Authors: Ali Jost, LICSW, and Caryn Bernstein, Manager, NACHC Clinical Affairs Division-Operations. Jost is a trauma therapist, trainer and behavioral health coach. She was faculty on the recent Innovative Approaches for Prescription Drug Abuse Management and Prevention project.
Editor’s Note: One year into the COVID-19 pandemic, let’s take a look back at one of the other major health issues that we were focused on before COVID hit: the opioid epidemic. And let’s see how community health centers managed to continue providing services to patients with substance use disorders.
Last spring, when community health centers across the country started limiting in-person care in response to COVID-19, it was hard to predict what would happen to innovative, client-centered behavioral health and substance use disorder programs that centers have spent years developing. What care could be moved virtually? How would the most vulnerable patients—struggling with substance abuse, living without housing or consistent phones—retain access? And how would the health center workforce maintain the collaborative, team-based care that has become synonymous with positive patient outcomes and resilient health centers?
Among a cohort of 10 health centers selected by the CVS Health Foundation and the National Association of Community Health Centers (NACHC) to apply community-based solutions to the national opioid crisis, the answers to these questions tell a tale of transformation through creativity, steadiness, perseverance, and the belief that if you meet patients and providers where they are, healing happens.
Overcoming the Digital Divide
Health centers brought their decades of experience delivering community-based primary care to address the various barriers that telehealth presents. Before COVID-19, MHC Healthcare, Inc. and Boston Health Care for the Homeless Program were using their CVS Health Foundation grant funds to explore alternatives to in-person care as a way to increase touchpoints with patients who cannot afford transportation, have limited childcare, or face cultural barriers to accessing in-person care. They were already innovating to increase use of virtual health care for populations who had previously been left out of digital spaces but may have the most to gain from them. Having launched the technology, obtained the licenses, and conducted initial employee and patient training, these health centers were able to scale up delivery of telehealth rapidly when the pandemic took root. They had already envisioned various telehealth barriers and were prepared to meet them head-on. They used phone donations, city-based hot spots, and a pop-up tent to establish virtual health stations to overcome the digital divide. They created visual name tags to humanize and personalize telebased care. And they were ready with questionnaires to immediately obtain feedback from patients so that they could tweak their delivery.
Engaging Patients in a Virtual Environment
The pandemic re-centered the importance of health centers and the creative wrap-around support they offer to individuals and families. All 10 health centers reported a decrease in patient no-show rates, and thus an overall increase in their behavioral health utilization. At the time, the centers did not know if the unique stressors of the COVID-19 crisis or the access to virtual care drove such an expansion. But the early results clarify how critical direct-service providers are to healthy communities. When Rocking Horse Health Center implemented Luma Health, a web-based platform for communicating with patients, a patient responded to an appointment reminder that they were having difficulty securing food. The center’s patient advocate swiftly secured an emergency food box. La Maestra Community Health Centers ensured that case managers had licenses to its telecommunication platform to avoid interruption in case management services, which are critical for patients with substance use disorders. When Union Community Health Center had to pause its mobile van, its new behavioral health case manager quickly transitioned to screening patients for substance use and abuse and depression during triage either in person in the health center’s brick and mortar location or via telephone.
Caring for Staff in a Crisis Environment
While there is no question that crisis response leads to burnout and health centers have been taxed at new levels, these innovative health centers met this inevitable challenge. They created space for virtual team huddles, increased staff supervision, one-on-one coaching with technology champions, and frequent emails and notes of support to employees. Harmony Health Medical Clinic and Family Resource Center launched a wellness initiative for employees to assess and respond to burnout–an innovation that will stay well beyond COVID-19 and may serve as a model for other centers seeking creative responses to the moral injury and vicarious trauma that impact health centers.
Continuing In-Person Services
Among the 10 health centers, the determination to find safe ways to show up and maintain care for patients may have saved countless lives. Public Health Management Corporation never stopped in-person MAT inductions. The MAT Mentoring team it was funded to test succeeded in creating a safe and collaborative environment that improves cultural competency and increases confidence among the team. The team was prepared to persevere with in-person care with the strength it had derived from mentorship. Santa Barbara Neighborhood Clinics relocated its substance use disorder clinic to a facility twice the size, believing that it would be a slow time with COVID-19. Instead it was completely booked. The clinic remained open for in-person visits, and providers remained available for walk-ins needing immediate care.
Innovation and Creativity Flourish
While many have been treading water during these heavy days of the pandemic, health centers have continued to swim upstream to ensure their patients receive quality care. Community Health Center, Inc. developed a dashboard to show providers the number of patients with chronic pain who are integrated with behavioral health support and other alternatives to opioid therapy. The goal is that the dashboard will influence provider behavior on the management of chronic pain and opioid prescribing. This dashboard could be used to influence any number of quality improvement goals–including vaccination rates. Cornell Scott-Hill Health Center redesigned its electronic health record to guide provider behavior around delivering brief substance abuse assessments. These technical innovations help strapped health care providers to be both more efficient and more human-centered, thereby increasing screening rates and referrals to behavioral health.
View the video featuring stories from three health centers from Year 1 and Year 2 of the project.