tell you this guys but we’ve notified a couple of those a few of those providers that we’re not going to be doing business with them and to that end you may see uh uh statues of rolling hung in effigy uh all on market street and i wouldn’t be surprised if you know city council came after me but the issue is this is that we have to begin to change the conversation and you know we’re not going to be you know there’s there’s no solution to the problem you know by by attacking with the same mistakes that created the problem and so we’re now going to do something differently and we’re moving now to talking to providers about first of all don’t come to us asking for increases in this and increases in that we want you to come to us and now talk about the bringing a consortium to us figuring out a way that you can bring not only yourself but also the other stakeholders in your community and let’s talk about putting together a package deal also let’s talk we just get away from this term fee for service it’s my belief that fee for service is going to go the way of the dinosaur um and we’re going to try to find alternative payment arrangements so our challenges first of all the lining thinking by changing the stigma discussion i think that one of the biggest hindrances that we have is that we sit down to the table with uh city council people legislators um the folks who who fund different things as far as you know advocate agents advocacy agencies we still have underlying stigma that affects us in three basic areas one on the individual level it impacts on worthiness you know people you know that’s why we have 23 million people who need to be in treatment in this country and we only see about three million that’s why we have two we know over 145 000 people in philadelphia and we’re only able to see 37 000 because we don’t do a great job in terms of the messaging around us on a public level stigma impacts on the disparities in care it’s about rights and stigma all you know under undermines the rights that’s why we have places in philadelphia where we don’t have a continuum of care we don’t have a lot of service delivery if you were to go back and take a look at that grid you would see that there are areas especially those areas that are in red that don’t have you know enough services where you in some cases you have places to have a plethora of services in the last area in terms of the public side stigma impacts on uh uh conflict and that gets to the quality of care you know it’s okay to defund drug and alcohol it’s okay to marginally fund you know a a a treatment for a disease whereas if you were talking about anything else you know people would would be outraged that she would undercut you know the support for you know disease management of a disease that you know pretty much impacts on 23 million people uh we’re looking to you know coordinate health care and wellness initiatives no longer are we talking about just treatment we’re talking now about wellness looking to integrate behavioral health care and bridging funding of regulations we’re talking about integrating with physical health care and the reason why i’m saying integrating you know behavioral health care we’re still not there yet in the city of philadelphia we still need to work on how well my office and the office of mental health work together around regulations around funding and around technology and then we have to and again this gets back to integrate the funding we can do a much better job in the drug and alcohol world with the co-occurring community than the mental health folks can do with the co-occurring community why because in many cases the co-occurring community are the folks that scare them half to death and in actuality we’re seeing a good study that was done by kathy bolton showed that in a four year period um a three and a half year period excuse me there were 2311 people that recidivized into acute inpatient services between four and nine times of that number we saw that uh the people who went into 23 hour beds which is purely a psych uh observation bed you know uh for uh over sixty percent of them who who were tested uh were tested for for uh drugs were positive in the most intense bed the acute psych bid over forty percent that were tested tested positive so the issue was this if we had just saved one episode of care for each of that 2311 people we would have saved 18 million dollars now i don’t know about you but i personally would have liked to have been able to put that 18 million dollars back into the the infrastructure for drug and alcohol expand the co-occurring capability of providers enhance the staff and actually um uh raise the whole standard of care within the system and i’m still at it so we can hopefully stay tuned for on that one so recovery continues as wellness we’re adopting a public health perspective we’re looking at trying to reverse expert we’re trying to convince tom to get involved with bill white arthur and myself so that we can begin looking at long-term recovery checkups and and i’ve added to this reverse engineer expert experts shouldn’t just be about a doc doing a screening for drug use and referring that person into treatment it should also be the drug treatment program doing a screening for medical problems and referring that person into a doctor and the reason for that is this i’m sorry it’s a little bit too dark we had we did a survey with the philadelphia health management i mean excuse me public health corp care corporation and that survey was done three years ago for southeastern pennsylvania and the good news first the good news is that we found in southeastern pennsylvania over 359 000 people self-identified as being in recovery in philadelphia alone we saw 128 300 self-identifiers being in recovery however part of the problem is is that we have differences in terms of personal assets and whether whether you look at me go over here on this side hopefully i don’t i’m sorry god for blocking you but measures of personal assets high school graduation we’re seeing that that that that they’re lower than the people who are not in recovery and that means people who are who are there’s the general population college degrees much lower full of part-time employment much lower unemployment rate much higher unable to work higher and again all these negative areas that we’re that we are identified in as far as recovery is concerned the same thing is true of health status when you begin to see you know uh uh whether or not health is fair or poor you know there’s a much higher rate of people in recovery who say that their health is poor fair or poor um uh diet asthma diagnosis is higher diabetes is higher uh physical mental and emotional disability is higher a high blood pressure is higher and in fact when you think about it uh past year er visits are higher so we’re also seeing you know um uh in fact the only area that we we were lower is obesity and it has i think our folks doing crack cocaine may be supporting that that number also in terms of health care screenings and recovery status we’re seeing that you know um uh did not seek care in the past year due to cost we see all these and again this is mostly all due to costs in terms of did not get you know get needed uh prescriptions due to cost did not get dental care due to costs you know again just showing up higher in all these different areas um women getting mammograms you know in the past year lower percentage lower percentage of men getting prostate exams but we have you know hiv testing we know we’re higher so we get we get tested because testing by the way is where it’s in the programs last but not least we’ve been we’ve been working with dr robert carter from columbia university around the idea of introducing a survey into our providers around the idea of race-based traumatic trauma and especially with our folks who are coming out of incarceration do you know how big is that an impact as i said to you earlier i have been very much consumed by the issue of stress and and and uh its relevance you know to to addiction and and not only people getting addicted but people staying addicted and how we don’t do enough in our programs to to address this issue with with folks and their families so that’s where we are as far as as our you know anything the new stuff that we’re doing and this is again a reminder about the recovery walk last year 20 000 uh we want you to come and you know be involved and hopefully uh sponsor some research folks to come and be in the part of the you know the the group on the 20th of september any questions
As part of our ongoing Science Meetings, TRI welcomed Roland Lamb, Director, Office of Addiction Services, Department of Behavioral Health and Intellectual disAbility Services.
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