By Amy Yuen, Camden Coalition of Healthcare Providers
How Camden Coalition interventions address opioid and other substance use disorders
With the rise in public awareness around opioid use disorder affecting over 2 million Americans annually, many people have asked us if the Camden Coalition has a specific intervention that addresses opioid usage in Camden. Our answer is: “All our interventions address opioid use.” Here at the Camden Coalition, we have been providing intensive, community-based care management for more than a decade to residents with multiple chronic illnesses, many of whom have struggled with addiction. Our work is part of a broader movement of partners, including Project H.O.P.E. and the Addiction Medicine Program at Cooper, who are leaders in improving the wellbeing of individuals experiencing addiction in Camden.
“A significant portion of our participants struggle with opioid use disorder along with other complex challenges,” said our CEO Kathleen Noonan. “Because all our programs are rooted in whole-person care, we address our patients’ health and social barriers to wellness through coordinated care and support. It’s about putting the person first, not only about addressing their disorder.”
To ensure that Camden residents with complex challenges get the quality, trauma-informed care that they need, the Coalition innovates and customizes our interventions to meet people where they are. Here’s a roundup of the ways we address the needs of our patients struggling with addiction to help make a difference in their recovery and wellbeing:
Addressing addiction through our core model
In our care management model, a team of nurses, social workers, and community health workers help patients gain the skills and support they need to avoid preventable hospital readmissions and improve their wellbeing. Of those residents who participated in our care management program from September 2014 to January 2017, 50% had an active substance use disorder, and 63% were actively using or had a history of substance use disorder.
One current participant, 58-year old Charlie Vazquez, had been struggling with a substance use disorder since he was 13. For the past several months, he has been working hard to stabilize his health and improve his wellbeing, and successfully had a five-year prison sentence for a probation violation dismissed with the support of our medical-legal partnership program, our care team, and his primary care provider, Project H.O.P.E. Now, he’s a candidate for a Housing First voucher for permanent affordable housing, which should become available in a few months.
“Before the Camden Coalition came in, I didn’t care if I’d see one doctor because I was using,” he said. “Now that I’m not using, it’s not only helping me with my medical issues. It’s got to do with how I feel about myself today. Having somebody in my corner, it’s led me to want the help that nobody has given me before.”
Helping new moms on the path to recovery
Through programs like Camden Delivers, women in Camden with complex health and social needs are getting the support they urgently need to improve their maternal health. To date, the program has served 135 women. The Camden Delivers addiction pilot served 18 women. Of the nine participants currently enrolled in the pilot program within Camden Delivers, seven have clinical documentation of substance use.
One of our graduates, Christine Keck, was an expectant mother who was homeless and struggling with opioid addiction. The Addiction Medicine Program at Cooper Hospital collaborated with our care team and Christine’s other providers to link her to the services she needed to meet her medical and social needs, and better manage her health long-term. Today, she is thriving with her boyfriend and their baby. She spoke candidly with New Jersey First Lady Tammy Murphy in February about her journey toward recovery.
“I had someone in my corner to help navigate the things that are ignored and forgotten during active addiction,” said Christine. “If programs like Camden Delivers were expanded and given funding, we would see the rates of homelessness, addicted newborns, and overdoses decrease; ERs not being misused; and employment increase.”
Recovery and wellness for Camden residents re-entering society
To better understand the challenges faced by residents with recurring histories of hospitalization and incarceration and to expand care management services to inmates at the Camden County Jail, we recently initiated Camden RESET in collaboration with the Camden County Re-Entry Committee. Our research has shown that many people struggling with opioid addiction have frequent contact with both the healthcare system and the criminal justice system. All 16 patients who are enrolled in Camden RESET have a documented history of substance use. And of the 16, ten have documented history of opioid use.
“Our participants are excited to be working with us to make the changes they want in their lives,” said Bill Nice, Program Manager of Innovation Operations at the Camden Coalition. “As we build on our relationships with patients and community partners, we’ll continue to focus on how we can address the challenges faced by our participants, including opioid use disorder, with the most impact.”
Housing patients first, addressing addiction second
Our Housing First pilot program follows an evidence-based housing model that ends homelessness for individuals facing long-term housing challenges, and our research has shown that the program dramatically reduces the patterns of high hospitalization and emergency room use among patients with chronic illnesses. Out of the patients who have been approved for housing vouchers from the Department of Community Affairs, at least 66% have a substance use diagnosis. And of the 66%, at least 31% have an opioid-related diagnosis.
Once patients are housed, they are in a safe, stable environment and are better able to make the changes in their lives that lead to better health. Jamal Brown, who had been in and out of the hospital over 30 times in eight months, was living with an addiction when he moved into supportive housing. Today, Jamal’s medical issues are under control and he plays an active role in the Camden Coalition Housing First support group, a space for anyone in the Housing First program to come and talk with other individuals who have recently been housed.
“For our patients struggling with serious health issues and substance use disorder, it feels intuitive to try and tackle the health condition or the addiction first,” said LaTonya Oliver, Clinical Manager of Social Work for Innovation Operations at the Camden Coalition. “In actual practice, what’s best is to have their basic needs addressed first, which is what we do with Housing First. After they are stably housed, patients are able to focus more on their health and address issues like addiction.”
The Camden Coalition has always focused on addressing medical complexity rather than a single disease-specific issue. Instead of having one program that tackles substance use disorder, we provide addiction training for each of our care team members regardless of which patients they see. In addition to our standardized addiction training, our care team is coached in supplemental care principles, such as harm reduction, trauma-informed care, and motivational interviewing. These care principles are essential to providers who are working with patients that have complex medical needs and are experiencing substance use disorder.
“When people with a substance use disorder seek care, they often encounter a healthcare system that siloes medical care from behavioral health and a society that stigmatizes their behavior,” said Victor Murray, Director of Care Management Initiatives at the Camden Coalition. “We’ve set our work up in a way that each of our care team members and our interventions are able to address medical, social, and behavioral health needs, without judgment, regardless of where we meet them.”