SSM Health partnership encourages patients considering treatment for opioid dependence
By ELLEN FUTTERMAN
Alexa Case says life is good now. The 31-year-old single mother of two young sons, who lives in Madison, Wis., underwent residential treatment in her mid-twenties for alcohol substance use disorder and an eating disorder. This included a 90-day stint at a treatment center in Costa Mesa, Calif., soon after she gave birth to her first child.
Today, Case is a peer recovery coach working with opioid-dependent pregnant women in a pilot program called Pregnancy2Recovery. The program is a partnership between SSM Health St. Mary's Hospital in Madison, SSM Health Dean Medical Group and Safe Communities of Madison and Dane County, Wis. SSM Health says the Pregnancy2Recovery peer coaching program is the first program of its kind in the country. The program is administered by Safe Communities, a nonprofit that counts drug poisoning prevention among its main priorities.
Alexa Case with one of her two young sons. As a peer recovery coach in Pregnancy2Recovery, a pilot program in Madison, Wis., she provides empathetic support for pregnant women and new mothers in treatment for opioid dependence.
According to the Centers for Disease Control and Prevention, opioid use during pregnancy carries potential risks including birth defects, stillbirths, preterm deliveries and neonatal opioid withdrawal symptoms. But abruptly stopping the use of opioids may be harmful for a pregnant mother and the unborn child as well.
The goal of the Pregnancy2Recovery pilot is to get women into regular prenatal care with SSM Health providers and get them enrolled in medication-assisted treatment programs, which are run by community-based providers outside of the SSM Health system.
Considered the most effective treatment for opioid dependence disorder, medication-assisted treatment programs combine behavioral therapy and medication such as methadone or buprenorphine to reduce opioid cravings. According to The Pew Charitable Trusts, studies show that women with opioid dependence disorder who complete treatment have a lower risk of relapse.
Tanya Kraege, recovery coach supervisor at Safe Communities, said that pregnant women who are using opioids illegally feel a heightened sense of shame, embarrassment, guilt and stigma.
The peer coaches "know exactly how these women feel, and can be instrumental in understanding and helping them to forgive themselves and get treatment," she said.
Pregnancy2Recovery coaches provide support during pregnancy and for three months after a birth, a time when the risk of relapse may be higher. They work to ensure that counselors in the drug-assisted therapy programs communicate with a woman's obstetrician over the course of the pregnancy.
"The work I am doing as a recovery coach helps me in my own recovery as well," said Case. "As a coach, I check in with my person every day, with a text or a phone call to see how she is doing. My main goal is to remove the barriers that might make her recovery more difficult. That could be helping her with housing, getting her to an OB appointment, or simply meeting her to go for a walk. As coaches, we are there for them no matter what, without judgment."
Skye Tikkanen is the drug poisoning prevention program manager at Safe Communities and she oversees the peer recovery coach program. She explained that the Pregnancy2Recovery component is an offshoot of Safe Communities' ED2Recovery. The latter program got its start sending peer recovery coaches to St. Mary's emergency room to meet with willing patients who had just survived an opioid overdose. Since its November 2016 launch at St. Mary's, ED2Recovery has expanded to the SSM Health Emergency Center in suburban Madison, four other hospitals in Dane County, and several other hospitals throughout the state of Wisconsin, including SSM Health St. Mary's Hospital – Janesville.
Tikkanen said all of the coaches in both programs have at least two years in recovery, and have been trained as coaches through a national accreditation program. "They are able to meet patients 'where they're at,' and help them," she said.
Since the ED2Recovery program's inception through early this year, more than 50 patients have been paired with one of six peer recovery coaches and roughly 90 percent of these patients have started treatment, according to Tikkanen.
Case is one of two peer recovery coaches in the Pregnancy2Recovery program, which started in August 2017. SSM Health providers began referring patients to the program in February. In its first three months, four patients were matched to peer counselors. These matches happen in a few ways. An obstetrician may arrange to have a Pregnancy2Recovery peer coach meet with a patient during a prenatal visit. A patient interested in recovery, might be given the contact information for the peer coach. The coaches may be called in to meet with a patient at a participating hospital's clinic or emergency room. They can guide a woman's search for a slot in a medication-assisted treatment program.
Dr. Kyle Martin, medical staff director for emergency services and physician sponsor of the ED2Recovery program at St. Mary's, said it has exceeded his expectations.
"This program — it does not require any fancy, expensive equipment or high-level training. It's just simply putting the right person in the ER to talk to the patient at the right time.
"In emergency, we can be seeing 10 to 12 patients at a time. If someone would sit with the patient who overdosed and explain the disease and take the time and energy to help them, they might have a better shot with getting help. But, because the ER is such a busy place, it's very rare we would have the time to do that. We weren't connecting properly," he said.
The peer recovery coaches fill that gap and they have the credibility of having been in the patient's place.
Toe to toe
"It's one thing for me to go in and say don't use drugs and lecture to (a patient) from a position of not really understanding truly where they are at," said Martin.
"Our (ED2Recovery) counselors are recovered addicts and they can anticipate a lot of the comments and questions from patients." The peer counselors "can speak truly from the heart of knowing this is where I was, this happened to me, and that is just invaluable," Martin said. It's totally different than hearing information about treatment options from a social worker or a nurse, he added.
"Because this is an ongoing relationship that moves beyond the ER, with recovery coaches continuing to call (patients) and follow up and make sure they are getting into programs, that's another huge part of why it's so successful," he said.
Since going statewide, the ED2Recovery program receives $75,000 a year from Wisconsin Voices for Recovery, which is an agency supported by the Wisconsin Department of Health Services. Pregnancy2Recovery has $109,000 of funding through 2018 from the Centers for Disease Control.
Healing and respect
Tikkanen said she never expected the overwhelmingly positive feedback she has gotten from the recovery coaches.
"They feel so respected by the doctors, nursing staff and law enforcement, and that's been really healing for them," she said. "Giving back to people and helping them to find recovery has also strengthened the recovery of the recovery coaches."
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