Quick recap

This meeting focused on identifying gaps and challenges in substance use disorder treatment services across Texas, as ASAP prepared their legislative agenda and provided input to the state on strategic planning. Participants discussed key barriers including the breakdown in transitions from residential to outpatient care, transportation issues, and the lack of integrated mental health services, particularly following the loss of COPS-D funding. The group explored challenges with telehealth implementation, particularly for state-funded providers, and discussed the difficulty in measuring and proving treatment outcomes that could demonstrate cost savings to legislators. Participants also highlighted the need for better coordination between treatment facilities and recovery support services, as well as the importance of addressing co-occurring mental health disorders, with many organizations reporting that 75% or more of their clients have mental health concerns.

Next steps

• Carmen: Research the possibility of billing for medical visits through the county hospital district or other state service options to address client medical costs.

• Noelle: Bring up the issue of medical billing for facility-provided services (as raised by Carmen) in the next billing group discussion to explore available billing codes and options.

• All participants: Post additional feedback, questions, or suggestions regarding gaps in service, innovation, or outcomes on the online discussion forum (link provided in chat), and/or email or call Noelle with further input.

• Noelle: Send reminders to participants about the online discussion forum and upcoming opportunities to provide further feedback on state planning questions.

  
  

Summary

Substance Use Disorder Legislative Planning

The meeting began with introductions from various participants representing different organizations in the substance use disorder field. Noelle Delgado, Executive Director of ASAP, led the discussion and outlined the focus on developing ASAP's legislative agenda and providing input on the state's strategic vision for substance use disorder services during their sunset review. The group discussed identifying common points where clients disengage from care or face barriers in transitioning to the next level of treatment, with an aim to address these gaps and improve the process.

Residential to Outpatient Care Transitions

The team discussed challenges with the warm handoff from residential to outpatient care in the Hill Country, where only 3-5 out of 10 referrals actually participate. Craig identified potential issues including patients' lack of familiarity with the program, transportation barriers, and the need for better coordination during discharge. The group agreed that improving communication with treatment centers and being more involved in the discharge process could help address these gaps, though the exact cause remains unclear. Noelle sought input on broader service gaps across different levels of care to relay to the state.

Service Delivery and Transportation Barriers

Miles reported that their organization is experiencing a 70% service delivery rate due to patients using their facilities as a respite rather than engaging in treatment, particularly among meth users with an average 8-10 day treatment stay. Brad from Helen Farabee Centers discussed transportation challenges in their 19-county region, noting that while Uber cards were previously used to address transportation gaps during COVID funding, these issues persist due to rising gas costs and limited public transportation. Both organizations highlighted housing shortages as an additional barrier to service delivery, with Brad mentioning their successful use of recovery coaches to connect patients transitioning from inpatient to outpatient care.

Psychiatric Services Funding Challenges

Miles discussed challenges with psychiatric services, noting that while they contract with a telehealth psychiatrist, the $260 initial session cost makes it difficult to provide these services to state-funded clients. Carmen added that they struggle with medical costs when clients become ill, as they often want to go to the hospital but the facility aims to keep them out. Noelle suggested exploring potential billing options through the state's billing group to address these funding challenges. The discussion also touched on difficulties serving high-acuity clients and the challenges of coordinating care, particularly for women and children, due to lack of childcare and transportation issues.

Substance Use Treatment Challenges

The group discussed challenges in substance use treatment, particularly around funding gaps and service delivery. Doug highlighted the loss of COPS-D funding, which previously allowed for employment of therapists addressing co-occurring disorders. The discussion revealed that many clients have co-occurring mental health issues, with FiskB estimating about 75% of their cases involve some type of co-occurring disorder. The participants explored the challenges of implementing telehealth services, noting that while effective for motivated clients, it presents difficulties for those in pre-contemplation stages of change and requires additional technology costs for state-funded providers. The conversation also addressed the tension between measuring access/capacity versus actual outcomes, with FiskB suggesting that treatment's value should be framed in terms of reducing costs in other areas like criminal justice and emergency room visits.