Tuesday, October 28, 2008

A Network of Partnerships and Technology Makes "Safety Net" Work for Delaware's Severely Ill

One year ago, Brandywine Counseling began an ambitious, multifaceted project targeting Delawareans with some of the most severe needs for substance abuse, mental health, and HIV risk reduction services. Never before in the state had all of these services been connected under one umbrella. Safety Net Services has changed that, and the results so far indicate this approach is working.

We started this program last October with a 5 year grant from CSAT, and admitted our first clients in January. Many of them enter the program through Christiana Care’s Wilmington Hospital. They come to the hospital for emergency care, OB/GYN care, or other services, but also have substance abuse and/or mental health needs which the hospital system is not equipped to treat. Through Safety Net Services, we’ve established a partnership with Christiana Care and other agencies so we can link these patients to appropriate care, whether it’s medication management; HIV outreach, education and risk reduction counseling; or substance abuse treatment.

We are reaching people who could otherwise get “lost in the cracks.” On one occasion, a woman we encountered during street outreach tested positive for HIV on our mobile van. She was ready to be linked to medical care and other services, and also was ready to enter substance abuse treatment. We got her admitted to our program that day, enrolled her in our on-site HIV medical clinic so her health could be monitored, and also connected her with our HIV case management program (NSAFE). She now has easy access to all these services under one roof, increasing the likelihood that she can adhere to medical care and be successful in treatment.

Safety Net Services owes much of its success to technology. Staff have the ability to do “mobile intakes” out in the community, which creates a path of least resistance for clients to enter treatment. We use laptops with wireless air-cards for Internet access to remotely dial into the Brandywine Counseling servers. We also depend on cell phones to keep our team in constant communication with one another, whether it be for a new referral or to contact a client who has been absent for treatment. Constant communication among our staff from various programs lets us assist each client with managing their time and responsibilities, such as keeping appointments.

In the past year, we’ve seamlessly transitioned 75 clients to co-occurring treatment, in which substance abuse and mental health disorders are treated simultaneously. Our average client is 40 years old and female. About half the population is minority. Of the 75, 42 clients had medical problems in addition to HIV that required medication management at our “one stop shop” clinic, with an average of four medical problems per participant. Most (83%) of the clients also have a mental health diagnosis, most commonly major depression. They are also seeking greater stability in regards to living situation, employment and income.

Six months after admission, we measure several indicators of recovery and stability. Our clients show good progress on all measures. None had dropped out of treatment after six months. Two-thirds reported no drug use, half reported no alcohol use, and 40% reported no alcohol or drug use.

Overall, Safety Net Services is making recovery and stability possible for many Delawareans with severe substance abuse and mental health issues. This program has allowed us to focus on some of the most needy individuals in this community, simultaneously addressing multiple critical issues. The interagency partnerships with organizations like Christiana Care, and the new technology available to us, make it possible to reach people who would otherwise have no contact with treatment providers.

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