Joint Legislative Child Protection Oversight Committee

Tuesday, November 29, 2016

Collaborative Response to the Opioid Challenge

Barbara Cimaglio, VDH ADAP Deputy Commissioner

Karen Shea, DCF Family Services Interim Deputy Commissioner

The number of individuals using heroin/other opioids at treatment admission is increasing rapidly

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2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Number of people treated in Vermont by substance

Alcohol Marijuana/Hashish Heroin/Other Opioids All Others

Source: Alcohol and Drug Abuse Treatment Programs

Most People Treated for Opioid Use Disorders are of Childbearing Age

Data Source: Vermont Substance Abuse Treatment Information System (SATIS). This reflects only people receiving treatment at state-funded treatment facilities.

Vermont Department of Health; Alcohol and Drug Abuse Programs; 108 Cherry Street, Burlington, VT 05401

Pe

op

le

State Fiscal Year

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500

1000

1500

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3500

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

<18

18-24

25-34

35-44

45+

Age 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

<18 28 21 22 34 28 22 25 21 20 24

18-24 678 750 725 796 718 747 850 863 972 953

25-34 691 812 947 1147 1215 1381 1702 2040 2839 3194

35-44 320 327 368 416 393 493 558 722 1024 1243

45+ 180 203 210 237 268 301 344 397 565 670

Source: Alcohol and Drug Abuse Treatment Programs

Women in Treatment in SFY2016

Estimated percentage of women who are pregnant and/or parenting

• Outpatient Treatment: 74%

• Medication Assisted Treatment/Hub: 60%

• Residential Treatment: 44%

Vermont Department of Health

Source: Alcohol and Drug Abuse Treatment Programs

Custody Trends

1407 1382

1293 1215

968 960 1000 1022

1168

1291 1375

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 (Jun30th)

Children in Custody on the Last Day of the Reporting Period

Impact of Opioids on Child Welfare Caseload

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November 2015

Point In Time Number of Children In Custody Between Ages 0-5

Opioids Involved

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120

July 2014

Custody Entrants Ages 0-3 During Prior 6 Months

Opioids Involved In Custody Entry

7

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Children in Care

Ages 0-5

Ages 6-11

Ages 12-17

Over 18

Centralized Intake and Emergency Services

12327

13680 14581

15377 15525 15756

17458

19292 20233

2564

3756 4581 4600 4908 4699

5135 5847 5641

2007 2008 2009 2010 2011 2012 2013 2014 2015

Intakes

Accepted Reports

The entry rate in VT(4.6 per 1,000 in FY12) is higher than the national rate (3.2 per 1,000 in FY11). However…not all states include Juvenile Justice entries…

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These states could benefit from targeted front end strategies

Entry rate is the number of children (ages 0-17) entering care during the year for every 1,000 in the general population. Data source is FY12 AFCARS (FY11 in PR, CT, NM, SD and National) CA data from CWS/CMS

Data source: AFCARS state submitted files; Claritas population estimates

Even for just younger children (ages 0-12), VT has an entry rate that is higher than the national rate.

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Entry Rates (Ages 0-12): An indicator associated with front end reduction strategies

These states could benefit from targeted front end strategies

Entry rate is the number of children (ages 0-12) entering care during the year for every 1,000 in the general population. Data source is FY12 AFCARS (FY11 in CT, NM, SD and National) CA data from CWS/CMS

Data source: AFCARS state submitted files

Collaborative Efforts

2014 • Jointly worked to expand LUND Regional Partnership Program (RPP) from two

DCF Family Services Offices to six

• Worked with the National Center on Substance Abuse and Child Welfare to: • Review and refine DCF child abuse report screening policy

• Create DCF policy on drug screening and drug testing in child welfare cases

• Substance Use Disorder Training offered in all FSD District Offices statewide and implementation of standardized screening process

Collaborative Efforts Continued

2015 • Support collaborative work between local DCF Family Services and Preferred

Providers including hosting statewide event in September 2015 which included Nancy Young from National Center on Substance Abuse and Child Welfare

• Began work on Risk Triage Instrument to be used by Preferred Providers which recognized DCF involvement as a unique risk

Collaborative Efforts Continued

2016 • Implementation of Risk Triage Instrument in HUBS • Jointly worked to expand LUND Regional Partnership Program (RPP) from 6 – 12 DCF

Family Services Offices • Expansion created opportunity to continue work between DCF Family Services and

Preferred Providers as they worked to prepare to integrate this new program into their continuum of care

• DCF and ADAP presented at the ADAP conference in September 2016 • Submitted cross-department application to National Center on Substance Abuse and

Child Welfare to participate in Policy Academy focused on improving care for opioid exposed newborns and their parents

• Participated in New England forum with Heath and Human Services involving representative across VT departments (including private/non-profits) focused on the impacts of opioids on women throughout the lifespan

Regional Partnership Program Overview

• Program design emerged when LUND sought and was awarded a federal grant

• Substance abuse screener/case manager works alongside child welfare staff during investigation or assessment when there is a concern about parental substance use

• Screener/case manager responsible for screening, coordinating assessment and assisting client in accessing recommended treatment

• Allows social worker to focus on assessing child safety and helps facilitate better assessment related to substance use related concern

• Added benefit of having two people responding to what can be volatile situations – more eyes seeing the same thing

Regional Partnership Program

• Started in Burlington

• FSD and ADAP expanded to St. Albans in 2013

• Expansion to Rutland, Springfield, Hartford and Barre in 2014

• Expansion to all districts in 2016

• Screener / Case Manager are currently in place in 10 of the 12 districts – Still interviewing in St. Johnsbury and Brattleboro

Regional Partnership Program Outcomes Very promising outcomes!! In fiscal year 2016 RPP served 835 clients across 6 sites.

Our Continued Collaboration

• Focus on relationship and trust building from the top down – many of the barriers to strong collaboration are related to lack of understanding

• Create opportunities for staff across the fields to come together and create working agreements around communication and information sharing

• Continued partnership around the Regional Partnership Program expansion

Our Continued Collaboration – Recommendations from Region I Women & Opioids Symposium

• Enhance women’s specific SUD treatment services

• Disseminate evidence-based practices through Hubs, and through allocating additional SAPT Block Grant funds

• Develop an awareness campaign “parents in recovery are good parents” (Connecticut example)

Our Continued Collaboration – AHS’ Substance Abuse Treatment Coordination Workgroup

• AHS Policy requires screening of all services program clients

• Staff are being trained on Addiction 101 and to implement screening (SBIRT)

• Working by District, local teams are developing screening & referral protocols to improve coordination and support for clients with substance use disorder needs

Change in Hub and Spoke Census Over Time

Pre Hub/Spoke - 2350 • OTP numbers served (4/2012): 650 (source: SATIS)

• OBOT Medicaid served (4/2012): 1700 (Source: Medicaid Claims)

Post Hub/Spoke – 5651 (140% increase) • Current OTP served (10/16): 3116 (Source: Hub Census Report)

• Current OBOT Medicaid Served (9/16): 2535 (Source: Blueprint Spoke Report)

Note: In 2015, over 5000 individuals received at least one prescription for an anti-addiction drugs dispensed by pharmacies, the overwhelming majority of which were for buprenorphine products. Source: VPMS

Vermont Department of Health

The statewide number of people waiting for opioid use disorder treatment in hubs has trended downward over time; the number of people served in hubs has increased

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In Treatment 1751 1891 1960 2152 2286 2407 2499 2493 2507 2520 2517 2542 2573 2663 2706 2656 2709 2785 2762 2804 2834 2820 2812 2851 2906 2885 2910 3005 3169 3171 3104 3103 3179 3116

Waiting 513 595 608 384 384 409 431 485 521 516 523 496 389 479 547 615 570 518 419 427 480 462 468 429 343 396 481 375 379 364 313 299 269 218

Number of People in Hubs and Waiting for Hub Services Over Time

In Treatment Waiting

Vermont Department of Health Source: Alcohol and Drug Abuse Treatment Programs

Hub Census and Waitlist: October 25, 2016

VT Department of Health Department of VT Health Access

Region # Clients #

Buprenorphine #

Methadone # Vivitrol

# Receiving Treatment but Not Yet

Dosed

# Waiting

Chittenden, Franklin, Grand Isle & Addison

924 269 645 2 8 189

Washington, Lamoille, Orange 471 210 261 0 0 0

Windsor, Windham 594 171 423 0 0 0

Rutland, Bennington 398 107 271 2 18 16

Essex, Orleans, Caledonia 729 185 539 5 0 13

Total 3116 942 2139 9 26 218

Vermont Department of Health Source: Alcohol and Drug Abuse Treatment Programs

Spoke Implementation: September 30, 2016 VT Department of Health Department of VT Health Access

Vermont Department of Health Source: DVHA/Blueprint for Health

Region Total # MD prescribing

pts

# MD prescribing to ≥ 10 pts

Staff FTE

Hired Medicaid

Beneficiaries

Bennington 11 5 5.6 236

St. Albans 15 11 6.6 390

Rutland 12 6 4.05 223

Chittenden 71 15 14.1 553

Brattleboro 10 5 2.57 138

Springfield 4 1 1.5 55

Windsor 9 3 3 197

Randolph 6 5 1.7 130

Barre 21 7 5.5 268

Lamoille 10 4 2.6 145

Newport & St Johnsbury 11 2 2 90

Addison 5 2 2 77

Upper Valley 5 1 1.5 34

Total 187* 64* 52.72 2,535

Table Notes: Beneficiary count based on pharmacy claims July – September, 2016; an additional 174 Medicaid beneficiaries are served by 31 out-of- state providers. Staff hired based on Blueprint portal report 9/30/16. *3 providers prescribe in more than one region.