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Wolf Administration Releases Warm Handoff Guidance to Emergency Room Doctors and Healthcare Professionals

December 21, 2016

Harrisburg, PA – Today, Governor Tom Wolf released guidance developed by the Department of Health and the Department of Drug and Alcohol programs in conjunction with the American College of Emergency Physicians to help emergency room doctors and healthcare professionals identify individuals with substance use disorder, including those who have been saved by naloxone, and get them into treatment – a process known as a warm handoff.

“Over the last few years, heroin and opioid overdoses have become the leading cause of accidental death in Pennsylvania, killing more individuals than motor vehicle accidents – 10 Pennsylvanians per day,” said Governor Tom Wolf. “We must do everything we can to destigmatize the disease of addiction and get patients into treatment so they can begin the recovery process.”

A warm-handoff is a process in which a person who is identified as having a substance use disorder is transferred from a hospital emergency room or other healthcare provider to a drug treatment provider.

“Ensuring overdose victims and other patients who seek help for opioid use disorders get into treatment is essential,” said Physician General Rachel Levine. “One of the best ways to help people enter treatment is for them to be properly identified by doctors and other medical personnel when they arrive in an emergency room, and referred immediately to treatment.”

“The Wolf Administration has been working with emergency room doctors to develop a ‘clinical pathways’ guide to help determine how to get a patient into treatment for substance use disorders,” said Secretary Gary Tennis. “We believe this guidance is critical to getting those who suffer from the disease of addiction the help that they need.”

Below are the steps physicians and healthcare professionals are advised to follow:

Permission

Asking permission to talk about the issue shows respect for the patient’s autonomy, which can help to minimize resistance. It keeps the conversation focused on the patient.

Open-ended questions

Using open-ended questions can help the conversation move forward. Open-ended questions encourage patients to tell their story. Generally, try to avoid questions that can be answered with yes, no or other one-word answers. And listen when the patient responds.

Listen reflectively

The provider should focus on listening to the patient, using reflective listening as a tool. Reflective tools such as repeating, rephrasing and paraphrasing keep the focus on the patient and reveal behavioral change opportunities. Listening with an attitude of respectful curiosity is easier when the patient is held up as expert and the physician recognizes him or herself to be more of a companion in the process of change.

Affirmation

Affirmation allows the provider to work with the patients’ strengths and acknowledge his/her  efforts. Affirmation can build confidence. Affirmations must be sincere to be effective.

Roll with ambivalence

As the patient talks, listen for information that could assist the patient in developing a plan to put them on course for less risky behavior. Listen for change talk, opportunities where the patient is willing and able to make changes. Talk of change often produces “but” or “if” statements indicating ambivalence. Ambivalence is not indecision but rather the equal desire for two opposing realities at the same time. Acknowledging the ambivalence can be the first step to finding a way out of it. The interviewer should use techniques to illicit “importance” and “confidence” statements from the patient. When you hear ambivalence, help the patient identify the ambivalence.

Summarize plans

Summarizing, or restating what you have heard, can be helpful at transitions or near the end of the conversation. If the patient has used a change statement, make sure to include it in your summary.

Contact number for the single county authority and/or substance use disorder referral and warm handoff personal: http://www.pa.gov/collections/opioid-epidemic/#GetTreatment


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