Treatment hubs offer hope for recovery amid opioid crisis

By ETHAN DeWITT – Concord Monitor
Monday, December 31, 2018

From the outside, the Riverbend Community Mental Health facility in downtown Concord looks the same. But inside, a team is crafting a new portal for those with substance use disorder that officials say could usher in a turning point in New Hampshire’s epidemic.

It’s called The Doorway, and it’s one of nine centers across the state to launch on New Year’s as part of a statewide “hub and spoke” program announced by Gov Chris Sununu in August. The idea is simple, officials involved say: a one-stop destination for the Concord area to connect those suffering from addiction with the treatment they’re searching.

As part of the system, Concord’s hub will work hand in hand with a new 24/7 phone hotline. Starting Jan. 1, anyone looking for treatment for substance use disorder can call “211” and get immediately directed to someone to hear their condition. The hotline service might direct the caller to emergency services. Or it might refer the caller to his or her local hub: in Concord’s case, Riverbend’s site at 40 Pleasant Street.

Business hours calls will be transferred by 211 directly to the caller’s local hub. Calls made after hours will be patched to Dartmouth-Hitchcock Medical Center in Lebanon, which will collect names and pass them onto the local hubs for follow-up the next day.

Once connected, the hubs will follow up with the caller to arrange an in-person, hour-long intake assessment carried out by the hub itself. The patient will then be passed on to a local provider depending on the results of the assessment – the “spoke” that leaves the hub.

And, of course, clients can at any time visit Riverbend’s hub on Pleasant Street during business hours.

Functionally, the tasks covered by the hubs will be similar to the work that Riverbend does already, Gagnon said. But local providers says the addition of a one-stop service will bring major improvements.

To start, there’s convenience. Before the hubs, for instance, those looking for treatment services had to know about the individual spokes, call them, and arrange assessments. The hotline takes the guesswork and necessary persistence out of the equation.

That’s important, providers say: That usual day-long wait between the initial phone call and the first appointment can deter those interested in treatment from actually showing up. By creating a streamlined process, the client now has, in theory, a guaranteed follow-through after that first phone call.

And the expected effects of the streamlined system go beyond just convenience. Providers hope the simplified emergency number will give those struggling with opioids a beacon in their darkest hour. That means potentially reaching an entire new population of drug users, they say.

“I think that having the 211 number, and having that advertised is an easy way, it’s an easy phone number to call, an easy way for somebody to pick up the phone, dial 211, and really get connected with where they need to get connected to,” Gagnon said. “If somebody doesn’t know about Riverbend, they haven’t done the research about what kind of spokes are in their community, it’s hard for somebody who’s actively using, just starting to be interested in change and thinking about recovery to do that. So the hub has streamlined that process.”

Meanwhile, the hubs’ role in assessing incoming patients before directing them on will also benefit the spokes themselves, who may now skip that step and move directly onto the next step, representatives say.

Then there are the strings attached to the federal funding for the program – $45.8 million over two years. Under rules by the Substance Abuse and Mental Health Services Administration, for instance, the hubs spending the money must carry out case management for all who use the services, checking in with patient even after they’ve moved onto the spokes until they’ve been discharged.

To the providers making up the spokes, that’s another boon. With case management handled by the hubs, patients who fall through the cracks and stop showing up for treatment can be more easily identified, they said.

“The fact that there’s going to be ongoing case management, and that some of the assessments have already been complete, we know that that person walking through our door is very likely to benefit from our services,” said Christopher Mulcahy, program director for Concord Metro Treatment Center on Hall Street.

Taking in that potential increased population through one main portal likely means high workload burden for the hubs. That could pose a staffing challenge if demand outpaces availability, though Gagnon isn’t worried about that.

The Riverbend hub has used the federal funds to hire a manager, two clinicians, a recovery peer, a case manager and data manager, Gagnon said. Should they need to, she says, the hubs could hire more employees.

Still, some uncertainties loom. The state opioid response funds represent that largest federal appropriation to the Granite State since the epidemic began. But the $46 million lapses after just two years, with little known about the next Congress’s intentions.

But Sarah Gagnon, Riverbend’s vice president of clinical operations and a key architect of the Concord hub, said she isn’t worried.

“It’s been very clear to us that there is funding for two years, but we’re confident that the funding’s going to continue based on the needs,” Gagnon said. “Because addressing this crisis is so important.”