By STEPHANIE DONAHUE and JULIE TROCCHIO, MS
The National Institute on Drug Abuse, part of the National Institutes of Health, reports that abuse of tobacco, alcohol and illicit drugs exacts more than $700 billion annually in costs related to crime, lost work productivity and health care.1 The human cost reflected in broken families and lost lives is incalculable.
Given the reach and impact of substance abuse, many Catholic hospitals and their partners have identified it as a significant health care need in their first round of mandated community health needs assessments (CHNAs) and implementation strategies. The Affordable Care Act requires all tax-exempt hospitals to work with public health and community members to conduct a CHNA to identify significant health needs and to develop implementation strategies for addressing those needs. The Catholic Health Association studied a sample of these strategies and found that many specifically cited substance abuse.
Strategies included plans for addressing tobacco use and the misuse of alcohol and prescription drugs, including opioids, and the use of recreational drugs. Many of these strategies targeted specific populations such as youth, pregnant women or homeless persons. Some programs dealt with prevention and education, while others were directed at access to treatment and support. Advocacy and collaborative action were frequently mentioned strategies.
Catholic hospitals are interfacing internal clinical programs, such as smoking cessation classes and counseling programs, with community initiatives. This two-pronged, internal/external approach takes advantage of an organization's clinical excellence, knowledge of its needs and those of the community, and community relationships. Here are just a few examples:
TOBACCO AND SMOKING
Addressing tobacco use is a priority for Presence Saint Joseph Hospital in Elgin, Illinois. The hospital, a member of Presence Health, offers a smoking cessation course based on the American Lung Association's "Freedom from Smoking" program. Through its medical home, St. Joseph Hospital provides referrals for smoking cessation and offers nicotine therapy through the hospital pharmacy at no charge to patients. It promotes the Illinois telephone "tobacco quitline" and is working with the Kane County health department and mental health council to get grant funding for a joint program to address tobacco use.
St. James Mercy Health System in Hornell, New York, which separated from Trinity Health in 2015, also identified tobacco use as a priority. It is focusing on prevention and access to treatment for adolescents. The system offers cessation programs and teen and family counseling.
PeaceHealth St. John Medical Center in Longview, Washington, focuses on tobacco use among pregnant women, offering cessation counseling as part of standard prenatal care. The facility also is working with partners to advocate for policies that would create more smoke-free places in the community. The Centers for Disease Control and Prevention reports that smoke-free laws and policies have a positive impact on cessation and prevention.2
HSHS St. Nicholas Hospital in Sheboygan, Wisconsin, found that 29 percent of the county's adults reported excessive and binge drinking, compared with 25 percent in the state and a national benchmark of 8 percent. The alcohol problem was confirmed by arrest and hospitalization records. In response, the hospital, part of Hospital Sisters of St. Francis, is including alcohol use in its emergency department electronic record system and is educating staff about alcohol and drug use. The hospital is also identifying community resources for individuals with alcohol-related concerns and researching CDC and Substance Abuse and Mental Health Services Administration (SAMHSA) for strategies and messages.
St. Joseph Health Petaluma Valley, in California, is continuing a youth alcohol abuse prevention program. Working with the county health department and other partners, the program focuses on children and adolescents in the county's low-income neighborhoods. The goal of the effort is to decrease the rate of ED visits due to alcohol among this age group by 10 percent. The program includes self-esteem classes and leadership development training in after-school programs, parent mentoring, referrals for families and young people at risk of alcohol abuse, advocacy on marketing practices and other strategies.
Another youth alcohol prevention program is "Parents Who Host, Lose the Most," sponsored by Covenant Health's St. Mary's Regional Medical Center in Lewiston, Maine. With its partners, St. Mary's also offers server/seller training programs for bars and restaurants that apply for local liquor licenses, community education and youth empowerment projects about underage drinking.
The abuse of opioids and other prescription drugs is a growing problem in many communities across the country and appeared in the CHNA list of priorities for many CHA members.
In Oregon City, Oregon, Providence Willamette Falls Medical Center, as part of the Healthy Columbia Willamette Collaborative, prioritized drug-related deaths as a significant health threat. The collaborative identified three strategies to begin to address the issue: 1) Agreement by member organizations on a standard for new and ongoing opioid prescribing policies for chronic, nonterminal pain; 2) implementation by member organizations of opioid-prescribing monitoring practices; 3) development and implementation of provider and patient education about chronic pain and prescription opioids. Providence also is exploring options for nonpharmaceutical treatment of pain and engaging in patient/family education.
CHRISTUS St. Vincent Regional Medical Center, in Santa Fe, New Mexico, as well as many other organizations, is addressing the problem of babies born addicted to opiates because their mothers use the drugs. The facility is coordinating its prenatal, medical and behavioral health care with other service providers and is part of a communitywide partnership on integrated care for opiate-addicted babies.
Most hospitals addressing substance abuse do so as part of community coalitions. Mercy Medical Center in Cedar Rapids, Iowa, is part of a Partnership for a Drug-Free Community coalition. The partners work together to increase awareness and prevent and reduce substance abuse. Mercy presents educational programs in local high schools on substance abuse and making healthy lifestyle choices. It also sponsors a free family program to support substance abusing individuals and their loved ones.
The Springfield (Ohio) Regional Medical Center, part of Mercy Health, is partnering with 12 other organizations in a community coalition to address the county's increased use of heroin, as well as other substance abuse trends. The coalition is using the SAMHSA prevention framework to shape its work, including reviewing epidemiological data, addressing the need for more professionals and more effective interventions, and developing and implementing a program for prevention, policies and programs.
Ascension Health's St. Vincent Carmel (Indiana) Hospital has developed plans to offer education on drug abuse and provides meeting space for Alcoholics Anonymous and Narcotics Anonymous sessions. The hospital is working to build the capacity of community primary care providers and faith-based service providers to address substance abuse problems, and it also sponsors prescription drug drop-off disposal events.
Substance abuse often is a part of hospitals' strategies for dealing with homelessness. For example, Mercy General in Sacramento, California, a Dignity Health hospital, offers an interim care program for substance abuse treatment for homeless persons discharged from the hospital. The program offers shelter, food, health care coordination and case management.
STEPHANIE DONAHUE was formerly a health policy and advocacy intern in the Catholic Health Association's Washington, D.C. office. She is a senior at Georgetown University.
JULIE TROCCHIO, MS, is senior director, community benefit and continuing care, in CHA's Washington, D.C. office. NOTES
1. National Institute on Drug Abuse, "Trends and Statistics," www.drugabuse.gov/related-topics/trends-statistics (accessed Jan. 25, 2016).
2. Centers for Disease Control and Prevention, "Smokefree Policies Reduce Smoking," Smoking and Tobacco Use www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/protection/reduce_smoking (accessed Jan. 25, 2016).
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