QUARTERLY NEWSLETTERJuly 2015

Progress in North Carolina’s Tribal Communities

Talking Circles

NC SBIRT Awareness and Training

On April 25, 2015, the Coharie Tribe of North Carolina held its first Talking Circle at the office of the Coharie Intra-tribal council in Clinton. Organized by Tribal Administrator Greg Jacobs and the tribe’s Health Outreach Coordinator Tabatha Brewster, the Talking Circle revolved around behavioral health issues affecting the community. Greg Jacobs described the event as a momentous occasion in the history of the Coharie Tribe marking the beginning of a period of healing for the Coharie, the Waccamaw Siouan and neighboring tribal communities. He opened the Tribal Circle with a prayer that was followed by the drumming and singing of War Paint, a renowned Lumbee Drumming Group. Kim Pevia, an Indian American behavioral health provider with multi-generational trauma expertise, facilitated the training. Chief Gene Jacobs Two Feathers welcomed the participants. Tribal Administrator Jacobs presented an eagle feather to Kaya Littleturtle, one of the War Paint drummers for his accomplishments. Another Talking Circle was held at the Waccamaw Siouan Tribal Center in Bolton on May 23, 2015 with the Smokey River Drum Team. A third Talking Circle took place at the Harnett County Coharie Building in Dunn on June 13, 2015 with both the War Paint and Smokey River drummers. Each Talking Circle had 25-35 people in attendance. All participants except for two were members of tribal communities.

Maria (Ging) Fernandez, PhD, SBIRT Program Manager, and Terrie Qadura, MPH, Tribal Liaison, gave a presentation on SBIRT at each talking circle and provided information on local primary care practices implementing SBIRT and other resources.

for health care providers in North Carolina (physicians, nurses, physician assistants, psychologists) who are American Indian or who serve in communities with high concentrations of American Indians. The training consisted of a conference that was held in Robeson County, with 24 providers in attendance, and an in-service for health care providers on the Eastern Band of Cherokee Indian reservation, with 33 providers in attendance. Drs. Kristy Le and David Miller, faculty members in the Department of Internal Medicine at WFSM and nationally recognized experts in SBIRT conducted the trainings. Additional activities included the development of print resources focused on the dangers of substance abuse in American Indian communities and the impact of SBIRT in addressing this disparity.

Ms. Flo Stein, MPH, Deputy Director of DMHDDSAS and Co-Project Director for NC SBIRT and Dr. Fernandez presented an overview of the NC SBIRT project during an event “Veteran

Conversations” honoring Veteran Tribal members held on June 26, 2015. At the event, Veterans also learned about the treatment and recovery services for substance use available through the NC Access to Recovery (ATR) project from Martin Woodard, ATR Project Director. Reverend Gary Deese, Command Sergeant Major, US Army Retired, explained, “We are a proud people. We have to learn to ask for and accept help.” The event had 120 people in attendance, including Representative Garland Pierce and former Representative Ronnie Sutton.

The North Carolina American Indian Health Board (NC AIHB), in collaboration with the Northwest Area Health Education Center (NW AHEC) and the Maya Angelou Center for Health Equity (MACHE) at the Wake Forest School of Medicine (WFSM), provided SBIRT training

Greg Jacobs, Tribal Administrator, described the event as a momentous occasion in the history of the Coharie Tribe marking the beginning of a period of healing for the Coharie, the Waccamaw Siouan, and neighboring

tribal communities.

Inside this issue● Progress in North Carolina’s Tribal Communities● Practice Implementation● Performance Assessment Infographic● News from the Field● Staff Announcements● Save the Date! Upcoming FREE Webinars● Faith Communities and SBIRT● What is NC SBIRT?

NC SBIRT: PRACTICE IMPLEMENTATION

Community Care of the Sandhills

The more rural area in Sandhills faced more challenges in SBIRT implementation compared with the urban area in the northwest. Three sites withdrew from NC SBIRT after less than a year of implementation. These were also sites that had very low rates for SBIRT intervention modalities. Pembroke Primary Care started screening in January 15, 2013 and withdrew in August 12, 2013. Southern Pines Women’s Health Center started implementing SBIRT in October 29, 2013 and stopped in June 5, 2014. Dr. Karen Smith’s Private Practice has been practicing SBIRT in Hoke County since July 2012.

Dr. Karen Smith Private Practice - Raeford, NC

Wanda Clark, ClinicianTBD, Care Ambassador

Robeson Health Care Corporation (RHCC)

Robeson Health Care Corporation, a federally-qualified health center (FQHC), is implementing SBIRT in three sites. The first FQHC site (Julian T. Pierce Medical Center) in Pembroke began implementing SBIRT May 1, 2014. The second FQHC (Montgomery Medical Center) site in Montgomery County began implementing SBIRT June 3, 2014. The third site in Maxton County started June 1, 2015. The FQHC now has three substance abuse clinicians, one for each site. RHCC currently uses nurses on staff to fulfil the Care Ambassador role.

Maxton Medical Center - Maxton, NC

Christopher Bullard, Clinician

Julian T. Pierce Medical Center – Pembroke, NC

Melissa Seals, Clinician

Montgomery Medical Center – Star, NC

Tawanda Gonzalez, Clinician

Northwest Community Care Network(NWCCN)

Community Care Center, a primary care practice in Forsyth County, started implementing SBIRT services towards the end of April 2012. In the latter part of June 2012, Wake Forest University Baptist Medical Center (WFUBMC) Family Medicine Clinic became the second primary care practice to implement SBIRT in the NWCCN area. Foothills Primary Care started delivering SBIRT services on November 1, 2012. Three weeks later, Peace Haven Family and Internal Medicine started delivering SBIRT services. By the end of 2012, Northwest Community Care Network had all of its targeted primary care practices implementing SBIRT.

Community Care Center - Winston Salem, NC

Jim Thornton, ClinicianDailen Celma, Care Ambassador

Wake Family Medicine - Foothills in Mt. Airy, NC

Holly Snyder, ClinicianSamantha Dollyhite, Care Ambassador

Wake Family Medicine - Piedmont Plaza inWinston-Salem, NC

Michael Leone, ClinicianBenjamin F. Jackson, Care Ambassador

Wake Family Medicine - Peace Haven inWinston-Salem, NC

Taylor Shannon, ClinicianAllison Greely, Care Ambassador

Mt. Airy Wake Family Medicine-Foothills

Winston-Salem Community Care Center Wake Family Medicine-Peace Haven Wake Family Medicine-Piedmont Plaza

Raeford Dr. Karen Smith Private Practice

Maxton Maxton Medical CenterPembroke Julian T. Pierce Medical Center

Star Montgomery Medical Center

Performance Report

Data as of June 20, 2015 | Year 5 begins Sept 2015

Years 1-4 | At-a-glanceScreening, Brief Intervention and Referral to Treatment

POSITIVE OUTCOMESData collected at six months and at discharge consistently show increased abstinence from and decreased consumption of alcohol and other drugs as well as improvements in health and residential stability following intake.

Target Met

www.NCSBIRT.orgProduced by the Governor’s Institute on Substance Abuse for the NC SBIRT Grant (TI-023453) with funds obtained by the DMHDDSAS of the NCDHHS from CSAT_SAMHSA. Content is solely the responsibility of the authors and does not necessarily represent the o�cial views of the agency.

81%81%18,34918,349

patients screened of target met

Primary Care Facilitie88

primary care facilities

765 patients

On-site grant-funded clinicians have provided brief interventions and

treatment to

130and have referredto more specialized

treatment.Clinicians made a positive impact by providing case management andother services that went beyond those speci�ed in the grant.

ABOVE AND BEYOND

Administered the 9-item Depression Screening Tool to714 patientswho met the threshold for risky and harmful use of alcohol.

NEWS FROM THE FIELD

A bulletin was released to announce recent changes to the Centers for Medicare & Medicaid Services (CMS) policy regarding Medicaid payments for services provided without charge (including services that are available without charge to the community at large, or “free care”).

The change gives providers the ability to bill only Medicaid and provide the service free to those who do not have alternative coverage. In the past, providers could not bill Medicaid for services that they provided at no cost to other patients. Therefore, if providers billed Medicaid for a specific service, they also had to bill patients who had private insurance. If that service was not covered by their private insurance policies, those patients were subject to an out-of-pocket expense, which could not be waived under the CMS rules.

The new ruling by the Departmental Appeals Board revises the previous policy and states:

During the June SBIRT Policy Steering Committee meeting, Bert Bennett helped to clarify MCO Communication Bulletin #J134. He explained that it does in fact mean providers now have the ability to bill only Medicaid and provide the service free to those who do not have alternative coverage.

To read the entire CMS publication regarding third-party liability and Federal Financial Participation (FFP) for Medicaid services provided without charge, visit www.medicaid.gov/federal-policy-guidance/downloads/smd-medicaid-payment-for-services-provided-without-charge-free-care.pdf.

If you have questions, please contact Kelsi Knick at Kelsi.knick@dhhs.nc.gov.

Nineteen NC SBIRT staff from DMHDDSAS, Centerpoint Human Services MCO, Community Care Network, and the Governor’s Institute attended a retreat held in Asheboro on May 15, 2015. Facilitated by the MCO at Centerpoint, the retreat was designed to be a forum where staff exchanged lessons learned, particularly those around changes in the cultures of the primary and behavioral health care providers as SBIRT was implemented.

Pictured:(Back row L-R) Michael Dublin, James Harner, Paul Kelly, Jim Thornton, Sam Young, Holly Snyder, Michael Leone, Catherine Anderson Arnold, Ray McBeth, Maria (Ging) Fernandez, Christopher Bullard, Judy Harmon, Andrew Clendenin

(Front row L-R) Marie Kaswandik, Tawanda Gonzalez, Kayla Stover, Terrie Qadura, Pollen Williamson, Ben Jackson

Medicaid Payment for Services Provided without Charge

NC SBIRT Idea Exchange

“Medicaid reimbursement is available for covered services under the approved state plan that are provided to Medicaid Beneficiaries, regardless of whether there is any charge for the service to the beneficiary or the community at large.”

STAFF ANNOUNCEMENTS

CONFERENCE CALLS

● Kellie Cosby, who served as our Grant Project Officer, has moved from SBIRT to a new role with the Health Resources and Services Administration. With this change, Reed Forman, the Lead Public Health Advisor for SBIRT grantees, will serve as our new Grant Project Officer. ● Tawanda Gonzalez joined the Federally-Qualified Health Center, Robeson Health Care Corporation (RHCC), as a new Clinician serving in the Montgomery Medical Center.

● Melissa Seals joined the Federally-Qualified Health Center, Robeson Health Care Corporation (RHCC), as a new Clinician serving in the Julian T. Pierce Medical Center.

● Pollen Williamson has joined the NC SBIRT team as a Program Coordinator to handle logistics for SBIRT trainings, conferences and meetings and coordinate communication efforts for the SBIRT program.

Integrating Screening and Brief Intervention for Alcohol and Other Drugs in Behavioral Health Settings Serving College StudentsDate: Wednesday, August 19, 2015 from 3-4:30pm ETDescription: This free webinar will focus on the application of cutting-edge research on integrating and applying the evidence-based practice of screening and brief intervention (SBI) for alcohol and other drugs within primary health and mental health care settings serving college student populations. Challenges associated with SBI implementation and program sustainability in the clinical setting will be addressed. Participants will learn innovative and creative strategies for making SBI more relevant and responsive to a range of diverse college student target populations identified in the literature as being at risk for alcohol and other drug abuse. CE Credit: Approved by NAADAC (Approval #189), NBCC (Approval #5703), NASW (in progress) and accredited by the American Probation & Parole Association for 1.5 free CEs.

Register Here - http://bit.ly/1OebXKq

Reed Forman, our Grant Project Officer with SAMHSA, will answer questions and provide general project updates on the second Tuesday of every other month from 2:30-3:00 p.m. The next call is scheduled for Tuesday, August 11, 2015.

Large state grantee calls with SAMHSA will take place the first Thursday of every other month from 3:30 – 4:00 p.m. The next call is scheduled for Thursday, September 3, 2015.

For call details, contact Pollen Williamson, 919-715-2365 or pollen.williamson@governorsinstitute.org.

The Prevalence of Prescription Opioid Misuse: Doctor Shopping, Co-ingestion and ExposureDescription: This self-paced online course covers important topics in prescription opioid misuse. The three sections will introduce you to prescription opioids, the link between multiple doctors and opportunities for misuse, and the prevalence of high-risk use among adolescents (including mixing pills with other drugs). Opioids are here to stay. Knowing and addressing risky behaviors associated with nonmedical use can help prevent potentially grave consequences such as overdose and addiction.CE Credit: Approved by NAADAC Approved for 2 CEHs, Social Work Approved for 2 CEUs

Take the Course - http://bit.ly/1SnARYq

SAVE THE DATE: FREE WEBINARS

NC SBIRT is funded through a cooperative agreement between the NC Department of Health and Human Services and SAMHSA-CSAT and is a project of the NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services.

Pollen WilliamsonNC SBIRT Program CoodinatorGovernor’s Institute on Substance Abuse(919) 715-2365 (direct)Pollen.Williamson@governorsinstitute.org

Contact Us

WHAT IS NC SBIRT?

FAITH COMMUNITIES AND SBIRT

Faith communities across North Carolina have faced myriad problems addressing public health issues internally while also serving the community at large.

As resources become less available to advocate for public health issues such as substance use disorders, awareness of health-ministry user-friendly tools is a must for leaders seeking to address the needs of their congregants and those served through outreach programs.

One of North Carolina’s progressive approaches has been to introduce Screening, Brief Intervention, and Referral to Treatment (SBIRT) tools that allow faith leaders at any level be able to help congregants determine some level of use that may or may not lead to a referral to treatment.

A free SBIRT app is now available (https://itunes.apple.com/us/app/sbirt/id877624835?mt=8) that will allow faith leaders to utilize their iPads, Kindles, Nooks or any reading device to address congregants and others in a variety of settings. Portability for faith leaders is essential in the electronic age.

The introduction of the SBIRT app is quite new and remains to be seen how effective it will be; anecdotal data indicate the prognosis is good for expanded use leading to more screenings in otherwise hard to reach populations.

Written by Michael Dublin, MA, CSAPC, ICPS | Faith Works Together Coordinator

SBIRT is a public health approach to the delivery of early intervention and treatment services for people with substance use disorders and those at risk of developing these disorders. Many different types of community settings provide opportunities for early intervention with at-risk substance users before more severe consequences occur. NC SBIRT is a cooperative agreement between the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMHDDSAS), the Substance Abuse Mental Health Services Administration (SAMHSA), and the Center for Substance Abuse Treatment (CSAT) to provide screening, brief intervention, and referral to treatment to adult patients seen in primary care practices. The Division collaborates with Community Care of North Carolina (CCNC) and the Governor’s Institute (GI) on Substance Abuse to implement the grant project.

The overall purpose of NC SBIRT is to reduce alcohol and drug misuse and addiction through a co-location model where Care Ambassadors and Licensed Substance Abuse Professionals are stationed at primary care practices to provide substance abuse screening, brief intervention, brief treatment, and referral to treatment as appropriate.

For more information on NC SBIRT, please visit www.ncsbirt.org.