Mission Priorities: Behavioral Health

By Anne Bakar, President & CEO

Telecare’s new mission statement is moving us forward on many fronts: health, effectiveness, and complex needs. But it’s also intended to move us forward in the care of people with serious mental illness (SMI) and substance use issues.

At Telecare, we estimate that at least 75% of the people we serve have a serious mental illness and a co-occurring substance use issue.
 
At least 75%.
 
That means that at least 75% of our clients are trying to manage two very daunting recovery challenges. At least 75% are at risk of having their health compromised and their lives cut short. At least 75% may be facing shame, stigma, and punitive program rules that make it hard for them to be honest about their lives and get the help they need.
 
It’s unacceptable.
 
Our new mission statement reflects our focus not just on mental illness but on substance use as well.
 
We are focusing on bridging systems and closing gaps in care by training our staff about evidenced-based approaches to integrated care. This includes things like motivational interviewing and recognizing there are “stages of change” in substance use recovery: times when clients are ready to consider treatment for their addiction and times when they are not.
 
In addition to training staff about new tools and interventions, we are introducing Medication Assisted Treatment (MAT) to our practice. This is a vital intervention that we are well suited to provide as a professional organization with a wholly owned Physician Services Organization led by Dr. Jeff Gould. Consistent with this direction, we recently completed a pilot program on how detox could be accomplished through outpatient telemedicine.
 
In this month’s newsletter, you will learn more about how we are moving this aspect of our mission forward. You can read about our three-year SUDS plan, meet our new SUDS Director, and get more detail about these new approaches.
 
We hope you enjoy this preview, and we look forward to sharing our learning and growth.

The Power of Hope: How Peer Services Provide Living Examples of Recovery

Erin "Wesa" Arthur is a PSC III Substance Abuse Specialist at Telecare’s Santa Maria ACT program.

Wesa specializes in addiction and co-occurring conditions among members and helps them through psychoeducation, assists in detox treatment, and conducts general case management. She uses harm reduction, the RCCS, and shares her story to instill hope.

"That is why I am so passionate about recovery and the work that I do—I’ve been there," said Wesa. "I have 28 years of sobriety and I am living with a mental illness and co-occurring disorders. I think that it helps clients when I open up with them about my own experiences."

Having the ability to have the challenging conversation surrounding substance use in a non-judgmental fashion is key for building trust and hope among our clients. "I think there is so much doubt that many people who are struggling with co-occurring disorders face and that it is something that is destined to hinder them, and that’s not true," Wesa said. "Like anything in recovery, it’s a process and it’s unique to every individual."

This year, Telecare has been expanding and improving the way we inform our staff about co-occurring disorders. With our online learning portal, we are now able to offer staff training sessions on substance use that they can access at any time to help with their understanding of dual diagnosis among clients and how to start conversations around these topics. More than 70% of Telecare programs successfully completed COEG facilitator training and launched COEG groups for the people they serve.

Wesa had the opportunity to share her own experiences when COEG was first being developed. "I feel so strongly that until someone is clean and sober, it’s extremely difficult to treat the psychiatric disorder,” she said. "Substance use can have such an impact on mental health symptoms. To provide adequate treatment for people who have a co-occurring disorder, you have to take the time to understand how the two are affected by one another."

Today, Wesa continues her interest in psychology and writes about her experience. Her recovery journey is a reminder to those she works with that anything is possible.

"People gave up on me when I was diagnosed with bipolar disorder, and I proved them wrong," she said. "The thing I love is being able to instill hope and show them by example that anything is possible. And I love the clients. I absolutely love the clients we serve."

SUDS Telemedicine Detox Pilot

Recovering from addiction can be an extremely stigmatizing and isolating experience for many of our clients. Telecare recently conducted a pilot on Telemedicine Detoxification (Tele-Detox) to see if we could help clients overcome this isolation, while getting the right treatment support at their own pace, in the safety of their own home or within a program.

“Tele-Detox is detox treatment provided via live video calls at the convenience of where our clients are,” said Scott Madover, Director for Specialty Product Services, Substance Use Disorder Services (SUDS). “Through this online process, clients can get connected with an addiction physician who can walk them through their detox, answer any of their questions, and prescribe medications so that their substance use withdrawal symptoms can be as mild as possible.”

The nine-month pilot started June 2016 and was conducted at our CHANGES program in Oakland, CA. CHANGES is Telecare’s first co-occurring program and has been instrumental in helping Telecare identify effective and collaborative ways to treat co-occurring substance use disorders. CHANGES clients receive both mental health and substance use services, but in this program, are not required to be abstinent. Staff encourage clients to reduce their substance intake through a harm reduction model and can refer clients to more robust inpatient detox services.

The Tele-Detox program came about because we wanted to help clients overcome the isolation of addiction recovery, while getting the right treatment support at their own pace, in the safety of their own home or within a program.

The Tele-Detox approach is promising because it supports these goals, as well as offers other system benefits. It’s less expensive than inpatient detox, enables clients to start the detox process faster because it does not require waiting for an available inpatient bed, and alleviates pressures on those inpatient beds for people who need inpatient care the most.

Through the Tele-Detox process, clients are screened and connected with an addiction physician through Clinics On Demand. Clients are loaned a personal computer or a tablet if they do not already have one, a blood pressure cuff, and a finger oxygen device. The blood pressure and finger oxygen devices connect automatically and wirelessly with a monitoring system at Clinics On Demand.

Clients who participated in the demo had regularly scheduled telephone visits with physicians and clinical staff to discuss progress, address concerns, resolve problems, and refer to higher level of care if needed. CHANGES staff could contact the client’s physician to report any change of condition they observe during the detox treatment. Once detox treatment was completed, CHANGES staff would help and support clients in their chosen Intensive Outpatient Programming (IOP) treatment in addition to the services at CHANGES.

“Although the turnout for the pilot program was modest, the support and encouragement clients received by participating really helped them understand their addiction,” Scott said. “As a company, we are looking to continue to have the opportunity to build expertise within Telecare around substance use for our staff.”

Michelle Norris worked on the Tele-Detox program pilot when she was a Personal Service Coordinator II at CHANGES. As someone with lived experience herself, she knows that there is a lot of stigma surrounding addiction, and that having more personalized access to help can make taking those first steps towards recovery a little easier.

“There's still a lot of misconceptions around addiction, like the thought that people could just stop if they wanted to,” she said. “You know what? If I could've stopped, I would have, but I couldn't until I got more education. Having the right education and being provided the steps you need to take to help the client is so important because recovery can be a lot harder than you think.”  

Michelle uses the experience from her own recovery to help guide others on their journey. She is now a Licensed Clinical Social Worker (LSCW) at Telecare’s Villa Fairmont Mental Health Rehabilitation Center.

SUDS: Expanding Treatment at Telecare

Our Plan for Building Skills, Staff, Practices & Programming

In January 2017, Telecare finalized a three-year plan to enrich and expand our substance use disorder services (SUDS) capabilities, with a specific focus on people who have a serious mental illness (SMI) and co-occurring substance use issues.

"Traditional substance use agencies are not necessarily prepared to serve people who have SMI," said Faith Richie, SVP of Development. "We have a 50-year history of working with SMI and complex needs and in the last few years, have made major steps forward in our ability to recruit, retain and support licensed staff, particularly psychiatrists, through our TLC Physician Services Organization. This will make it easier for us to step into more direct SUDS care, deliver Medication Assisted Treatment, and meet all of the licensing requirements to do this work and do it well." 

We are pleased to introduce the highlights of this plan here and will continue to share enhancements and updates as we move forward in this work.

Ultimately, we need to provide dedicated programming that combines mental health and substance use services directly to our clients in our programs. We believe that by doing that, we can better close the gap and help our clients holistically move forward in recovery – and dramatically improve their lives.
— Scott Madover, Director for Specialty Product Services, Substance Use Disorder Services (SUDS)

Overarching Goals

Our vision for our SUDS plan is ambitious. We want to:

  • Increase quality of care
  • Increase access to care
  • Increase strategies for effective care
  • Reduce the stigma of care
  • Nurture a safe space for change
  • Create many options and avenues for clients to make positive behavioral change
  • Enable staff and clients to work proactively and collaboratively toward recovery

SUDS Plan at a Glance

SUDS-Plan-At-a-Glance.jpg

What's New in SUDS

Director of SUDS: Scott Madover

To help us better address co-occurring conditions company-wide, we appointed Scott Madover, Ph.D., to take on the role of Telecare’s Director for Specialty Product Services, Substance Use Disorder Services (SUDS).

"We knew we really needed to focus on substance use, and ensure that we were capable and doing our very best to meet those needs. We thought the best way to do that was to hire a dedicated leader, and that's Scott Madover," said Faith Richie, SVP of Development at Telecare.

In addition to working with the Development and Operations departments at Telecare to create plans for how co-occurring programming could better serve our clients, Scott will also assist with Telecare’s planning efforts so that our services are aligned with parity requirements and SUDS funding in multiple states. He will also ensure that Co-Occurring Education Groups (COEG) curriculum is available at all our product types, and recommend new standards for our existing programs so that they are co-occurring capable.

Scott’s clinical training and program leadership experience coupled with his wealth of knowledge in co-occurring disorders positions him very well for this role.

Before accepting his role as the new SUDS Director, Scott has helped lead many of Telecare’s integrated care efforts, including the development and roll out of COEG, our first company-wide substance use education program, and the design and implementation of Telecare’s first pay for success program. He also helped design and oversee the CHANGES program, our first program specifically designed to support people with co-occurring mental illness/substance use needs. Scott has also served as Regional Director of Operations in the Bay Area.