By Dorothy Brooks
The CA Bridge model aims to make it a priority for frontline emergency providers to recognize patients who present with a SUD, even if that is not a patient’s chief complaint, and then to connect these patients to low-barrier treatment, explains Arianna Campbell, PA-C, director and a co-principal investigator for CA Bridge.
For example, at Marshall Medical Center in Placerville, CA, such patients can be referred to a Bridge clinic on the hospital campus. In appropriate cases, patients in withdrawal from opioid use disorders (OUD) will be initiated on buprenorphine during their ED visit and then referred to the Bridge clinic for ongoing treatment.
While not all participating EDs in California have a Bridge clinic on their campus, the essence of the model is to make it easy for patients to receive the care they need. To do this, each ED should designate a champion to drive the program and a navigator to facilitate treatment access.
This is a recipe that has proved so successful in California that the state legislature approved a budget that funds these positions for every participating ED, a move that has helped make the Bridge approach a reality in more than 200 facilities in the state. (Learn more about these sites here.)
“We recognized that we needed to [go] above and beyond for people to give them access to treatment in a very complex system,” Campbell notes, adding this is where the work of the navigators is so crucial. “Not only do the navigators advocate [for patients], they also do motivational interviewing. They have a great understanding of the resources that are available outside of the ED and how to connect people to that care.”
Campbell estimates a navigator job can be funded for less than $100,000 per facility per year.
“Navigation has been tried and true, and we have a lot of evidence already out there that it can actually provide cost-savings to health systems,” Campbell says.
For example, Campbell says the navigator at her hospital, Marshall Medical, can only see 50% of the people who need her assistance. However, when a navigator sees a patient who has been hospitalized for a SUD-related issue, Campbell estimates this lowers the likelihood of readmission for that patient fivefold. Navigators also shorten the length of stay for both hospital and ED visits.
Furthermore, Campbell says there is a ready workforce of potential navigator candidates. “There are a lot of certified drug and alcohol counselors out there ... an entire workforce of people who have been doing this work,” she says. “We emphasize being passionate about caring for people who use drugs. That is first and foremost.”
While Campbell does not require navigators to have a SUD history, she notes this experience can be helpful. Also beneficial is behavioral health (BH) knowledge.
“My navigator will go and see people who are experiencing BH emergencies and connect them to care as well,” Campbell says. “Frequently, there are co-occurring issues going on, BH challenges, and an SUD.”
Campbell affirms it can be helpful to obtain some grant funding when implementing a navigator position. That is how the program started in her ED, although navigators now are part of the ED budget. She says such funding can come from the state, nonprofit organizations, or opioid settlement funds that are earmarked for counties.
While not all participating EDs in California have a Bridge clinic on their campus, the essence of the model is to make it easy for patients to receive the care they need. To do this, each ED should designate a champion to drive the program and a navigator to facilitate treatment access.
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