Recovered Crack Addict, 74, Aims to Be ‘Vision of Hope’ Amid Opioid Crisis

By Nicole Levy
DNAinfo

 

Cynthia Williams graduated from Hunter College in January at age 74 as the oldest member of her class and the oldest student in her master’s program in rehabilitation counseling.

“I am the oldest person everywhere I go, doggone it,” said the Fort Greene resident. “I’m the oldest person in Narcotics Anonymous.”

Williams felt everything but her age when Hunter College President Jennifer Raab recounted her life story at the school’s commencement ceremony last month, a tale of addiction, homelessness, recovery and success that drew cheers from the audience.

Admiring classmates later called Williams a “vision of hope,” she said. One student hugged her so tightly she almost keeled over.

‘You don’t find too many people at 74 alive with HIV, having gone through [recovery from an addiction to crack cocaine], and graduating from a masters program,” she said.

It took Williams 12 years to finish her undergraduate degree in sociology, while she was working as a medical secretary at Long Island College Hospital.

She is now one exam away from becoming a Certified Substance Abuse Counselor (CSAC). A survivor of the crack epidemic that gripped urban communities of color in the 1980s, she will launch her career amid an opioid epidemic consuming the white suburbs.

Opiates — a class of drugs that not only includes illicit substances like heroin, but prescription painkillers like Percocet and Vicodin — were projected as of November to claim the record-setting number of 1,000 lives in New York City in 2016. The city that once waged a war on crack, locking addicts behind bars in response to fears about a spike in violent crimes, is now treating opioid dependency as a public health issue, dispensing anti-overdose drugs over the counter and cracking down on dealers.

Crack and heroin are chemically and physiologically different, too. Crack is a stimulant, giving the smoker an intense but short euphoria.

Opiates are depressants and have a longer high. Withdrawal has not just psychological, but physical symptoms such as nausea and abdominal pain, which make it even more difficult for addicts to quit.

Williams gave up crack for good on May 10, 1992. After cycling in and out of detox facilities for half a decade, she committed to a 28-day program at Methodist Hospital in Park Slope.

“The detox, the rehabs, the counseling, the groups, the motivation and the hope — that’s what got me here,” she said. “So I want to be a part of that and give that back somehow.”

Her experience is the very resource Mayor Bill de Blasio’s office hopes to tap with its new Certified Recovery Peer Advocate (CRPA) training program, preparing graduates of substance-use recovery programs for careers in those same programs.

During her internships at Hunter, Williams’ transparency about her past benefited the patients she worked with, said Michelle Lask, a clinical coordinator of fieldwork placements at the college.

“We teach the importance of meaningful self-disclosure … to overcome [the client’s] own shame about telling their own story,” Lask said. “They’re not proud of the things they did to get the drug, what they did on the drug.”

Williams, she said, “was a role model, helping minimize the shame and trauma of that.”

A Life of Addiction

Cynthia Williams was born on Aug. 17, 1942, to an alcoholic veteran and his numbers-running wife. She grew up in the James Weldon Johnson Houses in East Harlem, on a floor she described as rife with domestic violence.

Williams experimented recreationally with drugs throughout high school and her early working life as a typist. (She had dreams of a white-collar career that were dashed, she said, by school administrators who tracked her education out of a program for college-bound students.)

In her 20s, she dropped paychecks at clubs where dealers distributed powder cocaine on $100 bills, and she moved in briefly with a heroin addict — a man who fathered her son, taught her how to inject or “skin-pop” the narcotic, and enlisted her as a pregnant lookout while he burglarized apartments.

In the ’80s a childhood friend introduced Williams — then living in Section 8 housing in Far Rockaway with her teenage son and working as a medical transcriptionist at Lenox Hill Hospital — to crack cocaine.

“I went over to visit her, and we were talking about old times and next thing you know, she introduced me to crack and I loved it,” she said. “That weekend, I never got home.”

Shortly after, William’s son, a student at Brooklyn Tech High School, walked in on his mother smoking in her bedroom.

“I had the door closed, and I was getting ready to take a hit when he busted in the door,” she said, recalling his response. “Oh no! My mother’s a crackhead.”

He left immediately for his grandmother’s home.

She describes that moment as both the “beginning of the end” and “nirvana.” Williams sold her son’s drum set, his Nintendo, their silverware, even their curtains. Soon, she lost her job and the apartment.

Williams joined her son at her mother’s place, but she didn’t stop stealing to support her habit and soon wore out her welcome. So she packed a suitcase with the essentials: some clothes, her crack pipe and the scraper she used to clean it.

Williams began to cycle between crack houses and detox facilities, filling the times in between by living on the streets.

“I tried to be a prostitute,” she said, “but it didn’t work because I didn’t know how to get the money [before the sexual transaction].”

Williams was nearly as naive about begging, asking for spare change with her hands outstretched until a passerby recommended she use a cup.

In spite of her inexperience, Williams evaded arrest at a time when most addicts were jailed at least once, according to her Narcotics Anonymous sponsor Lindra Ware. It wasn’t the criminal justice system, but sheer exhaustion that motivated her to seek treatment.

Getting Clean

Williams met her sponsor 19 years ago, when she joined a Narcotics Anonymous group.

Ware coached her through nighttime dreams and daytime urges that might tempt her to use again, encouraging her to leave traumatic events in the past and take accountability for her actions.

“I’ve messed with her head,” said Ware, a recovered heroin addict. As a test, she once offered a jonesing Williams this intentionally unfair trade: $20 to buy coke in exchange for one expensive mink coat. Williams turned Ware down.

More than a decade younger than Williams, Ware set an example by earning her masters of public health at 50. Her second master’s degree is in social work, and Ware feels obligated to warn Williams of the challenges ahead.

“Now with this shift that’s coming, with heroin, be prepared,” she instructed Williams on a Saturday afternoon earlier this month, when the two women sat down for an interview with DNAinfo New York in the recreation room of Williams’ building in Fort Greene.

“I told you all five years ago, heroin is coming,” Ware said. “Crack is holding its own, but heroin is once again the drug of choice.” (Heroin was at the center of New York City’s drug scene in the 1960s.)

Substance abuse treatment programs have undergone their own cycle in that time, swinging between an emphasis on lived experience and a stress on professional distance, according to Justin Mitchell, director of residential services at Odyssey House, a nonprofit serving addicts in recovery.

Empathy can help a counselor guide her client through the highs and lows of the early recovery process.

“Someone who has had many years of recovery, who goes on to improve their life by going to school and working,” he said, “can show that there’s hope and opportunity if you’re able to address this issue that’s standing in the way.”

But formal training teaches counselors that they should always have a reason for disclosing personal information, one benefiting their client rather than comforting themselves.

With her personal experience and theoretical studies, Williams may be perfectly poised between the two schools of thought, Mitchell said.

But even though Williams will soon guide those starting their own recovery, hers is a story that continues to unfold. She’ll attend the same Narcotics Anonymous meetings that helped her stay on track and work with her sponsor.

When Williams stumbled over remembering her “clean date,” or the day she quit crack, Ware warned, ”Those who don’t remember are doomed to repeat.”

Connecting New Yorkers to treatment services

Harlem drug treatment outreachYesterday, Odyssey House hosted a press conference announcing a new program designed to improve addiction treatment services in East Harlem. The NYS Office of Alcoholism and Substance Abuse Services (OASAS) has awarded $190,000 to Odyssey House and Mount Sinai Behavioral Health System to support a new peer engagement specialist initiative.

Speakers inOpioid treatment Harlem announcementcluded OASAS Commissioner Arlene Gonzalez-Sanchez, Odyssey House President & CEO Dr. Peter Provet, and Teri Friedman, Director, Mount Sinai Behavioral Health System. The two peer engagement specialists, Anita Kennedy (Mount Sinai) and Mark Fowler (Odyssey House), also addressed the crowd, describing their experiences within the recovery community and how they plan to conduct outreach to connect individuals in East Harlem with treatment services.

You can find more information in the press release.  Below is the press coverage from the announcement:

The ER department fighting the US opioid crisis

By Thomas Urbain
AFP

Opioid abuse has turned into a public health crisis in America, blamed for the deaths of tens of thousands of people. But one hospital is determined to reverse the epidemic.

Since January, St Joseph’s Regional Medical Center, which boasts the largest emergency room in New Jersey, has stopped prescribing opioid painkillers in all but essential cases, slashing overall use by more than 40 percent.

While these powerful drugs are an “excellent” medication for terminal cancer patients or those with a broken leg, for the vast majority there are far safer courses of treatment, says emergency medicine chief Mark Rosenberg.

“In our first 60 days, we were absolutely shocked,” Rosenberg told AFP. “We had 300 patients. And out of those 75 percent of them did not need opioids.”

“It’s just a remarkable change of our prescribing habits and our management of patients’ acute pain,” he added.

In 2014, 14,000 people died from an opioid overdose in the United States, according to the Centers for Disease Control and Prevention (CDC). Since 1999, these powerful painkillers have caused 165,000 deaths.

The problem dates back to the 1990s but critics accuse President Barack Obama of being slow to respond to the scale of the epidemic, comparing his delayed reaction to Ronald Reagan’s sluggish response to the HIV/AIDS crisis.

Back in the mid-1990s, drug companies, professionals and authorities promoted opiates as a compassionate medicine that would end pain and minimized concerns that they were addictive.

“It led to the epidemic that we’re dealing with today,” says Andrew Kolodny, chief medical officer at Phoenix House Foundation, which treats addiction, and executive director of Physicians for Responsible Opioid Prescribing.

Clean for three months, former heroin addict Erik Jacobsen, 24, is determined to turn his life around after getting hooked on the class A narcotic.

– Endless cycle –

It all began when he popped a quarter of one of his grandfather’s painkillers in order to impress a girl he fancied.

“She was using it,” he told AFP at Odyssey House, a treatment center in New York’s East Village. “That’s why I got into it.”

He never tried to get them legally from a doctor. He didn’t have to, they were so easy to buy on the street in Gordon Heights, a hamlet an hour’s drive from celebrity summer resort the Hamptons on Long Island.

“There were so many kids that would get 200 pills a month and they’d sell it. And then they’d still owe their dealers because they were using more than they were selling. It would just be an endless cycle.”

That was until local authorities realized there was a problem, doctors clamped down on prescriptions and the police got involved.

“There was one night I couldn’t find any pills. So I tried heroin. And from there, I never went back,” he said.

He knew three people who died of an overdose, including a close friend.

“I just kind of accepted the possibility that one day I might die,” he said. “It’s horrible… It’s just crazy what it does to your body,” he said.

– White problem –

He got help when he was arrested and hauled before a judge, who ordered him to enter a treatment program or go to jail.

He likes Odyssey House and their approach but he is full of regret.

“I lost everything,” he said. He and his fiancee broke up because of his drug use and three of his best friends still refuse to talk to him.

“I want my life back,” he said.

He believes America’s opiate addiction is getting worse and wants to do more to help others before it’s too late.

“It’s scary,” he said. “The people that were young in my town at least, they didn’t realize what they were getting into,” he said. “You don’t really comprehend how intense it is when you try this thing.”

Experts say the opioid epidemic is a white problem. While heroin use is on the decline in inner city New York, painkillers are most abused in suburbs and rural areas — generally wealthier, whiter areas.

Rosenberg says St Joseph’s one-year fellowship, offered since January to New Jersey professionals, teaches safe alternatives, how to support patients to best manage pain and explain to them the dangers of opioids.

Next January, the program will expand to doctors, nurses and educators from across the United States and around the world, with enquiries already in from Britain, Canada, Scandinavia and Turkey.

“If you can sleep, if you can walk, then pain is not going to be your enemy. That’s what our goal is, to make you functional in pain, not to eliminate it completely,” said Rosenberg. “We need to do something.”

Deaths and Broken Lives from Drug Overdoses

In today’s edition of The New York Times, Odyssey House President Dr. Peter Provet comments on a recent article (“Drug Overdoses Propel Rise in Mortality Rates of Whites,” front page, Jan. 17) on the rising death rates for young white adults, driven by the opioid epidemic.

 

Deaths and Broken Lives from Drug Overdoses

To the Editor:

The dramatic increase in drug overdose deaths is not new to drug treatment. For several years treatment providers have been racing to save the lives of young Americans addicted to opioids as what started as a surge in prescription drug abuse morphed into a full-blown opioid epidemic.

It is also not news that intensive residential and outpatient treatment services are in short supply, and what resources are available in many parts of the country are often prohibitively expensive for the vulnerable populations who need them the most.

That today’s vulnerable addicts now include growing numbers of young white Americans highlights the tragedy of opioid addiction as a great equalizer.

Decades of experience treating young people from inner-city communities ravaged by drugs has shown us that recovery is a multistep, time-consuming process that, for the fortunate ones who are helped quickly enough, starts with overdose-prevention injections and detox, and continues with medically assisted treatment, behavior therapy and continuing community-based support.

Anything less just doesn’t work and is merely a Band-Aid that will inevitably lead to the loss of more young lives – tragically, lives we know how to save.

 

The year ahead

Experts’ Contributions: “Hopes and Fears” 2016

Leaders in the field of drug treatment share their predictions for 2016 and the challenges ahead. See Dr. Provet’s below. Click here for the full report. 

The escalating opioid epidemic among middle-class Americans drew unusual attention last year to our field across a wide public sphere of elected officials, leaders of medical and scientific communities, members of criminal justice and law enforcement agencies, and the mainstream media.

While this attention is welcome, we need to make sure the urgent need for treatment is reflected in the stabilization and expansion of services for vulnerable populations. As states (including New York, with high-need, disadvantaged populations) look to contain costs under Medicaid managed care, we must work hard to ensure that the federal block grant is maintained, the IMD [Institutions for Mental Diseases] exclusion is eliminated and parity under the ACA [Affordable Care Act] is fully enforced. Without these essential provisions built into federal and state budgets and policies, nonprofit organizations that provide the bulk of safety net services will find it harder and harder to meet the increased demands for care.

At Odyssey House, we have been preparing for the impact of managed care for quite some time and have established new systems to both contain costs and streamline care. These include: electronic health record keeping and linkages with hospital and other community-based providers; evidence-based practices and medication-assisted treatment; and extended outpatient and housing support services.

My hope as we look to 2016 is that we will not only continue to provide quality care for disadvantaged substance abusers (who often require intensive residential services in order to have a chance at achieving and maintaining a functional life), but that their needs will be reflected in the ongoing national debate on how best to treat addiction and its accompanying social ills.

Peter Provet, Ph.D.
President & Chief Executive Officer

Merging Missions: Building a Staff Wellness Program

BEHAVIORAL HEALTH NEWS

By Colleen Beagen

Bringing wellness into the workplace is a natural development for Odyssey House where the mission of the organization is to promote a healthy recovery for individuals and families facing a range of life challenges from substance use disorders, mental illness, homelessness and chronic medical conditions. In 2011, we introduced a free, voluntary program called R U Fit?! to offer employees the resources they need to improve their own health via education and a supportive work environment.

This staff wellness initiative is a continuation of our commitment to support and promote good health among program participants. It takes a similar positive reinforcement approach to the proven model Odyssey House developed with clients and provides staff with group support, free on-site fitness facilities, and access to an employee-only online health coaching service.

Our objective in implementing a wellness initiative is to help workers make changes in their lives that undermine their health, thereby boosting morale and productivity, improving employee recruitment and retention, and reducing health care costs.

The development of the program was spurred by Odyssey House president, Dr. Peter Provet, who has made wellness a top priority, based on his firm belief that “ultimately, it is the clients we serve who will be the beneficiaries of healthier, happier staff members.

“Given the steep rise in health care costs coupled with increased awareness of the importance of a healthy diet and regular exercise,” he added, “we looked at what we could do to both help staff improve their overall health and impact our bottom line. We found that a program that offered personalized and confidential coaching was a sound investment in our most valuable resource, the 350 counseling, educational, medical, and administrative staff who dedicate themselves to the mission of Odyssey House.”

A survey of American workers backs this up. The survey found that 51 percent of workers agree that having a wellness program encourages them to work harder and perform better at work; 59 percent said they have more energy to be productive; and 43 percent said that they have missed fewer days of work.

Conducted by The Principal Financial Well-Being Index in 2013, the survey further found that the incentive-driven and ease-of-access approach Odyssey House offers – an enhanced program that includes fitness center discounts, on-site prevention screenings, access to health experts, and onsite fitness facilities – is on target with wellness benefits most desired by employees.

Incorporating Wellness Into Company Culture

Fitness has long been a priority at Odyssey House. All staff are encouraged to practice healthy habits at work and have access to exercise equipment at Odyssey House treatment centers. The emphasis on diet and exercise is foremost in a number of events we host, including our annual 5K fundraiser, Run for Your Life, intramural sports leagues, and rigorous training with the Odyssey House Marathon Team (since 2002 more than 400 clients and former clients, staff, board members and other supporters have completed the New York City Marathon).

The purpose of R U FIT?! is to complement these activities with free, online, confidential health coaching and personalized programs to promote weight and nutrition management, encourage regular exercise and stress reduction, and support smoking cessation. All employees who enroll have access to health coaches, agencywide competitions, online workshops and more.

To allay any concerns staff may have about confidentiality and to encourage trust in disclosing personal information, Odyssey House provides these services via an outside company called Health Advocate. Data collected by the service is anonymous and in the aggregate, and only collated to monitor overall participation and refine services.

Each year we offer all staff on-site biometric screenings and confidential consultations with health educators. The screenings measure cholesterol levels, glucose readings, blood pressure and BMI (Body Mass Index). Using their results, employees complete an online Personal Health Profile (PHP), which provides a customized report containing overall wellness scores, identifying high risk areas, and describing steps that can be taken to reduce future health risks. In its first five years, R U Fit?! has contributed to a shift in culture toward a healthier overall lifestyle, and we have seen improvements in the health of our employees. Between 2013 and 2014, we found the following year-over-year improvements for all participating staff:

  • 50% improvement in average blood pressure
  • 55% improvement in average cholesterol ratio
  • 100% improvement in average glucose levels

For employees with at least one risk factor (e.g., BMI over 25, elevated blood pressure, high cholesterol) over the same period:

  • 55% improvement in average BMI
  • 45% improved average waist circumference
  • 70% improvement in average blood pressure
  • 75% improvement in average cholesterol

Our goals now are to continue to improve biometrics numbers for high-risk employees; maintain nonrisk employees in the healthy range; increase both participation and engagement in the R U Fit?! program; and expand the stress reduction program.

Sound Bodies, Sound Minds

To aid in managing R U Fit?!, we hired a nutritionist and wellness coordinator to act as a liaison between employees and Health Advocate. A registered dietician and certified Pilates instructor, the coordinator has been instrumental in promoting the program and encouraging staff participation.

She has made it her mission to build a wellness program that expands beyond the standard biometric screenings, gym discounts, health competitions, and cooking workshops. Her first order of business was to build trust with the community of employees that span across 13 locations from downtown Manhattan to the Bronx. By establishing rapport with the employees, the doors of communication were opened and she was able to carry on her mission within the agency.

Our coordinator used her expertise to develop nutrition and exerciserelated initiatives, such as agency-wide competitions like 10,000 steps, Pilates and yoga classes, and lunch and learn seminars. However, due to the fact that depression now costs employers more money than smoking does, she made it a goal to reach employees at a deeper level. Her latest initiatives focus on meditation, mindfulness, yoga and Pilates. She is also planning programs targeting compassion, gratitude, and self-esteem.

Employees often share their stories about how one or more aspects of R U Fit?! helped them in their lives, both professionally and personally. Whether it was the impact a nutrition seminar had on them, the weekly meditation classes, or the free gyms we have at six of our facilities, staff have been able to make changes to their lifestyle and create healthier habits that ultimately lead to a higher quality of life.

The Best and Worst of 2015, and Hopes and Fears for 2016

Leaders in the field of drug treatment share their predictions for 2016 and the challenges ahead. See Dr. Provet’s below. Click here for the full report.

The escalating opioid epidemic among middle-class Americans drew unusual attention last year to our field across a wide public sphere of elected officials, leaders of medical and scientific communities, members of criminal justice and law enforcement agencies, and the mainstream media.

While this attention is welcome, we need to make sure the urgent need for treatment is reflected in the stabilization and expansion of services for vulnerable populations. As states (including New York, with high-need, disadvantaged populations) look to contain costs under Medicaid managed care, we must work hard to ensure that the federal block grant is maintained, the IMD [Institutions for Mental Diseases] exclusion is eliminated and parity under the ACA [Affordable Care Act] is fully enforced. Without these essential provisions built in to federal and state budgets and policies, nonprofit organizations that provide the bulk of safety net services will find it harder and harder to meet the increased demands for care.

At Odyssey House, we have been preparing for the impact of managed care for quite some time and have established new systems to both contain costs and streamline care. These include: electronic health record keeping and linkages with hospital and other community-based providers; evidence-based practices and medication-assisted treatment; and extended outpatient and housing support services.

My hope as we look to 2016 is that we will not only continue to provide quality care for disadvantaged substance abusers (who often require intensive residential services in order to have a chance at achieving and maintaining a functional life), but that their needs will be reflected in the ongoing national debate on how best to treat addiction and its accompanying social ills.

Peter Provet, Ph.D.

President & Chief Executive Officer

ElderCare Services Address “Hidden Epidemic” Of Drug and Alcohol Abuse Among Older Americans

BEHAVIORAL HEALTH NEWS

 

As baby boomers, many of whom experimented with drugs in the 1960s and 1970s, head towards their senior years, the number of older Americans with substance use disorders is growing dramatically and with it the need for specialized treatment. Odyssey House’s ElderCare program has focused on the special needs of this population for more than 15 years, both by establishing dedicated residential and outpatient services and, more recently, developing a peer-run, community-based mentoring program.

Growing Demand for Services

Older adults represent one of the fastest growing segments of the US population in need of treatment for substance use disorders (SUD). The National Survey on Drug Use and Health found that among adults aged 50 to 64, the rate of current illicit drug use increased from 2.7 percent in 2002 to 6.0 percent in 2013. Additionally, Emergency Department (ED) admissions for illicit drugs and alcohol have been steadily increasing: from 2004 to 2010, the number of ED visits for drug use and misuse has grown 187 percent for adults ages 55-64 and 104 percent for those ages 65 and older.

The Substance Abuse and Mental Health Services Administration (SAMHSA) expects the number of adults aged 50 and older needing SUD treatment to double by 2020, from 2.8 million (2002 to 2006 annual average) to 5.7 million. The increase in substance abuse among older adults has led to a dramatic rise in the number admitted into treatment: substance abuse treatment admissions of individuals aged 50 or older increased by nearly 50 percent between 2004 and 2009 (Center for Behavioral Health Statistics and Quality, 2012).

The above data, coupled with national surveys that show older adults experience increased depression, isolation, and chronic medical conditions, point to the need for services that are age specific and address the unique physical, psychological, and social changes that may occur during this life stage.

Track Record in Treating Senior Substance Abusers

Odyssey House has an extensive track record in meeting the needs of this overlooked and underserved population. In 1997, we created the first-ever residential treatment program dedicated to treating older substance abusers, known as ElderCare. Since its inception, Odyssey House has increased capacity from 15 to 68 beds, reflecting the evergrowing demand for treatment among older adults.

While enrolled in the ElderCare program, residents receive specialized services and supports in addition to SUD treatment designed to help them to function independently within the community, such as life skills training, entitlements assistance, internal medicine, dentistry and psychiatry. Health care services are provided on-site at the Manor Family Center in East Harlem, where we also employ a geriatric social worker to work with our seniors to identify behavioral health care needs and develop a plan to address them.

In 2004, Odyssey House expanded services to include an outpatient SUD treatment track specifically for older adults. Because many elderly people are at risk of being cut off from their communities as they age, the treatment priorities of the ElderCare Outpatient Program, located on Southern Boulevard in the Bronx, are to encourage older people to develop a social support network among their peers in recovery; provide them with individual and group therapy; and visit them in their homes as necessary. Counselors trained in geriatric care develop individualized treatment plans incorporating age-related individual and group therapies targeting symptoms of depression and anxiety, bereavement counseling and life planning, and access to primary medical care.

To date, Odyssey House has served well over 2,000 older adults in residential and outpatient settings, and serves an average of 130 ElderCare clients annually. ElderCare consistently operates at full capacity and has a waiting list, reflecting the program’s appeal to a growing group of consumers as well as the tremendous need in the community.

Our residents are often the highest users of Medicaid services due to multiple risk factors: active SUD, cooccurring mental health disorder, (several) chronic illnesses, and homelessness. Forty-three percent have a primary medical diagnosis of hypertension, 20 percent are HIV+, 15 percent have asthma, and 10 percent have heart problems. Alcohol is the most common primary substance of abuse, 38 percent, although heroin and crack/ cocaine follow closely behind, 30 percent and 26 percent, respectively. Almost 68 percent list two or more substances of abuse at admission.

Building On Treatment: Peer Mentoring Network for Elders in Early Recovery

In Summer 2014, Odyssey House received a $445,000 grant from the New York State Department of Health to implement a peer mentoring track for older adults (Serving Older Adults Recovery System, or SOARS), based out of the Bronx-based Outpatient Services program. SOARS will allow Odyssey House to provide case management services and improve access to community-based recovery resources for up to 90 ElderCare clients over 14-16 months.

SOARS will deliver a continuum of support services for older adults utilizing both intensive case management and peer-based recovery coaching. Odyssey House case managers will work one-on-one with clients as they transition out of residential treatment, connecting them to community -based services to help them remain out of institutional care. In addition, clients will be paired with a volunteer Recovery Coach, who will serve as a peer mentor to assist in identifying and engaging in community-based recovery supports.

The goal of SOARS is to facilitate and expand older adults’ access to community-based Long Term Services and Supports (LTSS) and ongoing support through the utilization of intensive case management and peer recovery coaching. The expected outcomes from this project are to: keep older adults residing in their homes in the community; increase engagement in the recovery process; improve retention; reduce depression and drug use during and after treatment; and improve social connectedness, quality of life, and self-image.

Reference: Center for Behavioral Health Statistics and Quality (2012, January 12). Older Adult Substance Abuse Treatment Admissions Have Increased; Number of Special Treatment Programs for This Population Has Decreased. Data Spotlight. http://www.samhsa.gov/ data/spotlight/WEB_SPOT_043/ WEB_SPOT_043.pdf

Opportunities for Improved Services with Integrated Care

BEHAVIORAL HEALTH NEWS

By Peter Provet, PhD

The key component of integrated care – coordination of primary and behavioral health services in a way that is accessible from one place – is not a new concept for many substance abuse treatment organizations, such as Odyssey House in New York City, that operate Article 28 licensed medical and dental services as part of comprehensive residential and outpatient treatment. Odyssey House opened its first NYS Department of Health-licensed primary medical clinic in 1992. Staffed by primary care physicians, psychiatrists, and registered nurses, this clinic, co-located in a residential treatment center, was an early model of integrated care. For close to 25 years, our residents have benefited from accessible, on-site services that provide coordinated medical, dental, and behavioral health care across a multi-site system of treatment and housing services.

Early on, substance abuse treatment professionals realized bringing primary care into the treatment community offers clients significant benefits including: integration of medical, psychiatric, pharmacy, prevention, and social work services, and less missed time from treatment. On-site medical clinics were found to reduce use of emergency rooms for non-urgent care, improve management of preventable conditions such as asthma, diabetes, and hypertension and treatment outcomes by encouraging clients to stay in long-term programs.

A 2013 report by the Center for Integrated Health Solutions, published jointly by the Substance Abuse and Mental Services Administration (SAMHSA) and Human Resources Administration (HRA), looked at integrated primary care services and substance abuse treatment and convincingly found that the integration of physical health and addictions care not only helps reduce barriers to primary care, it also enhances recovery from substance abuse.

“In fact,” the report states, “two or more primary care visits in a 6-month period have shown to improve abstinence by 50 percent in individuals with substance abuse disorders, and those with medical conditions related to substance abuse are three times more likely to achieve remission over 5 years. Regular health and addictions care for people with substance abuse disorders also decreased hospitalizations by up to 30 percent. Lastly, substance use screening and services improve the general health of individuals with co-occurring substance abuse and physical health conditions and reduce the overall costs to the healthcare system.”

Today’s model of integrated care, ushered in by passage of the Affordable Care Act (ACA) in 2010 and the earlier Mental Health Parity and Addictions Equality Act (MHPAEA) in 2008, provides opportunities for behavioral health care organizations to further develop integrated care services. According to SAMHSA, ACA expands benefits to approximately 60 million Americans. This legislation mandates coverage of certain preventive services and, together with MHPAEA, ensures health insurers provide the same level of benefits for behavioral health.

This, as we know, is all good news for people in need of substance abuse and mental health treatment who also have physical health needs. Studies have shown that individuals with substance use and mental health disorders who also receive treatment for medical conditions demonstrate improved outcomes in both behavioral and physical health. The demand for medical services is further supported by advances in addiction treatment medication which require appropriately trained staff to administer and monitor these medications for opioid and alcohol addictions.

With the expansion of services comes significant changes to the way Odyssey House, and other behavioral health organizations, must deliver care. Chief among them in New York is a restructuring of Medicaid under the DSRIP (Delivery System Reform Incentive Payment) as part of the Medicaid Redesign Team’s mandate. This effort is charged with reducing avoidable hospital visits by 25 percent over five years by transforming systems and clinical management, and improving population health. Achieving these goals requires the integration of several systems of care from community-based clinics and hospitals, to supportive housing and rehabilitation services.

Positioning for the New Health Care Marketplace

As we prepare for, and participate in, the restructuring of health care services, Odyssey House is gearing up to expand community-based primary, behavioral health, and dental services located at our Family Center in East Harlem and outpatient center in the South Bronx. We are currently included in three Preferred Provider Systems (PPS) that include Mount Sinai, Bronx Lebanon, and Health and Hospital Corporation of New York, and have executed numerous contracts with managed care companies for primary and behavioral health care.

Our services are aligned with the core Health and Recovery Plan (HARP) principles that require Medicaid beneficiaries with mental illness and/or substance use disorders be provided with services in their own communities. These include an array of mandated Home and CommunityBased Services (HCBS) that are:

  • Person-centered
  • Recovery-oriented
  • Integrated
  • Data-driven
  •  Evidence-based
  • Trauma-informed
  • Peer-supported
  • Culturally competent
  • Flexible and mobile
  • Inclusive of social network
  • Coordinated and collaborated.

As an HCBS provider Odyssey House is designated to provide the following behavioral health services:

  • Community psychiatric support and treatment
  •  Psychosocial rehabilitation
  • Habilitation/rehabilitation support services
  •  Family support and training
  •  Pre-vocational services
  • Ongoing supported employment
  •  Educational support services
  •  Empowerment services – peer supports.

Another way we are preparing for changes in the integrated behavioral health care environment is by exploring an FQHC Look-alike designation at our Family Center in East Harlem. While FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits, they must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have ongoing quality assurance programs, and have an independent governing board of directors.

The criteria demanded to provide integrated primary and behavioral health care are aligned with the 48 year-old mission of Odyssey House to provide high-quality, holistic, treatment impacting all major life spheres: psychological, physical, social, family, educational and spiritual.

While the new regulatory environment brings challenges to how we manage our limited resources, who we partner with, and how we monitor the health needs of the individuals we serve, the benefits of an integrated system promise improved care for underserved Americans, not least among them the millions of individuals with substance use and/or mental health disorders.