CMH Addiction Recovery Program

Description

The CMH Addiction Recovery Program in rural Bolivar, Missouri, is an outpatient treatment program for people with substance use disorders such as opioid and alcohol use. The program is run through Butterfield Park Medical Center, a Rural Health Clinic (RHC).

The program has a family medicine physician, 2 nurse practitioners, a case manager, a nurse, a full-time counselor, and a peer support specialist (PSS). The RHC in Bolivar is the hub but sends a medication-assisted treatment (MAT) provider to Eldorado Springs, Hermitage, and Osceola for treatment and counseling. The program also has two locations in Stockton: within an RHC and within a women's transitional housing program.

The program is funded through third-party reimbursements (Medicare, Medicaid, and private insurance) as well as Health Resources and Services Administration (HRSA) grants: HRSA 2021 Rural Communities Opioid Response Program - Implementation Award and the HRSA 2023 Neonatal Abstinence Syndrome Award.

Services offered

• Medication-assisted treatment
• Counseling for patients and families, including play therapy for children
• Hepatitis C treatment
• Collaboration with OB/GYN for prenatal and substance use co-management
• Community education
• Nicotine replacement products
• Gas cards
• Peer support
• Case management for social needs

The program also offers contingency management, in which patients receive sobriety coins or other tokens at different milestones: at the beginning of treatment, 90 days, 6 months, and every year. Children of patients also receive a gift or token. After a year of treatment, patients have the option to ring a bell in the clinic and receive a certificate, T-shirt, and picture. Families are invited to celebrate with the patient.

Results

The program had 15 patients in the first month (January 2018) and was open two days a week. Now, the program operates 5 days a week and sees 400 patients each month.

Since the program began offering contingency management, no-show rates for appointments have decreased.

The program is working with county administrators to start a treatment court in January 2025. The treatment court will include MAT services and some primary care and other behavioral health services through an in-jail psychiatric nurse practitioner. This position will coordinate with a re-entry community behavioral health worker to help people access treatment and healthcare when they are no longer incarcerated.

Challenges

When program coordinators began looking for partners and champions, some providers turned them down, saying that their communities did not have a substance use problem or that they did not want to serve patients with substance use disorder. These sentiments indicated a need for community education and stigma reduction. Now, these same providers are reaching out to the program to collaborate after seeing its successes. In addition, more individuals are inclined to seek services as treatment becomes less stigmatized.

Replication

Before implementing this program, coordinators looked at models that reduced barriers for patients, such as self-referrals, walk-in availability, and starting MAT as soon as possible (medication-first approach).

The PSS was hired using grant money to avoid any issues with RHC-specific billing requirements.

The program partners with law enforcement, OB-GYN programs, a pregnancy resource center, housing assistance, and child welfare services. In addition, the program is working with the Mobile Integrated Healthcare Network, a community paramedic and community health worker program, to start offering MAT in patients' homes; currently, community paramedics refer patients to the Addiction Recovery Program. The program is also starting a “leave-behind” program with the emergency medical services department to provide a Narcan kit to those who seem impacted by substance use. The Osceola program also partners with its community's AA program and transportation assistance.

Contact Information

Christina Bravata, Director of Grants Management
Citizens Memorial Hospital
CMH Addiction Recovery Program
417.328.6000
Christina.Bravata@citizensmemorial.com