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[THE CHALLENGE]
Boston Medical Center (formerly Boston City Hospital) is the largest safety net hospital and busiest trauma and emergency services center in New England. In the early 1990s, when the nation was in the midst of the HIV/injection drug-use epidemic, patients came to the emergency department with complex needs related to their drug and alcohol misuse. This overwhelmed the care systems in place and led providers to seek new ways to meet the needs of these patients.
Edward Bernstein, M.D., emergency physician and then chairman of the Boston City Hospital ED's quality improvement committee, began by looking at scientific literature and found two important avenues to explore for intervention: research by Morris Chafetz in the late 1950s at the Massachusetts General Hospital Accident Floor that demonstrated that psychiatry residents and social workers could team up successfully to engage middle-age, homeless, heavy-alcohol-consuming patients in treatment; and Bill Miller and Stephen Rollnick's work on the efficacy of motivational interviewing.
In 1993, Edward Bernstein and Judith Bernstein, together with the Boston Public Health Commission and the Massachusetts Department of Public Health, submitted a "critical populations grant" application to the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment to improve the quality of care for the diverse patients struggling with substance-use disorders who were coming to the Boston City Hospital ED. They were awarded a three-year grant that supported hiring a team of outreach workers, recruited from the communities served by the hospital, to work as part of the medical team to identify patients with substance misuse needs, intervene and offer resources. This was the beginning of Project ASSERT, which aims to improve alcohol and substance use disorder services, education and referral to treatment for ED patients.
Project ASSERT was the first nationally cited program in an ED to deploy peer counselors/educators as motivators and navigators to identify and intervene with patients with substance use disorders. The Project ASSERT team of outreach workers provided the "in-reach" that the ED staff needed to bridge the gap between what patients needed and the capacity to provide.
Getting to the root of the issue
The gap between those who need treatment for substance use disorders and those who seek and receive treatment contributed greatly to the problem...