Difference between revisions of "Expand Early Intervention Strategies"

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=Introductory Paragraph=
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]
__TOC__
= Background =


Policymakers and insurers have been pushing people addicted to opioids into abstinence-based detox programs, but a new study concludes that methadone and similar drug-maintenance treatments save lives and money. If the nearly 47,000 Californians who began treatment for opioid-use disorder in 2014 had received immediate access to methadone or another opioid-agonist treatment – instead of first being forced to completely withdraw from opioids – the healthcare and criminal-justice systems would have saved $3.8 billion, researchers estimate.<sup class="reference">[1]</sup> Moreover, 1,262 lives would have been spared. “If you offer opioid-agonist treatment from the outset, people live longer, and they incur lower costs on society,” said senior author Bohdan Nosyk, a health economist and professor at Simon Fraser University.<sup class="reference">[2]</sup>
Early intervention services may be considered the bridge between prevention and treatment services. The goals of early intervention are to reduce the harms associated with substance use, to reduce risk behaviors before they lead to injury, to improve health and social function, and to prevent progression to a disorder and subsequent need for specialty substance use disorder services. Early intervention consists of providing information about substance use risks, normal or safe levels of use, and strategies to quit or cut down on use and use-related risk behaviors. When needed, early intervention facilitates patient initiation and engagement in treatment.  For individuals with more serious substance misuse, intervention in these settings can serve as a mechanism to engage them into treatment.<ref name="Facing Addiction in America: The Surgeon General's Spotlight on Opioids">https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf</ref>
 
 


== OAT - Opioid Agonist Treatment ==
=Key Information=


*International addiction experts consider initial opioid-agonist treatment, or OAT, ''with no duration restrictions'', the evidence-based standard of care for opioid-use disorder, the authors write online November 20 in Annals of Internal Medicine.
The 2018 National Survey on Drug Use and Health reported on the continued use of substances across the U.S.  
*But in California, where more people have been diagnosed with opioid disorder than in any other U.S. state, ''publicly funded treatment programs require patients to “fail” - twice - at a three-week course of medically supervised withdrawal before they become eligible for OAT''. Policymakers likely maintained this medically managed withdrawal requirement under the false belief it was saving money. The study demonstrates, however, that the policy creates significantly greater long term costs for criminal justice and healthcare systems.
**The study concludes OAT would have saved as much as $850 million over five years, not including savings to the criminal-justice system, and more than $2 billion, including the cost of arrests and prosecutions. Over 10 years, the total savings would rise to $2.87 billion.<sup class="reference">[3]</sup>
**“If we want to see overdose deaths come down, we need to make sure people who have opioid addiction are able to access effective treatment more easily than they can access heroin, fentanyl or pain pills."
**"We need a model whereby patients can get immediate access to opioid-agonist treatment, a lifesaving intervention, without obstacles."
**“Among experts in the field of addiction, we already know that detox doesn’t work, that they’re going to relapse and when they relapse, they’re going to be at great risk for an overdose, that they’ll be at great risk for hepatitis,” Kolodny said. “Opioid addiction is a life-threatening illness.” 


<br/> Access the study here: [http://annals.org/aim/article-abstract/2664093/cost-effectiveness-publicly-funded-treatment-opioid-use-disorder-california [1]]<br/> &nbsp;
* In 2018, approximately 20.3 million people aged 12 or older had a substance use disorder (SUD) related to their use of alcohol or illicit drugs in the past year, including 14.8 million people who had an alcohol use disorder and 8.1 million people who had an illicit drug use disorder. <ref>https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf</ref>


== Public Health Imperative ==
* The most common illicit drug use disorder was marijuana use disorder (4.4 million people). Within an estimated 2.0 million people with opioid use disorder, 1.7 million had a prescription pain reliever use disorder and 0.5 million had a heroin use disorder.<ref>https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf</ref>


*In terms of public health, research has shown the mortality rate for long-term opioid users is 6-20 times higher than the rate among non-users.<sup class="reference">[4]</sup>
'''Prevention vs. Early Intervention'''
*Relapse rates amongst opioid users are high (less than 30% report stable abstinence after 10-30 years of observation).<sup class="reference">[5]</sup>
*Developing and implementing practices to help new users and long-term users quit and stay clean will be an important step to reduce the number of deaths and prevent further monetary losses due to workplace and healthcare costs.  


<br/> The 2014 National Survey on Drug Use and Health<sup class="reference">[6]</sup> demonstrated that opioid misuse is more widespread than realized:
Early intervention differs from prevention efforts, especially when it comes to general and at-risk populations. Prevention targets the general population with a universal need to understand the risks of substance use disorder. While early intervention efforts can also engage the general population, it focuses on age groups, individuals, or families at risk for particular disorders like substance use, or those who may have just started experimenting or using substances.


*Approximately 1.9 million Americans met criteria for prescription painkillers use disorder based on their use of prescription painkillers in the past year.
Early Intervention in a Community Setting'''
*1.4 million people used prescription painkillers non-medically for the first time in the past year.
*The average age for first-time prescription painkiller misuse was 21.2 years old.


(as cited by the [http://(As%20cited%20by%20the%20 Substance Abuse and Mental Health Services Administration]).
* Early intervention can be provided when an individual presents for another medical condition or social service need and is not seeking treatment for a substance use disorder.


= Signs and Symptoms =
* Community intervention can involve multi-sector partnerships, community leaders and members, and/or deliver services in community settings such as clinics, schools, jails, workplaces, emergency rooms, social services, senior citizen centers, or campuses.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440941/
</ref>


Quitting opioids begins with recognition of signs and symptoms of misuse.
'''At-Risk Populations Who Should Receive Early Intervention'''
  For those taking prescription painkiller medications, these may be signs you are becoming dependent on the drug<sup class="reference">[7]</sup>&nbsp;:
 


*Feeling that you have to use the drug regularly — this can be daily or even several times a day
While the entire community can benefit from early intervention resources, there are populations that have been identified at a higher risk for substance use.
*Having intense urges for the drug
*Over time, needing more of the drug to get the same effect
*Making certain that you maintain a supply of the drug
*Spending money on the drug, even though you can't afford it
*Not meeting obligations and work responsibilities, or cutting back on social or recreational activities because of drug use  
*Doing things to get the drug that you normally wouldn't do, such as stealing
*Driving or doing other risky activities when you're under the influence of the drug
*Focusing more and more time and energy on getting and using the drug
*Failing in your attempts to stop using the drug
*Experiencing withdrawal symptoms when you attempt to stop taking the drug


<br/> For family members, these may be signs a loved one is struggling with a substance use disorder<sup class="reference">[8]</sup>&nbsp;:
* Adolescents or adults at risk or who show signs of substance use or are experimenting with substances.</span>
* Individuals who have suffered childhood trauma.<ref>https://www.acesconnection.com/</ref>
* Binge drinkers: In 2018, about 139.8 million Americans aged 12 or older were past month alcohol users, 67.1 million were binge drinkers in the past month. About 2.2 million adolescents aged 12 to 17 drank alcohol in the past month, and 1.2 million of these adolescents binge drank in that period.<ref>https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf</ref></span>
* People who use substances while driving.
* Expectant mothers who use substances while pregnant.
* Senior citizens. 
* Ethnic minorities who may not be receiving culturally relevant care
* Individuals with co-occurring substance use and mental disorders
*Homeless population.


*Problems at school or work — frequently missing school or work, a sudden disinterest in school activities or work, or a drop in grades or work performance
'''Components of Early Intervention'''
*Physical health issues — lack of energy and motivation
*Neglected appearance — lack of interest in clothing, grooming or looks
*Changes in behavior — exaggerated efforts to bar family members from entering his or her room or being secretive about where he or she goes with friends; or drastic changes in behavior and in relationships with family and friends
*Spending money — sudden requests for money without a reasonable explanation; or your discovery that money is missing or has been stolen or that items have disappeared from your home, indicating maybe they're being sold to support drug use


= Intervention =
* Screening, Brief Intervention and Referral to Treatment, or SBIRT <ref>https://www.yoursafesolutions.us/wiki/Expand_SBIRT_Program</ref> 
* Screen for risk factors for substance use such as childhood trauma and ACEs</span><ref>https://www.acesconnection.com/</ref>
* Reduce Stigma in Community <ref>https://www.yoursafesolutions.us/wiki/Reduce_Stigma</ref>
* Pre-Arrest Diversion Programs <ref>https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>
* “Reachable Moments,” such as providing patient education when prescribing opioids for chronic pain.<ref>https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder</ref>
* Utilize Prescription Drug Monitoring Programs (PDMPs) which are state-controlled electronic databases to track controlled substance prescriptions within a state. PDMPs also provide prescribing and patient behavior information to prescribers and other authorities who are granted access to the information.


*Intervention can be an effective means for getting someone to accept treatment. <sup class="reference">[9]</sup>
=Relevant Research=
*Interventions are most successful when conducted with the help of addiction experts and when users are coming down from a high. <sup class="reference">[10]</sup>
*During an intervention, close friends and family members tell their loved one how their drug use has affected them personally, and the person is presented with the opportunity to seek treatment. <sup class="reference">[11]</sup>


&nbsp;
SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.


= Case Studies =
=Impactful Federal, State, and Local Policies=


== Project Engage - Delaware ==
SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.


Project Engage is an early intervention and referral to substance use disorder treatment program designed to help hospital patients who may be struggling with alcohol or drug use. Project Engage collaborates with hospital staff to identify and connect patients with community-based substance use disorder treatment programs and other resources. Project Engage has also formed a partnership with the construction industry to offer recovery support to employees from participating construction companies.
= Available Tools and Resources =
 
  As part of the initiative, its founder, Dr. Terry Horton, worked to make questions about opioid use standard protocol for patients admitted to the ER. The goal is to identify patients going through withdrawal very quickly in order to treat it rapidly and break the vicious cycle they're in by immediately administering drugs like Suboxone. Health care workers also pair patients with addiction counselors and get them enrolled in community-based drug treatment program before they've even left the hospital. And so far, Christiana Care has been able to steer two-thirds of patients with opioid addiction into drug treatment.<sup class="reference">[12]</sup>
 
  Project Engage integrates peers in recovery, who are called Engagement Specialists, into the clinical setting in the hospital to meet with patients at their bedside about their alcohol and/or drug use. The Engagement Specialists learn about the patient’s goals and coordinate treatment options that support the patient’s needs. The Engagement Specialists use motivational interviewing to empower each patient in the decision-making process, assisting them to take that critical first step to seek help for their substance use. Project Engage Social Workers are experts in community resources, in obtaining access to facilities in the area and in assisting the team to overcome barriers so patients can receive care and transition into treatment.
 
  Simply put, Project Engage goes beyond just screening people. It treats opioid addiction as a disease, with medicine and in-house specialists, which is not common in screening programs, nor the American health system in general. The programs founders agree: the best way to curb opioid addiction is to connect patients directly with treatment, instead of leaving it up to patients to follow up on referrals, which is typically how it's done.<sup class="reference">[13]</sup>
 
  In addition to working with the patient and the hospital clinical team, Project Engage also works with treatment providers and insurers to develop a discharge plan to achieve the best possible outcome for each patient. After leaving the hospital and engaging in treatment, patients may have the opportunity to continue to work with an Engagement Specialist to help them stay engaged in their treatment.
 
  Learn more about Project Engage here: [https://christianacare.org/services/behavioralhealth/project-engage/ [2]]
 
 


= Preventing Relapse =
'''The Police, Treatment, and Community Collaborative (PTACC)''' <ref>https://ptaccollaborative.org/</ref> is an alliance of practitioners in law enforcement, behavioral health, advocacy, research, and public policy. Its mission is to strategically widen community behavioral health and social service options available through law enforcement diversion. Their focus educates law enforcement and communities on pre-diversion for those who have committed nonviolent misdemeanors. This helps people to be moved away from the criminal justice system and toward appropriate treatment or services that can support these individuals, helping them avoid falling into the revolving door of the criminal justice system. Pre-arrest diversion provides law enforcement with an effective alternative through referral to community-based intervention. <ref>https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>


&nbsp;
'''Facing Addiction in America: The Surgeon General’s Spotlight on Opioids'''


= Tools + Resources =
The following is taken from the section titled ''Importance of Prevention, Screening, Early Intervention, and Treatment:''


[[TR_-_Enable_People_Who_Start_Misusing_Opioids_to_Quickly_Quit|TR - Enable People Who Start Misusing Opioids to Quickly Quit ]]<br/> <br/> <span style="font-family: Georgia,Times,serif; font-size: 1.4em">'''Scorecard Building'''</span><br/> [[PO_-_Enable_People_Who_Start_Using_Opioids_to_Quickly_Quit|Potential Objective Details]]<br/> [[PM_-_Enable_People_Who_Start_Misusing_Opioids_to_Quickly_Quit|Potential Measures and Data Sources]]<br/> [[PA_-_Enable_People_Who_Start_Misusing_Opioids_to_Quickly_Quit|Potential Actions and Partners]]<br/> &nbsp;
“Currently, few primary care providers screen for or treat substance use disorders. Additionally, it is common for people who misuse opioids to misuse other substances or to have multiple substance use disorders, childhood trauma, or co-occurring physical and mental disorders. This highlights the need for full clinical assessment and comprehensive treatment services that are matched to an individual’s needs.” <ref>https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf</ref>


= More to Investigate =
'''Community Catalyst: Expanding Substance Use Prevention and Early Intervention in Schools''' <ref>https://communitycatalyst.org/resource/training-resources-for-the-implementation-of-sbirt-with-young-people/</ref> This online toolkit provides information and resources to mobilize communities to expand school-based services for substance use prevention and early intervention.&nbsp; Other resources describe a key set of tools for SBIRT early intervention plus strategies to implement and fund this intervention in schools and clinics.


[[More_RTI_on_Enable_People_Who_Start_Misusing_Opioids_to_Quickly_Quit|More RTI on Enable People Who Start Misusing Opioids to Quickly Quit ]]<br/> <br/> '''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' <span style="color: #ff0000">[insert name here]</span><br/> '''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': <span style="color: #ff0000">[fill out table below]</span>
'''HHS Office of the Assistant Secretary for Planning and Evaluation''' published a report titled "Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment" that includes information on screening and early intervention. <ref>https://www.aspe.hhs.gov/sites/default/files/migrated_legacy_files//187391/BestSUD.pdf?_ga=2.175262753.2025544468.1693431443-868347927.1691445109</ref>


{| class="wiki_table"
'''Mental Health during global conflict''' People across the world may find they struggle with their mental health during times of global conflict. This does not affect only those in active combat — these are humanitarian crises, impacting an entire community or region and beyond. This page addresses how your mental health might be affected by major conflict events like war, terrorism, geopolitical tension, territorial disputes, and political instability.. <ref>https://mhanational.org/crisis/global-conflict?eType=EmailBlastContent&eId=5fab664b-5726-42b6-a0da-0c1fcf0fba92</ref>
|-
| '''Reviewer'''
| &nbsp;
| '''Date'''
| &nbsp;
| '''Comments'''
|-
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
|}


&nbsp;
= Promising Practices =
 
'''OhioSTART (Sobriety, Treatment, and Reducing Trauma) <ref>https://ohiostart.org/</ref>
 
The state of Ohio developed OhioSTART to help families dealing with substance use disorder avoid disruptive and costly out-of-home placements and to help keep families together. For parents who have lost custody of their children to foster care or another government-approved living arrangement,&nbsp; the goal is to ultimately reunify and stabilize these families. The intervention program provides specialized victim services, such as intensive trauma counseling, to children who have suffered victimization with substance use of a parent being the primary risk factor. Additionally, the program assists those parents of those children with mentors who have firsthand experience with substance use disorder.
 
'''Project Engage - Delaware''' <ref> https://christianacare.org/services/behavioralhealth/project-engage/</ref>
 
ChristianaCare is a Delaware-based health system, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs. Project Engage was designed to help hospital patients who may be struggling with alcohol or drug use. It provides early intervention and referrals to substance use disorder treatment. Project Engage integrates peers in recovery, who are called engagement specialists, into the clinical setting in the hospital to meet with patients at their bedside about their alcohol or drug use. Project Engage collaborates with hospital staff to identify and connect patients with community-based substance use disorder treatment programs and other resources. Project Engage has also formed a partnership with the construction industry to offer recovery support to employees from participating construction companies.
 
'''Project IMPACT''' <ref>https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder
</ref>
 
Oregon Health and Science University (OHSU) and its partners conducted a needs assessment to map patient and system needs to critical intervention components and develop a business case. Using their findings, the group identified issues address in addiction treatment and intervention:
 
* Hospitalization is a “reachable” moment: A survey of hospitalized adults conducted by OHSU revealed that 68% of high-risk drug users reported wanting to cut back or quit. Many patients also reported that they wanted to initiate medication-assisted treatment (MAT) while hospitalized, and that they wanted providers that understand addiction.</span>
 
* Lack of usual pathways to treatment: OHSU Hospital lacked established referral pathways to outpatient addiction care, and wait times were often long.
 
Their findings resulted in an innovative intervention program: Project IMPACT, or the Improving Addiction Care Team. IMPACT includes two complementary components: First, an inpatient consult service gives patients a safe place to share their stories, improve patient engagement and trust, and to expand inpatient treatment options. Second, partnerships were forged with community providers to create rapid access pathways to treatment and a smooth transition to MAT.


= Sources =
= Sources =
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----
----


#[https://www.reuters.com/article/us-addiction-methadone-cost/substituting-methadone-for-opioids-could-save-billions-idUSKBN1DK2LE [3]]
[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Prescriptions and Medical Response]]
#[https://www.reuters.com/article/us-addiction-methadone-cost/substituting-methadone-for-opioids-could-save-billions-idUSKBN1DK2LE [4]]  
#&nbsp;
#Hser YI, Evans E, Grella C, Ling W, Anglin, D. Long Term Course of Opioid Addiction. ''Harvard Review of Psychiatry.'' 2015 Mar-Apr;23(2):76-89.
#*
#**
#***
#****
#*****
#******
#*******
#********
#*********doi: 10.1097/HRP.0000000000000052.
#*********[https://www.ncbi.nlm.nih.gov/pubmed/25747921 [5]]                 
#Hser YI, Evans E, Grella C, Ling W, Anglin, D. Long Term Course of Opioid Addiction. ''Harvard Review of Psychiatry.'' 2015 Mar-Apr;23(2):76-89.
#*
#**
#***
#****
#*****
#******
#*******
#********
#*********doi: 10.1097/HRP.0000000000000052.
#*********[https://www.ncbi.nlm.nih.gov/pubmed/25747921 [6]]                 
#[https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf [7]]
#Mayo Clinic Staff. "Drug Addiction Symptoms." ''Mayo Clinic''. Mayo Foundation for Medical Education and Research (MFMER), n.d. Web. 26 Jan. 2017. <[http://www.mayoclinic.org/diseases-conditions/drug-addiction/basics/symptoms/con-20020970 [8]]>.
#Mayo Clinic Staff. "Drug Addiction Symptoms." ''Mayo Clinic''. Mayo Foundation for Medical Education and Research (MFMER), n.d. Web. 26 Jan. 2017. <[http://www.mayoclinic.org/diseases-conditions/drug-addiction/basics/symptoms/con-20020970 [9]]>.
#Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016
#Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016
#Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016
#[https://www.npr.org/sections/health-shots/2017/11/22/563815531/asking-about-opioids-a-treatment-plan-can-make-all-the-difference [10]]
#[https://www.npr.org/sections/health-shots/2017/11/22/563815531/asking-about-opioids-a-treatment-plan-can-make-all-the-difference [11]]  
</div> </div>

Latest revision as of 11:50, 12 March 2024

Introductory Paragraph

Early intervention services may be considered the bridge between prevention and treatment services. The goals of early intervention are to reduce the harms associated with substance use, to reduce risk behaviors before they lead to injury, to improve health and social function, and to prevent progression to a disorder and subsequent need for specialty substance use disorder services. Early intervention consists of providing information about substance use risks, normal or safe levels of use, and strategies to quit or cut down on use and use-related risk behaviors. When needed, early intervention facilitates patient initiation and engagement in treatment. For individuals with more serious substance misuse, intervention in these settings can serve as a mechanism to engage them into treatment.[1]

Key Information

The 2018 National Survey on Drug Use and Health reported on the continued use of substances across the U.S.

  • In 2018, approximately 20.3 million people aged 12 or older had a substance use disorder (SUD) related to their use of alcohol or illicit drugs in the past year, including 14.8 million people who had an alcohol use disorder and 8.1 million people who had an illicit drug use disorder. [2]
  • The most common illicit drug use disorder was marijuana use disorder (4.4 million people). Within an estimated 2.0 million people with opioid use disorder, 1.7 million had a prescription pain reliever use disorder and 0.5 million had a heroin use disorder.[3]

Prevention vs. Early Intervention

Early intervention differs from prevention efforts, especially when it comes to general and at-risk populations. Prevention targets the general population with a universal need to understand the risks of substance use disorder. While early intervention efforts can also engage the general population, it focuses on age groups, individuals, or families at risk for particular disorders like substance use, or those who may have just started experimenting or using substances.

Early Intervention in a Community Setting

  • Early intervention can be provided when an individual presents for another medical condition or social service need and is not seeking treatment for a substance use disorder.
  • Community intervention can involve multi-sector partnerships, community leaders and members, and/or deliver services in community settings such as clinics, schools, jails, workplaces, emergency rooms, social services, senior citizen centers, or campuses.[4]

At-Risk Populations Who Should Receive Early Intervention

While the entire community can benefit from early intervention resources, there are populations that have been identified at a higher risk for substance use.

  • Adolescents or adults at risk or who show signs of substance use or are experimenting with substances.
  • Individuals who have suffered childhood trauma.[5]
  • Binge drinkers: In 2018, about 139.8 million Americans aged 12 or older were past month alcohol users, 67.1 million were binge drinkers in the past month. About 2.2 million adolescents aged 12 to 17 drank alcohol in the past month, and 1.2 million of these adolescents binge drank in that period.[6]
  • People who use substances while driving.
  • Expectant mothers who use substances while pregnant.
  • Senior citizens.
  • Ethnic minorities who may not be receiving culturally relevant care
  • Individuals with co-occurring substance use and mental disorders
  • Homeless population.

Components of Early Intervention

  • Screening, Brief Intervention and Referral to Treatment, or SBIRT [7]
  • Screen for risk factors for substance use such as childhood trauma and ACEs[8]
  • Reduce Stigma in Community [9]
  • Pre-Arrest Diversion Programs [10]
  • “Reachable Moments,” such as providing patient education when prescribing opioids for chronic pain.[11]
  • Utilize Prescription Drug Monitoring Programs (PDMPs) which are state-controlled electronic databases to track controlled substance prescriptions within a state. PDMPs also provide prescribing and patient behavior information to prescribers and other authorities who are granted access to the information.

Relevant Research

SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

Impactful Federal, State, and Local Policies

SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

Available Tools and Resources

The Police, Treatment, and Community Collaborative (PTACC) [12] is an alliance of practitioners in law enforcement, behavioral health, advocacy, research, and public policy. Its mission is to strategically widen community behavioral health and social service options available through law enforcement diversion. Their focus educates law enforcement and communities on pre-diversion for those who have committed nonviolent misdemeanors. This helps people to be moved away from the criminal justice system and toward appropriate treatment or services that can support these individuals, helping them avoid falling into the revolving door of the criminal justice system. Pre-arrest diversion provides law enforcement with an effective alternative through referral to community-based intervention. [13]

Facing Addiction in America: The Surgeon General’s Spotlight on Opioids

The following is taken from the section titled Importance of Prevention, Screening, Early Intervention, and Treatment:

“Currently, few primary care providers screen for or treat substance use disorders. Additionally, it is common for people who misuse opioids to misuse other substances or to have multiple substance use disorders, childhood trauma, or co-occurring physical and mental disorders. This highlights the need for full clinical assessment and comprehensive treatment services that are matched to an individual’s needs.” [14]

Community Catalyst: Expanding Substance Use Prevention and Early Intervention in Schools [15] This online toolkit provides information and resources to mobilize communities to expand school-based services for substance use prevention and early intervention.  Other resources describe a key set of tools for SBIRT early intervention plus strategies to implement and fund this intervention in schools and clinics.

HHS Office of the Assistant Secretary for Planning and Evaluation published a report titled "Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment" that includes information on screening and early intervention. [16]

Mental Health during global conflict People across the world may find they struggle with their mental health during times of global conflict. This does not affect only those in active combat — these are humanitarian crises, impacting an entire community or region and beyond. This page addresses how your mental health might be affected by major conflict events like war, terrorism, geopolitical tension, territorial disputes, and political instability.. [17]

Promising Practices

OhioSTART (Sobriety, Treatment, and Reducing Trauma) [18]

The state of Ohio developed OhioSTART to help families dealing with substance use disorder avoid disruptive and costly out-of-home placements and to help keep families together. For parents who have lost custody of their children to foster care or another government-approved living arrangement,  the goal is to ultimately reunify and stabilize these families. The intervention program provides specialized victim services, such as intensive trauma counseling, to children who have suffered victimization with substance use of a parent being the primary risk factor. Additionally, the program assists those parents of those children with mentors who have firsthand experience with substance use disorder.

Project Engage - Delaware [19]

ChristianaCare is a Delaware-based health system, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs. Project Engage was designed to help hospital patients who may be struggling with alcohol or drug use. It provides early intervention and referrals to substance use disorder treatment. Project Engage integrates peers in recovery, who are called engagement specialists, into the clinical setting in the hospital to meet with patients at their bedside about their alcohol or drug use. Project Engage collaborates with hospital staff to identify and connect patients with community-based substance use disorder treatment programs and other resources. Project Engage has also formed a partnership with the construction industry to offer recovery support to employees from participating construction companies.

Project IMPACT [20]

Oregon Health and Science University (OHSU) and its partners conducted a needs assessment to map patient and system needs to critical intervention components and develop a business case. Using their findings, the group identified issues address in addiction treatment and intervention:

  • Hospitalization is a “reachable” moment: A survey of hospitalized adults conducted by OHSU revealed that 68% of high-risk drug users reported wanting to cut back or quit. Many patients also reported that they wanted to initiate medication-assisted treatment (MAT) while hospitalized, and that they wanted providers that understand addiction.
  • Lack of usual pathways to treatment: OHSU Hospital lacked established referral pathways to outpatient addiction care, and wait times were often long.

Their findings resulted in an innovative intervention program: Project IMPACT, or the Improving Addiction Care Team. IMPACT includes two complementary components: First, an inpatient consult service gives patients a safe place to share their stories, improve patient engagement and trust, and to expand inpatient treatment options. Second, partnerships were forged with community providers to create rapid access pathways to treatment and a smooth transition to MAT.

Sources

  1. ↑ https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf
  2. ↑ https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
  3. ↑ https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
  4. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440941/
  5. ↑ https://www.acesconnection.com/
  6. ↑ https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
  7. ↑ https://www.yoursafesolutions.us/wiki/Expand_SBIRT_Program
  8. ↑ https://www.acesconnection.com/
  9. ↑ https://www.yoursafesolutions.us/wiki/Reduce_Stigma
  10. ↑ https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf
  11. ↑ https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder
  12. ↑ https://ptaccollaborative.org/
  13. ↑ https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf
  14. ↑ https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf
  15. ↑ https://communitycatalyst.org/resource/training-resources-for-the-implementation-of-sbirt-with-young-people/
  16. ↑ https://www.aspe.hhs.gov/sites/default/files/migrated_legacy_files//187391/BestSUD.pdf?_ga=2.175262753.2025544468.1693431443-868347927.1691445109
  17. ↑ https://mhanational.org/crisis/global-conflict?eType=EmailBlastContent&eId=5fab664b-5726-42b6-a0da-0c1fcf0fba92
  18. ↑ https://ohiostart.org/
  19. ↑ https://christianacare.org/services/behavioralhealth/project-engage/
  20. ↑ https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder
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