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Integrating Evidence-Based Care and Community-Based Solutions in Portland

Tuesday, April 3, 2018   (0 Comments)
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Lynn Gerlach, Tamarack Communication

- an interview with Andy Mendenhall, M.D. and Leslie Tallyn, M.A.

 

When Dr. Andy Mendenhall took on the job of Senior Medical Director – Substance Use Disorder Services at Central City Concern (CCC), he was coming home, in a way. A graduate of the University of Portland, he had completed medical school at OHSU and had done his residency as a Family Physician at Family Medicine at Richmond. Early in his medical training, he had rotated at Hooper Detoxification Center with Dr. Jim Thayer M.D. and had been struck by the rawness of the medical needs of homeless patients suffering from substance use disorders.

 

Andy has returned home with nearly 15 years’ experience in treating patients with substance use disorders. And he says he’s glad he’s returned to Portland and joined this “model” addiction treatment program. “Over much of the past 14 years, I’ve had the opportunity to treat people with significant financial means,” says Andy, referring to his nine years with the Hazelden Betty Ford Treatment Centers. A brief 18 months in New England with CleanSlate Addiction Treatment Centers in Massachusetts was formative in terms of clinical operations, but Portland, and the unique opportunity to serve Central City Concern, called Dr. Mendenhall home.

 

CCC provides a comprehensive continuum of affordable housing options integrated with direct social services including healthcare, recovery and employment, serving Portland’s most vulnerable populations. A big part of that comprehensive care involves substance use disorder recovery, and some of that care is specific to evidence-based practices for opioid and alcohol use disorders.

 

At CCC, however, the first clinical question is not, “What are you addicted to?” but “How can we help you, as an individual?” Andy explains, “We offer evidence-based treatment options. We’ve added some tools to the toolbox. Over the past few years, the CCC team has integrated medication-assisted treatment into our clinical continuum. It is important to acknowledge that the use of medication to support recovery is consistent with an abstinence-based approach. Our mission at CCC is to help more people achieve success in their recovery. The clinical evidence has been present for many years. I am proud that the treatment culture of this organization leads the region in integrating best-practices for treating patients with substance use disorders.”

 

Leslie Tallyn, M.A., Chief Clinical Operations Officer, came to CCC eight years ago with a QI background, including work in child welfare and a stint at Kaiser Permanente. She came to help launch CCC’s Quality Management program. Leslie agrees with Andy’s assessment: “The CCC philosophy is holistic services responsive to the individual patient’s needs and preferences, depending on where that person is on the recovery journey. Comprehensive care is a guiding principle, and we continually work to grow our capacity to serve our community.”

 

As Portland has grown and changed, so has CCC. The organization was founded in the 1970s in response to a crisis of homelessness and substance use in Portland’s Old Town-Chinatown neighborhood, and has evolved over the years to provide integrated housing, primary care, employment services, mental health care, and substance use disorder treatment. Almost half of employees are in recovery themselves, and a quarter have experienced CCC’s programs firsthand. Recovery is deeply woven into the organization’s culture.

 

“Our recovery culture supports patients who recognize that medication taken as medication to support recovery is consistent with an abstinence-based approach. It offers patients with both opioid use and alcohol use disorders vastly different success rates compared to patients who choose a different pathway. Medication, however, will never work a person’s recovery program,” Andy explains. CCC, he says, prefers the term medication-supported recovery to medication-assisted treatment, reflecting the role of medication as one part of the overall recovery journey.

 

“Like diabetes,” he continues, “addiction is a chronic disease. All patients with diabetes are encouraged to exercise, lose weight and manage their diets, and that’s absolutely the right approach. For a patient with a substance use disorder, this means changing people, places and things, going to recovery support meetings and practicing the day-to-day act of abstinence from alcohol and other substances. This is the ‘diet and exercise’ part of addiction self-management. What we must realize is that the brain changes present in opioid use and alcohol use disorder lead to very high levels of relapse - exceeding 50%, month over month, for people enrolled in treatment but not receiving medication support. Medication support for some patients with substance use disorders is like oral medication or insulin for people with diabetes.”

 

“We’ve found, though,” he said, “that a broader range of solutions can support that ‘diet and exercise’ approach.” CCC strives to keep patients in treatment as long as it is necessary, giving them a better chance of remaining abstinent. Ultimately, Andy explains, this makes them less likely to contract and transmit Hepatitis C and HIV, less likely to land in the hospital or jail, and less likely to consume community resources. “Simply put,” he said, “we help our patients become healthier people, and that leads to healthier communities.”

 

That integrated approach leads to impressive outcomes. More than 70% of patients who are receiving substance use disorder treatment while living in CCC’s recovery housing leave the program sober, while nearly 50% leave employed—often for the first time in many years. “At CCC, we focus on homes, health, and jobs to support the people we serve in making lasting change in their lives,” Leslie explained. “Comprehensive health care, including substance use disorder treatment, is essential, but only so much is going to happen in the exam room or in the therapy group. Safe housing, economic stability, and meaningful relationships—these are the things that, when coupled with the right treatment options, lead to good long-term outcomes.”

 

In early December 2017, CCC began offering evidence-based medical treatment for opioid disorders in pregnant women. “Only two other Oregon healthcare facilities offer this treatment for this patient population,” Andy said. CCC has been offering housing for pregnant women in its 29-bed Letty Owings Center since 1989, providing a safe place for expectant mothers in particular to deliver their babies and learn the essentials of mothering and family management while recovering from substance use disorders. The mothers’ toddlers are also welcomed, the average stay being nine months. Andy explains, “We reviewed our discharge data and discovered that we have treated very few patients with pregnancy and opioid use disorders within our continuum. It is exciting to provide access to evidence-based treatment for this most vulnerable population.”

 

In 2003, the organization became an FQHC; today it cares for 8,300 patients each year and receives a $2.2m federal grant from HRSA. Now CCC is able to welcome those addicted to opioids to a safe temporary home with an experienced recovery mentor and a full range of evidence-based treatment, including medication-assisted treatment.

 

Both Andy and Leslie agree that CCC is proud to offer patients with opioid use disorders a diversity of evidence-based treatment options to support their successful recovery.

 

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