The Role of Diverse Teams in Caring for Patients with Substance Use Disorders
Substance use disorders, including alcohol and opioid use disorders, are highly prevalent in our New England communities. Treating and supporting the recovery of patients with substance use disorders (SUDs) takes a diverse network of clinical and non-clinical support —primary care doctors, psychiatrists, therapists, social workers, case managers, and many others. In addition to medical care, patients struggling with SUDs need an array of social services, resources, and individualized care. To meet the complex needs of patients with SUDs, Partners HealthCare has expanded its behavioral health services to include new roles embedded in care teams.
“Recovery coaches and other non-clinical team members provide invaluable support to help engage patients with substance use disorder,” says Sarah Wakeman, MD, clinical co-lead of the Partners HealthCare SUDs initiative and a national expert in this area. “They can connect with our most vulnerable patients in ways that clinicians cannot and through these relationships help motivate positive change.” These roles include recovery coaches, behavioral health support specialists, and resource coordinators—all of which work hand in hand with the clinical teams to make sure the patient is getting the care they need.
Recovery coaches act as a coach, care coordinator, and peer to patients dealing with substance use disorders. Through the shared experience of having dealt with SUDs themselves, they can relate to what patients are going though. “It’s a relationship of equals, built on mutuality and past experiences,” says Michael Jellison, a recovery coach at Massachusetts General Hospital. “If you’re lying in a hospital bed and all you’re seeing is doctors telling you all sorts of medical stuff and then somebody comes in and says, You know I was laying in that bed at one time. And I’ve been through what you’re going through. That’s pretty huge.” Recovery Coaches are mobile, and meet clients wherever they need support. This can be anything from waiting with them at the RMV to get an ID card, or even meeting them for a cup of coffee just to talk.
Jellison works mostly with the homeless population of Boston—specifically “rough sleepers” who choose to sleep outside rather than shelters. “For the folks I work with, I’m measuring sobriety in hours, not days or weeks or months,” he says. But if he can make a connection, he can get little successes that build upon each other. He explains that he just visited a patient who went from being eight years homeless on the streets of Boston to getting a one-bedroom apartment of his own.
But for every success story, he’s had many more patients who have continued to struggle. “We don’t judge anybody; we walk with them. It’s their plan, their path. As a recovery coach I can give them a connection to something they want to do that I’ve been through before and have come out on the other side as successful.”
In addition to recovery coaches, behavioral health support specialists (BHSS) are embedded in primary care practices to help support patients with SUDs. The support specialist’s role is to act as a liaison between the patient and the care team, managing referrals, answering questions about co-payments or insurance, and providing resources like books, factsheets, or at-home exercise guides for patients presenting signs of depression, anxiety, or a substance use problem. For patients with SUDs, they initiate SBIRT, a public health model which stands for screening, brief intervention, and referral to treatment. They often help get patients into day treatment or connect them with a substance use disorder counselor.
Ayesha Fournier is a support specialist who works with four practices at Emerson Hospital. Her goal is to get the patients to start thinking about recovery, enroll them in an appropriate program, and motivate them to take those first small steps. “It’s less stressful because you’re not going into a mental health center, you’re just going into your doctor’s office,” she says. “It helps them feel less tense.”
To help support the clinical and non-clinical teams working with patients on the ground, several community hospitals and practices also have access to a resource coordinator. Resource coordinators are like medical resource detectives, hunting down the most appropriate, geographically convenient community resources hand-picked for each patient’s needs. While most resource coordinators answer questions related to depression and anxiety services, there is a central resource coordinator who specifically fields SUDs related inquiries, working with the rest of the care team to identify the most appropriate level of care.
Charles Tuttle is a SUDs-specific resource coordinator who supports some of our community practices through the Center for Population Health. “SUDs patients are Rubik’s Cubes compared to everybody else in the field,” he says. “There’s no one size fits all solution. There are so many different dimensions and as new information comes to light their needs often change. You have to be flexible.”
Resource coordinators draft action plans for patients, with a list of at least three appropriate resources for them to try such as therapists, outpatient programs. This plan can be revised and adjusted as needed. Support from resource coordinators started at MGH and the BWH and has now moved to the community hospitals and practices. “They’re taking the model and integrating it into their local systems,” says Tuttle.
These non-clinical roles are just one aspect of a much larger effort to better serve Partners patients and their primary care doctors. The Substance Use Disorders initiative at Partners HealthCare is opening up new opportunities to connect patients and their doctors with advances in treatments for these disorders. “The SUDs initiative is bringing educational trainings and supports, like project ECHO and SBIRT, directly to primary care practices,” says Brent Forester, MD, MSc, Medical Director for Behavioral Health for Center for Population Health and Chief of Geriatric Psychiatry at McLean Hospital. “Our goal is to help empower and support primary care clinicians and to engage patients so they can benefit from the many effective treatments that are available to help patients live healthy and productive lives.”