THE CALIFORNIA Helping Health Professionals Recover from

THE CALIFORNIA Helping Health Professionals Recover from DIVERSION Substance Use Disorders PROGRAMS OCTOBER 10, 2019

VIRGINIA MATTHEWS, RN, BSN, MBA Project Manager MAXIMUS 2 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

TOPICS OF DISCUSSION Signs, Symptoms and Impact of Substance Abuse in the Workplace What is the Diversion Program?

MAXIMUS Serves 8 Health Professional Licensing Boards Board of Veterinary Medical Board of Physician Assistant Physical Therapy Dental Board of Osteopathic Dental Hygiene Registered Nursing Pharmacy Board of California Medical Board Board Committee California Committee 4 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

Case study: Relapse Events RISK FOR HEALTHCARE PROFESSIONALS 10-14% 10-15% General population diagnosed with SUD Healthcare Professionals diagnosed with SUD* State: California Rate of relapse: In a retrospective study of relapse events, MAXIMUS identified that 75% of relapses occurred during first year of participation in the program, and 80% of those were during the first six months. 85% General population relapse within first year of recovery** 13% MAXIMUS Diversion Program participants relapse during first four years of recovery *Prevalence of substance abuse by physicians is between 10% and 15%. [Elliot 2010; O’Connor 1997; McCall 2001; Oreskovitch 2012; Berge 2009; Brooks 2012; Baldisseri 2007] **Annu Rev Clin Psychol. 2007; 3():257-84.

Article 3.5. Diversion Evaluation Committees § 4860. Legislative intent It is the intent of the Legislature that the Veterinary Medical Board seek ways and means to identify and rehabilitate veterinarians and registered veterinary technicians with impairment due to abuse of dangerous drugs or alcohol, affecting competency so that veterinarians and registered veterinary technicians so afflicted may be treated and returned to the practice of veterinary medicine in a manner that will not endanger the public health and safety. 6 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

Goal of the Diversion Program Protect the public health and welfare from Healthcare Professionals who may be impaired as the result of substance use disorders Immediately intervene and provide rehabilitation, help and hope in order to return the individual to safe practice. 7 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

Who is the Diversion Program? Board Worksite Monitor MAXIMUS Participant Random Drug Testing Support Group Facilitator Diversion Evaluation Committee 8 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

Application Process Board Referral - Participant agrees to participate in Diversion program after being notified by the Board that there is a complaint and investigation. Self Referral - Participant contacts MAXIMUS and requests to join the program Program is voluntary, must request to join Participant is enrolled in the Program, the investigation is completed, then set aside as long as the participant remains compliant and successfully completes In all cases, the Board is aware that the participant is enrolled in the program, and the case is managed in the same way 9 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

Initial Program Steps Intake assessment (phone) Clinical assessment (in-person with licensed clinician), no charge to applicant Entry into treatment, as recommended Weekly communication with MAXIMUS team (Case Manager) until seen by Committee, then monthly Remove from work until determined safe to practice 10 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

Program Components Community-based Support Groups 12-Step Meetings or Community Support Groups (AA/NA, Celebrate Recovery, etc.) Daily meetings to start (90 in 90) Peer support group, once weekly Led by licensed therapist Written monthly self report Weekly check in calls with Case Manager until seen by DEC, then monthly 11 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

Random Drug Testing Enroll in Random Drug Testing within 48 hours of intake Daily check in with lab provider (Phone, web or mobile app) When selected, must test same day Extensive test panel with low cutoff values (highly sensitive) Urine most common, also may use hair and blood ETG/ETS tests for alcohol metabolite in urine (approx. 3 day detection) PEth tests for alcohol metabolite in blood (approx. 3 week detection) Hair test for multiple substances (approx. 3 month detection) Not currently using breath, sweat, saliva or SoberLink

Return to work Participant must apply to DEC to return to work DEC evaluates readiness by considering: Compliance with program requirements Drug test results (Uniform Standards require at least 30 days of negative results to return to work) Recommendation of support group facilitator Participant’s own report of progress 13 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

Return to Work When a job is offered, must identify a worksite monitor Participant must submit release of information Agreement signed by worksite monitor (WSM) Provide contact information for WSM and employer MAXIMUS Case Manager must provide training to WSM 14 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

Return to Work Submit Org Chart to demonstrate that the Worksite Monitor is at least one step above the participant on the Org Chart In private practice, monitor must be a peer willing to make unannounced visits Submit Job Description Submit Affidavit that WSM meets criteria, has been trained, and agrees to expectations of position 15 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

PROGRAM COSTS Intake Assessment (no charge to participant) Clinical Assessment (no charge to participant*) Program administrative fee Veterinarians: 2000 one-time fee may be paid in installments Dentists, Dental Hygiene, and RDAs: 100/month; RNs: 25/month; Pharmacists: 100/mo; PAs, PTs & Osteopathic Physicians: 369/month-full administrative fee)

PROGRAM COSTS Support group (Varies, approx. 20-40 per month) Health care costs (varies) (e.g., Inpatient, Residential, Intensive Outpatient SUD treatment, psychiatric exam, medications, counseling, therapy, etc Random Drug Testing (per test, 62.50 collection fee)

Transition Period--One Year BEFORE COMPLETION AFTER 2 years of good compliance Participant is placed on reduced monitoring for a period of one year before granting successful completion The objective of Transition is to allow the participant to take full responsibility for their own recovery process while still in the Program. Participant must “petition for Transition” wherein they write an essay examining their life’s journey into recovery, develop a relapse prevention plan, and obtain letters of reference from sponsor, family members and support group facilitator. 18 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

Successful Completion Criteria Demonstrate a manner of living that supports ongoing recovery Have proof of negative random drug tests, and negative hair and alcohol tests prior to program completion Have no other evidence of relapse within 24 months of completion date Have completed at least 3 years of satisfactory participation 19 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

Diversion Evaluation Committee “DEC” Model is unique to California, and is used by 5 of the 8 Boards Formally reviews and accepts applicants into the Program Formulates a participant’s ongoing recovery plan Reviews and approves requests to change recovery plan Three meetings annually Follows Badgely-Keene Open Meeting Act 20 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

§ 4870. Agreements of participants to cooperate with treatment program Each veterinarian and registered veterinary technician who requests participation in a diversion program shall agree to cooperate with the treatment program designed by a diversion evaluation committee. Any failure to comply with the provisions of a treatment program may result in termination of the veterinarian's or registered veterinary technician's participation in a program. 21 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

DEC Members Appointed by the Board, majority vote Three members of a diversion evaluation committee shall constitute a quorum for the transaction of business at any meeting. Any action requires the majority vote of the diversion evaluation committee. Each diversion evaluation committee shall have the following composition: (a) Three veterinarians licensed under this chapter. The board in making its appointments shall give consideration to recommendations of veterinary associations and local veterinary societies and shall consider, among others, where appropriate, the appointment of veterinarians who have recovered from impairment or who have knowledge and expertise in the management of impairment. (b) Two public members. Each person appointed to a diversion evaluation committee shall have experience or knowledge in the evaluation or management of persons who are impaired due to alcohol or drug abuse. 22 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

DUTIES OF DEC COMMITTEE Each diversion evaluation committee shall have the following duties and responsibilities: (a) To evaluate those veterinarians and registered veterinary technicians who request participation in the program according to the guidelines prescribed by the board and to consider the recommendation of the administrative physician on the admission of the veterinarian or registered veterinary technician to the diversion program. (b) To review and designate those treatment facilities to which veterinarians and registered veterinary technicians in a diversion program may be referred. (c) To receive and review information concerning veterinarians and registered veterinary technicians participating in the program. 23 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018

DUTIES OF DEC COMMITTEE (d) To call meetings as necessary to consider the requests of veterinarians and registered veterinary technicians to participate in a diversion program, and to consider reports regarding veterinarians and registered veterinary technicians participating in a program from an administrative physician, or from others. (e) To consider in the case of each veterinarian and registered veterinary technician participating in a program whether he or she may with safety continue or resume the practice of veterinary medicine or the assisting in the practice of veterinary medicine. (f) To set forth in writing for each veterinarian and registered veterinary technician participating in a program a treatment program established for each such veterinarian and registered veterinary technician with the requirements for supervision and surveillance. (g) To hold a general meeting at least twice a year, which shall be open and public, to evaluate the program's progress, to review data as required in reports to the board, to prepare reports to be submitted to the board, and to suggest proposals for changes in the diversion program. 24 MAXIMUS: PRESENTATION TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA 09/26/2018