A Look at Policies & Procedures for Office Based Opioid Treatment in a Primary Care Setting

Transcription

1 A Look at Policies & Procedures for Office Based Opioid Treatment in a Primary Care Setting DATE: December 5 th, 2017 PRESENTED BY: Laura Heesacker, LCSW and Stormi Baumann, BSW

2 Disclosure Information Speaker Laura Heesacker, LCSW has nothing to disclose Speaker Stormi Baumann, BSW, CADC I, CPS has nothing to disclose 2

3 Learning Objectives 1. Describe the importance of having a well defined Policy & Procedure for Office Based Opioid Treatment (OBOT) 2. Review one Federally Qualified Health Center s OBOT Policy & Procedure 3. Differentiate between a more or less trauma informed approach to managing patients who lack adherence with OBOT Policy & Procedures 4. Review one Federally Qualified Health Center s practice for patients who lack adherence to the OBOT Policy & Procedure 3

4 Policies and Procedures The Continuum of OBOT Services One Doc Shop FQHC Strong Harm Reduction Model Clinic Each will have different approaches to OBOT which will influence the P & P P & P should be based on what a clinic can SAFELY and EFFECTIVLY provide

5 May you have a strong foundation; When the winds of change shift Bob Dylan

6 La Clinica's OBOT Policy & Procedure Phone or in-office Screening Patient enrolls into a community based treatment center ASAM Assessment is sent to PCP for review and documentation Patient and Behavioral Health staff complete an "Intake" appointment. Patient is scheduled for Consultation with X-Waivered provider Patient is offered a home induction or in-office induction based on providers assessment. Patient has short follow-up until stabilized on medication and all other substances are negative on urine drug screens. Once stabilized, both medically and behaviorally, patient placed into a monthly Shared Medical Visit.

7 Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. McLellan et al., JAMA, 284: , : , 2000.

8 Contingency Plan a plan that can be followed if an original plan is not possible for some reason-merriam Webster Luck is not a strategy!

9 Thus, drug addiction should be treated like any other chronic illness, with relapse serving as a trigger for renewed intervention. Source: McLellan et al., JAMA, 284: , 2000.

10 Not all Contingency Plans/Reinforcement Strategies are Created Equal

11 Contingency Plans/ Reinforcement Strategies 3 Strikes AKA Barriers to Success-L. Heesacker Tough Love -Bill Milliken Tit for Tat- Drug Dealer MD -Dr. Anna Lembke Love and Logic-Dr. Jim Fay and Dr. Foster Cline Conscious Discipline-Dr. Becky Bailey Collaborative & Proactive Solutions (CPS)-Dr. Ross Greene

12 Conscious Discipline A Trauma Informed Approach to Managing Contingencies An Approach for managing the unexpected behaviors your pts will display when treating addiction When we understand the brain state model, we can clearly see the importance of building our school on the core principles of safety, connection and problem solving Dr. Becky Bailey, Conscious Discipline

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14 Using a Trauma Informed Lens

15 Collaborative & Proactive Solutions (CPS)- Dr. Ross Greene Plan A=Authority Figure Imposed Plan B=Collaborative Problem Solving 1) Empathy 2) Define the Problem (focus on safety) 3) The Invitation 15

16 When the Patient does Not Follow the Policy At LaClinica Health Re-visit program policy with patient Increase frequency of appointments- can share the burden with behavioral health team. Strong collaboration with patients Substance Use Treatment provider Increase intensity of treatment Assess motivation to change, create patient centered goals Set boundaries- MUST be provider supported Timeline for change Clear consequences Follow through on consequences (positive & negative)

17 References Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It s So Hard to Stop by Anna Lembke (Stanford) Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. McLellan et al., JAMA, 284: , (Dr. Becky Bailey) (Dr. Ross Greene) LaClinica Health FQHC-MAT P & P-Medford Oregon-Stormi Bauman- Sbaumann@LaClinicahealth.org Rogue Community Health-FQHC-MAT P & P-Medford Oregon-Dbrooks@roguech.org AllCare MAT Program Review Check List-Mark Kantor- Mark.Kantor@allcareheatlh.com Sample MAT Prescriber Consultation Appointment, Patient Consent Form, Guidelines for Enrollment into MAT for Opiate Use Disorder-PolicBupPractice-buppractice.com