Be Well Coalition Meeting | June 24, 2021 - Be Well OC
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Be Well Coalition Meeting | June 24, 2021
Agenda
Welcome: Dr. Rick Afable Please take a moment to enter your
name and organization in the chat,
Keynote Presentation and Q&A: Dr. Shannon along with where you are joining
Robinson from, if you are from outside Orange
County
Breakout Room Discussions of Resilience and
Recovery (and Stigma) Meeting is being recorded
Be Well Updates: Trauma Informed Network of
Slides and recording will be posted at
Care
https://bewelloc.org/events
• Iliana Soto Welty (Executive Director, MECCA)
• Mike Weiss, MD (Vice President, Population Health, CHOC
Children’s)
Closing: Marshall Moncrief
Please enter questions in the chat 2
Vision: Be Well Orange County will lead the nation in optimal mental health and wellness for all residents.
Welcome
Keynote Presentation Dr. Shannon Robinson Principal, Health Management Associates (HMA)
INTRODUCTION
Shannon Robinson, MD Charles Robbins, MBA
Principal Principal
Health Management Associates Health Management Associates
Faculty Nature of Commercial Interest
Shannon Robinson, MD Dr. Robinson discloses that she is an employee of Health Management
Associates, a national research and consulting firm providing technical
assistance to a diverse group of healthcare clients.
Charles Robbins, MBA Mr. Robbins discloses that he is an employee of Health Management
Associates, a national research and consulting firm providing technical
assistance to a diverse group of healthcare clients.
Copyright © 2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL 5
SYSTEMS OF CARE PROJECT GOALS
Strengthen links and
Make treatment more communication among all Support all stakeholders’
accessible and equitable for stakeholders in the ecosystem achievement of shared
people with SUD/OUD/StUD county-level SMART goals
Improve the safety of transitions
Increase the number and activity
between levels of care
and cultural concordance of MAT
prescribers in the county
Copyright © 2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL 6
Substance
Use
Stigma and Harm Reduction
Shannon Robinson, MD
June 24, 2021
Physical Mental
Health Health
Funding for this event was made possible by the State Opioid Response grants from SAMHSA. The views expressed in written event materials or publications and by facilitators and moderators do not necessarily
reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government
OC DATA WILL LEAD US TO BUILD ECO SYSTEMS TO EVALUATE & TREAT ALL SUD
+ 88% increase in OD from 2000 to 2017
+ 67% OD deaths related to opioids (>50% related to prescriptions)
+ 700 deaths in OC yearly
+ > 5,500 hospitalizations related to substance use in OC every year; average LOS 4.3 d
+ $430 million in hospital charges
+ Drug of choice in OC:
+ 44% of people entering treatment drug of choice is methamphetamine; followed by
heroin at 20% and alcohol at 18%.
+ Rate of methamphetamine use in OC is higher than state or nation
+ Illicit drug use rate overall in OC is lower than state or nation
Source: https://windwardway.com/orange-county-addiction-statistics/
Copyright ©2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL 8
STIGMA
+ Medicalization of SUD and prescribing of MAT has been advertised to providers and
patients alike, but providers may not have skills to start these conversations
She doesn’t have an
+ MAT is not available for all SUDs SUD…”I’m sorry I have
to ask you these
+ Writing an RX is easy- instant gratification
questions. “
+ Asking questions & listening are hard
+ Motivational interviewing is hard; it goes against our desire to fix things, to think
we know how to fix things
+ Providers shun things they think they can’t impact, such as obesity and SUD
+ Providers are unaware of evidence- based interventions
+ Providers may not have the skills needed to do things other than prescribe
Copyright ©2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL 9
“No Room For Stigma is a mark of disgrace associated with a
Prevention: The particular circumstance, quality, or person.
Unintended
Consequence Of Mental
Health Stigma Reduction
Efforts” + Westfall, Miller and Bazemore “…negative
Stigma Definition thoughts attributed to mental health [or substance
(Health Affairs Blog, use] leading to a negative behavior”
June 30, 2016) + avoiding seeking care because of what people will think
+ avoid providing care because of judgement or blame
Copyright ©2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL
10THE IMPACT OF STIGMA
Beliefs= Thoughts Consequences= Feelings & Behaviors
More than three-quarters of respondents in a Stigma toward individuals with
2016 national survey reported viewing mental health problems associated
individuals with Opioid Use Disorder (OUD) with reduced life expectancy,
as to blame for their substance use, and decreased employment and
nearly three-quarters of respondents educational opportunities, poverty
characterized people with OUD as lacking and homelessness (Gronholm
self-discipline (Kennedy-Hendricks et al., 2017)
2017)
Individuals who had personal experience Individuals with OUD have 6 times
with OUD—for example, having a family suicide risk than the
member or close friend with OUD—reported rest of population (Oquendo
equally negative or more negative attitudes & Volkow, 2018)
toward the disorder than the general
public (Kennedy-Hendricks et al., 2017)
Copyright ©2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL
11TYPES OF STIGMA
+ Self-stigma - when people internalize public attitudes/
thoughts and suffer the consequences as a result.
+ Self Stigma may cause someone to not seek treatment; they feel
they should be able to handle this on their own, yet if they knew
they had diabetes would they respond the same way?
+ Structural or systemic stigma - systems sees people with
mental illness and addiction as less treatable and less
deserving of care.
+ People may not be able to avoid the initial subconscious reaction,
but moving the unconscious bias into the conscious realm allows
each person to decide whether to act on it and how. Keeping our
thoughts/judgements in mind and in check is important!
Copyright ©2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL 12HEALTHCARE STIGMA
+ Personal & professional experiences effect
stigma in healthcare settings
+ “Addict”
+ “Drug seeking “
+ “Waste of my time, they will never get better”
+ Stigma can greatly increase the experience of
burnout
+ Providers may not provide early detection,
adequate interventions, or community
referrals for individuals with SUD because of
your beliefs
Copyright ©2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL 13ADDRESSING STIGMA
+ Identify substance use disorder stereotypes.
+ Identify “gut” reactions as potential indicators of implicit bias
+ Take a “walk in their shoes” approach; consider things from their perspective
+ These aren’t easy things for the patient to talk about; it takes courage to ask for help
+ Avoid assuming you understand what’s going on. Listen and don’t jump to conclusions.
+ Don’t assume you have all the answers. We all know where assuming gets us
+ Increase your general knowledge about the experiences of people with SUD
+ Volunteer, watch documentaries, read memoirs, attend conferences, strive to create empathy
+ Ask yourself: what diagnoses would I have considered if I were unaware of the patient’s substance use
diagnosis? Or unaware of another characteristic of the patient
14
Copyright ©2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIALCOMBAT STIGMA & MISINFORMATION WITH EDUCATION
“They need to make better choices. The patient “It’s a waste of time to help them.
is in this situation as a result of their own “They haven’t hit rock bottom.”
choices.”* “They just keep relapsing”**
Accurate information
“Having Narcan encourages people to can influence our “People on MAT sell their medications.” **
party harder.”** thoughts, feelings &
behaviors
“MAT is just replacing one drug with another. I
“Treating people with addiction takes up resources
got sober without meds; abstinence- based
that could be used for more critical conditions.”
treatment is better.”**
Resources: Webinars- https://addictionfreeca.org/Resource-Library/Mom-Baby-Substance-Exposure-Initiative
** Issue Brief- https://www.chcf.org/wp-content/uploads/2019/06/MATOpioidOvercomingObjections.pdf
Copyright ©2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL 15TACKLE STIGMA WITH KNOWLEDGE
+ After the development of SUD, the drive for substances is greater than the drive
for food, water or sex
+ People do not have to hit rock bottom before being successful in treatment
+ Motivational Interviewing skills can move a person from pre-contemplative to
action and people who are court mandated to treatment have equally good
outcomes as others (actually better)
+ Access to Narcan or clean needles does not increase the rate of drug use
+ Stable neurochemistry allows for enough dopamine to be able to engage in
activities other than looking for substances
+ Abstinence based treatment fails 85%
+ We do NOT recommend treatments with an 85% failure rate
Copyright ©2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL 16TACKLE STIGMA WITH LANGUAGE
+ Replace these words + With these words
+ Addict + Baby with neonatal abstinence syndrome, an expected
outcome of mom taking SSRIs or MAT
+ User
+ Abuser + Patient
+ Person in recovery
+ Junkie
+ Person with unhealthy or hazardous substance use
+ Alcoholic
+ Drunk + Person with substance use disorder
+ Substance dependence
+ People aren’t their diseases
+ Former addict
+ People are people who have healthcare conditions
+ Addicted baby
Copyright ©2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL 17TREATMENT OF STIMULANT AND OPIOID USE DISORDERS: HARM REDUCTION
Stimulants and Opioids
+Educational materials on psychological & physical effects
+Fentanyl test strips
+Syringe Exchange & other clean injection supplies
+Naloxone and overdose prevention education
+Showers & antibiotics for infection prevention & treatment
+Testing for HIV and HCV
+Safe/safer sex practices
+ Condoms
+ Pre and post exposure prophylaxis (PrEP and PEP)
Stimulants
+Water for hydration
+Tooth paste and toothbrush
+Quiet rooms to come down
Copyright ©2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL 18HIV TESTING IS HARM REDUCTION
Source: Pitasi. MMWR Morb Mortal Wkly Rep. 2019;68:561.
+ A national survey conducted from 2016-2017 by the CDC found that
> 60% of US adults had never been tested for HIV
+ Testing rates varied
+ Rural areas had lower testing and diagnosis rates than urban areas
+ HIV testing is also a mechanism for engaging in services
Case Example
+ X presents with temperature between 99.3 & 100.3 daily for 3 months; HIV test was not ordered for 6 months.
+ What diagnosis would you have considered for someone with a low-grade fever for 9 months, if you didn’t know the patient?
+ Thoughts influenced the provider’s approach to the patient= stigma and suboptimal care
Copyright ©2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL 19HARM REDUCTION DATA AND ENDORSEMENT
+ Syringe Exchange* *National Roadmap on State Level Efforts to End the Nation’s Drug
Overdose Epidemic (by AMA and Manatt 2020) lists syringe
+ CDC, AMA, UNAIDS services as a
leading-edge practice and includes it as a next step to remove
+ Reduces risk of infections barriers to evidence-based patient care
+ 5 times more likely to get SUD treatment
+ 3 times more likely to reduce or discontinue injecting
*Evidence Based Strategies for Abatement of Harms From the
Opioid Epidemic (by Arnold Ventures 2020)
lists syringe services as well supported
+ Naloxone*
+ AMA; ASAM; Jerome Adams, US Surgeon General 2017-2021
+ Saves lives, but < 1% get naloxone
Copyright ©2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL 20TREATMENT OF STIMULANT AND OPIOID USE DISORDER
Stimulant Opioid
SBIRT Yes Yes
Harm Reduction Yes Yes
Motivational Interviewing Yes Yes
Cognitive Behavioral Therapy Yes Yes
Community Reinforcement Yes Yes
Approach
Contingency Management Yes Yes
Medication No Yes
Knowledge and skills can be taught.
Knowing what medication to prescribe is knowledge you acquire & become competent with.
SBIRT, harm reduction, MI… are knowledge that can be acquired & you can become competent doing.
Copyright ©2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL 21Stigma results from thoughts.
Thoughts can be changed. Substance
Use
Harm Reduction should be done in all settings.
Everyone’s scope of practice includes harm
reduction. Mental
Physical
Health Health
We can’t reduce harms if we don’t address
stigma.QUESTIONS AND
DISCUSSION
Send your questions to the host via the chat or
Q+A window in the Zoom meeting.On behalf of the Health Management
Associates, we wish you health and happiness.
Copyright © 2020 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL 24Questions?
Breakout Room Discussions Resilience and Recovery (and Stigma)
Please take a moment to enter any key takeaways you
had during the breakout session in the chatToward a Trauma Informed Network of Care Mike Weiss, MD (Vice President, Population Health, CHOC Children’s) Iliana Soto Welty (Executive Director, MECCA)
Orange County ACEs Aware
Trauma-Informed Network of
Care Goals
• Build an integrated, coordinated network of care to strengthen and expand cross-sector clinical and
community supports services
• Align and Connect Digital Resources: Coordinate existing resource and referral IT platforms and
establish multi-directional IT infrastructure to facilitate closed loop referrals
29ACEs Aware Trauma Informed Network of Care
Two-pronged Approach
CHOC and
MECCA, Family American
Physician
Solutions Academy of
Network, St. First 5, OCDE,
Cross- Coordinate Joseph Heritage CalOptima, 211,
Collaborative, Pediatrics,
Children and Coalition of OC
sector existing Healthcare, Dr. SSA, HCA
Families Community
Riba’s Health
network of resource Club
Coalition Health Centers
community and referral
and clinical tech for NAMI, OC
services closed loop Child Guidance
Saddleback United, Hecht
Church, Trauma
referrals Center, Western
Congregation Institute, Hoag
Youth Services
Shir Ha-Ma’a lot and Center for
Healthy Living
Equity and Inclusion
30Governance Approach
Executive Steering
Committee Committee
(CHOC, First 5 OC, MECCA,
(all partners)
and Mind OC)
Community- Equity & Coordinating
Clinical Inclusion Infrastructure
• CHOC • MECCA • Mind OC
• First 5 OC
31Coordinating Equity Community
Platform and Inclusion and Clinical
Trauma Informed Network of CareA Movement not a Moment
“Please, I can’t breathe.”
- George FloydIntersectionality
“There is no such thing as a
single-issue struggle
because we do not live
single-issue lives”
-Audre Lorde
Trauma Informed Network of CareEquity Framework
RESPONSE RELIEF
RECONCILIATION RECOVERY
REPAIR beliefs, premises,
1. REFLECTION agreements,
REFRAMING
REFORM concepts
REFLECTION
RADICAL RACISM
2. REFRAME shift, align, connect,
RESILIENCY
expand, change
RESISTANCE
questions to apply
3. RUBRIC the frameworkContact: andrea.mander@mind-oc.org
36Announcements
Connect with Be Well OC
Upcoming events: https://bewelloc.org/events/
Facebook: https://www.facebook.com/bewelloc
Instagram: https://www.instagram.com/bewelloc/
Be Well OC Community Suicide Prevention Initiative Private Facebook Group:
https://www.facebook.com/groups/BeWellOCSuicidePrevention/
Be Well Newsletters: https://bewelloc.org/newsletters/
Specific Questions: help@bewelloc.org
38Closing Marshall Moncrief
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