SBIRT: Why Should I Care?

(Note: this guest post was written by Mallori De-Salle, Outreach Coordinator and Lead SBIRT Trainer, Indiana Prevention Resource Center)

I hate thinking about what I’m not doing ‘right’ when it comes to my health. I eat pizza. I’m not overweight, so it must not be a problem. I add salt to my food (without tasting it). I don’t have high blood pressure, so it must not a problem. I drink coffee in the morning, mid-day, and sometimes in the evening. I still sleep, so it must not a problem. This is my logic when deciding if I have to make a change. If it isn’t a problem, I don’t think about the health behavior at all. So, why should I care about how much alcohol I drink, if it’s not a problem?

Does this sound familiar? It’s not a problem, so why even think about it? Is the lack of highly problematic symptoms of an illness the only way to measure the existence or severity of a health problem? Or could we as an “illness focused” culture be missing an opportunity to focus on wellness instead of lack of illness?

For decades, our healthcare system has operated under the belief that “health” is defined through the absence of symptoms. In other words, concerns aren’t addressed or even considered a problem until the symptoms can be diagnosed. But, is it possible that problems exist on a wider spectrum? Is it possible that you or I could improve our health by reducing our risks even before problems are visible? Think about using a seat belt. Most of us wear seat belts automatically. It’s a habit (thank you public health) that we no longer think about. We wear seat belts, but not because it makes us better drivers or because we plan to crash. We wear seat belts as prevention because it lowers our risk IF we experience a situation where harm is possible. Not wearing a seat belt increases your “risk” for harm, even in minor vehicle incidents and most importantly, in severe circumstances. Wearing a seat belt doesn’t remove the risk of crashing; it reduces the risk of harm WHEN a crash occurs. Seat belts lower risk for a problem that doesn’t even exist yet.

Seat belts are fairly concrete (actually they are fabric, but you understand). However, other health behaviors, such as alcohol or substance use, can be more abstract. What if we look at alcohol or substance use as a health behavior that can either increase or decrease our risk for experiencing harm, much like our current views on seat belts? Public health is back again with a new preventive practice to do just that!

SBIRT, or Screening, Brief Intervention, and Referral to Treatment, is a public health approach which changes how we view alcohol use. Instead of simply looking for indications of diagnosable problems, it examines all levels of use and how use impacts all levels of wellness. This suggests that wellness can be enhanced by understanding that health is not simply the absence of illness. SBIRT asks all patients (even the little neighbor lady down the street) annually about their alcohol or substance use. Doing so helps increase the chances that a person considers how their level of use is influencing their quality of health. SBIRT is not a diagnostic process, but instead a conversation that helps support intrinsic motivation for behaviors that support wellness and not just the avoidance of illness (in this case, addiction). SBIRT, like all other new movements, viewpoints and culture shifts (remember how people hated seat belts at first?) takes time to feel comfortable. Once it is in place, everyone starts to think, “Why haven’t we been doing this?” So, buckle up! SBIRT is taking the driver’s seat and letting us know that improving our health, wellness, and happiness is why we should care.

For more information on SBIRT or to download KHC’s toolkit for primary care providers, click here

QPR Reflections: Suicide Prevention Training Hits Home

A couple of weeks ago, the Kentuckiana Health Collaborative held its September Community Health Forum. The topic was youth mental health, and the date coincided with National Suicide Prevention Week. After the Forum, the KHC hosted a Question, Persuade, Refer (QPR) training as part of a goal to set a record for people trained in one week. Similar to CPR, QPR is a 90-minute training course designed to support an emergency response to someone in crisis. It was designed to equip individuals with the tools they need when someone in their life is facing a suicide crisis.

I was in that position last year, trying to convince the person I loved most in the world not to take their own life. It’s an experience I don’t wish on my worst enemy. I’m at a year of therapy and counting, and although I am a much stronger person for the experience, I wish I had never been through it.

In the end, my loved one didn’t take their life, and they got the talk therapy and medication needed to push through. Multiple people have credited me with that outcome. I’m not sure if I agree with that, but I do admit that my involvement might have had a positive impact and recognize now the power that even one individual can have in moments of crisis.

Hence the need for trainings like QPR. Suicide is the 10th leading cause of death in the United States, and it’s estimated that for every death by suicide, there are 25 more attempts. It happens more commonly than we’d like to believe. During National Suicide Prevention Week, more than 2,200 people in Louisville were trained in suicide prevention in 50 locations across the city.

I’ll admit that I was slightly disappointed by the QPR training. I guess I thought that it would reveal one magic thing that I could have said or done differently, to make the situation turn out more smoothly than it did in my case. I was disappointed to find that there is no magic bullet to be had. People are complex. These situations are complex. There is no one-size-fits-all approach to suicide prevention. It all comes down to being persistent, really listening to what someone else is telling you either with their words or actions, and not being afraid to have the tough conversations.

There is no one-size-fits-all approach to suicide prevention. It all comes down to being persistent, really listening to what someone else is telling you either with their words or actions, and not being afraid to have the tough conversations.

I don’t think I was prepared for the traumatic memories that QPR would bring up. Much of the 90-minute session was devoted to recognizing the signs and behaviors of distressed loved ones. I can say that from my personal experience, what was taught in QPR related to this was almost word-for-word what I experienced. I had to leave the room more than once in tears. But I always returned, determined to see it through. Then came the disappointing part of the training. The part where I discovered that there is no perfect phrase that can talk someone off the proverbial ledge. But that doesn’t mean that we can’t have an impact on the situation. We can all create safe spaces for our loved ones to talk to us when they are struggling, and we can together get through the tough times.

I had nightmares that evening about those past traumas. But then, a funny thing happened. The nightmares that I’d been accustomed to having for the last year stopped. Situations and places that used to trigger me no longer did. And I realized that it was a direct result of the QPR training. I had long ago forgiven myself for what I had seen as failings when I was faced with the crisis, but it turns out that I didn’t need to be forgiven at all. By participating in the training, I realized that I did probably more in that situation than I should have been able to. It wasn’t blind luck that prevented my loved one from taking their life. And that was the closure that I didn’t know that I needed.

It sounds like a cliché to say that you never think it will happen to you until it does. But that’s exactly how it is. And I would recommend that anyone learn how to have that conversation and develop that vocabulary, through QPR or a similar program. Because you never know when you might need those skills.

Students and Adults Work Together to Generate Ideas for Youth Mental Health at “Ideathon”

Prior to last Saturday’s StAMINA Youth Mental Health Ideathon, the concept of an “ideathon” was easy enough for me to imagine, much like a danceathon but just a whole day of generating ideas around supporting youth mental wellness. With this in mind, I didn’t expect the StAMINA Ideathon to be as engaging, organized, inspiring, and productive as it turned out to be. Even my teenage son, who does not typically spend his Saturdays hanging out with his mom, was completely engaged in the process, and we both left energized by the possibilities to make a positive impact on youth mental health.

StAMINA (Student Alliance for Mental Health Innovation and Action) discussed the findings of its new research on youth mental health at the KHC’s Community Health Forum on September 11, and the subsequent Ideathon, designed to generate ideas to address the findings of that research, was held on September 15. Amanda Tu, a Junior at Stanford and sister of StAMINA founder Allison Tu, led Ideathon participants through the design thinking process as defined by Standford’s d.school. The process for design thinking is comprised of five steps: empathize, define, ideate, prototype, and test. Since the empathizing and defining had already been completed through the research, the focus of the Ideathon was to “ideate” and begin to “prototype.”

Ideathon participants were led through the design thinking process as defined by Standford’s d.school.

There were about 50 people in attendance that were divided into several small teams of five to seven individuals. Participants included students, parents, grandparents, guidance counselors, mental health advocates, pediatricians, public health officials, and more. The groups were carefully divided into teams representing unique perspectives. Nearly half of the day was spent in our groups discussing solutions to the problems identified in the research, sorting the ideas, selecting the top idea, prototyping the idea, and, finally, pitching the idea to the group.

All seven teams generated detailed ideas and then presented their pitch and skits to all of the participants. The process was fun, and there was a lot of laughter and energy during the skits. The top three ideas selected included a student-led podcast on mental health, an app with mental health resources, and dinner card conversation starters for parents and students. The StAMINA and KHC teams will now analyze which ideas are feasible with current resources to be advanced in our community.

The winning team’s idea included a podcast that addresses youth mental health issues.

Tamlin Hall filmed the entire StAMINA event, conducted one-on-one interviews, and will be putting together a video of the event. Tamlin is an award winning filmmaker, whose movie “Holden On” tells the true story of his childhood friend, Holden Layfield, who struggled with mental illness as a teenager.

StAMINA’s three-prong approach is now moving from the learn and build phase to action. Allison Tu, founder of StAMINA, often explains to adults that it is the students that are experiencing their own mental health, and it only makes sense that they are the ones to help find the solutions. It’s clear from this work that she is right that a student led approach will realize the best results; it’s already happening.

See StAMINA founder Allison Tu talk about her group and Ideathon on WHAS.

 

PRESS RELEASE: High School students examine mental health stigma in KY teens


Findings: Adult, peer views on mental health contribute to stigma

Press Release by Hayley Kappes, University of Louisville

LOUISVILLE, KY September 6, 2018 – Parents who refuse to take their children to therapy because they don’t believe in mental health treatment. School counselors who have told students to stop crying because they’re “fine.” Teens further ashamed of mental illness because of negative portrayals in the media. These are some of the experiences that a high school student group, mentored by a University of Louisville clinical psychologist, has gathered from peers across Kentucky during yearlong research into factors that contribute to mental health stigma in teens.

Allison Tu

Allison Tu, a senior at duPont Manual High School who led the student group, and Stephen O’Connor, PhD, associate director of the UofL Depression Center who guided the students in research, will present findings during the Kentuckiana Health Collaborative Community Forum on Tuesday, Sept. 11, from 8 to 10 a.m. at the UofL Clinical and Translational Research Building, 505 S. Hancock St. After the forum, a Question. Persuade. Refer. (QPR) Suicide Prevention Training by the Louisville Health Advisory Board will take place.

The student group, comprised of teens across the state, is called the Student Alliance for Mental Health Innovation and Action (StAMINA) and is supported by the Kentuckiana Health Collaborative, a nonprofit organization that aims to improve health and the health care delivery system in greater Louisville and Kentucky.

StAMINA conducted a needs assessment of the state and held focus groups in urban and rural areas with high school students and parents to uncover what interferes with students acknowledging they have mental health issues and receiving treatment. The group also interviewed mental health professionals and pediatricians.

Factors that contributed to mental health stigma among high school students included negative representation of mental health in media and stigma from peers and parents who do not have a positive attitude about mental health, Tu said. The group found differences between rural and urban residents.

“Because there is more racial and ethnic diversity in urban settings, one of the big drivers of mental health stigma is ethnic heritage,” Tu said. “African-American and Asian-American students talked a lot about how culturally, mental health was often ignored. With rural students, generally there was more stigma resulting from religious factors. Some students said they would talk to their parents about mental health issues, and their parents would respond, ‘you’re not praying enough.’”

Stephen O’Connor, PhD

Messages that parents express about mental health impact a child’s views, said O’Connor, who guided the research design, and taught the students how to lead focus groups and conduct qualitative data analysis.

“The gatekeeper for getting children to treatment is often going to be a parent, so parental views on mental health are likely going to impact whether a child is taken to treatment,” O’Connor said. “The parent also is helping the child understand what they’re experiencing, so if the parent doesn’t have a good idea about what symptoms of mental illness represent, then the child is probably not going to understand either.”

Solutions to mental health stigma among teens may include a new mental health education requirement for high school freshmen or a social media campaign to amplify the visibility of resources, said Tu, who also stressed the need for parents to be educated on mental health issues and resources available for their children.

# # #

 

SBIRT Toolkit Released for Healthcare Providers to Address Opioid Crisis

In recent years, the misuse, addiction, and overdose of opioids has grown to epidemic levels at the national, state, and local levels. Kentucky is no exception, with its opioid epidemic ranking among the worst in the nation. As of 2016, Kentucky ranked fifth among states with the highest number of drug overdose related deaths. With 33.5 deaths occurring per 100,00 people, the state experienced a 142% increase from 2010.

Significant action has been taken by a multitude of stakeholders in response to this epidemic. A prominent force has been the work completed as part of the Kentucky Opioid Response Effort (KORE). KORE is part of the Opioid State Targeted Response (STR) grants, created by the 21st Century Cures Act and administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). The purpose of KORE is to implement a comprehensive targeted response to Kentucky’s opioid crisis by expanding access to a full continuum of high quality, evidence-based opioid prevention, treatment, recovery, and harm reduction services and supports in high-risk geographic regions of the state. Earlier this year, the Kentuckiana Health Collaborative (KHC) began a project in partnership with KORE to increase awareness and utilization of Screening, Brief Intervention, and Referral to Treatment (SBIRT) among primary care providers as a means of addressing unhealthy substance use among their patient populations.

SBIRT is public health approach to identifying and intervening with patients who are participating in risky substance use behaviors. As a system change initiative, SBIRT challenges traditional approaches to identifying and intervening with Substance Use Disorder (SUD) by viewing behaviors, problems, and interventions on a continuum. SBIRT focuses on reaching the 15%-25% of the population who are excessively using substances, while still intervening with the 5% needing traditional treatment and positively reinforcing behaviors of the 75%-85% who are abstinent/responsibly using. The bulk of health, social, and economic costs associated with substance use are associated with excessive use rather than addiction or substance use disorders. By addressing the population excessively using, primary care providers can negate the negative effects of these costs and prevent the progression of substance use behaviors. There is substantial evidence for the use of SBIRT in reducing risky behaviors related to alcohol, and its application for opioid use is accumulating and promising.

The KHC has developed a toolkit, titled “Screening Brief Intervention, and Referral to Treatment (SBIRT) – Addressing Unhealthy Substance Use in Primary Care Settings” that is being distributed to over 4,000 primary care providers and 400 group practice managers throughout the state of Kentucky. The KHC will also be holding a complementary webinar on Wednesday, October 10, 2018. Webinar registration and additional information can be found here.

SBIRT is a practical and promising approach to addressing the growing opioid epidemic in Kentucky. Join us in learning more about this initiative and encouraging its adoption throughout the Commonwealth.

View Toolkit

Louisville’s Multi-year Focus on Suicide Prevention Ramps up to Set a World Record, Save Lives

(Note: This guest post was written by London Saunders Roth, Local Integration Leader, Louisville Bold Goal, Humana. London is a member of the Louisville Health Advisory Board Behavioral Health committee.) 

A community-wide coalition focused on suicide prevention is organizing a broad-based community effort centered around National Suicide Prevention Week: September 9-15, 2018. The Louisville Health Advisory Board (LHAB) Behavioral Health committee seeks to help Louisville set a world record by training the most individuals in one week in the technique of Question, Persuade, Refer (QPR). Similar to CPR, QPR is a 90-minute training course designed to support an emergency response to someone in crisis, and it can save lives.

According to recently published data from the Centers for Disease Control and Prevention (CDC), suicide rates are on the increase, and more than half of people who died by suicide did not have a known mental health condition. For the years 2008-2014, Jefferson County ranked 11th out of 50 peer counties in terms of highest rates of suicide. This is a change from the prior ranking of 8th; however, the suicide mortality rates were higher nationally. Essentially, while other counties increased at a higher level, Louisville’s suicide mortality rate still increased. These statistics are what inspired a cross-sector of community partners to come together and set an objective to design and implement a community-wide, evidence-based and data-driven program to eliminate suicides in Louisville.

Many people are uncomfortable discussing suicide, even when family or friends may be in crisis. However, the technique of “Question, Persuade, Refer” (QPR; www.qprinstitute.com) can improve a person’s comfort and confidence in broaching this difficult subject. QPR is an intervention that can improve the “Chain of Survival,” similar to CPR’s impact on increasing public’s confidence to provide life-saving interventions. QPR focuses on three things: how to recognize warning signs of suicide, how to offer hope, and how to refer to resources to help to save a life. Early recognition of suicide warning signs is key to saving a life.

Please join Louisville, and the Louisville Health Advisory Board, in saving lives this September. If you are interested in getting involved in this effort to increase public awareness and the community’s skills in suicide prevention, please visit www.qprlou.com to sign up for a FREE training or email LouisvilleZeroSuicide@gmail.com with questions.

Additionally, LHAB and Kentuckiana Health Collaborative will offer QPR training immediately following the KHC Community Health Forum on September 11, which will examine findings of new, rigorous qualitative research that evaluated unique youth perspectives on mental health, as well as those of adult allies. You can register for the complimentary Community Health Forum here. Space is limited for the following QPR training session. If you would like to join in on this life-saving training, click here.

Please remember that there are resources for you, family, and friends related to suicide prevention. The national suicide prevention hotline is 1-800-273-8255 and a local (Louisville) crisis line number at Centerstone (formerly Seven Counties) is 502-589-4313.

The Louisville Health Advisory Board is a cross-sector group of community organizations and leaders working to improve physical, mental and social well-being where residents of Kentuckiana live, work, worship, learn and play. The Behavioral Health committee is a part of this board, and its mission is to design and implement a community-wide, evidence-based and data-driven program to eliminate suicides in Louisville.

 

The Complete Guide to Workplace Mental Health

(Note: This column was written by Mike Veny, CEO for Mike Veny, Inc. and one of America’s leading mental health speakers. Veny will speak at the KHC Annual Conference on March 13-14 in Louisville. This column was originally published on Veny’s “Transforming Stigma” website.)

Mike Veny

Jobs and careers are supposed to be a good thing, right? Your job should provide a place where you can use your gifts, talents, and education to make a difference in this world, big or small. It should be a place where you can build confidence and excel. However, that isn’t what it is for many people. Reports show that when it comes to workplace mental health, most people find their job mentally unhealthy. That means that for many people, work is just another place that is pulling them down and adding to the weight they are already carrying.

Why is Mental Health Important in the Workplace?

Take a look at these statistics:

I could list pages and pages of statistics like this for you, but I think you get the point. Mental health is a big deal in the workplace. There are hundreds of millions of people that are already dealing with mental health challenges on a regular basis, and they don’t need to add to these challenges while at work. Creating an environment for good workplace mental health benefits the economy as a whole and each individual employee.

To read the rest of this article, with information about what depression in the workplace looks like, creating the optimal environment to tackle the issue, and creating a plan to improve workplace mental health, click here.

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 kmcclain@khcollaborative.org 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 https://www.qualitycheck.org/. 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.