A report released Thursday once again underscored the need for Delaware to streamline its delivery of substance use services, expand collaboration of treatment within emergency departments and increase reimbursement rates for those treatments.
Those were just some of the nearly 60 recommendations detailed in the study conducted by HMA Institute on Addiction, which was commissioned by New Castle County along with Kent and Sussex county officials to evaluate the landscape of addiction treatment in Delaware and target areas for improvement.
The First State is not alone in its struggle to combat addiction and reduce overdose deaths, which skyrocketed amid the COVID-19 pandemic and have continued to plague communities across the country.
There were 515 overdose deaths last year, a 15% increase from 2020, which saw 447 deaths in Delaware, according to the report. There were 437 overdose deaths in 2019, state Department of Health and Social Services figures show.
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Here’s what experts say Delaware can do to address service gaps and deficiencies:
Increase Medicaid and Medicare reimbursement rates
Noted as a top priority to address, the report recommends state officials “thoroughly study” the actual costs of substance use disorder care to determine appropriate reimbursement rates.
This is a regular complaint among providers that appears to be receiving long overdue attention – Delaware’s Division of Medicaid & Medical Assistance has proposed rate increases for “selected adult substance use disorder services to be implemented Jan. 1, 2023.”
The division is taking public comment on the proposed rates until Sept. 15. More information can be found on the division’s website.
Provide adequate screening, treatment in hospitals
A key point of entry for those struggling with alcohol or chemical dependency in Delaware are emergency rooms and inpatient units of hospitals, thus “all hospitals must play a much larger part in screening, assessment, and initiation of treatment for Delawareans,” the report states.
Distribute Narcan to all stakeholders
The report recognized the state’s efforts to expand access to the overdose-reversing medication Narcan, but stressed that the 4mg one-step nasal spray and intramuscular autoinjector rather than the 2mg two-step nasal spray should be used. Access to Narcan should include community members, providers, and all first responders, including EMS and law enforcement.
Increase services for youth
Adolescents currently have little to no access to substance use disorder services in Delaware. The Institute on Addiction report recommended evaluating the need and building the necessary capacity. It also recommended each school have at least one evidence-based program that focuses on prevention and identification of substance use disorders.
Properly train service providers and staff
The study found there was “little uniformity” in screening and assessing individuals and a lack of widespread use of evidence-based treatments across providers. There is a “significant need” for initial and continuing education and training for staff for all levels of care.
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Develop ‘robust’ quality assurance programs
As evidenced by the downfall of Delaware’s once largest provider of substance use services, Connections Community Support Programs, all licensed substance use treatment providers “must develop robust quality assurance programs that assure fidelity to evidence-based practices and measure and report outcomes.”
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Use evidence-based tools consistently
Creating universal, evidence-based statewide tools for screening, brief assessment and level of care determinations will ensure consistency across service providers and treatment options.
Establish a ‘single point of control and oversight’
The final key recommendation suggests the state should “strongly consider” a separate entity reporting to the governor or governor’s agent to streamline operations, prioritize implementing evidence-based practices and standardized tools, ensure quality oversight with metrics and outcome measurements that are reported publicly, and develop other strategic plans to improve service delivery.
Got a tip? Contact Amanda Fries at afries@delawareonline.com. Follow her on Twitter at @mandy_fries.
