Integrating substance abuse and primary care: the NACHC/NIATx Learning Collaborative

In October 2010, NIATx and the National Association of Community Health Centers (NACHC) launched a learning collaborative focused on helping Federally Qualified Health Centers (FQHCs) integrate substance abuse and primary care.

The 1,250 FQHCs in the country provide vital primary care to 20 million Americans with limited financial resources.

With guidance from an expert coach, five FQHCs are partnering with a local substance abuse treatment provider to work together on integrating services.

One of these partnerships consists of Palladia Services (www.palladiainc.org) and Project Samaritan Health Center, an FQHC, in the Bronx, New York.

Palladia has a residential drug treatment facility called Starhill. It provides addiction treatment to adult men and women, many who have just been released from the state prison. Project Samaritan provides the medical and psychiatric care for these residents.

This partnership is working on ways to reduce the Starhill residents’ high no-show rate for initial and follow-up appointments with the psychiatric nurse practitioner at Samaritan.

Aileen Wehren, serves as coach for the Palladia/Project Samaritan team. Aileen is vice president of Systems Administration for Porter-Starke Services, a behavioral healthcare provider based in Indiana. Says Aileen, “Palladia is admitting more and more people who have a dual diagnosis and a need for psychiatric involvement. The sooner these patients can get in to see the nurse practitioner at Project Samaritan, they sooner they can start making progress in treatment.”

Anecdotal information from Zoleka Adams, Director of Centralized Admissions at Palladia, supports this. Zoleka indicates that hospital admissions seem to be decreasing when clients receive their outpatient psychiatric care from Project Samaritan soon after admission to Starhill.

The first step the change team took was to collect baseline data on the no-show rate. They talked with Starhill residents and staff at Samaritan to find out why people weren’t making it to scheduled appointments.

One of the main reasons for the baseline no-show rate of 34 percent?

“The team uncovered inconsistencies in information about how appointments were made and managed at the Starhill site,” says Aileen.

The change team examined the flow of information between the two organizations, specifically, who received appointment information, and how they used it. This helped them recognize a need to establish staff roles and responsibilities about conveying appointment information to the right person at the right time.

The team made changes to address the communication barriers. These changes have improved the no-show rate and included:

• The direct care staff at Starhill follow up with residents about their attendance to appointments.
• Starhill residents get a copy of their appointment information, to help them keep track of their appointments.
• Samaritan is in more direct communication with Starhill residents regarding their appointments.
• Filling an “expeditor” position. This person is responsible for ensuring attendance at scheduled appointments.

Working together, the change team has learned valuable lessons on ways to integrate substance abuse treatment with primary care. One of the most important, says Aileen, is establishing common expectations and goals. “The two organizations need to take time to learn how they each function and their respective philosophical orientations,” she adds. This includes examining each organization’s perspective on client and staff responsibility.

This integration project highlighted the need to examine the communication flow and identify where gaps might occur.

“It also showed the difference between a medical versus a social services model,” says Aileen. “The issue for Starhill is for residents to get appropriate care and medication, while at Project Samaritan a key issue is the organization’s productivity and financial stability.”

Another issue that rose to the surface in the first months of the project? “The nitty gritty of policies and procedures,” adds Aileen. “Are they written down, has everyone been properly trained on them, and are there considerations for revising them over time?”

The Palladia/Project Samaritan project points out the challenges in integration of services across organizations with different cultures, processes, and priorities, says Aileen. “ I am very impressed with the progress that they are making as they solve these problems and enjoy success.”

The project has been rewarding for Aileen as a coach. “I’m based in Indiana, and getting to know another state system has been helpful for me. The Palladia/Project Samaritan team is succeeding in meeting its goal. One of the biggest gains is that they’re starting to see how they can use this change project experience to build a base for working more closely together in the future. “

Palladia/Project Samaritan Integration Project Change Team

Palladia:
• Zoleka Adams, Director of Centralized Admissions
• Shiane Lee, Director of Centralized Admissions
• Maria Arpino, Director of Social Work
• Arnetta Matthews, Case Manager
• Michael Gibson, Social Work
• Anne Valentia, Substance Abuse Supervisor
• Gary Chang, Patient Care Coordinator

Project Samaritan:
• Alison Brown, Regional Nurse Manager
• Jieun Jung, Psychiatric nurse practitioner