First Step: Program Overview
The First Step program serves as the focal point of ED23 project activities, which ultimately aim to enhance programmatic service delivery. The foundational elements of First Step are described below:
Screening and Identification
Patients are screened in triage utilizing validated screening tools (AUDIT-C and DAST-10) and subsequently connected with specially trained registered nurses known as Addiction Care Coordinators (ACCS) who will facilitate entry into treatment.
The ACCs complete assessments based on a framework developed by the American Society of Addiction Medicine (ASAM) and formulate individualized follow-up plans based on ASAM criteria, insurance, access factors, patient preference and medical status. The ACCs also complete physical assessments as indicated and obtain pertinent lab work.
As indicated, patients receive Medication-Assisted Treatment (MAT), including buprenorphine or naltrexone, as well as medications to mitigate the severity of their withdrawal symptoms.
Transitions of Care: Care Coordination
The ACCs facilitate a seamless transition process via a warm handoff to internal and external service entities, which involves a clinician-to-clinician transfer of care for impending referrals, and by arranging transportation if appropriate. To promote patient adherence during this critical phase, the ACCs also provide education pertaining to anticipated next steps in the recovery journey, as well as harm reduction services. Patients may be connected to a varied assortment of addiction, behavioral health and medical services.
Recovery Support: Peer Recovery Coaches and Case Management
In collaboration with United Way of Summit County (UWSC), First Step offers patients peer recovery service. With consent, the ACCs provide patients with an opportunity to connect with certified peer recovery coaches (PRC) from Catholic Charities, whose lived experiences and focused training provide the foundation of their non-clinical assistance. Case management, imbedded within the Intensive Outpatient Program (IOP) sites, involves the provision of vital services aimed at assisting and supporting patients with a broad category of needs as they navigate their unique journeys toward recovery.
Harm Reduction Initiatives: Naloxone Distribution and Hope Bags
First Step dispenses naloxone kits to any consenting Opiate Use Disorder (OUD) patient, family member or significant other that presents to the ED irrespective of their readiness to initiate addiction treatment. Patients are also offered a “Hope Bag”, a backpack that contains basic care items and informational resources for various addiction treatment agencies, recovery support entities and harm reduction services.