Community Health Improvement
Our Community Health Improvement team partners with clinic and community partners to improve conditions that significantly affect the health and well-being of people in the communities served by Dartmouth-Hitchcock.
Addressing New England public health crisis: facilitating Dartmouth-Hitchcock's approach to substance use and behavioral health
In recent years, Community Health Needs Assessments in communities served by Dartmouth-Hitchcock have overwhelmingly pointed toward the need to better address the needs of people struggling with mental health and substance use disorders. Dartmouth-Hitchcock defined this as our highest priority for Population Health, and has launched a multi-strategy Substance Use and Mental Health Initiative (SUMHI) in our clinics and with our communities to help address this need. Our strategies include:
Recovery coaching in the DHMC Emergency Department
In 2017, we began offering Recovery Coach services to Emergency Department patients seeking substance use care. Recovery Coaches provide follow-up support to help patients enter treatment and recovery programs. Fifty-two patients received Recovery Coaching during a six-month pilot in 2017, and we have recently re-started this service in May 2018.
Improved care coordination for patients with behavioral health needs
We are helping Dartmouth-Hitchcock clinics across NH participate in NH’s Integrated Delivery Networks. This state initiative is driving integration of primary and behavioral health care by fostering new partnerships between health care, community mental health, and community organizations. Dartmouth-Hitchcock co-leads this work in western NH with Cheshire Medical Center, and participates in project teams in our southern NH clinics. These projects are in the planning stages, with services due to start in FY 2019.
Medication assisted treatment for patients with opioid use disorder
Dr. Charlie Brackett is leading efforts for our primary care clinics to offer evidence-based Medication Assisted Treatment for patients who have opioid use disorders. Dr. Brackett is also working with Hospital and Emergency Department teams to explore ways to help patients with Opioid Use Disorders start these treatments at Dartmouth-Hitchcock and then enter community treatment programs at discharge.
We are developing a standard, evidence-based collaborative care model, integrating primary and behavioral health care. Since the September 2017 start of our Nashua pilot, 3,198 patients participated in routine behavioral health screenings, about 700 received follow-up questions resulting from the screenings, and we are helping 38 patients manage behavioral health needs as part of their primary care. This project will expand to other clinics across the Dartmouth-Hitchcock system in 2018.
Safe medication and syringe disposal
We provide support for regional unused medication take-back and syringe disposal efforts. In 2017, these efforts resulted in collection of 2,131 lbs. of medications and 125 lbs. of used syringes.
Supporting substance use prevention
Our Community Health Improvement team hosts the Upper Valley’s “All Together “ substance use prevention partnership, convening schools, police, health care, counseling, recreation, and other partners to design and implement policies, practices, and programs to prevent and reduce harm from substance use. We also provide funding for similar coalitions in Nashua, Manchester, Concord, Keene, Windsor, and Bennington in a novel partnership with the NH Charitable Foundation.
We are partnering with National Alliance on Mental Illness (NAMI)-NH and West Central Behavioral Health to offer evidence-based CONNECT Suicide Prevention trainings and Mental Health First Aid training to teens, parents, teachers, and other community members, and have helped NAMI-NH refine CONNECT to be peer-delivered among 18-25 year olds. To date, we trained 33 community members in CONNECT and 24 community members in Mental Health First Aid.
Routine adolescent behavioral health screening
Our Population Health Team has helped facilitate the integration of DartScreen, a comprehensive screening for teen substance use, depression, anxiety, and other behavioral needs, into adolescent well visits in Lebanon, Concord, Manchester, and Bedford. This year 5,701 teens have completed DartScreen. Pediatricians indicate that DartScreen results help them better engage and focus health conversations with teens and has helped identify teens in need of services whose needs would not otherwise have been known
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