Opioid Treatment Archives - CARF International https://carf.org/blog-programs/opioid-treatment/ Commission on the Accreditation of Rehabilitation Facilities Wed, 07 Aug 2024 17:59:57 +0000 en-US hourly 1 https://wordpress.org/?v=6.7.1 https://carf.org/wp-content/uploads/2023/08/cropped-carf-favicon.png?w=32 Opioid Treatment Archives - CARF International https://carf.org/blog-programs/opioid-treatment/ 32 32 218515885 Accreditation – Enhancing people’s lives https://carf.org/blog/accreditation-enhancing-peoples-lives/ Fri, 05 Apr 2024 17:37:16 +0000 https://carf.org/?p=416047 Since 1966, the CARF accreditation seal has been the hallmark of quality...

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9,300+

Service providers

67,000+

Accredited programs and services

31,000+

Locations

13+ million

Persons served annually

Our reach

Countries, states, territories, and provinces on five continents recognize one or more of our areas of accreditation, and many mandate CARF accreditation exclusively.

Since 1966, the CARF accreditation seal has been the hallmark of quality in human services. CARF’s reputation for advancing excellence in the industry is founded on its unique consultative peer-review survey model, conformance focus, and evolving field-driven standards.

Accreditation positively impacts organizations’ business and services in many ways. These benefits combined with the strength of our international standards and consultative peer-review model, are distinguishing factors that make CARF the accreditor of choice for health and human service providers.

We asked accredited organizations across the continuum of care to answer a few questions about CARF accreditation and their experience with CARF. Below are their answers:

Q: What does CARF accreditation mean to your organization?

In 2016, accreditation became a mandatory prerequisite for agencies to maintain their foster care and residential licenses issued by the California Department of Social Services. However, the true significance for Koinonia lies in its pivotal role in streamlining our strategic planning processes and refining numerous policies. This accreditation has notably contributed to elevating safety practices across all our facilities and establishing a systematic approach to measuring and enhancing the quality of our programs.

–Laura Richardson, Compliance Manager, Koinonia Family Services, Loomis, California
Child and Youth Services
Accredited since October 2016.

CARF accreditation is confirmation that Hillel Lodge has met or exceeded a comprehensive set of standards encompassing all our activities. Accreditation also underscores our commitment to continuous quality improvement and commitment to evolve our service offering to meet the needs of the persons served.

–Ted Cohen, CEO, The Bess and Moe Greenberg Family Hillel Lodge of Ottawa,
Ottawa, Ontario,
Aging Services
Hillel Lodge has always been an accredited home, but recently switched to CARF,
and is in its first accreditation cycle.

CARF guidelines are the foundation for our program and service areas. When looking to grow into a new service area, the CARF guidelines are integral as a tool for expansion. This ensures we provide the highest quality of services and keep our focus on continuous improvement.

–Stacy Freed, Director of Programs, Pioneer Resources, Muskegon, Michigan
Employment and Community Services
Employed by CARF-accredited organizations for 18 years,
and a CARF surveyor for three years.
Pioneer Resources has been accredited for 22 years.

On With Life feels that being CARF accredited distinguishes us as an organization that strives to set ourselves apart, challenges us to be better, and holds ourselves accountable to provide high quality care and service. The consultative approach that CARF has provides us with the opportunity to be accountable to what we do, but also see how we can strive to be better!

–Tammy Miller, Director of Outpatient Services, On With Life, Ankeny, Iowa
Medical Rehabilitation
Personally involved with CARF accreditation since 2004 while
On With Life’s has been accredited since 1994.

CARF accreditation signals a strong commitment to providing high-quality services. It demonstrates that our agency is willing to undergo a rigorous evaluation process to ensure that our programs and services meet or exceed industry standards. Accreditation by CARF enhances an agency’s credibility. It provides external validation of CODAC’s commitment to excellence, which can be reassuring to members, families, funders, and the community. Many stakeholders, including government agencies, health plans, and members, may prioritize or require services from accredited organizations, giving accredited agencies a competitive edge.

–Amy Munoz, Chief Compliance Officer, CODAC Health, Recovery & Wellness, Inc., Tucson, Arizona
Behavioral Health
CODAC has been accredited by CARF since 2002.

At Centerstone, our noble purpose is “To deliver care that changes people’s lives.” Our noble purpose is critical to the development and provision of quality treatment to individuals that trust us with their care. We feel strongly that the mission of CARF aligns with our noble purpose. In fact, accreditation is not required in all the states wherein Centerstone provides service; instead, we proactively choose accreditation. The CARF standards provide guidance for best practices for service delivery as well as expectations for administrative functions. The application and integration of the CARF standards into our day-to-day functions supplements our organizational structure and enhances our quality of care. To internal and external stakeholders, accreditation is evidence of the organization’s commitment to the highest standards of care. The CARF standards have provided a common set of language for our organization as we moved through the merger process and has provided opportunity for standardization of functions and tasks.

–David Guth, CEO, Centerstone, Nashville, Tennessee
Behavioral Health
Centerstone has been CARF accredited since 2010. The earliest accreditation
for various legacy organizations, prior to the merger(s), was achieved in 1996.

Accreditation is a requirement for reimbursement for many of our funders; however, we would seek accreditation even if not required. It provides us a guideline of organizational best practices; it keeps us current in the field; and it provides a system of planning and documenting administrative and clinical issues. It is a great indicator of the quality of services we provide. We have added programs since the time of our original survey to now including five Behavioral Health programs and one Employment and Community Services program; and have also included the Governance standards.

–Brad Farmer, Executive Director, Acadiana Area Human Services District, Lafayette, Louisiana
Behavioral Health and Employment and Community Services
CARF surveyor for 26 years. The organization has participated in four surveys
and has received a three-year accreditation each time.

CARF accreditation is the Gold Seal of approval. It is the highest standard an organization can achieve. CARF accreditation is the recognition of the work we put in every day to meet the needs of our clients, community and stakeholders by providing the highest quality care at the highest industry standards. CARF accreditation sends a message to insurance companies, contractors and payers that our organization is able to achieve the triple aim of healthcare: access, quality, and cost.

–Laureen Pagel, CEO, Starting Point Behavioral Healthcare, Yulee, Florida
Behavioral Health
Involved with CARF accreditation for 24 years,
and our first accreditation was in 2000.

CARF accreditation has been an excellent way to demonstrate how our agency provides quality services in all areas of the organization. Continuing to receive a three-year accreditation has assisted us when applying for grants and in expanding our programs.

–Sue Evans, Chief Operating Officer, Walden Family Services, San Diego, California
Child and Youth Services
Been accredited nine years, and just completed our fourth survey.

Q: What did preparing for CARF survey accreditation do for your organization?

Primarily, gearing up for our CARF survey accreditation fostered a sense of camaraderie among our staff, as we collectively pursued the substantial achievement of international accreditation. The preparation process also facilitated a thorough examination of our organizational processes, leading to the establishment of consistency across our accredited programs. –Laura

Preparation for CARF survey accreditation helped our organization formally come together to perform a comprehensive review of how our organization conforms to the CARF standards. This review provides us with an excellent opportunity to examine our organization’s strengths and weaknesses which not only helps us plan for future quality improvement activities, but also provides valuable information that will inform our ongoing strategic planning activities. –Ted

Continuous improvement is always the goal and by preparing for our accreditation, it keeps everything fresh on our radar. It requires a lot of intentional preparation, which in turn helps us to ensure we are in conformance with quality standards. –Stacy

As a CARF accredited facility, the preparation for the surveys does not place undue stress upon us because, as an organization, our daily function is very much aligned with the CARF standards. For us the preparation is a good check and balance of where we are, what we need to continue to do better, and where we can strive to go in the future. –Tammy

Accreditation involves a thorough review of operations, policies, and procedures. This process was meaningful in identifying areas of potential risk and developing an opportunity for us to address and mitigate these risks, ultimately enhancing overall organizational resilience. Our CARF survey required collaboration among different departments and teams. Staff appreciated the teamwork involved and the chance to work together towards a common goal. –Amy

The CARF standards have provided a common set of language for our organization as we moved through the merger process and has provided opportunity for standardization of functions and tasks. The continuous quality improvement process that is built into CARF accreditation has provided significant value to our organization in that it has ensured continuous improvement and afforded us opportunities for growth. –David

It helped us organize our policies/procedures and all supporting documentation. It provided a common language internally and focused our efforts as a team. It assisted us in ensuring a thorough review of our plans, mission, strategy, implementation, and the mechanisms to ensure ongoing review and monitoring of all of those items. –Brad

Preparing for CARF helped all staff focus on the same common goal. It ensured we all spoke the same language and it provided consistency across all program areas and locations. CARF preparation “raises the bar” for the entire organization. It is an opportunity for supervisors and directors to identify gaps in care, training deficiencies, communication breakdowns, and possibly even rogue staff who decided not to follow agency policy. As well as those who exemplify the CARF standards every day in their work. CARF preparation is not something that occurs six months before a site visit…it is something we do every day. –Laureen

CARF accreditation has led to our organization continuing to improve our standards by building frameworks to continually review our systems and services, and looking at ways we can improve to provide relevant services. CARF has been a valuable tool as our agency has grown and developed new programs. The standards have assisted us in ensuring that our services are client centered and continuing to develop based on the feedback of our youth and families. –Sue

Q: What was your staff members’ general impressions and feelings about the survey process?

Initially, our staff members felt a significant amount of anxiety and stress leading up to the survey process. However, the actual experience of the survey proved to be quite uplifting and affirming. The presence of surveyors who demonstrated a clear understanding of our work and their capacity to offer supportive feedback was immensely beneficial. –Laura

Once our staff members became familiar with the accreditation process they really appreciated how the CARF standards added structure to their departmental quality improvement initiatives. CARF outlines what is expected for our home to achieve conformance to the standards and also provides documentation requirements and review cycles as well as education requirements. This structure helps to support our quality improvement program. –Ted

Staff who are new to the organization can be intimidated by the process. However, we do try to focus on the peer-consultation process of the surveyors, ensuring that staff understand they are there to support and offer suggestions on ways we can make our programming even better. –Stacy

There is always trepidation when the word “survey” comes up, especially when a majority of “surveys” that come to our buildings are much more tied to deficiencies or punitive in nature. Our staff has really begun to appreciate the CARF survey opportunities in which they can share the incredible things that we are doing as an organization and ask questions of the surveyors of how they can be better—what they have seen others do. They enjoy the consultative experience that has come with doing the CARF surveys. –Tammy

Many staff members expressed a sense of pride and validation during the CARF survey process. Achieving accreditation can be seen as a collective accomplishment, reflecting our hard work and CODAC’s commitment to high standards and quality services. Specifically, staff members appreciated the chance to showcase their knowledge, skills, and dedication to quality care during the survey process. The overall pressure associated with the survey was seen as a motivator for maintaining excellence. –Amy

As an organization, we approach accreditation less about a required activity, but rather, activities that enhance service delivery and business functioning. As such, generally speaking, staff are well aware of the organization’s commitment to accreditation and all levels of the organization participate in the accreditation processes. On an ongoing basis, the effort is to effectively integrate standards in such a way that they are relevant to staff and meaningfully contribute to quality of care for persons served. –David

Our original survey was intimidating to many of the staff as it seemed to be a huge project. Now that we have been accredited for a number of years, the staff looks forward to the surveys as a way to hear feedback from peer surveyors, to learn new trends and information, to be recognized for their efforts. We have designated a “CARF team” to help us maintain our efforts in between surveys and those team members take pride in their efforts and appreciate working with the surveyors when they are on site. –Brad

Our QI Director found the survey process to be simple and straightforward. We know what to prepare for and what to expect. The surveyors are always professional, courteous and helpful. They have a vested interest in helping organizations maintain the CARF standards and it shows. –Laureen

Although initially preparing for our first survey was a lot of work for many staff, once the structure was in place the staff have found it beneficial and helpful as the agency continues to grow and develop our programs. Our staff have found the survey process beneficial in discussing best practices and how other accredited agencies have met standards. –Sue

Q: Do the persons you serve notice or make comments about your CARF accreditation?

Many individuals and families we serve have actively participated in interviews during our survey process and found it to be a positive experience. While I believe that most of the individuals we serve value the improvements implemented as a result of CARF accreditation, they may not be fully aware of all the specific changes attributed to CARF. The counties we serve and our donors, however, highly appreciate the assurance that comes with partnering with an internationally accredited provider. The recognition of our CARF accreditation instills confidence in the quality and standards of our services. –Laura

Our persons served are very aware and proud that we are CARF accredited. They experience the benefits of the accreditation process daily through improved services and outcomes. Each quality improvement project is ultimately focused on helping Hillel Lodge evolve to better serve the needs of the persons served. –Ted

Families understand that CARF accreditation is the gold standard for service organizations. They know that the organization is focused on continuous improvement and satisfaction of services. –Stacy

Because we place signage around our facility and on our website, we are often asked about it from our persons served and families. When we talk about it and share with them what it means, they are impressed with our desire to constantly be holding ourselves accountable, seeking growth, and striving to be a top provider offering quality services. –Tammy

Members voiced appreciation for the opportunity to be involved in the accreditation process. The members interviewed during CODAC’s survey felt empowered knowing that their feedback contributes to the evaluation of services. –Amy

While clients are involved in the actual survey, I believe that the accreditation process and outcome is often invisible to them. What they do see and experience is our commitment to delivering care that changes people’s lives which aligns with CARF standards. –David

Not so much in those direct words, but we do hear positive feedback about things that we do as a part of our efforts to meet the standards. For example, as part of maintaining a warm, safe, and welcoming environment for services, clients make comments about the cleanliness of the facilities, or the artwork in the clinics, and the opportunity to directly provide feedback about concerns they may have. Clients also appreciate the customer service focus offered and the opportunity to actively participate and provide input into services provided. –Brad

The families and youth have been very willing to talk with surveyors and share their experiences of the services provided and how they have been able to give their feedback into how services are offered. –Sue

Thank you to all who contributed to this article. We are grateful for your commitment to continuous improvement and enhancing the lives of persons served!

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CARF celebrates Recovery Month https://carf.org/blog/carf-celebrates-recovery-month/ Tue, 31 Aug 2021 15:00:20 +0000 https://carf.org/?p=4138 Formerly hosted by the Substance Abuse and Mental Health Services Administration (SAMHSA),...

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Formerly hosted by the Substance Abuse and Mental Health Services Administration (SAMHSA), and now supported by Faces and Voices of Recovery, the theme for National Recovery Month 2021 is “Recovery is for Everyone: Every Person, Every Family, Every Community.” Recovery Month celebrates the millions who have found recovery from mental health and substance use disorders and serves as an opportunity for education on the benefits of mental health and substance use treatment. SAMHSA defines recovery as “a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential.”

According to SAMHSA, there are four major dimensions that support recovery:

  1. Health: overcoming or managing one’s diseases or symptoms and making informed, healthy choices that support physical and emotional well-being.
  2. Home: having a safe and stable place to live.
  3. Purpose: conducting meaningful daily activities and having the independence, income, and resources to participate in society.
  4. Community: having relationships and social networks that provide support, friendship, love, and hope.

Recovery does not look the same for everyone and is not necessarily defined by abstinence or cessation of symptoms, but rather through a holistic look at a person’s wellness. This year’s theme highlights the fact that everyone’s journey is different but we “are all in this together,” and recovery is possible, especially with support. To CARF, this theme highlights the importance of community in recovery, made even more apparent throughout the course of the COVID-19 pandemic, which has disrupted support services and increased social isolation. While recovery should be celebrated all throughout each year, it is especially important to recognize those in recovery, given the prolonged grief and anxiety caused by the pandemic and the accompanying loss of life and economic and family stresses, which have increased the risk of substance use disorders and relapse.

CARF International commends all providers for their courageous work in continuing to provide quality services to persons with substance use disorders during this challenging time. A great deal of recognition is due to providers and professionals in the addiction treatment field continuing to support those in recovery. With our surveyors, staff, and partners, CARF celebrates all those in recovery along with their families/support systems and communities.

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Social Workers: Generations Strong https://carf.org/blog/social-workers-generations-strong/ Tue, 31 Mar 2020 15:00:11 +0000 https://carf.org/?p=6753 March is Social Work Month. This year’s theme, Social Workers: Generations Strong,...

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March is Social Work Month. This year’s theme, Social Workers: Generations Strong, honors the powerful, positive impact the profession has had on society.

During this unprecedented pandemic, CARF acknowledges all social workers during National Social Work Month in collaboration with our International Advisory Council member, the National Association of Social Workers (NASW). We deeply value the courageous work of those in the field who continue to serve their communities and connect persons in need to essential services. We echo the combined statement of solidarity by NASW and the Canadian Association of Social Workers (CASW) in supporting our network of social services. Read the statement.

During the month of March, CARF recognized social workers across health and human services. Following this year’s Generations Strong theme, we reached out to social workers at various stages of their careers in the aging services field. Below are their insights on the social work profession.

Q: Briefly describe your career in the social work field. How did you get started? What motivated you?

I started in the social work field to make a lasting impact on individual lives one little victory at a time. We know there are significant system-related issues; however, it motivated me to start this career to be the bridge for patients’ access to services and counseling. 
—Jonathan Moore, M.S.W., Clinical Social Worker, Maple Health Centre, Maple, ON

I was working in geriatrics as a psychiatric treatment assistant in the summers while I completed college. I was thinking at first of environmental studies, but the head nurse on my unit strongly encouraged me to be in a “people field” like social work. I listened to her advice.
— Karen Appel, LICSW, Director of Social Services, Heritage Health Care Center, Utica, NY

I was motivated to serve at a young adult age—after someone provided local agency support for my maternal grandparent who received dialysis services that required a lot of care coordination by a case manager. This was gratifying to learn that someone cared about a member of my family that much when we lived three hours away. The support services were in place, and this gave my family members advocacy services that allowed us to focus on the caregiver role more. 
— Andrea Mckie-Bradley, Social Services Director, ACTS Retirement-Life Communities, Charlotte, NC

I have always had an interest in working with people in a helping profession. I started by working in community services and quickly realized that in order to better serve my clients as well as to develop myself professionally, I would need formal training and education. 
— Devora Waxman, Director, Social Work and Care Coordination, Better Living Health and Community Services, Toronto, ON

I studied social work in college with a concentration in gerontology and graduated in 1985. I originally wanted to work with children; however, I was required to do an internship in a nursing home. After that, I never left the long-term care setting. 
— Linda Unger, Social Service Coordinator

I have been in the field for almost 21 years, all in geriatrics. I got into the field because my grandmother lived with Alzheimer’s disease, and I wanted to help others who are affected. Now I am providing dementia education to other staff in my community. 
— Catherine Nakonetschny, LCSW, Social Services Coordinator, The Evergreens, Philadelphia, PA

While getting my undergraduate degree, I rented housing from an 86-year-old woman, and we became friends. I saw her spirit, her strength, and her challenges. She taught me to grow roses and bake bread, how to keep house and to go on adventures. I changed my major from music to social work, graduating in 1974 with a B.S.S.W., and going on to attain an M.S.W. in 1978, obtaining my LCSW, and finding a long, satisfying career in geriatrics. I have loved every job, some more than others, but have always learned and grown. I am very near retirement, and I could be considered a peer counselor at this point, but my passion for the work is stronger than ever. I love coming to work each day, feeling strong and committed, and going home knowing I connected, supported, and helped clients and team members. 
— Barbara Bolin, M.S.W., LCSW, Social Worker, Goodwin House, Alexandria, VA

I started my career in 1996, working at a children’s residential facility as mental health home-based clinician, then as a case manager, helping others to help themselves and advocating for those who do not have a voice.
— Teri Miskowski, Assistant Administrator, Rice Manor, Parma, MI

Q: What was it like to be a social worker when you began your career?

It was quite the experience as I was only 22 when starting my career. I was assisting individuals a lot older than me, but over time I gained confidence. I started to see the impact of my work and of my fellow social workers. That is what pushed me to complete my M.S.W. to create further systemic change.
— Jonathan

I started in [redacted] and worked in subsidized housing for senior citizens. I was a jack of all trades there, calling Bingo, taking residents on trips, etc. After a few years, I returned to [redacted], but as a social worker, having completed my B.S.W. and a master’s degree in geriatrics as I knew it was my profession of choice. 
— Karen

It was hard. There was not a lot of guidance when I first started, but that has improved over the years. 
— Catherine

When I began my career, the field of geriatrics was fairly new. Services for behavioral health were more comprehensive and Medicare coverage was more comprehensive. There seemed to be more community-based programs for mental health, in-home support, and activism. On the bright side, there is so much more knowledge about aging, dementia, and abilities in the aging person. People are living longer; have a “younger opinion” of themselves; and have access to information about fitness, diet, and healthy aging.  
— Barbara

Q: How has social work changed over your time in the field?

I have been in the field for about eight years now. When I first started, it was very much based on advocacy. However, with systemic pressures and funding cuts, unfortunately clients suffer. However, over time, I learned when working in the healthcare system, the more informed the clients are, the more you can empower them. This is where I started to see the impact I wanted to have in society. I learned you have to change the system from within and celebrate the small victories along the way. As social workers, we continue to push for change and advocate for our clients. I foresee there will be a big shift in the coming years in healthcare especially. 
— Jonathan

As our population is aging and drawing more resources from the healthcare system, the system is becoming strained and struggling to meet the needs of patients. Social workers in the community are providing services to clients who years ago would have been in long-term care beds. Our clients are incredibly frail and complex, and our practice has needed to change in order to meet our clients’ needs. 
— Devora

I believe over time the role of the social worker has become more important in long-term care. 
— Linda

I think we have access to more resources, including colleagues from other states and backgrounds. It gives me different perspectives to consider. 
— Catherine

I see social work as leading the way in bringing attention and empathy to so many populations such as LGBTQ, transgender, immigrants, considering and calling out racial and religious discrimination, mental health, social media, and so many more realms. Social work has not shunned tough societal problems, and always seeks to assure dignity and respect for all. 
— Barbara

Q: If you could give a piece of advice to someone considering a career in social work, what would you tell that person?

I would tell them to consider a career in geriatric social work. With our aging population, there is tremendous professional opportunity as well as the opportunity for a very rewarding career! 
— Devora

Remember why you are a social worker. Some days are going to be really difficult, but if you remember why you do this work, it will make those days few and far between. 
— Catherine

Learn all you can about the art and craft of social work, keep your horizons as broad and diverse as possible, and seek knowledge and awareness from every place and everything. Keep asking ‘what if’ and ‘what next’ and ‘what more.’ 
— Barbara

Focus on the individuals you serve, speak your mind, and share your thoughts and concerns in advocating for them. They are our focus, and we work strictly for them and their well-being. 
— Teri

As we enter this new decade and Social Work Month comes to an end, CARF honors the powerful and positive impact social work has on society. We wish to thank those who contributed to this article as well as all social workers across the health and human services field.

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When the opioid crisis comes home https://carf.org/blog/when-the-opioid-crisis-comes-home/ Thu, 27 Feb 2020 15:00:07 +0000 https://carf.org/?p=4142 When an opioid treatment program opens its doors in a residential area,...

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When an opioid treatment program opens its doors in a residential area, its neighbors may have concerns, but these programs are providing life-saving treatment that will ultimately strengthen the community.

As local, state, and federal leaders continue to address the opioid epidemic, there is much discussion around access to care. Some of this discussion centers on concerns about programs, particularly those offering medication-supported recovery, opening in communities. Although there may be nuances specific to an opioid treatment program (OTP), there are many similarities to any new business opening in a community with residents asking questions. 

Who are the proprietors? Why this neighborhood? How will this impact traffic, noise, and parking? Can this affect my home’s value? Fortunately, OTPs have federal requirements and accreditation standards to address some of these concerns.

These questions might be especially important if the community has little history or information about the business, or worse, if the community has been misinformed about OTPs or what are sometimes referred to as methadone clinics. OTPs are opening across the nation, including in residential areas, to combat the opioid crisis. Unfortunately, they carry a stigma that can evoke a “Not in my backyard” reaction from community members. Residents may worry the program would bring loitering, crime, active drug dealing, and drug use into their community. 

The reality is OTPs provide life-saving treatment and ultimately strengthen communities. 

What is an OTP?

OTPs provide comprehensive opioid-use disorder treatment that includes FDA-approved medications, such as methadone, buprenorphine, and naltrexone, along with counseling, medical services, and connections to social services.

OTPs are heavily regulated at the federal and often state and local levels. They are licensed (and visited) by the Drug Enforcement Agency. They must also be certified by the federal Center for Substance Abuse Treatment (CSAT), a division of the Substance Abuse Mental Health Services Administration (SAMHSA). CSAT has developed robust regulations included in 42 CFR, Part 8 under which OTPs operate. Additional oversight is provided through national accreditation by an independent accreditor like CARF International. The CARF accreditation process occurs at least every three years to ensure quality treatment services and to assess compliance with CSAT regulations. CSAT is notified if an OTP is not in compliance with a federal regulation or guideline. Beyond this rigorous federal oversight, most OTPs also have the added layer of their state or local licensing body.

Why this community? Will this bring drug use here?

OTPs are required to measure community impact when opening. They must assess the community’s needs and understand both the negative and positive influences of their physical presence on the community. So an OTP moves into a community to address an unmet need as opposed to bringing a problem into the community. It must engage community leadership and other stakeholders throughout the opening process and an ongoing basis. CARF accreditation surveys assess the OTP’s conformance to this requirement.

Will this program bring loitering and traffic?

OTPs with CARF accreditation are required to have an ongoing community relations plan. This plan must include elements of community education on substance use and the use of medications in treatment, identification of staff members to serve in community relations activities, and written procedures to address and resolve problems such as patient loitering and medication diversion. The plan must also ensure that the program’s operation does not adversely affect community life. To conform to this standard, the OTP should monitor traffic flow and loitering and seek input from community stakeholders about the program’s impact on the community. Again, conformance is assessed during the accreditation survey.

Are the medications dangerous; will they be sold illicitly in the community?

Any medication that is not used as intended can be dangerous, and this is especially true of controlled substances. OTPs must have robust controlled-substance diversion control plans with specific measures to reduce the possibility of diversion from legitimate treatment use. They have to assign specific responsibility to medical and administrative staff to carry out the diversion control measures and functions described in the plan.

In addition, individuals served by the program must attend the clinic daily and take their dose in the presence of nursing staff. A person may be eligible for “take-home” medication on a graduated scale based on their treatment progress. Eight-point criteria assess community and individual safety in these cases.

Similar to the community relations plan, the diversion control and take-home systems are reviewed in the accreditation process.

How can I learn more about what is happening in the community?

Engage with the program leadership; learn more about how they plan to operate the program and co-exist in the community. OTPs are required to have a program sponsor whose responsibilities include ensuring compliance with all federal regulations. Community members can ask for the sponsor’s contact information and bring any concerns or complaints to that person. The accrediting body itself can also be a mechanism for sharing feedback and resolving issues.

Some questions a community member may want to ask the program sponsor and other leadership include:

  • How was the program site selected?
  • What population(s) does the program plan to serve?
  • What are the hours that you will provide dosing services?
  • How do you plan to control traffic flow and overcrowding?
  • How will you manage parking and wait times?
  • What are your measures to prevent diversion?

An OTP’s community relations activities promote recovery and integration of the persons served. Opening the conversation keeps leadership accountable to the community while providing life-saving services to its residents. Informed community members can change public perception and promote recovery.

If you have concerns about a CARF-accredited OTP, please go to www.carf.org/accreditation/public/ for tips and information on how to provide feedback about the provider to CARF.

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10 tips: How unpaid caregivers can beat burnout https://carf.org/blog/how-unpaid-caregivers-beat-burnout/ Wed, 13 Nov 2019 15:00:24 +0000 https://carf.org/?p=4136 November is National Family Caregiver Month sponsored by the Caregiver Action Network....

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November is National Family Caregiver Month sponsored by the Caregiver Action Network.

With a growing aging population, many adult children and other loved ones step up to provide care. It seems idyllic for seniors to reside with relatives instead of unfamiliar staff in a retirement community, and for those with illnesses or disabilities to be cared for by people who know and love them, but family caregivers take on a significant amount of work in addition to regular jobs and family responsibilities, which can lead to extreme burnout.

The Caregiver Action Network, formerly the National Family Caregivers Association, reports that more than 43 million Americans care for a loved one who is aging or lives with a chronic illness or disability—and the scope of their work is significant. Gallup reports that the average unpaid caregiver spends a full 13 days per month on tasks like shopping, food preparation, housekeeping, laundry, transportation, and giving medication; 6 days on feeding, dressing, grooming, and bathing; and 13 hours researching care services or information on disability or disease, coordinating healthcare appointments, and managing financial matters.

Although this around-the-clock caregiver’s level of dedication is admirable, the time and effort required can take a toll—especially if a caregiver has other responsibilities and challenges. As the average age of an unpaid caregiver is 49.2 years old, many are still in full-time jobs and/or juggling parental responsibilities. AARP, a CARF International Advisory Council (IAC) member, found that 60% of caregivers in the U.S. also work other jobs, nearly half have struggled to balance caregiving with work, and 8% report their career growth is affected by caregiving responsibilities.

Caregiving stress results in a range of physical and emotional symptoms. In one American Psychological Association (also a CARF IAC member) study comparing caregivers with non-caregivers, caregivers displayed a 23% higher level of stress hormones and a 15% lower level of antibody responses. Persons caring for family members with dementia were more likely to have weakened immune systems and greater odds of developing chronic illness. And caregivers providing 36-plus hours of care per week were more likely to display depression or anxiety. Many caregivers may be unlikely to seek treatment for their own symptoms or acknowledge their burnout or need for help due to feelings of guilt and a sense of duty to the care of their loved one.

“Caregivers are taken for granted, and they are invisible in the system,” said Georgetown University Professor of Public Policy Judy Feder. “It’s bad for them, it’s bad for care recipients, and it’s bad for the system.”

What can be done to address your threat of burnout if you’re a caregiver? In recognition of National Family Caregiver Month in November, some experts weighed in with these tips:

  1. Acknowledge your challenging role. Admitting your job is not always easy doesn’t imply a lack of devotion to your loved one; rather, it’s the first step in finding solutions. “Daughters, spouses, partners, and friends frequently do not perceive themselves as a caregiver—and as a result, do not recognize the need to seek support or don’t know the ‘language’ that can open doors to valuable resources,” says Jed Johnson, CARF’s managing director of Aging Services.
  2. Don’t expect perfection. You may not be able to handle every element of your caregiving job on your own, or you may need to go part-time. You’re human; you may make mistakes; choose the wrong options; and get tired, frustrated, or snarky. Forgive yourself and move forward. “It’s normal to feel guilty sometimes, but understand that no one is a perfect caregiver,” notes staff of the Mayo Clinic. “Believe you are doing the best you can and making the best decisions you can at any given time.”
  3. Accept help. Don’t be too proud to accept help offered by friends or other family members. Keep a list of tasks others could complete for you— perhaps running errands, bringing a meal, or providing transportation for your loved one.
  4. Set realistic goals. Establish boundaries by saying no to actions and events you know to cause too much stress, such as taking your loved one on a faraway trip or hosting a major family gathering on their behalf.
  5. Stay organized. Eliminate hurry and indecision by keeping lists and calendars and breaking each day down into manageable routines.
  6. Become connected. Learn about caregiver resources in your community. Support groups made up of like-minded individuals may allow you to vent your frustrations while sharing joys and sorrows. You may also identify services such as transportation, meal delivery, or housekeeping that are geared toward caregivers.
  7. Don’t isolate yourself. Spending every day focusing on your loved one without other socialization can make you feel alone. Schedule time with other family and friends who can support you in your caregiving goals, and pursue activities you find relaxing and enjoyable.
  8. Advocate for your own health. Control your stress levels and maintain your wellness by following a solid sleep routine, staying hydrated, having regular physicals, and seeking counseling as needed. An impartial third party can help you understand and cope with your feelings.
  9. Look into respite care. Respite care comes in several forms and may be covered by insurance. Options include in-home aides, adult care centers, or short-term care programs. “Respite care provides relief for the caregiver and helps to reduce burden and stress,” advises Johnson, who recommends checking out the ARCH National Respite Network and Resource Center. “It can be for a few hours a day, a few days a week, or even a few weeks a year.”
  10. Take advantage of industry resources. Optimize the help and resources available through caregiver advocacy organizations. Johnson recommends AARP; the Family Caregiver Alliance/National Center on Caregiving; the Caregiver Action Network; and the National Alliance for Caregiving.

Caring for a loved one can be a full-time commitment. Recognizing the physical, mental, and emotional challenges of being an unpaid caregiver is crucial in keeping yourself from becoming overwhelmed. Asking for help does not mean you are any less committed to your loved one; it will only make you a better caregiver to arm yourself with resources in order to provide the best care possible.

CARF’s provider search can help you find an accredited program in your area. Visit our Resources page to explore consumer guides and articles on caring and advocating for the health of your loved ones.

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Addressing social determinants with higher standards https://carf.org/blog/addressing-social-determinants-with-higher-standards/ Thu, 25 Jul 2019 16:00:00 +0000 https://carf.org/?p=4140 The CARF standards confront barriers of access, capacity, and social determinants that weaken outcomes...

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The CARF standards confront barriers of access, capacity, and social determinants that weaken outcomes for providers and the persons they serve.

Social determinants of health (SDH) are the conditions in which people live, work, and age and include factors like housing stability, employment status, geographic location, education, and other socioeconomic circumstances. SDH, often determined by distribution of wealth and resources, has proven responsible for inequities in healthcare and has become its biggest cost-driver. And this inequity is proving very costly; some $111 billion in health-related costs in the next decade will be the direct result of unstable home conditions, according to a study published by Children’s HealthWatch at Boston Medical Center.

This relationship between SDH and health is continually monitored by the World Health Organization (WHO). WHO’s position is that unjust and avoidable inequalities in environmental risks, between and within countries, call for relevant policies and interventions to mitigate and reduce risk in the affected population groups. Echoing WHO initiatives, Healthy People 2020 has established and reports on its ten-year national objectives for SDH, with the goal of creating better health across the U.S.

These global and national initiatives aim high, but the disparity in healthcare is most prevalent at the community level, and it’s the providers of health and human services who are directly absorbing the high cost and are expected to address SDH on the frontline. “Social determinants of health are no longer a novelty; they are part of a comprehensive strategy to deliver quality, affordable healthcare,” writes Margaret A. Murray, CEO of the Association for Community Affiliated Plans, in Modern Healthcare. “Collaboration between health plans, providers, state agencies, and the federal government should be the norm, not the exception.”

Providers can turn to the CARF standards for guidance in confronting barriers of access, capacity, and social determinants that can weaken service outcomes. Outcomes- and evidence-informed service delivery involves addressing the unique, changing needs of individuals across ages and life situations. As persons served transition through life milestones related to behavioral health, disability, and medical rehabilitation, their services must adapt. Any transition can pose barriers that affect service delivery and, ultimately, a person’s quality of life and outcomes. CARF’s accreditation model is ideally constructed to address these barriers and to help maintain service continuity.

CARF accredits programs that serve individuals across the lifespan. The field review and standards development process ensures that evidence-based practices related to service integration, transitions, and population specialization are written into all areas of the standards.

“We have been developing quality standards for services that address social needs since our inception,” says Debbi Witham, CARF’s managing director of public policy. “Our standards are designed to encourage organizations to include this in their planning. For instance, the standards related to accessibility planning include financial, attitudinal, transportation, and other barriers related to social needs that may impact an individual’s ability to access services that may improve their health and community functioning.”

CARF standards require accredited programs to examine the needs of the community when developing services. These needs should inform strategic planning efforts and how outcomes and improvement data are collected. CARF’s General Program/Care Process standards support and guide organizations to better understand and stratify the needs of the population served and create collaborative relationships with community resources.

The accreditation process also connects providers with expert peers across the global health and human services community. CARF surveyors bring expertise from their own programs and offer insight and consultation stemming from hands-on experience in similar communities.

CARF works with more than 2,700 providers accredited for programs that target SDH, many in conjunction with social services that encourage a holistic health perspective. Although the concept and practice of assessing and addressing SDH appears in the ASPIRE Performance Measurement, Management, and Improvement standards, CARF does accredit specific programs that deal more directly with SDH, including:

  • Case Management/Services Coordination
  • Community Housing
  • Community Integration
  • Crisis Intervention
  • Crisis Stabilization
  • Employee Assistance
  • Health Home
  • Home and Community Services
  • Supported Living
  • Rapid Rehousing and Homelessness Prevention Program
  • Foster Family and Kinship Care

Witham says CARF will continue to concentrate on improving healthcare quality for persons served with a strong focus on social needs. “These services have not historically been purchased through traditional healthcare payment systems. However, that’s changing, and many payers are struggling with how to identify quality in those services and realize an effective return on investment. CARF’s standards and accreditation process can help payers identify quality services delivered by organizations with efficient business practices and performance management systems that focus on ensuring a strong ROI.” Deploying data-driven systems and tools, providers can effect real change—locally and globally—in reducing SDH-related barriers and improving outcomes for persons served.

For a full list of CARF program descriptions, visit www.carf.org/accreditation/programs.

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Alternatives to opioids, continued: The Community Integration Pain Rehabilitation model https://carf.org/blog/alternatives-to-opioids/ Fri, 07 Jun 2019 15:00:02 +0000 https://carf.org/?p=6755 Using options like acupuncture, physical fitness, pottery, and more within an organized...

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Using options like acupuncture, physical fitness, pottery, and more within an organized community-based program can help people reduce reliance on opioids.

In the April issue of this series, CARF covered the nature of pain, which tells us that chronic pain is best managed not by opioid pain medication, but by a biopsychosocial approach that addresses the physical, psychological, and social needs of each individual. This holistic approach is supported by CARF standards for Interdisciplinary Pain Rehabilitation (IPR) programs. CARF spoke with Greg Smith, a CARF surveyor and the director of Progressive Rehabilitation Associates (PRA). PRA runs IPR, specialty brain injury, and occupational programs in Portland, Oregon, and a Community Integration Pain Rehabilitation Program in Vancouver, Washington, all accredited by CARF. What makes the Vancouver program unique is that it is the first IPR program to be accredited under CARF’s Behavioral Health Community Integration standards—with a Psychosocial Rehabilitation Specialty. (Pain programs typically seek accreditation through CARF’s Medical Rehabilitation Standards Manual.)

In 2015, the medical director for an insurance company approached Greg and asked him to design a program for insured individuals with a long history of treating pain with opioids via emergency rooms and urgent care facilities. Together with his staff, Greg researched and developed what is now PRA’s Community Integration Pain Rehabilitation Program. The keys to success of the program were to establish working relationships with primary care physicians, expand services offered by creating linkages to the community, and offer a safe space where people can learn at their own pace.

This IPR program is a hybrid of psychosocial rehabilitation and a clubhouse model that includes structured activities under one roof and linkages to primary care, substance abuse treatment, therapy pools, community mental health services, massage and movement specialists, and others providing low-cost or sliding-scale services. Expressive arts, including pottery and painting, support themes like “You are not your pain.” Persons served can participate in weekly nutritionist-guided cooking classes to prepare non-inflammatory meals and leave with the recipe. Translating skills learned to the home and community is emphasized along with use of the community services available.

A program is designed for each individual in cooperation with the primary care physician and based on that person’s needs. Each person served has a case manager who assists with goal setting and skills development. PRA can recommend treatment, monitor the patient’s physician schedule, and call the insurer to assign a caregiver, but only if necessary. The clubhouse activities are paired with cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) techniques, combined with traditional behavioral approaches, as well as complementary health approaches such as acupuncture and hypnosis. Activity coaching and occupational therapy round out the physical components to improve function.

The program is offered five days per week, and persons served are encouraged to attend any and all sessions and can stay until the facility closes. Content is reinforced to keep those with sporadic attendance engaged. A therapist is always present on site, but the goal is for persons served to self-manage their care. Group therapy sessions help individuals work on issues among themselves. Individuals are in control of their treatment plan. Greg says the program is working because persons served are engaged in their own treatment, but more so because “people have fun there.”

This “fun” program isn’t reducing persistent pain simply by distraction. Organized activities and therapies promote neuroplasticity in a patient, which allows the brain to compensate for injury or trauma by forming new neural connections. To reconnect injured or severed neural pathways, neurons must be stimulated by activity. The new neural pathways help to restore or improve a patient’s function, precisely the goal of IPR.

Greg’s hope is wide proliferation of this model. When asked what advice he’d give to an organization looking to adopt IPR, he says emphatically “Do it!” Greg recommends that a program look into its own community and use the resources available. PRA added acupuncture to its programming by linking to local providers of the service, and establishing a relationship with the community swimming pool enabled further recreation opportunities.

PRA’s community pain rehabilitation program has garnered the attention of other large insurance companies as well. In April, Greg presented this rehabilitation model for persistent pain to United Health Group, which is interested in migrating its current pain treatment protocols to the community-based IPR model.

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Alternatives to opioids, continued: Understanding the nature of pain https://carf.org/blog/alternatives-to-opioids-continued/ Thu, 18 Apr 2019 20:47:00 +0000 https://carf.org/?p=9145 These articles complement a three-part CARF webinar series on pain management, starting with...

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These articles complement a three-part CARF webinar series on pain management, starting with the physiology of pain, and continuing with a discussion surrounding the interdisciplinary pain care model presented by CARF surveyor Greg Smith, whose Community Integration Pain Rehabilitation program is accredited under CARF’s Behavioral Health Standards Manual.

In October, we highlighted some emerging medtech options that may help reduce reliance on opioids for pain management. Next, in our series on pain management, in the context of the current opioid crisis, we examine the deeper issue of the nature of pain itself.

Although pain stems from physical injury or tissue damage, it actually is a mental and emotional response. An injury causes nerve pathways to send a signal to the brain. The brain then generates a mental and behavioral response, which a person experiences as pain. The experience of pain, the brain’s responses, can exist or remain even in the absence of physical damage to the body. And because pain is a sensory experience, much like the experience of fatigue or hunger, it cannot be precisely measured. A quantifiable dose of opioid pain medication is able only to reduce sensory awareness of pain. The effectiveness of opioids to counteract pain in this way decreases over time, meaning a person will need an increased dose to achieve the same sensory-awareness reduction, causing dependence and eventual addiction.

The National Institutes of Health’s National Pain Strategy concludes that pain is best managed with a “biopsychosocial” approach, a combination of methods to address the physical, psychological, and emotional needs of each individual person. This holistic, person-centered approach has been supported by CARF standards for Interdisciplinary Pain Rehabilitation (IPR) programs for more than 30 years.

Key elements of an IPR program:

  • Primary focus is return to functioning rather than simply eliminating pain.
  • Uses a multifaceted approach that considers the psychology of living with pain, including a person’s life roles, children and family, and quality of life.
  • Considers a variety of treatment approaches based on evidence-based practices, clinical pathways, and protocols.
  • Person served is engaged in his or her treatment plan; self-management of care.   

Webinar 1:

April 17, 2019 – Understanding Persistent Pain: Physiology and a Population Health Approach

Presenters: Zachary Watson, PT, D.P.T., OCS, National Director of Quality and Research, PT Solutions

Tye Marr, PT, OCS, Senior Residency Faculty, PT Solutions

Webinar 2:

May 14, 2019 – The Treatment of Persistent Pain: The History and Evolution of Models of Care

Presenter: Gregory Smith, Ph.D., Director, Progressive Rehabilitation Associates

Webinar 3:

June 18, 2019 – Managing Persistent Pain and Substance Use Disorder: Identifying Trusted Providers and Building a Continuum

Presenter: Gregory Smith, Ph.D., Director, Progressive Rehabilitation Associates

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Your health literacy: 5 ways to be your own best advocate https://carf.org/blog/your-health-literacy/ Mon, 25 Feb 2019 15:00:34 +0000 With healthcare information more widely available than ever, consumers are boosting their...

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With healthcare information more widely available than ever, consumers are boosting their health literacy, taking the initiative to educate themselves more thoroughly on how to take care of themselves.

“Consumer engagement with healthcare continues to grow, from searching for care and accessing new channels of care to tracking and sharing health data,” notes a recent Deloitte study. “Health systems, clinicians and health plans — as well as biopharmaceutical and medical device companies — are developing tools and strategies that can help consumers become more engaged in their health.”

Here are some suggestions for taking control of your own health literacy.

Be an informed healthcare consumer

Keep copies of your health records from all providers you see and share them with new or different providers as needed. Keep a written list of the names of every medication you take and every condition you have so you can share this information as needed with new healthcare providers as well as research them to keep up on breaking news that may be related.

Choose providers wisely

When possible, do some screening. You may be under time pressure or other stress when looking for a provider, but it’s perfectly reasonable to try and conduct online research, read reviews, schedule visits and tours, and ask questions until you feel confident you’ve chosen the best possible option. Facilities and providers can greatly vary in quality and effectiveness.

Of course, such screening is crucial when it comes to continuing care retirement communities (which also should be checked for financial soundness) and assisted living facilities. Look to do screening of these types of services in advance of when you or your loved one might need them.

Make use of technology

Even if you’re not particularly tech-savvy, it’s worth your while to learn to use some digital and mobile technology that helps you communicate with providers, track your own health, get info on demand, remember appointments, etc. This type of technology is often called telemedicine, or telehealth.

Patient portals, for example, are handy, secure websites offered by providers that allow them to provide updates on your personal health information 24–7. They allow you to track recent doctor visits, get lab results, request prescription refills, make payments, and more.

Another area of health technology’s popularity is mobile health (mhealth). You can use smartphone apps to help remind you of healthy behaviors, prescription schedules, or other assistance.

Know who will know

Be aware of the primary authorities for information on common conditions and illnesses. Many have resources for people and their families. Examples include the Brain Injury Association of America, the National Stroke Association, the United Spinal Association, ACRM, the American Psychiatric Association, and AARP.

For more ideas, ask your doctor or healthcare provider which authorities (and their websites) you can research on your own time.

Understand your rights

In the U.S., download and read the U.S. government’s Consumer Action Handbook and read the section on healthcare to be clear on your rights as a healthcare consumer.

In Canada, ABC Life Literacy’s Health Literacy section offers concrete tips to prepare for your next healthcare visit, including what your rights are and what to do if you feel they have not been met.

Never be afraid to seek information and ask questions. Taking charge of your own health and making educated decisions about providers can be empowering.

One place to start can be CARF’s provider search feature. Programs accredited by CARF are implementing best practices to help them address the unique personal healthcare factors of the people they serve.

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Alternatives to opioids: Medical technology offers other pain control choices https://carf.org/blog/alternatives-to-opioids-medical-technology/ Sun, 14 Oct 2018 20:51:00 +0000 https://carf.org/?p=9148 Partly in response to the opioid crisis, medtechs across the nation have...

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Partly in response to the opioid crisis, medtechs across the nation have ramped up development of devices that aim to manage pain without exposing patients to the risk of drug addiction.

Opioid misuse has been rising nationwide since the 1990s, since the widespread production of painkillers such as Oxycontin that weren’t initially deemed addictive. However, the drugs ended up creating dependencies, leading to nearly a half million U.S. deaths from overdoses between 2000 and 2014 alone.

To combat that, medtechs and other entrepreneurs have been exploring innovations that help address pain in less drug-intensive ways. A few examples:

  • Augmented/virtual reality devices: Through this technique, virtual reality glasses combine with apps to offer immersive environments that use the concept of neuroplasticity; breathing and mindfulness exercises, games, and other ways to help teach patients techniques for managing acute or chronic pain. Some vendors even combine the technology with data analytics to personalize experiences for users. In Forbes, Reenita Das recently predicted the market for such healthcare applications will reach $5.1 billion by 2025, with some 3.4 million patients taking advantage.
  • Neuromodulation devices: A number of tools in development or already in use treat pain by modifying the nervous system via electricity or highly targeted drug application. For example, a nerve stimulator can be placed in the spine or skin that then sends mild electric currents controlled by a mobile tablet to relieve symptoms.
  • Virtual pain consulting: The Veterans Administration is a leading organization in the fight against opioid addiction, looking to integrate evidence-based prescriptions and non-pharmacological solutions into pain control care plans — and using a virtual program called SCAN-ECHO to continually monitor those plans. E-consultations and telehealth tools are used to bring medical teams, patients, and families together for updates regardless of their physical locations. “We’re accomplishing something not typical within the Veterans Integrated Service Network — having sites working together in a non-competitive fashion to do multi-disciplinary, integrated programs,” explains Dr. Ken McQuad.

    This interdisciplinary approach to pain can include the use of telepsychology as well as remotely teaching rehabilitation techniques—such as body mechanics, posture, or strengthening exercises—to incorporate into a person’s life outside of a healthcare environment.

Perhaps even better news for patients? Many pain control alternatives may be covered by insurance.

“These therapies are covered by Medicare, insurance and worker’s comp, so people have the ability to have [them] paid for,” Medtronic exec Dr. Marshall Stanton recently said in reference to implantable devices. “It’s just a question of getting physicians to understand these are options.”

View this short video explaining what pain is and how to address it:

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