Spotlight: Get to Know KHC’s Newest Employee

Recently, Kentuckiana Health Collaborative welcomed a new full-time project coordinator, Natalie Middaugh. Natalie joined the KHC part-time in early 2018 to support the KHC’s Kentucky Opioid Response Effort (KORE) grant. After KHC was given funding for year two of the KORE grant, Natalie was hired full-time to support that work and other KHC projects. KHC members will get to know Natalie well as she becomes more familiar with her role in upcoming months.

Natalie graduated earlier this month with a MPH in Health Promotion and Behavioral Sciences from the University of Louisville. She is most interested in continuing to work with the KORE grants.

“It’s inarguable that the opioid epidemic is currently one of the most prominent public health concerns facing Kentuckians,” Natalie said. “I am eager and hopeful for how the KHC can be a contributing force in addressing it.”

In her spare time, Natalie likes to stay physically active, whether through exercise or entertaining her two dogs, Harper and Nova. She is also passionate about food and nutrition, so she spends a lot of time researching and cooking.

A Little More About Natalie

Area of interest in healthcare: Chronic disease prevention and management, nutrition and food access, worksite wellness, geriatrics, substance abuse
Something that might surprise you about Natalie: She has never broken a bone
Favorite place to travel: Anywhere with a body of water or rich history. Her favorite place so far is Rome, Italy.
Favorite quote: “Do the best you can until you know better. Then when you know better, do better.” – Maya Angelo

Hepatitis A outbreak continues to grow in Louisville, throughout the Commonwealth

(Note: This guest post was written by Lori Caloia, MD, medical director for Louisville Metro Department of Public Health and Wellness)

Map of confirmed hepatitis A cases shows where outbreaks of the virus are most prevalent.

The hepatitis A outbreak continues to grow in Louisville and throughout Kentucky. To date, 392 cases have been identified, and there have been two deaths within Jefferson County. The majority of people in these cases have the common risk factors of recreational drug use – any drug use, not just injection drug use — homelessness and insecure housing. However, about 10% of our cases have no identifiable risk factors. To complicate matters, cases of hepatitis A may go unrecognized. Some people who are infected may not show symptoms, especially early in the disease, and some may not seek medical care when they do.

Hepatitis A is a liver virus found in the stool of people with the infection and spreads when trace amounts of stool are ingested. The two best ways to protect yourself from hepatitis A are to:

  1. Practice good hand washing with warm water and soap, especially after using the bathroom and before you prepare food or eat; and
  2. Get vaccinated

The Louisville Metro Department of Public Health and Wellness (LMPHW) recommending community members protect themselves by getting vaccinated. Just one dose gives you almost complete protection in the outbreak setting! Consider how your organization can help in our community and state-wide efforts to reduce barriers to vaccination for both the general community and for the at risk groups in particular. We can all work together to end to this outbreak!

Two other important things to know and share about the hepatitis A virus:

  • Hand sanitizer is not as effective at preventing the virus as handwashing
  • A person with hepatitis A can be contagious for up to two weeks before they ever show signs or symptoms of illness

There is more information and educational materials about hepatitis A on the LMPHW website. Additionally, answers to frequently asked questions about the hepatitis A vaccine can be found on the Centers for Disease Control and Prevent website.

Last Chance for Public Comment, KY Core Healthcare Measures Set

The public comment period for the Kentucky Core Healthcare Measures Set ends on Thursday, May 24, 2018 at 11:59 p.m. (ET). This is the final opportunity for healthcare stakeholders to weigh in on the relevance and feasibility of new and revised measures.

The Kentucky Core Healthcare Measures Set includes 38 provider performance measures in the areas of prevention, pediatrics, chronic and acute care, and behavioral health. Ultimately, the expectation is for the measures set to be adopted by public and private organizations to better focus improvement efforts toward shared areas.

The PMAC Executive Committee will weigh the opinions, suggestions, and comments resulting from the public comment period. If you are a healthcare stakeholder in Kentucky, please download and review the draft KCHMS on the KHC website here and fill out an online form to submit your comments.

Please email any questions to

KY Core Measures Set Now Available for Comment

Stephanie Clouser

Last year, the Kentuckiana Health Collaborative partnered with Kentucky Department for Medicaid Services to form the Kentucky Performance Measures Alignment Committee (PMAC), a public-private partnership with the goal of creating a core measures set for Kentucky stakeholders to align to. The goals of the core healthcare measurement set are to establish broadly agreed upon priority quality measures that improve the quality and value of care, reduce provider reporting complexity, and align Kentucky’s healthcare organizations to focus on key indicators of quality healthcare in the Commonwealth. The final measures chosen will be included on a core healthcare measures set. Ultimately, the expectation is for the measure set to be adopted by public and private organizations to better focus improvement efforts toward shared areas.

Today, a draft of the core measures set, the Kentucky Core Healthcare Measures Set (KCHMS), is available for public feedback. This public comment period will end on May 24, 2018.

PMAC consists of a large oversight committee and four subcommittees dedicated to areas of primary care and pediatric care: Preventive Care, Pediatric Care, Chronic and Acute Care, and Behavioral Health Care. Subcommittees have spent the last several months creating recommended sets of measures in their area of focus. The result is a measures set with 38 unique measures.

Of those 38 measures in the recommended set, 24 are defined as high priority. The committees found high priority measures to be strong predictors of quality care and reflect priority conditions for Kentucky. These measures had very strong consensus for adoption, and often there was additional enthusiasm from the group around these measures. Standard measures are also important, but they are not elevated to the level of high priority because of either being smaller predictors of quality care, data availability challenges, or lack of provider focus in that area.

There were a few themes that we saw throughout the committees, particularly around behavioral health, BMI, and chronic conditions. For example, behavioral health and preventive health teams both selected the same tobacco screening and cessation measure, and the pediatric group also selected a tobacco screening and cessation measure directed specifically at adolescents. Although the chronic care team didn’t review tobacco measures, they made it clear that tobacco use has a large impact on chronic conditions and asked the other subcommittees to make that a priority in their selection. The behavioral health team selected depression screening and follow up (NQF #418, a CMS measure), and the pediatric group selected as a future area of development a new HEDIS depression screening and follow up measure that was also based on the CMS measure that the behavioral health group chose.

The large PMAC oversight committee has begun to work with these recommendations to create a final set of measures, which will include weighing the opinions, suggestions, and comments resulting from the public comment period. If you are a healthcare stakeholder in Kentucky, please download and review the draft KCHMS on the KHC website here, and fill out an online form to submit your comments.

Please email any questions to

Louisville Coming Together to Curb the Spread of Hepatitis A

(Note: This guest post was written by Sarah Moyer, MD, MPH, director of Louisville Metro Department of Public Health and Wellness, and Lori Caloia, MD, medical director for Louisville Metro Department of Public Health and Wellness)

Map of confirmed hepatitis A cases shows where outbreaks of the virus have been most prevalent.

Louisville continues to work to control an outbreak of acute hepatitis A, which remains centered among the city’s homeless and those who use illicit drugs.

Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by a virus. It is usually transmitted person-to-person through the fecal-oral route or consumption of contaminated food or water. Most adults with hepatitis A symptoms may experience fatigue, low appetite, stomach pain, nausea, or jaundice, that usually resolve within two months of infection; most children less than six years old and some adults do not have symptoms or have an unrecognized infection.

The best ways to prevent hepatitis A infection is to get vaccinated and to wash your hands frequently with soap and water, especially after using the bathroom or changing diapers and before eating or preparing food.

On November 21, 2017, the Kentucky Department for Public Health declared an outbreak of acute hepatitis A in several counties throughout the state, with the vast majority of cases in Louisville. The Louisville outbreak is epi-linked (shares the same genotype or genetic linkage) to a similar outbreak in San Diego, CA. Hepatitis A outbreaks are also occurring in Michigan and in Utah.

As of April 24, there had been 273 cases in Louisville with one death associated with the outbreak. There had been a total of three hepatitis A -associated deaths across the state. The Kentucky Department of Public Health has recommended that everyone living in counties affected by the outbreak be vaccinated. The Department of Public Health and Wellness continues to work with the Centers for Disease Control and Prevention (CDC) and the Kentucky Department for Public Health to provide vaccinations for those who use illicit drugs and for the homeless. Our vaccine is designated by federal regulation specifically for these groups.

The department and its community partners have given well more than 14,000 hepatitis A immunizations at homeless shelters, homeless camps, recovery houses and at agencies such as Family Health Centers’ Phoenix Health Center. It has also provided immunizations at Metro Corrections, both at intake and in the general population of inmates. It regularly continues to provide immunizations at its syringe exchange sites, its Specialty Clinic and at the MORE Center.

Others wishing to get hepatitis A immunization should check with their insurance company on where the insurer prefers that they go to get the vaccine and what, if any, cost might be associated with it. The vaccine is widely available at local pharmacies and health care providers.

Those who do not have health insurance, can be vaccinated at:

Louisville has really come together to protect our out-of-town guests as well as residents during Derby festivities. Public Health and Wellness is teaming up with the U of L Global Health Clinic to offer below-cost immunizations to food service and hospitality businesses throughout the city. Thanks to donations from the Aetna and Anthem foundations, the cost has been reduced from $65 to $25 per dose. As of April 20, more than 1,100 food service workers from more than thirty businesses, including Churchill Downs vendors, had been immunized under this initiative. Businesses wishing to take advantage of this offer should call Dr. Ruth Carrico at 502 – 852-1324.

Like every year, the Department of Public Health and Wellness will be inspecting all food vendors at events like Derby, Oaks, and the Chow Wagons to make sure they are practicing safe food handling. While the outbreak remains centered among those who use illicit drugs and the homeless, the general population attending Derby events can protect themselves from hepatitis A by practicing good handwashing after using the restroom and before eating or drinking.

The Kentucky Derby Festival is posting signage at the various events to emphasize thorough handwashing. Hand sanitizer has been found to be not as effective as good handwashing at protecting against the hepatitis A virus, so the Derby Festival is installing hand washing stations at all events and has tripled the number of handwashing stations this this year over previous years.

The CDC has praised Louisville’s response to the hepatitis A outbreak, calling it the “gold standard” and a model for other cities to emulate.

Physicians and other healthcare providers can help to curb the spread of hepatitis A as follows:

  1. Expand your differential diagnosis. Think of hepatitis A in your patient work up, particularly if they have jaundice or the outbreak risk factors for hepatitis A of homelessness or drug use.
  2. Order a Hepatitis A IgM antibody test for confirmatory testing (a Hepatitis A Total Antibody does not help distinguish acute from prior infection or vaccination and should only be ordered to confirm immunity to HAV).
  3. Take a good history. Find out if infected patients have been in contact with anyone with hepatitis A, exactly when symptoms began (particularly jaundice, as this helps us to determine their infectious period in which they could have spread the virus to others), and where they have been living (i.e. homeless, correctional facilities or other congregate settings). Do they use drugs? Do they have other co-morbid diseases such as hepatitis B or C that may put them at risk for severe outcomes?
  4. Promptly report any suspected or laboratory confirmed case of Hepatitis A to LMPHW. Call communicable disease staff at (502) 574-6675 or fax EPID-200 form to (502) 574-5865. All communicable diseases are reportable to the health department (acute Hepatitis A within 24 hours) and the sooner we receive this information, the more time we have to contact the case patient, identify their contacts and provide post-exposure prophylaxis to contacts, further preventing disease. Please don’t rely on someone else to do this. The hospital lab reporting is often delayed. You, who are caring for the patient, are the first to suspect and often the first to respond to the positive lab result. The infection prevention nurse at your hospital can help with the reporting.
  5. Recommend hepatitis A vaccination to your patients! As a routine preventive health measure, HAV vaccine is covered by insurance. It is an incredibly effective vaccine, with 96 – 100% seroconversion within 4 weeks of vaccination. Even one dose of vaccine can be effective for up to 10 years and completion of the 2-part vaccine series confers 20 or more years of immunity.
  6. Provide post-exposure prophylaxis (PEP) to those who have been in contact with someone infected with HAV within 14 days of exposure. Healthy people age 1-40 should be provided Hepatitis A vaccine for PEP. Provide Immunoglobulin (IG) to close contacts of those with HAV if under age 1, pregnant, or if other comorbidities exist, if available. Hepatitis A vaccine should be offered to contacts if IG Is not available. The dosage of IG is 0.1mL/kg. 3,4,5
  7. Consider helping with the local efforts. There are various ways to do this:
  • Join the Medical Reserve Corps (MRC). Though some paperwork is required to be completed up front (background check), once you become a member, you can respond with any of the LMPHW efforts that are already ongoing. Joining the MRC does not obligate you to respond to future events. If you are interested in joining the MRC, please contact Kim Rogers at (502) 526-6833.
  • Work with your organization to spread the word of the outbreak and encourage involvement in response efforts. We all have competing priorities within our own organizations and having physician champions for this cause can help highlight this as a priority in your organization. If you are a leader within your organization, consider how you could assist in our outbreak response. Kentuckiana Health Collaborative members can help by ensuring the populations under their care receive vaccine. Increasing communications with those within their organization on how they can receive the vaccination is instrumental in this process.
  • Identify additional locations where vaccination may be needed. If you are involved in community organizations or events that serve at-risk populations, let us know! We have found many locations such as churches and food pantries that have allowed us to reach those with vaccine that we might not have reached otherwise.
  • Donate money or items to help with vaccine efforts. Thank you to those partners who have already been generous donors, including Anthem, Aetna, and the many businesses who have provided immunizations for their workers.

For more information or to get involved in the HAV outbreak response, please contact us at or






Minority Health Month Brings Focus to Groups that Often Have Health Disparities

Minority Health Month, held each year in April, is a time to learn more about the health status of racial and ethnic minority populations and to raise awareness of the health disparities that continue to affect racial and ethnic minorities. As an African-American female born with benign ethnic neutropenia, a blood disorder characterized by white blood cell counts that are persistently below the normal range of those with people of Caucasian descent, I adhere to suggested preventive clinical guidelines and annual health exams. A large proportion of healthy African-Americans have this blood disorder. With a family history of colon cancer, diabetes, and breast cancer, it is important for me to take personal responsibility for my health.

In 2010, I started my doctoral degree in education and completed my dissertation, Predicting Adherence to Mammography Screening Practices among African-American Women, in 2014. I chose this topic because African-American women were disproportionately dying from breast cancer at a higher rate than other ethnic groups in Louisville, KY. You can see from the graph that there is a wide disparity between black Louisville residents and white Louisville residents in breast cancer deaths.

Breast cancer is a leading cause of cancer death among women in the United States. According to the American Cancer Society, about 1 in 8 women will develop breast cancer and about 1 in 36 women will die from breast cancer. If look at current Jefferson County data, those statistics have improved overall and the disparity gap is narrowing. However, African-American women still have a higher death rate.

According to the Susan G. Komen organization, overall nationally, breast cancer incidence (rate of new cases) is slightly lower among black women than among white women. However, breast cancer mortality is higher in black/African-American women. Lower screening rates in the past may be one possible reason for the difference in survival rates today. Black women now have slightly higher rates of mammography screening than other women. Even after accounting for differences in income, past screening rates, and access to care, black/African-American women are diagnosed with more advanced breast cancers and have worse survival than white American women. More research focusing on the differences in reproductive factors and breast cancer biology is needed to close the mortality disparity gap among African-American women and other ethnic groups. I proud to say that my sister is a 23 year breast cancer survivor!

Men, don’t stop reading! Minority Health Month focuses on all minorities, not just women. My father and sister are both living with Type 2 diabetes; my father has had two lower-limbs amputated. Members of some racial and ethnic minority groups are more likely to have diagnosed diabetes than non-Hispanic white individuals. The Centers for Disease Control and Prevention reported among adults, American Indians/Alaska Natives had the highest age-adjusted rates of diagnosed diabetes among all racial and ethnic groups examined.

Diabetes-related complications can be serious, costly, and deadly. They include heart disease, stroke, kidney damage (chronic kidney disease and kidney failure), blindness, and amputations of the legs and feet. People with diabetes can better manage their condition and improve their health by following preventive care practices. These practices include receiving annual foot and eye exams and attending diabetes self-management classes.

Kentucky has the seventh highest adult obesity rate in the nation, according to The State of Obesity: Better Policies for a Healthier America, released August 2017. Kentucky’s adult obesity rate is currently 34 percent, up from 22 percent in 2000 and from 13 percent in 1990. While Kentucky is trending in the wrong direction, black residents are leading the obesity figures. There are many socioeconomic reasons for this trend. Jefferson County is trending in the right direction. The Louisville Metro Behavioral Risk Factor Surveillance Survey (BRFSS) for the 2016 measurement period, maintained by Louisville Metro Public Health, reported overall obesity rates at 31 percent, down from 33 percent in 2015.

Several of my friends have been diagnosed with prostate cancer. Prostate cancer develops mainly in older men, although it can affect women in very rare cases. The American Cancer Society reports about 1 man in 7 will be diagnosed with prostate cancer during his lifetime. What may be surprising is that race and ethnicity significantly influence who gets prostate cancer and who dies from it. African-American men have, by far, the highest incidence of the disease: they are roughly 1.6 times more likely to develop prostate cancer than whites and 2.6 times more likely than Asian Americans. The gap in mortality rates is even more dramatic – African-Americans are more than twice as likely to die of prostate cancer as whites and about five times more likely to die of it than Asian-Americans. The high incidences of prostate cancer in African-American men holds true for those living in Jefferson County.

Health disparities affect everyone. Healthcare providers, policymakers, private sectors, and public sectors must all collaborate on initiatives to reduce disparities, advance equity, and strengthen the health and well-being of not only minorities, but all ethnic groups.

National Quality Forum Releases Opioid Stewardship Playbook

Louisville Metro also releases two-year action plan for addressing substance abuse


For the past several months, the KHC has put an increased focus on the behavioral health issues that face our region, including substance use disorder. One of the activities KHC has been involved in is the creation of an opioid stewardship playbook, through National Quality Partners (NQP) Opioid Stewardship Action Team, a program by the National Quality Forum. The KHC joined more than 40 other organizations across the country to develop the National Quality Partners Playbook™: Opioid Stewardship, which provides strategies for healthcare organizations and clinicians across practice settings and specialties of care.

This month, the playbook was released and is now available for download. It contains resources for organizations of all sizes to practice opioid stewardship. The NQP Playbook identifies fundamental actions to support high-quality, sustainable opioid stewardship, including:

  • promoting healthcare leadership commitment and implementation of organizational policies that support opioid stewardship;
  • advancing clinical knowledge, expertise, and practice in pain management and opioid prescribing guidelines;
  • engaging patients and family caregivers in discussions about the risks and benefits of pain management strategies, especially the use of opioids;
  • tracking, monitoring, and reporting performance data on opioid stewardship and pain management;
  • establishing accountability for promoting, establishing, and maintaining a culture of opioid stewardship; and,
  • supporting community collaboration to achieve maximum impact.

The NQP Playbook includes concrete examples and tactics for implementation, identifies barriers and corresponding solutions, and connects clinicians to important tools and resources that are applicable across care settings. Implementation examples are organized into basic, intermediate, and advanced to allow organizations with varying levels of resources and expertise to identify opportunities for action. The intent is for organizations to determine which approach best fits their individual efforts and community needs.

Public Webinar on Opioid Stewardship Planned for March 29

NQF will host a public webinar on opioid stewardship on March 29 in conjunction with the NQP Playbook. NQP Opioid Stewardship Action Team chairs, Christina Mikosz, Centers for Disease Control and Prevention, and Paul Conlon, Trinity Health, will speak, along with other members of the Action Team.

The webinar will address the national opioid epidemic and will highlight how healthcare organizations and clinicians can take concrete steps to drive effective pain management and opioid stewardship, including authentic engagement of patients and family caregivers. Members of the NQP Opioid Stewardship Action Team will address the critical roles that various stakeholders play in making opioid stewardship programs successful and sustainable. To register for the webinar, click here.

NQF will also host a fully accredited, one-day workshop on May 1 for clinicians and healthcare quality leaders to learn about implementing the NQP Playbook. For more information, click here.

Louisville Metro Substance Action Plan Released

Locally, the Louisville Metro Department of Public Health and Wellness released its two-year action plan for addressing substance use and misuse in Louisville, “Coming Together for Hope, Healing & Recovery.” The 80-page report includes a science-based analysis of the use of illegal drugs, tobacco, and alcohol in Louisville and 10 strategies for accelerating the city’s fight against drug abuse:

  1. Prevent and reduce youth substance abuse
  2. Increase trauma informed care
  3. Reduce stigma
  4. Increase harm reduction
  5. Expand diversion from emergency rooms and jail
  6. Improve connection to treatment
  7. Measure the quality of treatment programs
  8. Establish guidelines for sober living houses
  9. Make expungement affordable
  10. Improve job placement

Approximately 50 organizations provided insight and expertise for the creation of the action plan, including the KHC. Click here to read the report.

Kentucky Schools Invited to Participate in Research Project on Mental Health Stigma

(Note: This guest column was written by Dr. Stephen O’Connor, a faculty member in the Department of Psychiatry and Behavioral Sciences at the University of Louisville and associate director of the University of Louisville Depression Center)

The KHC has embarked on a unique research project with students from duPont Manual High School, Somerset High School, and Sayre School to better understand the factors that contribute to mental health stigma among high school students in the Commonwealth. The KHC previously featured an overview of this work in a blog entry by Allison Tu, founder of  the Student Alliance for Mental Health Innovation and Action (StAMINA). In that blog post, Allison described a three-phase approach, beginning with a needs assessment and student conference, followed by an action phase in fall 2018.

Through the generous support of a grant from GE Appliances, we have been able to move forward with Allison and her team to conduct a statewide needs assessment on the topic of mental health stigma in high school students. Allison and a few other trained students who are part of her research team aim to conduct 10 focus groups with high school youth that each last 1-1.5 hours. We believe that the youth-driven aspect of this study helps ensure that their collective voices are heard when we consider how best to support their mental health concerns. I am helping the StAMINA team conduct the study and will lead five separate focus groups with parents to gain insights into their perspectives on contributors to mental health stigma in high school youth. We will use the focus group data to identify themes about barriers for youth with mental health concerns to access available resources, as well as their preferences for support by family, friends, and the larger community.

This is where we need your help. We are trying to cast a wide net in recruiting students and parents from different schools across our state to participate in focus groups so that they can share their thoughts on what factors contribute to mental health stigma. If you know of a contact in your local school system, such as a Superintendent, Principal, or Vice Principal, who might be in a position to support their high school’s participation in our study, please reach out to us. We are hoping to complete all of our focus groups by May 2018 in order to analyze our results and finalize a written report on our findings this summer. Adhering to this timeline will enable Allison and her team to move forward with the action phase of their project, where students step forward to address mental health stigma in new and innovative ways in our state.

Please contact Kaitlyn McClain at of (502) 238-3603 if you would like to learn more about the StAMINA needs assessment and how you might be able to help us identify interested schools.

Moving Past the Stigma of Addiction: Implementing National Principles of Care

(Note: this column was written by Samantha Arsenault, Director of National Treatment Quality Initiatives at Shatterproof, a national nonprofit organization dedicated to ending the devastation addiction causes families. Samantha will speak at the 2018 KHC Annual Conference.)

Samantha Arsenhault

In the past year, 20.1 million Americans had a substance use disorder (SUD), of which more than 2 million were addicted to opioids. Approximately 90,000 Americans die every year related to the misuse of alcohol, and in 2016, 63,600 people died of a drug overdose. Of those, approximately two-thirds were related to prescription or illicit opioids. In addition to rising mortality and morbidity, the cost of the opioid crisis to our society in lost productivity, healthcare, and criminal justice costs exceeds $500 billion per year.

Many of us are all too familiar with these statistics. In fact, addiction affects 1 in 3 people in the US. Yet, many people are not aware that addiction is a chronic relapsing disease, or that decades of scientific evidence has shown that it can be treated with the same effectiveness as other chronic illnesses, such as diabetes or hypertension. Evidence-based SUD treatment can reduce the risk of overdose while improving outcomes and reducing costs.

What is “good” addiction treatment?

Unfortunately, there is no one-size-fits-all model. There is no standard programmatic combination or duration of medications, behavioral therapies, or social supports that will reliably bring about recovery for all those affected with SUD. Individuals with SUDs vary substantially in the nature, complexity and severity of their health problems as such, treatment should include an individualized combination of FDA-approved medications, behavioral therapies, and social supports to reduce or eliminate the substance use and to improve general health and function. The National Principles of Care for SUD Treatment are core components of addiction treatment that are shown to improve patient outcomes. These include:

  1. Universal screening for substance use disorders (SUDs) across medical care settings
  2. Rapid access to appropriate SUD care
  3. Personalized diagnosis, assessment, and treatment planning
  4. Engagement in continuing long-term outpatient care with monitoring and adjustments to treatment
  5. Concurrent, coordinated care for physical and mental illness
  6. Access to fully trained and accredited behavioral health professionals
  7. Access to FDA-approved medications
  8. Access to non-medical recovery support services

Implementing the National Principles of Care

There is a deadly stigma around addiction – a misconception that it is a moral failing rather than a manageable disease. Stigma causes individuals to suffer in silence rather than seek life-saving help and has resulted in a fragmented treatment system separate from mainstream healthcare. Currently, only one in ten people with an SUD receives any form of treatment, and many of those receive care that is absent of the evidence-based best practices highlighted above. This can result in poor outcomes and significant costs for patients and families seeking help, as well as a blemished reputation for the field.

While legislative and regulatory mechanisms, including the Mental Health Parity and Addiction Equity Act and Affordable Care Act require insurance coverage of addiction treatment at par with other medical conditions, and the passage of the Comprehensive Addiction Recovery Act (CARA) and Twenty-First Century Cures Act seek to expand prevention, education, and treatment around this disease, there has been slow adoption of life-saving treatment modalities.

Shatterproof is a national nonprofit organization dedicated to ending the devastation that addiction causes families and the lead convener of the Substance Use Disorder Treatment Task Force. This coalition of key stakeholders and experts in addiction treatment is working to close the gap between the tragic outcomes of those suffering from SUDs and the promise of effective treatment. Currently, this work is focused in four key areas: payer-based strategies, provider practices, consumer education, and legislative and regulatory policies.

In addition to the responsibility to cover mental health and addiction treatment at parity with physical health conditions, payers can influence access, availability, and delivery of evidence-based treatment modalities. The first deliverable of the Task Force was a publicly signed agreement by sixteen large insurers, representing more than 248 million lives, to recognize and adopt the National Principles of Care. The agreement among payers included a commitment to identify, promote, and reward addiction treatment practices consonant with the Principles. The Task Force is now working with payers to adopt strategies which reduce barriers and incentivize high quality care.

Groups across the country, big and small, are working to reverse stigma and improv access to life-saving addiction treatment. Join us at the Fourth Annual KHC Conference to learn more about 1) the core components of evidence-based addiction treatment, and 2) understand current systemic barriers and opportunities to changing this system.

The Joint Commission Sets Standard of Care for Providers of Substance Use Disorder Treatment

(Note: This column was written by Julia Finken, Executive Director of Behavioral Health Care and Psychiatric Hospital Accreditation for The Joint Commission)

I’m sitting in my office and yet another article arrives in my email regarding a substance use provider delivering substandard services. On any given day, in any selected media, there are dozens of stories about unethical practices by substance use disorder (SUD) treatment providers. What we don’t hear about every day is the high quality and effective SUD care provided by many organizations on a daily basis. We don’t regularly hear about those individuals who remain abstinent after completing treatment, or those individuals that return to productive, meaningful lives with the support of medication assisted treatment, or individuals who are reunited with their families and loved ones after years of battling addiction. Every day, thousands of SUD providers strive to provide quality services to those individuals in need so that they can live productive, meaningful lives surrounded by those they love. The Joint Commission is helping these providers achieve these goals by raising the bar for the quality and safety of the care treatment and services these organizations provide to the individuals they serve.

In 2016, approximately 20.1 million people aged 12 or older had an SUD in the past year, including 15.1 million people who had an alcohol use disorder and 7.4 million people who had an illicit drug use disorder. In 2017, approximately 3 million people received SUD treatment. It is estimated that approximately one in six problem drug users globally receives treatment for drug use disorders or dependence each year. The overriding finding regarding the efficacy of SUD treatment is that treatment is associated with a reduction in harmful behaviors that are associated with problem drug use. The majority of treatment seekers received care-coordinated treatment, expressed satisfaction with their care, were retained in treatment beyond three months, and reported significant and substantial reductions in drug use and offending, and improvements in mental well-being and social functioning. Medication assisted treatment (MAT) has been shown to increase participation in behavioral therapy and reduce both drug use and criminal behavior. Yet, because of what consumers, payers and providers read regularly in the media, there is a lack of confidence that there are an ample number of ethical, effective SUD providers in the United States today.

So how can one discern between the providers that adhere to a higher standard of care and those that don’t? Joint Commission accreditation is one way to identify the providers who achieve a higher standard of care. The Joint Commission has accredited Behavioral Health Care (BHC) providers since 1969. Accreditation of Substance Use Disorder providers has been a growing segment of Joint Commission accredited BHC providers, with the fastest expansion beginning in 2013 and continuing through 2017. The Joint Commission currently accredits more than 2,800 BHC providers, more than half of which offer SUD services. Substance use disorder providers who are Joint Commission accredited must adhere to a rigorous set of standards, covering topical areas including:

  • Care Treatment and Services
  • Human Resource Management, Leadership
  • Environment of Care
  • Emergency Management
  • Infection Prevention and Control
  • Information Management
  • Life Safety
  • Medication Management
  • National Patient Safety Goals
  • Performance Improvement
  • Record of Care Treatment and Services
  • Rights and Responsibilities of the Individual
  • Waived Testing

Map of The Joint Commission accredited and/or certified providers, all programs.

What does Joint Commission Accreditation mean for providers and consumers? It means that Joint Commission accredited SUD providers must admit only those individuals in which the provider can deliver the care, treatment, and services that will meet that individual’s needs. The Joint Commission has developed a set of standards in collaboration with BHC industry leaders that are based on trauma informed concepts and the tenents of resilience and recovery. This means that care, treatment, and services must be patient centered and developed through the process of a comprehensive individual assessment, development of a plan of care, treatment, and services based on needs identified for the individual served and the implementation of such plan. This plan for care, treatment, and services includes objectives and goals for each individual served. The individual’s progress towards goal is monitored and outcomes of the plan are measured through the use of a standardized instrument.  Only qualified staff who meet the requirements for licensure, certification, education, and training as required by the organization, State, or Federal authority may provide care, treatment, and services. Joint Commission Accredited organizations must provide a safe environment of care including minimizing the risk for infection and having a regularly tested plan to manage emergencies. The buildings in which care, treatment, and services are provided must be determined to be in compliance with Life Safety Code Requirements. Individual care is documented, and that documentation is maintained in a manner compliant with organization, Federal, and State requirements to preserve the integrity and confidentiality of the record. Medications must be procured, stored, prepared, dispensed, and administered in compliance with strict standards of safety. Organizations must regularly evaluate their own performance and gather information from the individuals they serve regarding the perception of the quality and safety of the care provided. The findings from this data must be utilized to improve the quality and safety of the care, treatment and services provided to the individuals served and the population served.

Map of The Joint Commission accredited and/or certified Behavioral Health Care providers.

Substance Use Providers who seek to become and maintain Joint Commission Accreditation must undergo an initial on-site survey, conduct a self-assessment of standards compliance at 12 and 24 months following their last survey, and an on-site survey every three years. These surveys are performed by field representatives, including Licensed Clinical Social Workers, Clinical Psychologists, Registered Nurses, Psychiatrists, Advanced Practice Nurses, Physician Assistants, and Engineers.  These field representatives have extensive experience in the BHC services and settings that they survey. They hold advanced degrees and must have substantial clinical and administrative level experience in the services and settings in which they survey. During the survey, the Field Representative will identify Requirements for Improvement and offer organizations ideas for correcting such findings. Based on customer feedback, the survey is highly consultative and educational in nature. Within 60 days of completion of the survey, the organization must complete an Evidence of Standards Compliance (ESC) for each survey finding. Once the ESC is accepted, the organization is granted an Accreditation for 36 months.

Many consumers seeking care for a substance use disorder also need assistance with their physical health needs. Some SUD providers take the extra step to become a Behavioral Health Home, meaning that they’ve taken the extra step to earn a Behavioral Health Home Certification on top of their accreditation. This certification validates that the provider demonstrates a high level of integration of treatment of substance use disorder and/or mental health and physical health care services. A BHH-certified provider must demonstrate that there is a consistent high degree of coordination and communication between the mental health, SUD and physical health care staff in order to develop an integrated plan of care and meet the goals of the plan of care. The staff must demonstrate additional competencies and training in MH, SUD and physical health services, integration of care, care coordination, and care management. Organizations are required to perform additional measurement, such as disease management outcomes, the individual’s access to care within timeframes determined by the organization, the individual’s perception of the coordination of care, treatment and services, the individual’s perception of the continuity of care treatment and services and the individual’s experience and satisfaction in regard to access to care, treatment, and services, to name a few.

So if you are looking for a Substance Use Disorder provider that is held to a higher standard of care, look for the Joint Commission “Gold Seal” of Accreditation. You can find a directory of Joint Commission Accredited providers at Joint Commission Accredited Behavioral Health Care providers can be found in all 50 states, U.S. principalities, and internationally. As I shut down my computer for the day, I am heartened by the data showing that we continue to accredit additional Substance Use Disorder providers every day.