At rock bottom “Katie” was homeless, rummaging through dumpsters for food, doing whatever it took to get her next high, having lost her job as an emergency room nurse and stepped away from family and friends. Today, thanks to highly coordinated, evidence-based treatments and services, she is employed in a management role, with her own place to live, healthy friends, and new (sober) hobbies.
Substance use disorders, recovery, intergenerational trauma, and the stabilization and healing of lives are complex, long-march issues that urgently require a new and comprehensive approach. America’s opioid crisis is getting worse, ruining and ending lives at staggering rates, and children and families are bearing the consequences.
Traditionally, treatment providers, law enforcement, and social services agencies have provided crucial interventions, services, and/or care in silos with little or no communication. Lack of coordination, adequate data systems, and accountability has resulted in overcrowded jails, high rates of recidivism, overdoses, and deaths.
Organizations that provide services are typically paid based on the number of persons encountered or heads in beds — not based on their respective contributions to reducing and ending the opioid crisis.
People seeking recovery often describe episodic and fractured care, long waits to access treatment, lapses in medication assisted treatment (MAT), and no access to mental health services or recovery-oriented skill-building opportunities. Moreover, most don’t have a safe place to lay their heads that allows MAT. Those who do manage to navigate the challenging maze of treatment options face, at best, minimal prospects for stable employment.
Continuing to focus resources and energies in parallel and on immediate needs (Narcan availability, number of detox beds, fractured systems of care) can’t drive sustainable progress. We need to step away from long-held practices that have produced such poor outcomes and introduce true collaboration with proven interventions and systemic accountability for all services, with financial models that incent only the desired outcomes.
Nonprofits, foundations, and government funders are increasingly partnering toward such shared outcomes goals. Mercy Hospital and the Greater Portland Addiction Collaborative (GPAC) are proud to be among these pioneers.
While Maine has some of the country’s highest rates of drug-affected births, we also have some of the best news in the national opioid crisis. We have made progress with a new prescribing law that requires provider education and limits opioid prescriptions. We have developed new multidisciplinary rehabilitation approaches designed to educate patients and their families about coping with chronic pain, restoring physical fitness, and returning to the life functions they have lost.
GPAC’s outcomes-oriented approach brings many southern Maine players to a common table to agree on goals, share data, measure results, institute operating principles, and, ultimately, fund only what works. GPAC comprises local hospitals, the City of Portland, the Portland Police Department, a community detox center, treatment providers, the recovery community, crisis providers, housing and employment providers, and peer recovery centers.
Our common goal is to strengthen the capacity and effectiveness of all area providers, and to demonstrate a successful model for other communities. Building upon the learnings of the Data Driven Justice Initiative, we are working with the Laura and John Arnold Foundation and Open Lattice on a multi-sector data platform to give all GPAC partners the real-time information we need to track what is working and what isn't, and to adjust our efforts accordingly. We are also exploring new performance-based contracting.
Two years in, GPAC continues to march towards a shared solution. We know that asking community-based organizations with limited resources to reconsider long-held treatment models presents challenges. We also understand the organizational fatigue and competing priorities that continue to challenge partner organizations: In recent weeks, three GPAC-connected CBOs have had to reduce hours and services due to budget shortfalls.
The challenges of this work are daunting. But continuing with the status quo is not an option. We are losing a generation. We need courageous leadership with new rules for engagement.
Melissa Skahan is Vice President of Mission Integration at Mercy Hospital, and founder of the Greater Portland Addiction Collaborative.