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Community SOS: Providing Key Follow-up Support for Substance Abuse

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Erin Booker, LPC
Vice President Community Health and Engagement
Christiana Care Health System

Substance abuse is one of the greatest health risks in America today, fueled in part by the opioid epidemic. The CDC reported a record 70,237 fatal drug overdoses in 2017, reflecting a steady upward trend over the past several years. Just as concerning, the risk of relapse among addicts is 40-60 percent, meaning many of the non-fatal overdose cases in our community hospitals are patients we have seen before.

Community SOS was born from the conviction that we should clearly be doing more to support substance abuse patients after their overdose, to try to prevent relapses and recurrences. 

Community SOS is a unique and powerful partnership between Christiana Care, Connections and New Castle County to provide secondary outreach to overdose patients who refuse substance abuse treatment after leaving the hospital. We have created response teams of specially trained engagement specialists and emergency responders who (with appropriate patient consent) visit with patients at home following an overdose. The team provides education and access to resources to patients and their families to help break the cycle of addiction.

How It Works

At Christiana Care, we already have a nationally recognized program called Project Engage that enables us to reach patients in the hospital who are dealing with substance use issues and connect them to treatment. While they are hospitalized, they often are at a reachable moment-when they are receptive to talking about treatment. But some people who have a drug overdose are never admitted to the hospital.

Community SOS coordinates with paramedics to identify patients who received emergency treatment for a drug overdose, but either were not admitted to the hospital or refused treatment after they were stabilized. Within 72 hours of the ER visit, a Community SOS team consisting of an intake specialist and a person in recovery-a peer counselor-will visit the patient and their family at home and attempt to engage them into a willingness to receive treatment. If the patient agrees, the response team can take them for treatment right then and there. This is one of the most powerful aspects of the program, because it closes a critical gap between verbal consent and follow-through.

If the patient decides to not attend treatment at that time, the team will train the patient and any family members on the use of Narcan, the overdose reversal medication available over-the-counter. They will also leave a dose of Narcan at the home to be used as needed.

At first, Community SOS was limited in scope to overdose patients who came to the emergency department. However, the initiative has been so successful that we have recently expanded it to include other substance use disorders, as well as for patients being seen for other reasons. If the doctor recognizes a substance use disorder but the patient declines treatment, Community SOS now provides a second opportunity to get those patients the treatment they need.

Patients suffering from substance use disorders must often be given multiple opportunities before they receive help. Community SOS serves a vital role in creating these second chances.

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