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Dartmouth-Hitchcock Officials Offer Details on Addiction-Treatment Model



Valley News Staff Writer
Tuesday, January 08, 2019

Lebanon — Dartmouth-Hitchcock officials on Tuesday outlined their plans to offer addiction treatment in the Upper Valley through a broader state program known as The Doorway-NH, though some community members at the session raised questions about the hours of operation and other access issues.

D-H is the recipient of a $1.5 million grant to participate in New Hampshire’s new hub-and-spoke model that began operations this month, and the new model means the Lebanon-based health care system will need to collaborate with community partners to connect people with the help they need when they need it.

Building on D-H’s addiction treatment program, which first came into existence in 2005, D-H aims to use this opportunity to “engage more deeply with others in the community who are pulling in the same direction,” Will Torrey, vice chairman for clinical services for D-H’s Department of Psychiatry, said to the approximately 50 people gathered at Dartmouth-Hitchcock Medical Center on Tuesday morning.

D-H will serve as one of nine regional hubs across the state where people struggling with addiction can go for treatment and referrals out to community partners, who will serve as “spokes.” The hub funding comes out of a $45.8 million two-year grant from the federal Substance Abuse and Mental Health Services Administration that was announced in September.

The effort is aimed at curbing the number of fatal drug overdoses in New Hampshire, which have been on the rise in recent years, going from 201 in 2011 to 488 in 2017. The state medical examiner last month, however, estimated that deaths are beginning to drop, with a projected 437 having died last year. Some 2018 deaths are still pending toxicology tests to determine cause.

Some changes related to The Doorway already have rolled out, while organizers are continuing to work on others.

Since the beginning of this month, D-H’s outpatient treatment center, located in the Rivermill Complex in downtown Lebanon, has gone from providing treatment four days a week — from 8 a.m. to 5 p.m — to five days. After hours and on weekends, clinicians can be reached by calling 211, a statewide hotline that connects callers to a wide range of health care and social services.

But some other details of the program have yet to be worked out. Attendees of the session expressed a range of concerns, from how people might access treatment after hours, to how people in need of treatment might get to Lebanon to be evaluated, to how the 211 line might connect people to a suicide hotline when necessary, to whether people would take advantage of the increased access the Doorway aims to provide.

Michele Merritt, CEO of New Futures, a Concord-based health care advocacy nonprofit, asked D-H officials to describe how people would access treatment when the Lebanon outpatient treatment office is closed.

Pointing to the “safe station” model, which invites those seeking treatment to come to fire stations in Manchester and Nashua at any time of day, Merritt asked, “How are you trying to replicate that?”

DHMC is working to begin providing medication-assisted treatment in the emergency department, said Sally Kraft, D-H’s vice president of population health. Also within the emergency department, Kraft said providers connect people struggling with addiction with recovery coaches.

“When the time presents itself, we want to be ready,” Kraft said to Merritt.

Given that people will need to get to Lebanon to be evaluated at the Rivermill Complex, Kirsten Vigneault, director of community health preparedness for the Greater Sullivan County Public Health Network, asked if that would be a barrier to access.

If people can’t make it to Lebanon, perhaps clinicians could reach people using telemedicine, Torrey said.

“I can’t imagine we couldn’t solve this problem,” he said.

Cameron Ford, executive director of Headrest, the Lebanon-based nonprofit that operates a suicide hotline and provides both inpatient and outpatient addiction treatment, said he worried that people with suicidal thoughts who call 211 may have trouble getting the help they need.

“You can’t put someone on hold,” Ford said.

Lauren McGinley, who is responsible for setting up the state’s opioid response via 211, said 211 operators have been trained to stay on the line with people who may be suicidal as they connect them to an appropriate suicide hotline.

In addition to training 211 operators, Kraft, D-H’s vice president of population health, said the health system is looking for suggestions on how to refer people to the services they need and ensure that they actually get those services.

Though the model aims to allow people to choose the care that is right for them, Torrey said, they have work to do to determine how best to inform people about the options available to them.

“We’re asking you all to come and help build that system,” Kraft said.

To that end, she invited all providers of medication-assisted treatment to come to an open house at the Rivermill Complex tonight at 6 p.m.

Torrey pointed out that the field of addiction treatment has changed in recent years. While previously people would have been dropped from treatment if they failed to comply with strict rules, including the use of any illicit substances, that is not the way treatment works now, he said.

Now, Torrey said addiction treatment aims first to keep people alive, at least in part by preventing an overdose, and then focusing on supporting people to rebuild their lives.

“People have to be alive to get better,” he said.

Suellen Griffin, president of West Central Behavioral Health, said she will be interested to see whether people use The Doorway to access services because an office West Central recently opened to provide outpatient addiction treatment in Claremont, which had not previously been available there, has not been well-utilized.

Though providers can build new programs, that doesn’t mean that people are motivated to seek treatment, Griffin said.

The “real question is ‘How do we get people into those services?’ ” she said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.