Wicomico County Health Department
COAT - Community Outreach Addictions Team peer specialist program
Wicomico County Health Department is located in Maryland serving a population of approximately 110,000. There are many rural areas in the County. The County began to see a spike in overdose deaths and non-fatal overdoses in 2016. Within the first three months of the calendar year the number of non-fatal overdoses treated in the Emergency Department had already exceeded the volume from the entire year of 2015. As a community we had to address this issue. The goal of the program was to decrease the number of fatal and non-fatal overdoses occurring in the County while providing outreach and education to those in need. The county Leadership met to determine the needs and provided funding for a peer specialist program (COAT - Community Outreach Addictions Team) to address the numbers of overdoses. The program began in June 2016 as a pilot project. This program is a collaboration in which law enforcement, hospitals and peer support specialists partner to offer treatment to overdose victims. Peers in recovery with a minimum 2 years of documented recovery time were hired part-time to respond to overdoses in the community with law enforcement and to the emergency department . The peers maintain a professional relationship with the identified individuals until such time they access treatment or decline services. The peers also work closely with law enforcement and conduct ride alongs with law enforcement to hotspot areas or to areas to provide education and outreach related to treatment access. The objective to link individuals with treatment was met. The COAT program experienced a success rate of 53% of getting overdose victims into treatment. COAT is performing at a 62.68% higher rate than the nation in assisting drug users into rehabilitation at specialty facilities. The use of peers is key to the success of the program as is the constant follow-up to assist in accessing treatment. The program is the bridge to treatment for victims of overdose. The COAT program impacts access to care for victims of overdose. The Health Department website is wicomicohealth.org
During the first few months of calendar year 2016 our jurisdiction began to witness a significant rise in overdose cases, both fatal and non-fatal. During the calendar year of 2015 there were 100 overdose cases in the hospital emergency department whereas there over 100 in just the first three months of the calendar year 2016. The primary drug was heroin or other opiates. This trend was seen nationwide and statewide as well. The leadership of the Health Department worked with the State's Attorney to develop a plan to address the issue. Meetings were held with law enforcement, City and County Elected Officials, hospital emergency department leadership to present the issues and the plan to have individuals in recovery respond to overdose cases to assist with linkage to treatment. The County government agreed to pilot project funding to begin the program. The peers respond to law enforcement calls as well as calls from the Emergency Department. In addition the peers do outreach to the HOTSPOT areas - areas of known drug use and selling with law enforcement to do education and make efforts to engage the individuals into treatment. Since program inception in June 2016 through October 2017, of the 404 individuals served - referred for overdose- 214 have engaged in treatment. This represents 53% of the population of the individuals served. Peers have been utilized in the past as an adjunct to outpatient case management services to help engage or re-engage individuals. This program targets individuals at the time of overdose and works with the individuals until they engage in treatment or refuse the service. Multiple contacts are made with the individuals during the engagement process to insure the individuals remain in the area so when a treatment slot opens they can be transported for admission. This practice is an evidenced based as referenced by SAMHSA's Recovery to Practice Initiative. They report that people living with substance use conditions can increase social connections when they have access to recovery-oriented services. They are also able to establish positive relationships with the individuals identified in need of services and their family member.
The Goal of the practice is to decrease the number of fatal and non-fatal overdoses. The objective is to link a minimum of 30% of overdose victims to treatment to avert future overdoses. In order to address the goal and objective the Health Officer and State's Attorney presented the program plan to the local elected officials to gain financial support for the project. $125,000 was awarded for the first year. Recruitment efforts began to hire three peer support specialists - individuals with a minimum documented 2 year recovery period. Data was collected regarding the volume of overdoses, time of day of overdose and location of overdose in efforts to schedule peer work time during times of peak calls and the remainder of the time be for on-call response to overdoses.
The COAT program goal is to decrease the number of fatal and non-fatal overdoses in our county with the objectives to link overdose cases to treatment services. We also wanted to demonstrate return on investment through the program services. Goals and objectives are being met. Data from June 2016 through October 2017 show a 53% linkage to treatment. There is also a 35% decline in the number of overdose cases in the Emergency department. Data on the numbers of overdoses is collected by data reported by the emergency department, law enforcement, medical examiners office and the COAT program data. The program was also evaluated by an independent organization - Beacon at Salisbury University. Beacon reviewed multiple data sets including The Department of Health and Mental Hygiene's annual report highlighiting the count of deaths attributed to drug use. Beacon also compared the program to similar programs and determined the COAT program had a 53% conversion rate (conversion to treatment). They also looked at data related to estimated costs related to drug and alcohol abuse. These costs included: criminal justice system costs ( costs for the county estimated at 7.4 million), medical expenses (costs for the county $112K), property loss ( total costs estimated at $21K for the county), lost productivity (total costs estimated at $12K for the county). Return of investment is a performance measure to evaluate the efficiency of a program by comparing the projects outcomes relative to its costs. Calculating the return of COAT was used to evaluate the impact of COAT on the total costs of illicit drug use in the County. Beacon calculated a return of 666% in COATs first year of operation. In other words for every dollar spent on COAT it is saving over $6. The evaluation also noted that compared to the nation COAT is performing at a 62.68% higher rate than the nation in assisting drug users into rehabilitation at specialty Programs. Their recommendations associated with the evaluation include increasing the staffing to assist with the neighboring county overdoses that are seen in the Emergency Dept., a support group for the peers to prevent relapse of the COAT staff themselves. They also recommended tracking two additional data points: number/percentage of individuals that complete treatment and number/percentage of individuals using again after 6 months, 1 year, etc.
Partner collaboration is key to the success of the program as well as sustainability. Partner collaboration early on in the process is important as well. Having a champion is an important component. Someone well respected and a key leader in the process. The partner collaborations must start early and all partners need to be involved in the planning process and continued review of the program. In addition, identifying data points for evaluation purposes early in the program development is key to having an independent evaluation done. The independent evaluation completed examined the many factors associated with alcohol and drug use including crime, medical costs, property loss, and lost productivity and determined that the program experienced a return of 666% in the first year of operation. The partners involved in the program determined that with this level of success they were going to continue the program and expand the funding to add additional staffing.
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