By Mary Pat Rowland
Posted Jan 1, 2019 at 7:36 PM Updated Jan 2, 2019 at 8:31 AM
DOVER — A new program to combat the opioid crisis is scheduled to open Wednesday morning in Dover.
The Doorway-NH, created through a state grant awarded to Wentworth-Douglass Hospital and eight other sites in New Hampshire, will not directly treat patients suffering from opioid use disorder and is not located at the hospital.
Instead, Dover’s Doorway, located in a renovated and roomy blue-gray Dutch gambrel at 798 Central Ave. across the street from the hospital, will serve as a hub to assess patients who come through the doors and find the right treatment programs and community-based supports they need to combat their disease. It’s being called a hubs-and-spokes system.
Kellie Mueller, director of Behavior Health at Wentworth-Douglass, said the most important point patients need to know to get through The Doorway is the address, if they are going to visit the facility and the phone number if they want to access it by phone.
Patients can get in touch with The Doorway by using the state’s 211 phone number. Help is just a phone call away and ensures access to assistance beyond the hours of operation at The Doorway office in Dover or one of the other eight sites across the state.
The 211 phone system is hooked into the state’s opioid services line 24 hours a day, seven days a week through Dartmouth-Hitchcock medical center. That after-hours service began on New Year’s Day.
The Doorway in Dover will be open Monday through Friday, 8 a.m.-5 p.m.
Mueller said it has been a sprint to the finish line to make sure The Doorway opens Jan. 2 as planned. As of last Friday, there was still a flurry of renovation work ongoing at the Dover site. Workers were laying carpeting inside the former private home and a newly built handicap access ramp had been installed at the entrance.
Mueller said a team of about 40 people at Wentworth-Douglass had been working in overdrive on the project and, after the grant was finally approved on Oct. 31, they only had about eight weeks to get the program up and running and the building renovated and ready.
The hospital donated the gambrel for The Doorway’s use and paid for all the renovations, which, Mueller said, is “amazing and generous.”
Neither the site nor the renovations were part of the state grant used to create the hub-and-spokes program, Mueller said. The gambrel has been transformed to include a reception and waiting area, three private interview rooms for patients and an upstairs work space for staff members, according to Mueller.
The state sought the $45.8 million State Opioid Response grant from the federal Substance Abuse and Mental Health Services Administration over the next two years to make addiction treatment more accessible for New Hampshire residents.
Some of the money, about $8.8 million, went toward the establishment of the nine regional hubs. The Doorway in Dover is for all Strafford County residents and those residing in Rockingham County communities on the Seacoast, including the Portsmouth area, Mueller said.
Besides The Doorway in Dover, six other regional hubs in the state are affiliated with hospitals, including Concord, Berlin, Hanover, Keene, Laconia and Littleton. Two other hubs – one in Nashua, the other in Manchester, are affiliated with Granite Pathways, an organization already providing some of those hub services, Mueller said.
How the hubs will work
Mueller, 49, who holds a master’s degree in counseling, and has worked at the hospital more than 20 years in social work and behavioral health, said patients coming through The Doorway will be greeted in the newly renovated reception area and waiting room. From there they will go to one of three private interview rooms where they will meet with a licensed alcohol and drug counselor (LADC), who will assess their substance use problem and other issues that may be standing in the way of their recovery.
“The intent of the hub is to assess the patient and their full gamut of needs — insurance, substance abuse, mental health, finances, housing, all of their needs — understanding that all of those pieces affect people’s access to treatment and recovery,” Mueller said. The Doorway is the hub that will connect patients with existing services or the spokes — so they can begin their recovery.
The Doorway will also provide ongoing case management using a care coordinator who follows up and makes sure patients are connecting with the services that have been recommended to them, Mueller said.
There will also be a Certified Recovery Support Worker (CRSW), a “grassroots person” who encourages the patients from a peer-based perspective to partake of the services recommended to them, according to Mueller.
One of the challenges for all the hubs in New Hampshire is the lack of LADCs throughout the state, Mueller said. The Doorway in Dover has come up with a solution to that shortage by using the program’s administrator, Peter Fifield to play the dual role of running the program and doing patient assessments, Mueller said.
Fifield, 48, has the passion and knowledge needed to make the program successful, according to Mueller. Fifield has a doctorate degree and holds dual licenses as a clinical mental health counselor and licensed drug and alcohol counselor. He has worked in the field for 12 years, including at Families First.
Fifield said the main mission of The Doorway is to coordinate and collaborate with other services.
The assessments are a key component of the mission. “We will troubleshoot to help patients get the level of care they need,” Fifield said. That helps to identify barriers to recovery and will help to better allocate recovery resources, Fifield said. Not everyone, for instance, needs a bed in a treatment facility to begin their journey toward recovery. Some patients do well in community-based programs if they have a stabile living situation or other barriers are removed, such as lack of health insurance.
Mueller also hopes The Doorway will lead to better allocation of services. “The hub will make sure that those who truly need a bed will get those referrals and others will be assessed and perhaps referred to lower levels of services. Our job is to determine the level of care and better match up the needs to the resources,” she said.
Concerns about spokes
Mueller acknowledges that spokes coming off the hubs such as the one in Dover may not be as plentiful or sturdy as they could be, adding part of the role of the hubs is to advocate for more spokes.
John Burns, director of the Dover- and Rochester-based SOS Recovery Community Organization, said he is hopeful about The Doorway, but also has serious reservations about those spokes.
“I think it makes sense. I’m optimistic,” Burns said of The Doorway. “The concern that’s going to be difficult to navigate is the capacity of the spokes doesn’t exist. If there’s not any place to go after assessment where do we go? If there’s no safe housing, outpatient treatment, in-patient treatment, where do we go? I like the concept, but it’s going to take a while. You can’t navigate people into a black hole that doesn’t exist,” Burns said.
The federal grant money that rained down on New Hampshire was welcome in the state in which a projected 437 people are expected to have died statewide due to overdoses by the end 2018, down from 488 in 2017 and 485 in 2016, according to the latest drug death data from the state’s chief medical examiner’s officer.
“It’s good that it’s getting better, but the numbers are abominable,” Burns said recently.
Burns said the money doesn’t immediately increase treatment capacity or access to other services that make a difference for opioid users. Burns claims recovery services in New Hampshire continue to be swamped and have deep waiting lists. In addition, unstable housing is one of the biggest barriers to recovery, according to Burns, and he hasn’t seen state grant money helping with that.
“Money doesn’t mean those things will be provided overnight. To have that amount of money dropped and be truly operational on Day 1 is unrealistic,” Burns said.
He said he isn’t taking shots at the hubs-and-spokes model, but views it more as a starting point than an immediate solution. The model, he said, has been in operation for five years in Vermont where they have just now started seeing an end to waiting lists for treatment.
Burns is also concerned that the opioid grant funding does not address other substance use problems such as alcoholism, which still kills many New Hampshire residents, or the growing threats from the resurgence of crystal meth and cocaine.
Mueller acknowledges the grant funding is specific for the opioid crisis, but said The Doorway in Dover won’t turn people away if they have other substance use problems revealed during assessment and will try to connect them with services no matter what substance problem they are suffering from.
She also emphasized the collaborative role she hopes The Doorway plays in the community. She said there have been a lot of conversations with SOS and other providers and that the Doorway is ready to help.
“We want to streamline things for patients, not to make it more complicated. SOS is a good example of good programs already existing in the community,” Mueller said.
One of the biggest strengths of The Doorway, according to Mueller, is the contract with the state demands ongoing patient follow-ups, which are designed to prevent people from falling through the cracks.
What the public needs to know
Mueller said Wentworth-Douglass will be hosting a public information forum about The Doorway on Tuesday, Jan. 15, at 9:30 a.m. in the Garrison Auditorium at the hospital. Mueller, Fifield and some representatives from the state will be there to explain the program and answer questions.
Gov. Chris Sununu encourages the public to attend local forums, which will be held at all nine The Doorway sites in the state over the next several weeks. “The Doorway-NH represents a new, comprehensive and local response to the opioid epidemic in New Hampshire,” Sununu said in a statement. “It will provide a single point of entry for residents seeking treatment for Substance Use Disorder. The location of each of the nine Doorways will ensure that help for substance use disorder will be less than an hour away. This new approach will provide an integrated, one-stop-shop model offering the full array of treatment, recovery and self-sufficiency services.”
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