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Dartmouth-Hitchcock and Cheshire Medical Center Take Part in State’s Addiction Treatment Strategy

Dr. Will Torrey speaking at public forum.

Of all the diseases I’ve worked with as a clinician, there is no other disease that requires such a different approach to treatment as what we call behavioral health diseases, which includes mental health as well as substance use disorders.

Sally Kraft, MD, MPH, vice president for Population Health
Will Torrey, MD, vice chair of Clinical Services for D-H Psychiatry speaks at the public forum.

At public forums held across the state recently, public health officials and community partners introduced “The Doorway-NH,” which is the state’s hub-and-spoke model to transform access to addiction treatment in all 10 New Hampshire counties.

The hub-and-spoke model means that organizations are serving as “hubs” to coordinate the programs, and agencies are serving as “spokes” to provide treatment services. Dartmouth-Hitchcock (D-H) and Dartmouth-Hitchcock Health member Cheshire Medical Center are serving as hubs, with the D-H Lebanon site also providing treatment services in addition to evaluation and coordination. This new state model is a comprehensive strategy to ensure patients with opioid use disorders have access to services for clinical screening, evaluation and care coordination in their respective service areas. The Doorway-NH initiative is funded by the federal Substance Abuse and Mental Health Administration (SAMHSA) through a two-year $40 million grant.

Each Doorway organization hosted a public forum, along with representatives from the Department of Health and Human Services, to discuss each regional model and the types of 24/7 services that will be offered for each service area.

The Dartmouth-Hitchcock Medical Center public forum was held on Tuesday, January 8. Forum speakers included:

  • Sally Kraft, MD, MPH, vice president for Population Health at D-H, who discussed the various regional programs D-H has been involved with to address substance use disorders.
  • Luke Archibald, MD, director of Addiction Services, Department of Psychiatry, who discussed current services at D-H and future services through the Doorway program.
  • Keri Height, PsyD, director of Hanover Psychiatry, Department of Psychiatry, who gave an overview of the hub-and-spoke program in Vermont.
  • Will Torrey, MD, vice chair of Clinical Services for D-H Psychiatry, who talked about engagement with community partners.
Sally Kraft and Will Torre
Sally Kraft, MD, MPH, right

Below is a summary of their comments.

Sally Kraft: Of all the diseases I’ve worked with as a clinician, there is no other disease that requires such a different approach to treatment as what we call behavioral health diseases, which includes mental health as well as substance use disorders. These diseases impact every aspect of a person’s life—their relationships, their jobs, and even housing and transportation. At D-H, we’re proud of the work we’ve been doing with our colleagues and community partners to look for holistic solutions. I’d like to highlight three of these programs:

  1. The Doorway NH—We have two Doorway programs in our system—one is at D-H and the other is through Cheshire Medical Center. Both are serving as “hubs” to coordinate the programs, and the Lebanon program also serves as a “spoke” in that it provides ongoing treatment services.
  2. NH Regional Public Health Networks—are a part of 13 public health networks to address substance use disorders. D-H supports the Upper Valley and Greater Sullivan county networks.
  3. NH Medicaid Delivery System Reform Incentive Program—This is a federally funded program to create integrated delivery networks to support substance use disorders and mental health, serving largely a Medicaid population.

Will Torrey: We are honored to be asked by the state to be a “hub” in this program, which gives us an opportunity to engage more deeply with our community partners in this work so that we are all pulling together. We can go further together than if we were on our own. This program gives us an opportunity to learn from each, gather data and implement real solutions. It also gives us an opportunity to be a leader for our region and for the nation as we address this challenge.

Luke Archibald: Through the Addiction Treatment Program, we offer the following current services:

  • Clinical evaluation
  • Individual and group psychotherapy
  • Intensive outpatient program
  • Medications for addiction treatment (including Suboxone)
  • Moms in Recovery program
  • Overdose prevention (Naloxone distribution)

Through the Doorway program, what will change is our ability to enhance our relationships with community partners to increase access and offer the right level of care and provide more choices for patients. Here are the services we will be able to provide:

  • In-person evaluation, stabilization, treatment referral and case management services in one location Monday – Friday, 8 am to 5 pm.
  • Telephone services to receive calls and assess an individual’s need for Hub services by calling 2-1-1, which is an already-established community resource hotline.
  • Crisis intervention and stabilization for individuals in an acute opioid use disorder related crisis, which requires immediate, non-emergency intervention provided by a licensed clinician.
  • Clinical evaluation and development of a clinical service plan with a client based on the evaluation.
  • Facilitated referrals to substance use disorder treatment, recovery support, and other health and social services, as well as case management.
  • Data collection and reporting Naloxone purchase, distribution, information and training.

Keri Height: We can learn a lot from the Vermont program, which has similarities to what we are trying to achieve with The Doorway-NH program in that it is a regional hub and spoke model that spreads geographically for better access. The Vermont hubs offer training and consulting and have been able to eliminate wait lists for people trying to get into treatment. Highlights of the Vermont program’s progress include:

  • Increased employment
  • Decreased opioid abuse, including abuse of medications for addiction treatment
  • Decreased injected drug use
  • Decreased depression and anxiety
  • Improved levels of recovery capital
  • Increased engagement in mental health outpatient therapy
  • Dramatic increase in medications for addiction treatment utilization

Continued challenges include:

  • Unstable housing
  • THC (tetrahydrocannabinol) use (THC is the main ingredient in cannabis)
  • Tobacco use
  • Cocaine use

Will Torrey: The ultimate goal with The Doorway-NH is to help patients get coordinated, seamless care. We are just starting this program, so we don’t have all of the answers just yet, but we want to work with our community partners to reach this goal. Another important principle in this work is providing informed patient choice. We need to set up a system so that people can get the care they want and need in the location that they want to receive that care.

For more information about Doorway-NH, visit their website at thedoorway.nh.gov. For those who need immediate help, call 2-1-1 to connect to resources from specially-trained referral specialists.


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