On September 20, the Health Care Council of Chicago (HC3) co-hosted a Recovery Month Event with the Illinois Association for Behavioral Health and Third Horizon Strategies addressing the opportunities and role of recovery in the Chicago health care ecosystem. This event highlighted the intersection of addiction and recovery with health care by lowering barriers to recovery support, creating inclusive spaces and programs, and broadening our understanding of what recovery means for people with different experiences.
Jud DeLoss, CEO, Illinois Association for Behavioral Health
Sara Howe, Director, Third Horizon Strategies
Greg Williams, Managing Director, Third Horizon Strategies
Tom Britton, President and CEO, Gateway Foundation
Dennis Deer, Commissioner of the 2nd Cook County District
Dan Lustig, President and CEO, Haymarket
Maureen McDonnell, Executive Director, Peer Services
Dora D. Wright, Founder and CEO, Chicago Recovering Communities Coalition
News Coverage COOK COUNTY LOOKS TO LABEL MENTAL HEALTH A PUBLIC HEALTH CRISIS | Health News Illinois | 9.24.2021 | Link to article
PANELISTS CALL FOR CHANGES TO RECOVERY CARE | Health News Illinois | 9.24.2021 | Link to article
Watch the Recap | Link to Video
What would you change if you could change one thing about the healthcare industry?
TB: The system needs to move towards recognizing that addiction is a chronic disease that kills people if untreated, supported by a transition from fee-for-service models of care to value-based care models.
DD: More focus and impact on underserved communities, really helping them get access to better health care and addressing social factors or social determinants of health. And, it will require the public and private sectors to do better to “give a hand up” to underserved communities.
DL: We need better access for all to adequate health care. The inadequate and not equal health access to the appropriate care is not only killing people but impacting the next generation. We are one of the wealthiest countries with 11 million children living below the poverty line.
MM: Removing the silos that exist between traditional health care treatments and addiction treatments would make us all more efficient. Our organizations are already siloed between health care and payer systems, these continued barriers just decrease opportunities to partner and collaborate.
DW: Accelerating the progression of system transformation from treating behavioral health as an acute illness will stop us from continuing to treat these symptoms acutely and not holistically.
From your experiences, what do you think are the most important things to share about substance use disorder (SUD) prevention treatment and recovery services?
DL: Treatment works and when you look at addressing SUD in a comprehensive way, you will find that the medical outcomes actually fall in line with other chronic conditions. The American Medical Society (AMS) definse SUD as a medical condition, we need to address it as such. Stigma is the number one barrier to access, and stigma is going to kill our loved ones if we don’t address it.
DD: Racism plays a strong role in stigma. As we do more research, African American males are still the top group dying from opioid use. All members of the health care system need to “sound the trumpet on this” issue.
DW: Recovery is a process that requires time, patience, support. Policies that discriminate against people in recovery must be reversed.
MM: Recovery is real and can be made more attainable or less attainable based on stigma and how we treat people. Stigma keeps individuals from accessing care, so again integration can be a huge support for all if done right. People are often still afraid to get treatment and disclose information because of stigma.
What does it mean for the Chicago health care system to become recovery-oriented?
DW: It is not a competition, and we need to come together to link services and share data, because collaboration is key. All stakeholders need to realize what they are good at and when they need to refer out for when things are beyond their purview.
What are some SUD goals from a policy-maker perspective?
DD: The primary goal is to transform the system. There is an opportunity to be a voice of the voiceless through declarations on racism to addressing gun violence. New initiatives are ushering the opportunity to declare that the lack of behavioral health services as a public health crisis. Many individuals cannot celebrate recovery because they cannot access treatment services, because there is a stigma barrier, or a lack of knowledge/education as to what to do next, which includes some social factors. The whole system is a problem and all stakeholders and providers “need to be sick and tired of being sick and tired.”
Tell us more about the innovative maternity program at Haymarket.
DL: It was started over 10 years ago with the Sheriff’s department. The program is for pregnant and post-partum incarcerated moms that are moved from incarceration to treatment, along with their children. The program can also include fathers or significant others. One of the biggest risk factors that many of these women face is returning home. This led to the development of a fatherhood program as well, as an opportunity to do family-based treatment. Any child under 18 and in the mother’s custody that faces problems with school, relationships, or other challenges/barriers is eligible to receive supportive services.Treating this as a family condition helps build healthier family environments. This demonstrates that if you truly treat SUD in a comprehensive way, it can impact more than just mothers in recovery.
How do you treat patients who need different levels of care or present to Gateway at different places?
TB: The system is extremely fragmented. But we operate at Gateway with a “No wrong door” policy to meet people exactly where they are. There has been a migration of treatment from residential-based care to community-based care. Social influencers or factors affecting one’s health are critical to keep in mind when engaging an individual. Providers also need to be innovative so that everyone can get treatment, no matter what they can pay or what insurance they have. People can access Gateway services by phone, in-person, in jail, and so forth. Gateway used to focus on residential care but has learned it is necessary meet them in the community and provide care that way. Gateway focuses on how to serve all people in all places in all times.
How are you helping to manage chronic underlying conditions with SUD?
MM: At Peer services, we made the decision to understand where individuals who require treatment surface most often. The places where people turn up most often with unaddressed addiction are in hospitals and jails. When it comes to hospitals, people show up because of opioid overdose, acute alcohol overdose, car accidents related to substance use and so on. There are also circumstances where substance use is more in the background, but still slowing down the healing process. We connected with the hospitals in our area (Evanston) and were able to secure a small grant to pilot a program with St. Francis. This eventually evolved into more funding for a more advanced pilot project with AMITA Health. The program has seen over 300 patients since it started in December 2020. As part of the service, patients are asked: “What is the thing that brought you to the Emergency Department?” and then expands with navigation to offer ways of helping address the reason and/or fixing it. Through having a better understanding of what the patient wants to change or not, this project has allowed Peer Services to assist with triaging these individuals accordingly. For example, an outreach worker spoke to the father of a young man who had his third overdose in three weeks, which resulted in the young man going into treatment. Or, an older gentleman fell on some ice and broke his hip. He disclosed that he used heroin daily, although that wasn’t why he was in the hospital. However, because he mentioned his usage, the outreach worker had an opportunity to speak with him about his options to not only treat his hip, but to treat his SUD as well. Projects like this should not be one-offs. This type of partnership should be happening at all hospitals, jails, and so on. There needs to be a systematic adoption of models like this.
How has the pandemic impacted the SUD system overall?
TB: Overdoses went up, and we observed lower rates of vaccination of those treated at Gateway. We shifted 1,500 people who were coming in for care to virtual and the adoption was really successful. Some providers will leave these methods behind, but many will see it as a way to provide access for people who previously had barriers.
DL: Substance use providers were an afterthought throughout the pandemic, and that is worrisome for how the field is treated and viewed. For example, most SUD treatment providers did not receive PPE until much later and were not prioritized. There is still a segment of homeless individuals who do not have access to technology, and this population continues to be underserved. Soon enough, we will know if those people overdosed more or less throughout all of this, and how much the SUD community was using their facilities as shelters rather than treatment opportunities.
I have been involved in hearings to open a new location where there have been criticisms because grants are not a sustainable funding source, but currently that is how this industry functions. We need to move to a financial platform that feeds itself. We should have a funding mechanism to help support these programs. There are actually Medicaid billing codes that are available to mental health and primary care that are not available to substance use treatment. Maureen’s program provides life-saving treatment and it’s funded by a grant.
DD: During the pandemic, people started substance use who weren’t using at all before.
GW: Virginia doubled the rates of reimbursement for office sized treatment programs, and it increased the workforce for treatment. The economics are there; it all comes back to stigma.
MM: The shortage/lack of resources, especially during the pandemic, was very difficult. BCBS gave Peer Services a grant to provide devices to those with housing insecurity during the pandemic. All these events around George Floyd murder – clients came forward and talked about their experiences in policing and incarceration in ways they didn’t before, this allowed opportunity to show clients it’s okay to talk about these things. This changed the way that Peer Services addressed their clients. These big events affect so many and need to constantly be involved in the thought processes.
DW: The recovery community was not ready for the pandemic. Adapting to the changing needs of the community was and will be vital, not just in the pandemic but also moving forward. We have work to do. Relapse increased; hospital admissions were over the top. This work makes a difference. Recovery benefits individuals and their families. Impacts the community, improves public health, reduces tax burden.
DL: A group like this is very powerful and it helps to create a social diffusion model where people can talk about this. How is it that the federal government was able to dump $10 billion into mental health and SUD in the past year? Because of these conversations.
TB:On a systems level, there needs to stop being a three-care world. Wealthy, middle, and low-income. Need to create true, systemic change and it can’t just go in hand with the
administrations, needs to be consistent.
DD: In order to get a different result, you have to do something you’ve never done. Talk is good but action is obviously vital. We all need to make sure that these conversations are acted upon and actual change is realized. Now is the time to make real change. We are the pioneers trying to change this system. This is a grassroots effort.