By Layne Turner, Julia Kocis, and Samantha Shaak
Lehigh County is at, or exceeds state averages in the number of overdose deaths, treatment admissions, and use of naloxone. This is striking, given the fact that the overdose death rate in Pennsylvania increased from 26.7 per 100,000 in 2015 to 36.5 per 100,000 in 2016, according to the Analysis of Overdose Deaths in Pennsylvania, 2016, a study done at the University of Pittsburgh. Lehigh County finished 2017 with over 200 drug-related deaths, an increase of over 40 from the prior year. The current year (2018) has witnessed roughly (toxicology reports still pending) 132 drug-related deaths through mid-November. Because of the growing incidence of drug use and abuse, community members in Lehigh County have called for innovative and collaborative responses to address this complex issue that affects all aspects of a community.
The Lehigh County Drug and Alcohol Department – Single County Authority (SCA) has committed to working innovatively with partners in other sectors, starting with healthcare and law enforcement, to address substance use, including opioid abuse, concerns in the community and optimize the resources available to provide services efficiently and comprehensively in the community. The hope is that by doing something different, we will be able to achieve better outcomes over time. Core to this approach is using data in a manner that helps combat the effects of the opioid crisis in the community. Prior to this collaborative initiative the level of opioid and other drug related data that was collected and available to the SCA was of little value to assist them in supporting individuals and their families plagued by opioids in accessing treatment or in accurately informing the strategies used to address substance use. Each of the sectors serving individuals facing addiction was collecting some data components in their own system but there was no way of understanding the collective use of services across sectors and agencies.
This disjointed approach limited the County’s ability to take a more proactive approach toward engaging those in need. To counter this problem, the SCA worked with the Department of Community Health at Lehigh Valley Health Network (LVHN) and the Lehigh County Regional Intelligence and Investigation Center (RIIC) to develop two separate systems with data collection at the forefront of the design process. The SCA also realized that in order to advance cross-sector strategies they would need a separate platform where they could share de-identifiable data from these two closed systems with a wider audience; the Lehigh Valley Hub provided this space.
Blue Guardian is an initiative between the District Attorney, the Lehigh County Regional Intelligence and Investigation Center (RIIC), police departments in Lehigh County, and the Lehigh County Department of Drug & Alcohol. Each time an officer utilizes naloxone they enter the naloxone administration into the Blue Guardian program, in as near to real time as possible. It includes victim name, contact information, amount of naloxone administered as well as pre and post naloxone symptoms. This data is then used to coordinate a home support visit which typically occurs within a 48-72 hour window after the initial event. A uniformed police officer and Certified Recovery Specialist (CRS) will go to the home and re-engage the individual by offering a connection to treatment and provide resources to the family. The SCA had to initiate changes to the treatment system to ensure the individual had immediate access to treatment, if he or she was interested, and the family could immediately engage in family co-dependency support groups.
The face-to-face home visit is made by an officer of the police department where the individual resides, which may differ from where the incident occurred. Since its inception in March of 2018, over 280 naloxone administrations have been entered in the Blue Guardian system with 45% resulting in a home visit or attempted visit. 122 attempted home visits were made and during 67 visits, face-to-face contact was made with the individual. As a result of the face-to-face meeting, 33% (23 individuals) entered inpatient treatment. An additional 15% of the individuals and their families
continue dialogue with the CRSs or are pending treatment referrals. While these numbers may seem low, these outcomes are actually quite positive as it may take several visits to engage the individual into treatment. Drug and alcohol addiction is a complex issue that is predicated on an individual’s readiness to change. One particular visit that illustrates this complexity involved a person who was already in a residential treatment program, and had overdosed on multiple separate occasions requiring multiple home visits. The CRS assigned continued to encourage and work toward the best treatment outcomes for this person and continues to be engaged during their transition into a recovery house. An unintended positive benefit of this program has been a shift of perception from the community toward law enforcement. Police are now seen as being there to help instead of to arrest.
Not all administrations will result in a positive home visit outcome, over 30% of the individuals identified through this program are homeless and difficult to locate, and a majority do not reside in Lehigh County. By joining law enforcement and treatment supports together and meeting an individual and their family where they live we can lessen the barriers and obstacles that exist and concurrently support those in need. While Blue Guardian can capture the data on law enforcement encounters with individuals who have overdosed on drugs, there are many instances where the individuals themselves or family and friends may take them directly to the hospital emergency department. The Hospital Opioid Support Team (HOST) program at LVHN is designed to capture that data at this intersection. Lehigh County has contracted with a drug and alcohol provider in the county to be present in the Emergency Department (ED) of the hospitals in Lehigh County. When an individual comes into the ED due to an overdose or is struggling with substance abuse, there is a trained individual from the contracted agency to meet with the patient, complete an assessment, and offer a direct connection into treatment, if the individual is interested. This effort shortens the time between a person being identified by the healthcare system and the outreach to offer them treatment options, again allowing for more proactive approaches to addressing drug and alcohol addiction. Data collection for these assessments has been streamlined to be completely electronic and contain all the information needed in one location, which enables daily reviews of applications placed to the County and real-time reports of the number of assessments completed in the HOST program. Prior to 2017, the SCA received less than 40 annual referrals from EDs. Since the inception of the HOST program in January 2017, the SCA has received over 2,700 referrals for assessment and/or patient linkage to treatment, largely due to the improved process and workflow to connect the healthcare system, drug and alcohol provider, and the County.
The prevailing thought that complex social problems require complex solutions is being challenged. The success of the collaborative relationship between the RIIC, LVHN and the SCA office is founded on each entity doing what it does best. By creatively leveraging abilities and realigning them, we are able to create a significant positive impact in our community that we will continue to build on.