Page 15 - Delaware Medical Journal - June 2016
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CASE STUDY
Specialists (ES) who are in recovery from drugs and/or alcohol use and are embedded into the various clinical settings within PE results in reduced health care utilization and costs.5
ES utilize early engagement strategies such as motivational interviewing and, when appropriate, share their own story of recovery to quickly build a therapeutic relationship in order to focus on the needs of the patient. ES assess readiness to change and perform a brief intervention appropriate to the patient’s willingness to change. Along with the PE Social Worker, PE staff provide
a range of services from giving information or teaching about
drug treatment at the bedside and/or connecting patients with community resources including fellowship self-help groups or drug treatment (outpatient or inpatient).
A Community Engagement Specialist (CES), also a peer counselor, is available to continue providing ongoing continuing care for patients upon discharge from the hospital. The CES works in partnership with the PE Social Worker to provide a range of services such as relapse prevention and care coordination for substance abuse, physical, and mental health needs. This process allows a patient to start recovery in the hospital and then continue recovery once discharged from the hospital.
The following case presentation illustrates the critical interplay between PE, behavioral health, and primary health care in the hospital and the community to provide this patient an opportunity
CASE DESCRIPTION
The patient is a 52-year-old white male with a 43-year history of continuous chronic alcohol abuse without any intervening episode legal issues, no family support, no sober support network, and a
lack of coping skills further complicating his ability to achieve and maintain abstinence. Before entering the PE Community Program on May 5, 2015, the patient had two inpatient episodes (total of 38 patient moved to Delaware the fall of 2012. In addition to the hospital
episodes prior to entering the Community Program, the patient had four inpatient episodes (total of 49 days) and 19 ED episodes from December 2012 until May of 2014.
did well on IV antibiotics and stabilized on the Clinical Institute Withdrawal Assessment (CIWA) triggered protocol. After expressing to his nurse he was “tired of waking up in the hospital and ready for a change,” he met with the Inpatient ES who began the substance abuse treatment referral process utilizing the PE adjust his psychotropic regimen.
Upon discharge on May 8, 2015, the psychiatric staff learned that he was no longer approved for his residential bed. Unfortunately there were no options and he was discharged to a temporary shelter while waiting for inpatient substance abuse treatment
in order to provide a safe recovery environment. The CES transported the patient to the shelter and continued close contact
to maintain engagement while alternative treatment plans psychiatric staff, the PE Social Worker, and the CES, the patient was eventually enrolled in a local inpatient stabilization drug treatment program at Gaudenzia where he stayed until he was able to enroll in the Rockford Intensive Outpatient Program (IOP) on
to attend three to four sessions per week on days of their choice. The program helps individuals identify the underlying causes of addiction, assists them in developing coping skills, and improving overall mental wellness. When the patient moved to his own apartment, the CES continued to meet with him two to three times weekly, providing encouragement and reviewing critical lessons learned at the Rockford IOP. While at the IOP, the CES escorted the patient to his psychiatric and primary care appointments
where the CES helped the psychiatrist and other physicians better graduated from the IOP program on August 10, 2015.
After graduation from the Rockford IOP, the CES and the patient developed a treatment plan that included relapse prevention, improving life skills such as hygiene, housekeeping skills, and nutrition. Working closely with the CES, the patient reported him to accomplish, as well as practiced new skills to live a sober community resources such as local transportation to attend social services, primary care, and ongoing mental health treatment. After
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