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Using Peers to Improve ED Patient Engagement and Linkage to Substance Use Disorder (SUD) Services
BACKGROUNDBACKGROUNDBACKGROUND
The prevalence of substance misuse has been a pressing issue for New York State and the
Staten Island community. A high volume of patients with substance use disorders (SUDs) have
presented to Staten Island Emergency Departments (ED), many of whom frequently returned.
While patients received the proper medical care, the challenge of engaging patients to seek
immediate treatment or recovery support still prevailed.
Through the Behavioral Health Infrastructure Project, the ED Warm Handoff Program was
created to introduce peers in the Richmond University Medical Center ED for the first time.
Peers were integrated as hospital staff to engage, educate, and advocate for patients, while
supporting clinicians to connect patients to SUD services. The program served as an
intervention to better engage patients who present with substance use needs and to link them
to an appropriate level of care in a timely manner. This initiative was launched with a six-month
pilot (November 30, 2016 to May 31, 2017) and was also supported by several infrastructural
system-level enhancements, including the expansion of treatment provider hours of operation,
a 24/7 call center and online searchable provider directory, and the growth of the peer
workforce.
PROGRAM MODELPROGRAM MODELPROGRAM MODEL
Establishing
a 24/7
call center
Placing certified recovery
coaches/peer advocates
in the Emergency
Department
Expanding
treatment
providers’
hours of operation
Conducting substance
use disorder level-
of-care in the
Emergency Department
Patient
Crisis Stabilization &
Resource/
Recovery
Recovery Coaches /
Peer Advocates SUD Treatment
Providers
Behavioral Health
Specialists
Staten Island
Connect
844-877-7828
PROGRAM OUTCOMESPROGRAM OUTCOMESPROGRAM OUTCOMES
75% 25%
Male Female
From November 2016 to May 2017,
a 13 % Reduction
in preventable ED utilization for people with
substance use disorders and other behavioral
health diagnoses
3% increase
in the initiation of SUD treatment within
14 days and engagement within
30 days after initiation
Victoria Njoku-Anokam, MPH
Director of Behavioral Health Initiatives,
Staten Island Performing Provider System
Kimberly Lewis, LCSW
Assistant Director of Social Work,
Richmond University Medical Center
Maralie Deprinvil, MPH
Coordinator of Behavioral Health Infrastructure Project,
Staten Island Partnership for Community Wellness
Marianne Howard-Siewers, MS, RN
Clinical Consultant
Staten Island Performing Provider System
Steven Chan, MPH
Coordinator of Evaluation
Staten Island Partnership for Community Wellness
WORKFLOWWORKFLOWWORKFLOW
Patient Arrival & Medical Assessment
Peer Engagement
Psychosocial & Level of Care Assessment
Appointment/Transportation Scheduling
Handoff/Escort
Follow Up
Program Oversight: Staten Island Performing Provider System, Staten Island Partnership for Community
Wellness, the Richmond University Medical Center, and the Resource Training & Counseling Center
Goal .Connect patients with substance use disorder
needs to treatment and support services in a timely manner by:
Transformed
ED Culture
of Managing
Patients with
Substance Use
Disorders and
Reduced Stigma
Among ED Staff
We really needed a
program like this for
a while now and
things are going
well.
Peer ED Medical Leadership
A chance to save a
life is stressful but at
the end of the day
to go home with a
natural smile and
feel good especially
in the emergency
room.
I’m tired of this and
you’re the only one
who's been talking
to me for 2 days
now. I'm putting my
life in your hands -
whatever you think is
best .
Patient
LESSONS LEARNEDLESSONS LEARNEDLESSONS LEARNED
Clearly defining peer’s role and collaborating with
peers as part of the ED interdisciplinary care team is
integral to a successful patient engagement and
handoff
Educating ED staff to combat stigma was necessary
for peer productivity and improved patient
experience
Hospital leadership must constantly improve workflow
and get buy in from all levels in the ED
Hospital leadership & staff should work with treatment
providers and utilize available resources to facilitate
quicker access and confirm handoffs (providers who
responded confirmed 46% of handoffs)
Effective supervision of peers and access to
continuing education is critical to support peer
professional development
Timely planning must occur with community partners
and regulatory agencies to financially sustain peer
services and improved care outcomes
PATIENT PROFILEPATIENT PROFILEPATIENT PROFILE
P4P MEASURES IMPROVEMENTP4P MEASURES IMPROVEMENTP4P MEASURES IMPROVEMENT
709
Engagements
458
Unique Patients
22%
Case Finds
PEER ENGAGEMENTSPEER ENGAGEMENTSPEER ENGAGEMENTS
PATIENT ACCEPTANCEPATIENT ACCEPTANCEPATIENT ACCEPTANCE
591
Refusals
83
Handoffs
15 % higher rate
of people that accepted and were linked
to services compared to SAMHSA*
reported national average
118
Requests
Age
Several patients refused SUD
services at time of peer
engagement but peers
educated patients and their
families about treatment and
support services.
Reasons for refusal:
They did not believe they
had a SUD
Aware of disorder, but not
ready for treatment
Already in treatment
* SAMHSA : https://www.samhsa.gov/data/sites/default/files/sr134-health-insurance-2014/sr134-health-insurance-2014/sr134-health-insurance-2014.htm
Data Sources: RUMC EDIMS Hospital ED Patient Data, RUMC Peer Engagement Logs, RUMC Care Coordination Social Worker Notes and LOCADTR Results, SI Connect Call Reports, Salient NYS Medicaid Enterprise System DSRIP Performance Module
*Based on 6 month pilot—November 30, 2016—May 31, 2017
70% of engaged patients had
alcohol-related issues
Insurance
Substance Type
327
40 19 16 9 5
50
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