Providing Integrated Access to Health Services in Nashua, New Hampshire
Access to health care is a key determinant of physical and behavioral health outcomes. Regular access to primary health services is critical for preventing and detecting diseases, ensuring comprehensive treatment, and improving overall quality of life.1
The Partnership for Successful Living (PSL) in Nashua, New Hampshire takes an integrated approach to health care. Its goal? To provide comprehensive care that’s easy for vulnerable populations to access, with services ranging from primary care, behavioral health, and oral health to housing support and treatment for substance use disorder.
A New Model for Integrated Care
PSL is made up of 6 non-profit agencies that collaborate to connect the most vulnerable populations in the community to the care and services they need to thrive. The organizations are separate entities, but as members of the Partnership they share a Board of Directors and a CEO.
Originally envisioned as a way to coordinate services for people with complex mental health issues, the Partnership has since expanded its work over the past 15 years. Their services now reach over 10,000 New Hampshire community members annually.2
Peter Kelleher, CEO, says that sharing resources and expertise has allowed the Partnership to successfully address challenges that the typical “single-fire” organization is not usually able to fully solve.
Spotlight: Nashua Safe Stations Program
One new program that has shown remarkable success is the Nashua Safe Stations program, in which firefighters at 7 local fire stations—together with Partnership staff—provide 24/7 help and coordinate access to services for people who need treatment for opioid use. The Partnership adapted the idea from a similar program in nearby Manchester, New Hampshire that was the brainchild of a firefighter named Chris Hickey.
The opioid overdose rate in New Hampshire is the second highest in the country—nearly 3 times the national average—with almost 500 overdose fatalities in 2016.3 A large contributor to this problem is significant barriers to care. In the local Nashua area, Kelleher says, people with substance use disorder (SUD) typically had to wait 8 or 9 months to access treatment. Overdose death rates began to skyrocket. For people who are simultaneously struggling with other medical challenges or mental illness, waiting 8 or 9 months for SUD treatment is just too long.
Now, when someone arrives at a Nashua fire station and asks for help, they are medically cleared by personnel from the local ambulance company and then Partnership recovery staff arrive within 10 minutes. The PSL staff begin working with them right away and facilitate immediate entry into treatment services. “This is the best way to reach people who are in the magic moment of saying, ‘I need some help’,” says Kelleher. “When you get someone in the time-limited action phase, you want to maximize their access to care.”
Increased Access to Services
When someone comes through a Safe Station and begins receiving treatment, that’s only the beginning. Not only does the Partnership connect people to substance use treatment services like medication-assisted treatment, it also has patient navigators who help folks get enrolled in health insurance. And since the treatment location is co-located within and adjacent to primary and behavioral health services, oral health services, and enabling and supportive services, this allows patients to, as Kelleher puts it, “one stop shop” all these services. This significantly addresses barriers to their ongoing recovery.
Taking such a comprehensive approach to treatment means that people aren’t just being connected with substance misuse services, says Melbourne Moran, a social worker who oversees the Partnership’s behavioral health services. Thanks to Safe Stations, patients are also “seeing a primary care doctor, getting their teeth cleaned regularly…. [and] are now in long term housing.” For many folks, this also means they’re able to get diagnosed and treated for other medical conditions, such as hepatitis C.
A Short Window of Time
With substance use disorder, the window of time in which someone is ready for help can be very small. “You have to be there when someone’s ready for help if you really want to be effective,” Kelleher says. But, he notes, traditional treatment systems can “go numb” to people who repeatedly seek help but aren’t able to improve.
What makes Safe Stations so effective is that it exemplifies the kind of community engagement people who use opioids need to “get off their traditional pathways and get connected to care and treatment” when they are ready for it.
Success by the Numbers
Since the program was established in November 2017:4
- More than 2,100 people have accessed the 7 fire station locations
- Fatal overdose deaths have decreased by 36%
- There has been a 13% reduction in overall emergency visits related to opioid overdoses
- Safe Station participants were 71% less likely to non-fatally overdose after entering Safe Stations compared to before entering Safe Stations
- Safe Station participants were 74% less likely to fatally overdose after entering Safe Stations compared to before entering Safe Stations
Of course, there are challenges to running a program like Nashua Safe Stations: ensuring that the services are continuously available, maintaining stakeholder engagement, and securing the resources to keep everything running. But Kelleher, who has a personal connection to the cause, says that witnessing the impact on the population first hand makes it all worth it.
Moran agrees. For him, seeing someone come in at a personal low point but ready to change, and then watching that person stabilize and progress through the system is the most rewarding part of the process.
The Safe Stations model has already sparked interest in surrounding communities; 10 fire departments have approached the Partnership for advice over the past year, and 2 have already set up their own programs. To help them be successful, Kelleher notes that building trusting relationships with health care providers and facilities such as hospitals needs to be a priority.
“We’re hoping this will be an opportunity to share what we’ve been doing and get others to consider this as a practice that would work in their own communities,” Kelleher says. He also wonders what other community health issues could be addressed using a similar approach. “I'm on fire about this concept,” he continues, without a hint of irony.
2 Data provided the Partnership for Successful Living.
4 Data provided by Partnership for Successful Living.
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