Addiction Recovery Mobile Outreach Team (ARMOT)

Description

According to the CDC, 5,168 Pennsylvanians died from drug overdoses in 2020, a rate of 42.4 deaths per 100,000 people.

In addition to overdoses, some patients were going to the hospital looking for comfort medications, while others seeking detox or treatment didn't know where to go. The rural counties of Armstrong, Indiana, and Clarion developed a program that would provide these patients with treatment and support whether they entered a hospital or a treatment facility.

The Addiction Recovery Mobile Outreach Team (ARMOT) is a collaboration of:

• Armstrong-Indiana-Clarion Drug and Alcohol Commission (AICDAC)
• Armstrong Center for Medicine & Health
• Clarion Hospital
• Indiana Regional Medical Center

ARMOT provides case management and recovery support services to adults and adolescents with substance use disorders. Program staff encourage patients to involve their families in the recovery process so that ARMOT staff can educate families on the types of support their loved ones will need at home.

This video highlights ARMOT's impact in its first 18 months through its case management and support services:

ARMOT was funded by a 2015-2018 Federal Office of Rural Health Policy (FORHP) Rural Health Care Services Outreach Grant, received a 2019-2022 grant, and is now funded by a 2022-2025 grant of the same name.

Services offered

Hospital staff:

• Screen patients to determine type of substance use disorder
• Ask patients if they would like to be referred to the ARMOT program
• Refer patients to ARMOT if patients give verbal consent

The Mobile Case Manager (MCM):

• Meets with patients at their bedside
• Screens and assesses patients to determine type of treatment needed
• Discusses treatment options with patients and completes referral to treatment
• Coordinates with treatment agency to determine pickup time for patients
• Connects patients to community resources
• Educates hospital staff on substance use disorders and the recovery process

The peer Certified Recovery Specialist (CRS):

• Can share lived experience and knowledge of substance use disorder and the recovery process
• Can meet first with patients on request
• Educates patients' families on the recovery process
• Connects patients to community support, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) meetings
• Attends first AA/NA and other support group meetings with patients

In addition, through ARMOT, two hospitals now distribute naloxone to overdose survivors and their families.

Results

The ARMOT program received over 2,956 referrals between September 2015 and November 2022. ARMOT staff have screened 73% of the patients who were referred to the program and completed a Level of Care Assessment with 45% of these screened patients. Of the patients assessed by ARMOT staff, 91% went to treatment. However, of the patients referred to ARMOT, 6% were discharged prior to meeting with ARMOT staff and 6% of patients declined to meet with ARMOT staff.

AICDAC is currently providing technical assistance for 4 rural healthcare facilities that are establishing a program modeled after the ARMOT program.

ARMOT is also featured in RHIhub's Prevention and Treatment of Substance Use Disorders Toolkit Program Clearinghouse.

You can read more about ARMOT in the Rural Monitor article Pennsylvania Mobile Team Addresses Substance Use Disorders.

Challenges

Because of hospital staff turnover, educating line staff is an ongoing process. There's also the challenge of being a mobile unit working among three hospitals, especially in scheduling adequate coverage and transporting records. Currently, an ARMOT staff member is present in the hospital from 8:00 a.m. to 4:00 p.m. Patients entering the hospital at night might not be willing to wait until 8:00 a.m. the next day to speak with an ARMOT employee.

To address this barrier, two additional staff were added to the ARMOT program. These staff members work in the hospitals Monday through Friday from 3:00 p.m. to 11:00 p.m. and from 12:00 p.m. to 8:00 p.m. on the weekends. Adding the evening/weekend staff has really helped with better patient engagement, and the number of patients who are discharged prior to meeting with ARMOT staff has decreased significantly.

HIPAA regulations can make sharing patient information a challenge as well. Hospitals invited ARMOT staff to new employee orientations so they could become familiar with confidentiality policies. ARMOT staff are considered sub-contracted volunteers with the three hospitals, giving them minimal but sufficient access to each hospital's electronic medical records.

Stigma around substance use disorders can be a barrier when implementing a program like this. Education is important to help understand the patient population whom program coordinators are trying to reach. The use of peer Certified Recovery Specialists has been vital to the program's success, helping with both patient engagement and education of hospital staff on addiction and recovery.

Some doctors in the three hospitals' emergency departments were hesitant about utilizing buprenorphine to treat withdrawal symptoms, but ARMOT has been able to increase the number of physicians in the emergency department willing to use buprenorphine to treat opioid withdrawal.

The COVID-19 pandemic has created additional barriers for patients accessing treatment services. ARMOT had to utilize telehealth more often when staff members were not allowed in the hospitals. It's also been challenging to find treatment facilities that will accept a patient coming from a hospital and to coordinate transportation.

Hiring and retaining staff to work within the program has been a challenge over the past couple of years, especially the positions that work evenings and weekends. When those positions fill, staff opt to move into a daylight position when one is available. To address this challenge, ARMOT added an increased hourly rate for staff who work in the evenings and on weekends.

Replication

Management staff at AICDAC met with interested partners at the very beginning of program implementation to establish the need for services and collaborate on a program that would meet identified needs. Local agency investment is key. This program would not be possible without FORHP funding and the support the agency receives as the ARMOT program progresses.

Contact Information

Mike Krafick, Certified Recovery Specialist Supervisor
Armstrong-Indiana-Clarion Drug and Alcohol Commission
724.548.8334 Ext. 505
mkrafick@aicdac.org