HSHS Illinois hospitals offer 'warm handoff' to treatment for substance dependence

October 1, 2022


Hospital Sisters Health System this year expanded to all of its nine hospitals in Illinois a federally funded and state-administered program to ease the path to treatment and potential recovery for patients who show signs of substance use disorder. The program supports "warm handoffs," meaning a patient may go straight from a hospital to an outpatient or inpatient addiction treatment program.


Kimberly Luz, director of community outreach for HSHS Illinois, said the program got a trial run at HSHS St. Elizabeth's Hospital in O'Fallon, Illinois, in 2019 but that effort was stalled by COVID-19. She said the revival and expansion of the program was prompted by a spike in the number of patients who were presenting with serious substance use disorders since the start of the pandemic.

"We just kind of looked at the numbers to see if this is something that we felt would benefit our communities and found overwhelmingly that, yes, there's an increase of substance use," Luz said.

Health care providers across the nation are trying to counter a rise in dangerous drug abuse and overdose deaths, particularly involving opioids. The National Institute on Drug Abuse reports that researchers "have observed increases in substance use and drug overdoses in the United States since the COVID-19 pandemic was declared a national emergency in March 2020."

The Centers for Disease Control and Prevention said in May that provisional data indicates 107,622 deaths in the United States last year were from drug overdoses, a jump of 52% from 70,630 in 2019. Of the 2021 total, 80,816 overdose deaths were linked to opioids. The Illinois Department of Public Health said fatal overdoses in that state climbed to 3,717 in 2021, up 33% from two years before. Of last year's total, 3,013 deaths involved opioids.

Chasing a high
Luz recalled talking to a county sheriff who told her that, until recent years, individuals who misused substances had their personal go-to preference among drugs. Nowadays, the sheriff said, users who are chasing a high are willing to go with whatever drug is available.

Luz said that seems to match what HSHS providers have noticed, especially amid the spread of cheap synthetic opioids which are being added to street drugs to increase intoxication. "We're seeing that if someone is using meth or cocaine or even marijuana, more and more, it's being laced with fentanyl and with other synthetic opioids, because then it guarantees a customer is going to (become) addicted and come back more and more," she noted.

The program HSHS is using to rapidly connect patients to drug treatment is overseen by the Illinois Department of Human Services. It is funded through grants from the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services.

HSHS' program is a partnership with the Gateway Foundation, a nonprofit provider of substance use disorder treatment across the country that has its largest presence in Illinois. Gateway staffs a warm handoff program at 26 hospitals across the state. Other Catholic ministries that Gateway works with include Saint Anthony Hospital and the three hospitals within the Loyola Medicine system, which is part of Trinity Health; all four hospitals are in Chicago or its suburbs.

Gateway is one of five agencies that contract with the state to facilitate warm handoffs to recovery services. The Illinois Department of Human Services said service delivery by those agencies "must be consistent with the evidence-based Screening, Brief Intervention, and Referral to Treatment, or SBIRT, model that has been the focus of multiple Substance Abuse and Mental Health Services Administration-funded cooperative agreements and discretionary grants." Under that model:

  • Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment.
  • Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.
  • Referral to treatment provides those identified as needing more extensive treatment with access to specialty care.

Luz said HSHS likes the team approach that Gateway uses in its program. Any time a patient who is getting care in an emergency department or who is admitted to one of the HSHS hospitals presents with a substance use disorder, HSHS workers notify a Gateway "engagement specialist" assigned to the hospital. That specialist is either a certified addiction treatment counselor or a licensed clinical social worker. Once the patient is medically stable, the counselor meets with the patient for an intake screening and assessment. The screening and assessment can occur virtually, if necessary.

Assessment, hand-holding
Teresa Garate, Gateway's senior vice president of strategic partnerships, explained that the counselors use motivational interviewing techniques to help patients acknowledge their substance use disorder and the counselors encourage them to enter treatment for addiction.

Once a patient agrees to treatment, the counselor makes a referral to a recovery program based on services and programs covered by the patient's insurance and the availability of immediate slots for patients. The referral could be to one of the 17 inpatient or outpatient programs run by Gateway in Illinois or to a program run by other providers. Garate said the counselors work with uninsured patients to see if they qualify to enroll in Medicaid.

Gateway also pairs patients with another staff member called a recovery coach. These are people who are in long-term recovery from substance use disorders. "That person is going to do the hand-holding and get the person from the hospital to their treatment facility," Garate said.

The recovery coach's support can include helping a patient entering a recovery program secure safe, reliable child care and/or transportation. The coach encourages the patient and connects the recovering person to community programs that can assist with job placement, housing and other social supports.

The recovery coaches are especially good at helping patients overcome the shame that sometimes surrounds seeking out mental health or substance use disorder care, Garate said. "They talk about, 'I had this disease and it's a chronic disease, and now I'm living long-term recovery,' and that there should be no stigma around this issue," she said.

Cautious optimism
While the warm handoff program initially focused on patients whose disorders involve opioids, now any patient diagnosed with substance use disorder is offered assistance. Luz noted, for example, that just as for opioids, studies suggest that the use of alcohol and methamphetamines took a jump during the pandemic and that increase has been noticeable among HSHS patients.

Though the warm handoff collaboration between HSHS and Gateway currently is just for patients who seek care at an emergency department or are admitted to a hospital, Luz said HSHS is open to eventually having the counselors meet with patients with substance use disorders who are identified at primary care physicians' offices.

In the fiscal year that ended July 1, interventions were offered to 120 patients at the hospitals and about 40% agreed to a direct handoff to a recovery program. "That's much higher than if we hand someone some information or give them a phone number to call on their own," Luz said. "We are very pleased with the results that we're seeing and with the expansion."

Since Illinois began the warm handoff program in 2017 and through the end of March, the state said 8,150 persons were provided outreach services and 5,503 of them screened positive for opioid and other illegal substance use and expressed an interest in treatment; 3,253 of these patients completed a meeting with a counselor; and 2,572 showed up for the treatment intake.

Luz said HSHS hopes to persuade more patients with substance use disorders to enter recovery programs. "It's discouraging sometimes to see the number of refusals" for the treatment, she said. "Those are the people that you hope the next time they come in, it's not one of those fatal overdoses, but maybe they'll be more ready."

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