Families of loved ones treated in our emergency department for overdoses or other substance use problems once begged us to get these patients into treatment programs. All they wanted was to help them get treatment — and stay alive. For years there wasn’t much our emergency medicine team could do. Now there is: We’ve added recovery coaches.

For years we would hand patients or their family members a packet of papers with information and phone numbers for treatment centers and, essentially throwing our arms in the air, urged them to start making calls. If they were lucky enough to have private insurance, their chances of finding a placement were good and maybe they got the help they needed. For those who had Medicaid or no insurance at all —which is the vast majority of these patients — their odds were much slimmer.

I don’t know how those stories ended. I don’t know if our patients got the help they needed, if they had another overdose, or worse. But as my colleagues and I saw this narrative repeating with ever-increasing frequency, we knew there had to be more we could do — as a hospital and as an industry.

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Across the country, emergency departments are treating rising numbers of patients harmed by using alcohol, opioids, methamphetamine, and other substances. Between 2006 and 2014, emergency room visits for alcohol and substance use disorders increased about 75%. Once these individuals have been medically cleared, they are usually discharged with little support or treatment to fight their addictions.

As my colleagues and I explored our options, we became aware of City of Angels, a nonprofit organization with a solution. In its work supporting people struggling with addiction, the organization has a team of volunteer recovery coaches who work with individuals one on one in various settings — the emergency department, drug houses, on the street, and more — and connect them to resources and support for long-term recovery. These coaches, with their own experiences battling drug or alcohol use disorders or helping a loved one through that process, connect with their clients and provide guidance and emotional support by meeting them “where they are at.” They are also expert in navigating the process of securing placement in treatment programs and the barriers that stand in the way.

With the blessing of our hospital’s administration, in early 2017 we invited recovery coaches into the emergency department at Jefferson Washington Township Hospital. When a patient seemed to be a candidate for their help, we asked if they’d like to meet a coach. If the answer was “yes,” we’d call one to come to the hospital. As we started connecting patients and coaches, we saw a transformation.

Patients opened up to recovery coaches in ways they didn’t with doctors or nurses. The coaches advocated for patients and partnered with our medical staff to make sure patients got the care and support they needed. It was incredible to see what they could do. If finding an available treatment program could take a social worker or case manager upward of six hours, a recovery coach could do it in one. The coaches provided hands-on support when needed, like driving patients to detox programs and staying by their side during the intake. They would call, text, or email the patient for weeks or months after discharge to provide ongoing guidance, support, and mentoring.

Although we’re still in the initial stages of tracking long-term outcomes, our early and anecdotal results show that the program is working. In the first year, 73% of eligible patients accepted the services of a recovery coach. In conjunction with the medical team, recovery coaches helped 47% of those individuals connect with inpatient services, 48% connect with partial hospitalization or outpatient services, and 5% prepare for treatment services.

The hospital is now staffed with recovery coaches 24 hours a day, seven days a week. Our patients and our providers are happier. Physicians and nurses feel like they are partners with the coaches, and appreciate knowing that coaches are providing meaningful support that stretches well beyond what they could offer during a brief hospital stay. And as the community has become increasingly aware of the program, and patients began to understand we can connect them with the help they need, some now arrive at the hospital with their bags packed, ready to meet their coach and start treatment.

Every hospital in the country could benefit from a recovery coach program. Although the health care industry is great at treating patients in the “episode of care,” like a trip to the emergency department, it isn’t very good at helping those patients stay well once they are discharged. It’s essential that we change this by adopting programs like recovery coaches.

In New Jersey, where I work, we’re lucky to have funding through the state, via federal grant dollars, to pay our recovery coaches. Several other states — Wisconsin, Massachusetts, Rhode Island, and others — are experimenting with their own models and methods of reimbursement for coaches. I hope the Centers for Medicare and Medicaid Services will realize the benefit of these programs and create a formal reimbursement mechanism to make recovery coaches available in hospitals nationwide.

It’s important for the health care industry to take a more active role in helping patients access the resources they need to get sober, stay out of the hospital, and stay alive.

James Baird, D.O., is the TeamHealth assistant medical director for the emergency department at Jefferson Washington Township Hospital in Turnersville, N.J.

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  • I was trapped in addiction for over four decades, and am substance free for eight years.
    I could not have done it on my own.
    Families who are caught in the wreckage of this disease, also get assistance.
    This is a great idea.

  • I am impressed with the level of compassion and care shown to a patient that suffers from addiction at your facility. Here in Minneapolis, MN, virtually all the nurses and physicians at our array of hospitals are condescending and rude to any patient seen in the ER for addiction issues. I know, I have been that patient.

  • We should be asking why this has not already been implemented, if it works. It was interesting to see how the various industry lobbyists ensured that the ACA would not cover addiction treatment. It is really obvious that our current healthcare system is much too corrupt to do anything meaningful about addiction and other problems.

    An addiction coach would be expensive, and there is a real shortage of qualified people. It is now 22 years out since the begging of the so called opioid crisis, and we have had thousands of ideas marketed in venues like this. Few of these good ideas ever translated into functional policies or improved outcomes.

  • I certainly hope that the Recovery Coaches explain the implications of the proposed changes to the federal substance use disorder confidentiality regulations to those patients in need of substance use disorder treatment. While the emergency room visits are not covered by 42 CFR Part 2, the proposed intent in 42 CFR Section 2.63 would use patient SUD records to investigate and/or prosecute the patient, any SUD treatment program into the patient is admitted, or any professional prescribing controlled substances to the patient who may be scrutinized for drug trafficking. The Recovery coaches should be transparent as to the limits of HIPAA in permitting self-incrimination, as well as harm from disclosures to non law enforcement entities.

    • Exactly and not only that, they relaxed “recovery coaches” to now include people that don’t even have prior alcohol or drug usage background. It was a Very simple answer to it prior to everyone wanting to get in on the $$$ for this “crisis”, all they had to do is call the 800 number for AA or NA in their area and believe me they were supplied with the info. and a person would come and do a free “12 step” call right to the hospital all anonymous and then they don’t have any of their medical records or getting paid for it and it helps the person who goes stay sober and or clean too..and it costs NOTHING. That worked for the people who Wanted help..Now it’s a never ending cycle…treatment (if they make it back, and don’t die) relapse..treatment (with other addicting drugs)..relapse..on and on.

  • I Trevor .A .Merchant .have very little or no confidence at all within any Hospital Institutions as i consider them all to be Death Chambers Or Cells based on ,my experience. knowledge and as a witness there off at one or more within the past five [5] years or so with my Mother . and Brother , wherein my beloved Mother died on a Friday afternoon like this at 2.45 p.m on November , 25, 2016 . Yes this Hospital hastened and contributed with and to my mothers death . Plos .The Library Of Science wrote the article depending on which hospital you go to you are three times more likely to die . to quote .unquote . Plos . i thank you Trevor .Merchant today Friday . August . 30, 2019 at 4.22 p.m . day light savings time . New York City .

  • Back in England prior to 1900 they had females doing this type of work. Later on it became a profession called Social Work. The movement of Jane Addand, Emma Lazarus- yes that Emma Lazarus- see her words on Lady Liberty- Selma Freiburg and so many others both with or without degrees. In Cleveland, Ohio Women’s Hospital had the first female unit for recovery for females created by a medical social worker.
    Emergency Rooms started having Social Service Staff in the early 1980’s. Some hospitals had or have 12 step programs in house and recovery programs in house as well.
    Public medical centers usually have a strong connection to the local area by employees and by memory. After WWII case aids were used by Social Service Departments many from the immigrant communities that they interacted and helped.
    I don’t know about pay scale for recovery coaches. I don’t know their relationship with the Social Service Department.
    What a strong ethical community hospital can provide with a continuous of staff – for degree does not make a helper in the Mr. Roger’s sense. Housekeeping staff is just as important- see Fritz Reidel “ When We Deal with Children.”
    A team approach is best and a holistic approach and outreach to the community itself is needed.
    A Trauma Team with OT’s and PT’s and RD’s and Chaplin’s to help deal with the trauma continuum. For if one looks hard and well- sex abuse and substance abuse related to poverty related to housing, related to education, related to sexism, related to racism,related to recreation, related to hobbies, related to community contacts and connections.
    I would like to have an old timer 12 stepper who has been a sponsor to comment as well. Because coaching ad been part and parcel of Mr Bill and Dr. Bob since they met.

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