Only 10% of Americans who could benefit from the services of groups such as Alcoholics Anonymous and Narcotics Anonymous receive that help, says Barbara Healey, RN, Project ASSERT nurse manager at Boston Medical Center. To close that gap, Project ASSERT screens, intervenes, and facilitates patient access to primary care, clinical preventive services, and drug and alcohol treatment.
Nurses play an integral role in the success of the program at Boston Medical Center. If substance abuse is suspected in a patient, the nurse requests an assessment from a Project ASSERT staff member.
When approaching patients about the topic, health promotion advocate Ludy Young, BA, visits them and checks their health history form. At the end of the assessment, Young brings up substance abuse treatment or detox if she feels its warranted.
Many patients hide their addictions, says Young, a licensed alcohol and drug consultant. For example, they may have a drug addiction, but they work and maintain a home. So Young asks them about their day-to-day life, such as how many drinks they have per week. Even when it is revealed that a patient has a problem, participation in a treatment program is voluntary.The Project ASSERT team, back row, from left, Melanie Rambaud, Brent Stevenson, John Cromwell, Lee Lambert, and Moses Williams. Front row, from left, Ed Bernstein, MD, medical director; Barbara Healey, RN, nurse manager; Ludy Young; and Dominique Gutierrez.
Youve got to leave the door open because everyone has a voice and a choice, Young says. Not everyone is available to go to detox. Some will never find recovery.
When patients agree to treatment, health promotion advocates collaborate with doctors on discharge planning and make real-time follow-up doctors appointments at times convenient for each patient, says Young, who has been with the program since 1994.
Staff support patients through treatment and provide them with necessities, such as food, clothing, and medicine. Many clients cannot pay for medication, so Project ASSERT staff provide them with starter medicine kits until they can go to their doctors appointments.
We deal with such an underserved population, Healey says. Many patients show up repeatedly, but the attitude of the Project ASSERT health promotion advocates is this could be the time when that patient gets clean, she says.
Two Project ASSERT staff members are available 24/7 and the program has assisted 60,000 patients since it started 15 years ago, Healey says.
Situated between three Boston shelters, the hospital cares for many homeless patients, says John Cromwell, LADC, a harm reduction specialist with the Opioid Overdose Prevention Program in the ED. Common barriers homeless patients face to treatment are arranging transportation to appointments and understanding health coverage.
About 30% of the people who come into the ED by ambulance have overdosed, Cromwell says, and there are two opiate overdoses a day in Massachusetts. To reduce these alarming statistics, the opioid program, a partnership between Project ASSERT and the Boston Public Health Commission, trains substance abusers and their significant others how to use nasal Narcan, a potent reversal agent, and initiate rescue breathing until paramedics arrive. The training also stresses how to place someone who has overdosed on his or her side until help arrives.
But a patient doesnt need to be homeless to have an addiction. Many substance abusers are ordinary people. Health promotion advocates say people from all walks of life deserve the option of treatment. The person who froze to death on the bench is somebody, Young says. He is somebodys brother, son, or uncle.