Community Voices

Substance Use Disorder Providers

In May 2020, The DC Health staff planned and facilitated an online engagement session with about eight community providers who serve people with substance use disorder. Facilitators asked providers for their perceptions of what was happening in the lives of people who misuse drugs, including identifying their top concerns, service gaps, and what they see as the strengths of the community.

Concerns

Gaps on the substance use disorder care continuum – DC has many substance use disorder resources, but they are unevenly distributed. Not everyone can get the type of care they need, when and where they want it. Assessment and referral challenges are prevalent. The District needs more harm reduction services (such as syringe access, safer consumption spaces, naloxone distribution, sobering centers) and primary and secondary prevention services. Service capacity is hindered by low payment rates and cumbersome licensure, certification, and documentation requirements.

Provider training and capacity building – Ongoing training and education are necessary for providers at all levels, including clinical, paraprofessional (such as case managers, peer leaders, peer recovery coaches, and recovery specialists), and nonclinical staff (such as front desk staff, managers, and referral coordinators) to promote high-quality patient engagement.

Care transitions – People are often discharged into the community or to other service providers with limited support, which hinders recovery. Some populations (such as individuals experiencing homelessness or with unstable housing, survivors of abuse, individuals who were formerly incarcerated or returning citizens, older adults, and people with children) require specialized attention and care.

System improvements and capacity-building needs – Substance use disorder providers need improvements to infrastructure and systems, including enhanced payment and compensation mechanisms, workforce training and technical assistance infrastructure, quality and performance improvement and accountability structures, and systems to promote the use of health information technology (IT) and health information exchange to coordinate care, integrate services, and improve quality, care transitions, and crisis stabilization.

Strengths

  • Resilience
  • Spirituality and faith

Opportunities

Gaps in the substance use disorder care continuum:

  • Expand evidenced-based services offered through transitional housing programs or multiservice community centers operated within existing “anchor” institutions through specific requests, contracts, and program initiatives in targeted communities.
  • Expand and refine the “no wrong door” approach to assessment and referral.
  • Invest in the development of a web-based, interactive, and well-maintained resource inventory for consumers and providers.
  • Develop policies that enhance payments and reduce other barriers to providers’ entering into the system.
  • Support programs that link people to services that address the social determinants of health (such as education, employment, and housing).
  • Explore expansion of harm reduction services in the District.

Provider training and capacity building:

  • Develop and/or implement training and technical assistance programs in multiple formats. Practice transformation coaching, webinars, case conferencing, and learning collaboratives.
  • Training and technical assistance should address issues such as patient engagement, cultural sensitivity, confidentiality and ethics, conflict resolution, substance use disorder treatment protocols, best practices for peer support and recovery groups, and self-care for staff.


Care transitions:

  • Support organizations that operate multiple services on the substance use disorder continuum, or that have formal partnerships with other agencies, as they are best equipped to coordinate seamless transitions for clients.
  • Support the development of community-based multiservice institutions that provide a broad range of substance use disorder treatment, recovery, and supportive services.
  • Support the development of provider networks with enhanced referral arrangements.
  • Scale existing programs that provide case management and navigation and recovery support services to better facilitate care transitions.
  • Promote the use and effective application of risk-based contracting.
  • Work with community-based organizations to identify and implement targeted approaches to improving care transitions for high-risk populations.


System improvements and capacity-building needs:

  • Develop pay-for-performance and other enhanced compensation policies that reward organizations for meeting defined benchmarks and metrics.
  • Invest in training and education for recovery specialists and peer recovery coaches.
  • Develop and refine existing data collection methods, analysis, and reporting systems to promote quality and performance improvement.
  • Develop and enhance clinical practice guidelines, decision-making tools, and operating manuals for substance use disorder providers to clarify best practices and define roles and responsibilities.
  • Support the adoption and use of health IT and health information exchange systems that promote documentation of visits, care plans, information sharing, referral coordination, etc.


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