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.
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.