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Expanding Services For Substance Use Disorder

Drug Medi-Cal Organized Delivery System

Shaina Zura, LCSW, Chief of Substance Use Disorders at the County of Santa Cruz presented on the Drug Medi-Cal Organized Delivery System (DMC-ODS) pilot program. Operating under federal approval of Substance Use Disorder (SUD) service expansion, this program provides a continuum of care modeled after the American Society of Addiction Medicine (ASAM) criteria for SUD treatment services. As ASAM criteria has revolutionized the way in which residential services are used, this program seeks to provide beneficiaries with improved access to care and system interaction to achieve sustainable recovery. The program includes a specific array of services and specific limitations to beneficiaries eligible for residential services. This is a shift for Santa Cruz County. Due to the limitations set by Drug Medi-Cal for residential services, it is important that pilot programs identify additional funding streams to cover room and board costs. To access an ASAM assessment and services, beneficiaries can enter through three “primary gates” the County Health Services Agency (HSA) access team, community providers (Janus, Encompass, and Sobriety Works), and HSA service coordinators. The program will train more providers throughout the county. With two phases set, the program will increase access to residential beds and have no cap on outpatient capacity. As it is currently in the “ramp up” phase, Shaina looks forward to providing a future update once the expansion has been implemented.

Family Practice Residency Program

Doctors Eric Sanford, Director of Community Medicine Rotation, and Nathaniel Lepp, Chief Resident, shared details and experiences of the Family Practice Residency Program in training residents in the care of patients with substance use disorder at Natividad Medical Center. Dr. Sanford explained that part of the unique purpose of this residency is to expose residents to available community resources and to allow them to connect more deeply with the patients in their care. Residents are required to organize and offer presentations at community meetings, such as AA, Alanon, and Sun Street Center. They use a train-the-trainer model in which each resident chooses a topic, offers a brief presentation, then utilizes motivational interviewing in interactions.

This format further integrates residents into the community by allowing them to hear patients' personal stories including triumph and challenges as well as allowing them to see the resources available to patients. Dr. Lepp applauded this concept and commended other positive aspects of the residency such as the program’s requirement of buprenorphine training and prescribing in the emergency department, the early integration of residents with behavioral health staff, the robust telemedicine support, the importance of brief interventions in the patient visit, and the benefits of having the residents attend group therapy and shared medical appointments. Dr. Lepp further explained that the enhanced training through this program has led to a beneficial mutual understanding among the residents that there should not be any new prescribing of opioids, but noted that managing legacy patients on opioids remains a challenge. Dr. Lepp concluded the presentation with a call-to-action for all residents and senior physicians to partner together to learn from each other and continue to develop and improve care for all patients.

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