University Of Colorado Health

ZERO SUICIDE AT SCALE: A COORDINATED APPROACH TO SUICIDE PREVENTION IN HEALTHCARE - UCHEALTH WILL IMPLEMENT ZERO SUICIDE AT SCALE, A SYSTEMWIDE INITIATIVE TO STRENGTHEN SUICIDE PREVENTION ACROSS ITS COLORADO HEALTHCARE NETWORK, SERVING ADULTS AT RISK IN EMERGENCY, PRIMARY CARE, AND BEHAVIORAL HEALTH SETTINGS. REACHING MORE THAN ONE MILLION PATIENTS ANNUALLY, THE PROJECT WILL IMPLEMENT ALL SEVEN ELEMENTS OF THE ZERO SUICIDE FRAMEWORK BY EXPANDING WORKFORCE TRAINING, STANDARDIZING SUICIDE RISK SCREENING, ASSESSMENT, SAFETY PLANNING, CARE TRANSITIONS, AND ELECTRONIC HEALTH RECORD WORKFLOWS. EVIDENCE-BASED PRACTICES INCLUDE QUESTION-PERSUADE-REFER, COUNSELING ON ACCESS TO LETHAL MEANS, AND COLLABORATIVE ASSESSMENT AND MANAGEMENT OF SUICIDALITY. EXPECTED OUTCOMES INCLUDE INCREASED SUICIDE RISK SCREENING, EXPANDED DELIVERY OF EVIDENCE-BASED INTERVENTIONS, STRONGER CARE COORDINATION, ENHANCED DATA-DRIVEN QUALITY IMPROVEMENT, AND A SUSTAINABLE, SYSTEMWIDE APPROACH TO SUICIDE PREVENTION.

BRIDGING HOPE, BUILDING RECOVERY: ADVANCING POST-OVERDOSE CARE AND TREATMENT ENGAGEMENT - UCHEALTH PROPOSES TO EXPAND TIMELY ACCESS TO EVIDENCE-BASED MEDICATIONS FOR OPIOID USE DISORDER (MOUD) BY IMPLEMENTING A COORDINATED, SYSTEMWIDE MODEL THAT IDENTIFIES PATIENTS WITH OPIOID USE DISORDER (OUD) ACROSS EMERGENCY DEPARTMENTS, INPATIENT UNITS, AMBULATORY CLINICS, AND BEHAVIORAL HEALTH SETTINGS, RAPIDLY INITIATES TREATMENT, AND ENSURES SEAMLESS TRANSITIONS TO ONGOING RECOVERY SERVICES. THROUGH STANDARDIZED CLINICAL WORKFLOWS, PEER RECOVERY SUPPORT, CARE COORDINATION, AND STRONG CONNECTIONS TO SPECIALTY ADDICTION TREATMENT, THE PROJECT WILL REDUCE TREATMENT GAPS, IMPROVE ENGAGEMENT, AND STRENGTHEN LONG-TERM RECOVERY OUTCOMES FOR ADULTS WITH OUD ACROSS COLORADO. UCHEALTH IS A LARGE INTEGRATED NONPROFIT HEALTH SYSTEM SERVING URBAN, SUBURBAN, RURAL, AND RESOURCE-LIMITED COMMUNITIES THROUGHOUT COLORADO. THE PROJECT WILL LEVERAGE THE HEALTH SYSTEM’S EXTENSIVE BEHAVIORAL HEALTH INFRASTRUCTURE TO STANDARDIZE EVIDENCE-BASED OUD CARE ACROSS PARTICIPATING FACILITIES. THE CENTER FOR DEPENDENCY, ADDICTION AND REHABILITATION (CEDAR), UCHEALTH’S SPECIALTY ADDICTION TREATMENT PROGRAM, WILL SERVE AS THE SYSTEM’S ADDICTION SUBJECT-MATTER RESOURCE, PROVIDING CLINICAL CONSULTATION, IMPLEMENTATION GUIDANCE, REFERRAL PATHWAYS, AND TREATMENT CONTINUITY FOR PATIENTS REQUIRING SPECIALTY SUBSTANCE USE DISORDER SERVICES, WHILE PATIENTS MAY ALSO BE REFERRED TO OTHER QUALIFIED COMMUNITY PROVIDERS BASED ON PARTICIPANTS WILL INCLUDE ADULTS (18 YEARS AND OLDER) WITH DIAGNOSED OR SUSPECTED OUD, OPIOID MISUSE, OR UNHEALTHY SUBSTANCE USE WHO PRESENT WITH ACUTE OR CHRONIC MEDICAL CONDITIONS, INCLUDING OVERDOSE, WITHDRAWAL, INFECTION, INJURY, OR OTHER SUBSTANCE-RELATED COMPLICATIONS. MANY PARTICIPANTS MAY PRESENT WITH CO-OCCURRING MENTAL HEALTH CONDITIONS, POLYSUBSTANCE USE, CHRONIC PAIN, TRANSPORTATION BARRIERS, HOUSING INSTABILITY, OR OTHER SOCIAL DETERMINANTS THAT COMPLICATE TREATMENT ENGAGEMENT AND RECOVERY. THE PROJECT WILL IMPLEMENT VALIDATED SCREENING AND ASSESSMENT, RAPID INITIATION OR CONTINUATION OF FDA-APPROVED MOUD, MOTIVATIONAL INTERVIEWING, INDIVIDUALIZED TREATMENT PLANNING, PEER RECOVERY SUPPORT SERVICES, CARE COORDINATION, TRANSPORTATION ASSISTANCE, TELEHEALTH, OVERDOSE PREVENTION EDUCATION AND OPIOID OVERDOSE REVERSAL MEDICATION (OORM) DISTRIBUTION, PRESCRIPTION DRUG MONITORING PROGRAM (PDMP) REVIEW, INFECTIOUS DISEASE SCREENING AND REFERRAL, TOBACCO CESSATION SERVICES, CONTINGENCY MANAGEMENT CONSISTENT WITH SAMHSA GUIDANCE, AND WARM HANDOFFS TO CEDAR, OPIOID TREATMENT PROGRAMS, AND OTHER COMMUNITY PROVIDERS. CLINICAL WORKFLOWS WILL BE INTEGRATED INTO EPIC AND SUPPORTED BY WORKFORCE TRAINING, STANDARDIZED PROTOCOLS, CONTINUOUS QUALITY IMPROVEMENT, AND PERFORMANCE MONITORING THROUGH SAMHSA’S PERFORMANCE ACCOUNTABILITY AND REPORTING SYSTEM (SPARS). THE GOALS OF THE PROJECT ARE TO INCREASE IDENTIFICATION OF INDIVIDUALS WITH OUD, EXPAND ACCESS TO EVIDENCE-BASED MOUD, IMPROVE TREATMENT INITIATION AND RETENTION, STRENGTHEN TRANSITIONS OF CARE FOLLOWING HOSPITALIZATION, REDUCE OVERDOSE RISK, AND ENHANCE UCHEALTH’S LONG-TERM CAPACITY TO DELIVER INTEGRATED, RECOVERY-ORIENTED OUD TREATMENT. MEASURABLE OBJECTIVES INCLUDE IMPLEMENTING STANDARDIZED SCREENING AND TREATMENT PATHWAYS ACROSS PARTICIPATING SITES, SERVING 1,000 UNDUPLICATED PARTICIPANTS ANNUALLY, INCREASING INITIATION OR CONTINUATION OF MOUD AMONG ELIGIBLE PATIENTS, EXPANDING PEER RECOVERY ENGAGEMENT AND CARE COORDINATION, IMPROVING SUCCESSFUL LINKAGE TO ONGOING TREATMENT FOLLOWING DISCHARGE, STRENGTHENING WORKFORCE CAPACITY THROUGH EVIDENCE-BASED TRAINING, AND USING PERFORMANCE DATA TO DRIVE CONTINUOUS QUALITY IMPROVEMENT AND PROGRAM SUSTAINABILITY.

IMPLEMENTATION OF SERVICES AND MENTAL HEALTH CARE CONNECTION IN THE MENTAL HEALTH COMPONENT OF OUR HOSPITAL-BASED VIOLENCE INTERVENTION PROGRAM (HVIP), AT-RISK INTERVENTION AND MENTORING - PROJECT NAME: IMPLEMENTATION OF MENTAL HEALTH SERVICES IN OUR HOSPITAL-BASED VIOLENCE INTERVENTION PROGRAM SCOPE: THIS PROJECT CONTINUES OUR HOSPITAL-BASED VIOLENCE INTERVENTION PROGRAM (HVIP), CALLED THE AT-RISK INTERVENTION AND MENTORING PROGRAM (AIM), BUT FOCUSES ON THE GAP OF ASSESSING FOR MENTAL HEALTH ISSUES, AND PROVIDING MENTAL HEALTH SERVICES IN A RESPONSIBLE, CULTURALLY APPROPRIATE WAY TO REDUCE VIOLENCE RECIDIVISM AND ASSIST PATIENTS IN EXITING A CYCLE OF VIOLENCE. POPULATION: WE PRIMARILY SERVE THE 6TH CONGRESSIONAL DISTRICT OF COLORADO. AS A LEVEL 1 TRAUMA CENTER WE SERVE ALL PATIENTS AGED 14 AND OLDER WHO PRESENT TO OUR HOSPITAL. OUR POPULATION OF FOCUS IS VIOLENTLY INJURED PATIENTS, AND THESE PATIENTS ARE 85% MALE, 90% BEING NON-WHITE. INTERVENTION: OUTREACH WORKERS ARE HIRED THROUGH THE GANG RESISTANCE AND SUPPORT PROGRAM (GRASP) AND ARE CONTRACTED EMPLOYEES AT THE UNIVERSITY OF COLORADO HOSPITAL. WHILE THEY WORK FOR GRASP, THEIR PRIMARY RESPONSIBILITY IS TO THE HOSPITAL-BASED PROGRAM. THIS PROPOSAL REQUESTS FOUR OUTREACH WORKER DUE TO THE ENGAGEMENT RATE WE HAVE HAD. THE OUTREACH WORKERS CAPITALIZE ON THE TEACHABLE MOMENT BY RESPONDING TO BEDSIDE WHEN A PATIENT IS ADMITTED WITH AN INTENTIONAL TRAUMATIC INJURY (GUNSHOT WOUND, STABBING, ASSAULT). AT THIS MOMENT, PATIENTS NEED TRAUMA-INFORMED ADVOCATES TO HELP THEM NAVIGATE THEIR HOSPITAL STAY AND ARE MORE OPEN TO SEEKING HELP IN AVOIDING RISKY LIFE CHOICES AND CHANGING THE TRAJECTORY OF THEIR FUTURE. DURING A BEDSIDE VISIT, OUTREACH WORKERS CONNECT WITH THE PATIENT AND HELP THEM PROCESS THEIR TRAUMATIC EVENT. OUTREACH WORKERS IDENTIFY ANY CONCERN FOR RETALIATORY VIOLENCE AND WORK TO DE-ESCALATE THE PATIENT WHILE ALSO PROVIDING SUPPORT. THE OUTREACH WORKERS PARTNER WITH THE HOSPITAL SOCIAL WORKER AND CASE MANAGER TO HELP GUIDE PATIENTS THROUGH MENTAL HEALTH CARE AND RISK REDUCTION RESOURCES OFFERED THROUGH THE HOSPITAL, CITY AND COMMUNITY, AND MAY FOLLOW THE PATIENT FOR UP TO 18 MONTHS. GOAL 1. ASSESS THE IMPLEMENTATION OF MENTAL HEALTH ASSESSMENT AND SERVICES IN OUR HVIP - OBJECTIVE 1: IDENTIFY BARRIERS AND FACILITATORS TO IMPLEMENTATION OF ASSESSMENT MEASURE (START TOOL) THOUGH INTERVIEWS WITH OUTREACH WORKERS AND SOCIAL WORKER. (QUALITATIVE) - OBJECTIVE 2: EVALUATE RATE OF MENTAL HEALTH DIAGNOSIS AND SERVICE CONNECTION IN THE COMMUNITY FOLLOWING DISCHARGE, INCLUDING RATE OF APPOINTMENT ATTENDANCE WITH THE THERAPISTS OF COLOR COLLABORATIVE. (QUANTITATIVE) - OBJECTIVE 3: INCREASED HEALTH SERVICES CONNECTION AND UPTAKE OF INSURANCE COVERAGE FOR HOSPITAL GOAL 2. ASSESS THE EFFECTS OF MENTAL HEALTH NAVIGATION/SERVICE CONNECTION ON MULTIPLE OUTCOMES. - OBJECTIVE 1: INTERIM REPORTS WITH EFFECTIVENESS AND COST-UTILITY ANALYSIS AT EACH FISCAL YEAR INTERVAL - OBJECTIVE 2: DECREASED VIOLENT INJURY RECIDIVISM TO THE HOSPITAL - OBJECTIVE 3: SUCCESSFUL TREATMENT OF MENTAL HEALTH CONDITIONS SUCH AS PTSD, DEPRESSION, SUICIDALITY - OBJECTIVE 4: DECREASED RECIDIVISM FOR MENTAL HEALTH ISSUES IN THE EMERGENCY ROOM WE ANTICIPATE ENROLLING AT LEAST 125 CLIENTS THIS YEAR, WITH INCREASE UP TO 200/YR OVER THE LIFE OF THE PROJECT GIVEN CURRENT POPULATION GROWTH. THERE IS NO ANTICIPATED STOP DATE FOR OUR PROGRAM AS WE ANTICIPATE THAT IT WILL CONTINUE TO BE NEEDED FOR SEVERAL YEARS

DOE FUNCTIONAL GENOMICS CONFERENCE GRANT (OCTOBER 10-14, 2007)