Mind and Body

Recovery intervention at emergency rooms, by the numbers

New report details success of innovative initiative, AnchorED

Courtesy of AnchorED

A graph showing the age range of overdose survivors who received recovery coaching in emergency rooms at Rhode Island hospitals through an innovative program called AnchorED, begun in July of 2014.

Photo by Richard Asinof

Jim Gillen, the manager of Recovery Support Services at The Providence Center, is managing the new AnchorED program, providing recovery coaches in hospital emergency rooms to help link overdose survivors to recovery and treatment. Above, Gillen is shown introducing a gubernatorial candidate's forum held at the Anchor Recovery Community Center in Pawtucket in August of 2014.

By Richard Asinof
Posted 2/9/15
A new report documented the success of an innovative program providing recovery coaches at emergency rooms at hospitals in Rhode Island. The approach, which seeks to provide support and links to recovery and treatment to survivors of overdoses, appears to have made a dent in the continuing epidemic of accidental drug overdoses in Rhode Island.
If Gov. Gina Raimondo and the R.I. General Assembly are serious about wanting to reduce the costs of Medicaid spending, will they invest in the promising AnchorED program as a way to do that? Will health insurers change their policies to allow hospitals to be reimbursed when they dispense Narcan kits to overdose survivors? More than totaling up the body counts, will the news media begin to keep track of the number of lives saved through recovery programs?
At the Senate confirmation hearing of Stefan Pryor to become the head of CommerceRI, Pryor talked at length about his plans to create new tools to grow Rhode Island’s economy, with a focus on new public-private partnerships and to create a new vision and purpose for the redevelopment of the former Route 195 land. A bevy of witnesses from Pryor’s past testified to his brilliance in addressing economic development in Newark, N.J., education in Connecticut, and economic recovery in lower Manhattan in the wake of the Sept. 11 attacks. The senators voted unanimously to endorse his confirmation.
After the hearing, with most everyone departed, ConvergenceRI noticed a clerk gathering up the name placards of the senators; he looked very familiar. It was Jonathan Goyer, a young man in recovery, who was featured in the latest media ads promoting the message, “Recovery is possible.” Goyer was also a featured panelist on RIPR’s hour-long program on the Hep C crisis.
The success of Goyer’s recovery is perhaps the true story of how to “Make It in RI,” Gov. Raimondo’s new slogan for economic recovery. Pryor, who was touted as someone who listens very well, should make a point to listen to Goyer’s story, because for the state’s economic recovery to succeed, it needs to be inclusive of everyone.

PROVIDENCE – In June of 2014, with Rhode Island in the grips of an epidemic of accidental overdose deaths, a new innovative program was developed to connect overdose patients in emergency rooms with certified recovery coaches at Rhode Island hospitals, in order to provide the support needed to link patients to treatment and recovery.

The effort, called AnchorED, was an initiative managed by the Anchor Recovery Community Center, a program of the Providence Center.

Jim Gillen, director of Recovery Support Services at the Providence Center, and Holly Cekala, the manager of AnchorED, coordinated the new initiative.

It placed certified peer recovery coaches on call, every weekend from 8 p.m. Friday night through 8 a.m. Monday morning at participating hospitals. Weekends had been identified as a time when frequent overdoses occurred.

The first hospital to introduce this program was Kent Hospital in July of 2014. Since then, Rhode Island Hospital [on Aug. 29, 2014], Miriam Hospital, Memorial Hospital and Newport Hospital have joined the effort.

The goal of placing on-call recovery coaches in hospital emergency rooms was to break the cycle of overdose and addiction, linking patients to treatment and recovery resources. The recovery coaches also provided education on overdose prevention, including the use of Naloxone [or Narcan], as well as connecting patients and their families to support services after discharge.

The new innovative program was created with support from Gov. Lincoln Chafee, Dr. Michael Fine, the director of the R.I. Department of Health, and Craig Stenning, the director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. Funding came from Stenning’s agency.

How effective was the program? A new report provides some stunning details.

Saving lives, saving money
A new report, “AnchorED: A Care and Treatment Approach to Opioid Addictions, written by Holly Cekala and Jen Palo,” was released on Monday, Feb. 9, detailing the efforts.

Seven months after the program began, 112 survivors of overdoses in hospital emergency rooms were seen and 88 percent of them engaged in recovery supports.

To put those numbers in some perspective, in 2014, a total 232 people died of accidental overdoses in Rhode Island.

The report also broke down the demographics, ethnic diversity and ages of the patients that received recovery coaching and support.

There were 79 men and 33 women; 75 percent were White, 18 percent were Latino/Hispanic, 3 percent were African American, 2 percent were Pacific Islander, and 2 percent were more than one race.

Rhode Island Hospital had made the most calls for peer recovery support specialists to assist patients being treated with suspected overdoses in the Emergency Room, with 70.
Miriam had 19, Kent 17, Memorial 4, Newport 4, and Hasbro Children’s Hospital 2, as of Jan. 26, 2015.

There are plans to move forward with the certified recovery coach program at South County Hospital, Westerly Hospital and Landmark Medical Center, according to the report.

The report also noted that although the services had been offered, the program had not had a response from Roger Williams Hospital and Fatima, both part of the for-profit CharterCARE hospital system, or from the VA.

In addition, the report said that in response to the apparent underutilization of services at both Kent Hospital and Newport Hospital, the program’s services were being expanded to cover alcohol in those locations.

All generations
The age range of survivors was from 15 to 77, demonstrating that every generation in Rhode Island is affected by accidental overdose from opioids. The largest grouping was in the 21-28 age range, with 42 survivors engaging with recovery coaches, according to the report.

Prior treatment, prior overdoses
The numbers also reinforced the difficulty in treating the chronic nature of the disease of addiction.

When survivors were asked in they had been in treatment in the prior year, one-third, or 38 out of 112 said yes.

Survivors were also asked if they had overdosed before in the last 12 months; 38 percent, or 42 out of the 112 survivors, said that they had had a prior overdose, according to the report. Some reported multiple overdoses, ranging from two to as many as 16.

Use of Narcan
The report also detailed the effectiveness of the use of naloxone, or Narcan, in treating opioid overdoses. Of the 112 survivors, 48 had been revived by doses of Narcan: six by rescue, 25 at the hospital, 10 by the police in the street, three by a Good Samaritan, and four unknown.

As part of the program, the AnchorED recovery coaches educate survivors on Narcan and how to use it. Rhode Island hospitals also provided Narcan kits upon discharge. As of Dec. 1, 2014, hospital pharmacies had reported the distribution of 73 kits, with 56 from Rhode Island Hospital, 13 from Miriam Hospital, and four from Kent Hospital.

The report raised the issue of cost of the Narcan kits as a barrier, because it is not currently reimbursable by health insurance providers. Rhode Island Hospital was covering the cost, as was Kent, but Memorial Hospital was reported unable to do so.

Health insurance
The report’s pie chart of health insurance in which the survivors were enrolled painted a surprisingly disparate picture. Blue Cross & Blue Shield of Rhode Island covered 6 percent of survivors, Mass Health covered 8 percent, Medicaid covered 22 percent, Neighborhood Health Plan of Rhode Island, through its managed Medicaid program, covered 23 percent, UnitedHealthcare, through its managed Medicaid program, covered 15 percent, UnitedHealthcare Optum covered 3 percent, TriCare VA covered 3 percent, Cigna covered 6 percent, 11 percent had no health insurance, and information on the remaining 5 percent was listed as N/A.

The report, citing the numbers for Medicaid insurance, including Neighborhood Health Plan’s managed Medicaid program with 23 percent, Medicaid with 22 percent, and UnitedHealthcare’s managed Medicaid with 15 percent, said: “Clearly, Medicaid dollars can be saved by Rhode Island taking a more aggressive stance on connecting people with recovery support services.”

Survivor stories
As part of the report, stories of survivors’ experiences were offered. One, from Oct. 12, 2014, at Kent Hospital, showed the important role that families can play in supporting recovery.

“The survivor, a clean-cut young man about college age, overdosed while driving and caused a car accident,” the story began. “The recovery coach connected with the survivor, helping him understand the severity of this near-death experience and cultivated a willingness from the survivor to get help.”

The story continued: “The family arrived distraught and confused. The survivor gave permission to the recovery coach to speak with the family. The recovery coach moved the family’s anger from the survivor to the disease.”

The story concluded: “Days after the overdose the recovery coach continued to work with the family helping them find a treatment program that accepted their insurance. The survivor went to detox locally then entered a long-term treatment facility. This type of family interaction is growing as the AnchorED program progresses.”

A constituency of consequence
Jim Gillen, the very public face of the recovery movement in Rhode Island, and one of the organizers of the AnchorED program, is reported to be very ill but fighting very hard, as ConvergenceRI wrote this story.

Gillen, the manager of the Anchor Recovery Community Center, opened a gubernatorial candidates’ forum on Aug. 22, proudly wearing a lapel sticker that said, “I’m in recovery and I vote.”

“We vote,” he said. “We’ve become a constituency of consequence, as more and more people have had the right to vote restored. It’s like being a kid at Christmas all over again, and people are excited.”

“They know the issues; they are not afraid to speak up and say how they feel. We vote,” Gillen said, again. “I’m a person in long-term recovery, which for me means I haven’t used alcohol and drugs, I’ve been managing my condition of addiction, since 1998.”

And, Gillen continued, “As a result, my life has gotten a whole lot better. Recovery is a reality, and ladies and gentlemen, recovery will save the state money, a lot of money.”

Garry Bliss, communications director at The Providence Center, who served as moderator and had to follow Gillen to the podium, said: “There are hard acts to follow and there are impossible acts to follow.”


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