CHEESE CLAIMS THE LIVES OF 25 NORTH TEXAS TEENAGERS

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Cornelia Singleton
8 years ago
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1 CHEESE CLAIMS THE LIVES OF 25 NORTH TEXAS TEENAGERS Jose Almaguer Jr., 16 April 21 Scott Clark, 18 July 14 Lyle Hatfield Jan. 7 Lorenzo Ontiveros, 18 April 16, 2005 Alfonso Barajas, 18 May 6, 2006 Fernando Cortez Jr., 15 March 31 Gregorio Herrera, 17 Sept. 10, 2006 Hugo Rivera, 18 Aug. 11, 2005 Karla Bacerra, 18 April 24, 2006 Blake Edgil, 17 Dec. 22, 2006 Garret Hill, 17 Jan. 22, 2005 Uriel Rodriguez-Perez, 18 Dec. 21, 2006 Scott Boone, 16 Aug. 16, 1006 Jorge George Gasca, 18 May 22, 2006 Sergio Leija, 18 March 10, 2008 Joshua Tarkington, 18 May 8, 2006 James David Burnette, 17 July 31 Keridma Godina, 18 April 18 Diego Martinez, 18 Oct. 22, 2006 Jason Washington, 16 Jan. 30 Nicholas Cannata, 16 June 5, 2005 Oscar Gutierrez, 15 Feb. 18 Robert Meade, 18 July 22, 2006 Keith Witherspoon, 17 Nov. 1, 2006 Brandi Nolen, 16 Jan. 3, 2005

11, 2005 Karla Bacerra, 18 April 24, 2006 Blake Edgil, 17 Dec. 22, 2006 Garret Hill, 17 Jan. 22, 2005 Uriel Rodriguez-Perez, 18 Dec. 21, 2006 Scott Boone, 16 Aug.

2 Dallas Coalition for Treatment Improvement Treatment Providers Homeward Bound, Inc. Nexus Recovery Center Adult - Detox, Residential, Outpatient, and Recovery Adult - Residential, Outpatient Services, Women/children Adolescent - Residential and Outpatient Services Phoenix House Adolescent - Residential and Outpatient Services Dallas County Juvenile Dept Adolescent - Day Treatment Payors Texas Department of State Health Services Value Options/North STAR Medicaid Managed Care Program Dallas County Other Participants Carlos Tirado, MD UT Southwestern Medical Center Medical Director, Nexus - MAT Jane Maxwell, PhD Local Evaluator

and Outpatient Services Phoenix House Adolescent - Residential and Outpatient Services Dallas County Juvenile Dept Adolescent - Day Treatment Payors Texas

3 Magnitude of Emerging Cheese/Heroin Issue Identified in Various Arenas throughout the Community Poison Control Center Heroin Calls Dallas Independent School District Police Campus Arrests related to Cheese/heroin 20 Offenses Under Offenses / /2007 Hospital Based Detox Admissions Youth Female Male /05-05/06 05/06-05/07

Offenses 15 160 140 10 Under 17 18-25 120 100 80 Offenses 5 60 40 0 2000 2001 2002 2003 2004 2005 2006 20 0

4 AIM: We will improve our addiction treatment system by 1) Increasing continuation across levels of care by using Motivational Interviewing as a technique for engagement and retention 2) Using the medications suboxone/ subutex to support retention in treatment, especially retention in out patient treatment for heroin addiction

engagement and retention 2) Using the medications suboxone/ subutex to support

5 Engagement and Retention in Treatment Following Hospital Based Detox from Cheese/heroin NorthSTAR 107 hospital based detox admissions of youth 4 discharged with IOP while the remaining 103 were pre-authorized to enter residential treatment 52% did not complete the transition from detox to residential 5% of those entering residential discharged AMA within first week

remaining 103 were pre-authorized to enter residential treatment 52% did not complete the

6 Barrier Analysis Walk-Through Despite our brainstorming efforts to identify barriers around transportation, etc. we have not seen improvement in the percentage of detox to residential transitions. In order to further analyze the barriers, the Dallas Coalition has begun a series of walkthrough to experience the transition process from post detox referral to admission into residential treatment. Family Surveys Some initial responses from families regarding lack of follow up on residential treatment recommendation highlight the importance of this activity in barrier analysis: Belief that detox episode was treatment Lack of understanding that it would be covered by the Public benefit Multiple concerns about child being out of school and home coupled with poor understanding of seriousness of the substance abuse

Family Surveys Some initial responses from families regarding lack of follow up on residential treatment recommendation highlight the importance of this activity in barrier analysis: Belief that

7 MI Activities First Quarter The Department of State Health Services (SSA) set up a two day MI training enhanced with a supervisory component for four counselors from each provider agency Nexus Recovery Center hosted the training in Dallas on April 14 and 15. A follow-up MI training for supervisors will be held in Austin on April 28, 2008 The training was led by Mary Velasquez, Ph.D. and Nannette Stevens Ph.D., Center for Social Work Research at UT- Austin. Each participant was given a tape recorder and assigned an MI coach for tape reviews and coaching sessions over the next three months

A follow-up MI training for supervisors will be held in Austin on April 28, 2008 The training was led by Mary Velasquez, Ph.D.

8 Buprenorphine Pilot Project From research to clinical practice: Project Overview 2 clinical trials (RTCs) support use of bupe for periods of days for treatment of early heroin dependence in young population. (Marsch LA, 2005 and Woody G, CTN-0010) Transition to school, job, normative behavior Emergency Room or Detox Facility Nexus Recovery Residential + Bupe/Nal stabilization Project Aims: Primary: Prevent or delay relapse to heroin use Engage families in treatment process Secondary: Facilitate entry into school, job, normative behavior Reduce juvenile recidivism and re-entry into costly emergency room treatment Two week med Taper + Transition to SOP Nexus Recovery IOP, Family tx + Bupe/Nal Extended Treatment Cost of medication covered through Medicaid program for 90 days Medications dispensed in weekly intervals and yoked to IOP and family visit 3-5 IOP visits per week encouraged, but not required Urine drug screen checked at each medication visit and at random during IOP

(Marsch LA, 2005 and Woody G, CTN-0010) Transition to school, job, normative behavior Emergency Room or Detox Facility Nexus Recovery Residential + Bupe/Nal stabilization Project Aims: Primary:

9 FUTURE DIRECTIONS Train more staff on Motivational Interviewing as an engagement/retention strategy. Expand the use of medication assisted treatment as a retention strategy. Use walk through process and client surveys to continuously evaluate and understand barriers. Modify processes to remove barriers and to improve transitions between facilities and levels of care.

Use walk through process and client surveys to continuously evaluate and understand barriers.

Advancing Recovery. Maine s s State Provider Partnership for Quality Addiction Care

Advancing Recovery. Maine s s State Provider Partnership for Quality Addiction Care Advancing Recovery Maine s s State Provider Partnership for Quality Addiction Care The Office of Substance Abuse (OSA) & The Maine Association of Substance Abuse Programs, Inc. (MASAP) The Maine Project