Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Ludy Young, LADC I¹, Brent Stevenson, LADC II¹, John Cromwell, LADC II¹, Dominique Gutierrez, LADC I¹, William Graham, LADC II¹, Moses Williams, LADC II¹, Patricia Dowd, RN, MSN¹, Benjamin Shelton, MD¹, Whitney Holmer², Jonathan Olshaker, MD¹, Judith Bernstein, PhD, RNC³, and Edward Bernstein, MD⁴. (1) Department of Emergency Medicine, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118, 617-414-4399, Ludy.Young@bmc.org, (2) Department of Emergency Medicine, Boston University School of Medicine, 1 Boston Medical Center Place, Boston, MA 02118, (3) Youth Alcohol Prevention Center, Boston University School of Public Health, 715 Albany St., Boston, MA 02118, (4) Youth Alcohol Prevention Center/Dept. of Emergency Medicine, Boston University School of Public Health, 715 Albany St., Boston, MA 02118

Background: Project ASSERT is an ED program at Boston Medical Center, funded in 1993 as a federal demonstration grant. Six Health Promotion Advocates (HPAs), hired from the community, work collaboratively with ED professionals to screen, intervene, and facilitate access to primary care, preventive services and substance abuse treatment. In 1998, Project ASSERT became a hospital budget line item, providing services daily from 8:30am-midnight. Physicians and nurses are more willing to screen patients because HPAs are a resource for the lengthy and complex referral process. Since 1993 Project ASSERT has trained >2000 health care professionals across the nation in this model.

Results: From 1999-2005, Project ASSERT served 27,101 patients (32% female; 46% Black, 16% Hispanic; 27% without primary care and 61% smokers. 15,786 (58%) screened positive for unhealthy current alcohol and other drug use. 11, 315 patients without SA (42%) received primary care appointments and referrals to mental health and preventive services. At-risk and dependent drinkers and drug users received motivational interviews. 6,862 (43.5%) accepted placement in detox, 1359 (8.6%) were referred to outpatient services, and 6677 (42%) to NA/AA.

1856 (21%) who requested detox could not be placed because of bed unavailability (a 25% increase in the last two years). Uninsured patients had an 83% greater risk of bed unavailability than the insured (p<.000; 95% CI 1.68, 1.98).

Conclusion: The Project ASSERT model represents an innovative collaboration between public health, peer advocates and medical providers to improve the care of patients with alcohol and other drug related illnesses and injuries.

Learning Objectives: At the conclusion of this session, the participant/learner will be able to

• Define the term 'in-reach'--a new role for community outreach workers/public health advocates in an Emergency Department setting.
• Describe a collaborative model for screening, brief intervention and referral to treatment in the Emergency Department.
• Identify the scope of the problem of detox bed unavailability for uninsured patients and strategies to address this problem.

Keywords: Community Health Promoters, Substance Abuse

Presenting author's disclosure statement:

Not Answered