Wicomico County Health Department is located in the South Eastern part of Maryland on the Delmarva Peninsula and has a population of over 102,000. Some of the area is rural in nature and other parts are suburban. The COAT (Community Outreach for Addictions Team) program focuses are responding to the opioid public health crisis. The Goal of the Program is to link individuals who are survivors of overdose with services to prevent future overdoses. The program uses peers to respond to the scene of an overdose or to the hospital for an overdose. They also frequent community areas to provide outreach to individuals who have overdosed in the past. The practice was implemented in response to a rising number of overdose deaths in the community. Research was conducted to determine the most effective means of connecting with the individuals to encourage enrollment in treatment. The main objective was a decrease in overdose deaths and secondarily a decrease in the number of overdose cases treated in the emergency dept. The program began in June 2016 and there has been a reduction in the number of deaths and the number of cases treated in the emergency dept. The success of the practice is attributed to the use of the peer specialists as well as the community support for the project. Public Health impact of the practice is a reduction in overdose deaths. LHD website - wicomicohealth .org
Wicomico County, as well as the nation, has experienced a rise in Drug overdose deaths over the past few years. The most significant rise has been occurring in the calendar year 2016 with the numbers tripling. One of the biggest contributors to this increase is the fentanyl being combined with the heroin. The majority of the overdose deaths have been occurring in white males, age 30-50. The population of the county is just over 102,000. The population being served are individuals who have overdosed in the community but survived. We targeted this group to prevent future overdoses and to decrease the number of fatalities with the use of peer support specialists providing outreach to this group of individuals. In the past the individuals were provided referrals to agencies and many times had to navigate the healthcare system or had a long wait period to access treatment. Needless to say many of these individuals relapsed before accessing needed treatment. Many times they would overdose multiple times in a month, utilizing the more costly Emergency medical system for treatment or perhaps becoming a fatality. This new program, COAT, employs certified Peers who have a minimum of 2 years of recovery time to respond to overdose cases and provide the bridge to treatment. The peers assist the individuals in navigating the treatment system and maintain contact with the individuals (daily if needed) until they are able to enter treatment. The peers also provide outreach in know drug hotspots in the community to provide outreach and education related to treatment availability and the use of Naloxone to prevent overdose deaths. The use of peers is not new to the field of public health. This use of peers responding in the community to overdose cases is a creative use of the peer support specialists. The MAPP process was used in developing this practice as a way to Build Capacity for Community and System Change. Leaders in the community came together to examine the issue and strategize ways to address the problem. Having individuals who were champions of the effort was key in developing the program and receiving funding to pilot the program.
The Goal of the program was to decrease the number of overdose deaths in the community. The objectives centered around identifying the cases, connecting them with the peer support specialists and helping the individuals to enter treatment. The peer support specialists are oncall to the local law enforcement and the local hospital emergency department to respond to all overdose cases. In efforts to implement the program, buy in from the stakeholders was necessary. Educating the public, the elected officials, funders, law enforcement and the local hospital as to the issue we were attempting to address and how the use of peers could assist in this endeavor was key to the process for implementation of the program. The Health Department began this educational process in January 2016 and was able to engage the needed stakeholders by April 2016. Funding was obtained to begin this program as a pilot project. The staff were hired and services rendered beginning in June 2016 and will continue throughout the fiscal year ending in July 2017. Stakeholders that were key in the planning and implementation of this project were many and included, law enforcement, emergency medical services, local hospital, local elected officials and treatment providers. Memorandums of Understanding were developed to formalize the relationships with stakeholders and continue at this time. Monthly meetings are conducted to look at the data and tweak the program as needed. The champion of the effort was our local elected States Attorney. The total funding for this pilot project is $125,000 for the year. The funding is primarily for salary costs.
The objective of the program was to connect the overdose cases with a peer and connect them with treatment in efforts to reduce overdoses and costly emergency services for repeated overdose calls. To date we have responded to approximately 300 cases and linked 35% to needed treatment services. The peers capture data on all calls for service to include the routine demographic information, length of time followed in the community, and whether they entered treatment. Other data sources captured include overdose cases treated in the local emergency department and cases investigated by law enforcement. The number of overdose cases treated in the hospital and responded to by law enforcement have declined significantly (the month of October the number of cases treated in the hospital was 9 compared to 44 in the months of March and April). There has also been a decline in the numbers of overdose deaths. In addition the team reached out to 121 groups to educate regarding the COAT team. The data is reported to the funders twice a year.
The use of peers is key to this project as they are able to establish a close working relationship with the individuals in need. Buy in early on by partners is also key to the success of the program. Educating partners on the issues early on in the process of program development assists in establishing partner buy in. The funders are happy with the current outcomes and the decrease in the numbers of overdoses and deaths and are considering continuing funding for the project. With the decline in the numbers of people being treated in the Emergency room and the cost of emergency services the cost of the overdose epidemic is declining.
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