Ongoing Management of the Continuum of Addiction Care During COVID-19

Ongoing Management of the Continuum of Addiction Care During COVID-19

A guide for addiction treatment clinicians and programs working to treat patients with substance use disorders safely and effectively during the COVID-19 pandemic.

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While many states across the country are starting to relax physical distancing and other restrictions put in place in response to COVID-19, the pandemic continues to impact the work of addiction treatment clinicians and programs as they strive to maintain safety for both staff and patients.

People across the country remain at risk for infection from sustained community transmission and increasing population prevalence of the COVID-19 virus. In some areas, this has meant treatment programs may be experiencing another wave of COVID-positive patients and staff. In other areas, a significant impact is only now being felt for the first time.

Regardless, clinicians and programs should continue to implement policies and procedures to reduce the risk for coronavirus transmission, based on national public health guidance informed by the available data, and recommendations specific to their state and local areas. In addition, preparations should be made to respond to potential new spikes in viral transmission in communities and all clinical settings.

Treatment programs and clinicians should consider:

  • Maintaining or implementing an incident command structure to address any operational or management issues that arise due to COVID-19.
  • Continually re-enforcing infection control processes, including the monitoring of the extent to which staff and patients are adhering to them.
  • Assessing what worked well in your initial response and improving and updating related policies and procedures as needed.
  • Continually assessing the use rate of PPE (personal protective equipment) supplies and identifying reliable sources for acquisition.
  • Connecting with and sharing COVID-19 best practices with other local programs and clinicians.
  • Maintaining regular communication with treatment partners to safely move patients through the continuum of care and identifying which programs are admitting patients, which are at capacity, and any special accommodations they have made due to the COVID-19 pandemic.
  • Connecting with state and local departments of public health to support the reporting and tracking of new COVID-19 cases and how this may impact treatment program admissions.
  • Reviewing emergency preparedness plans and assessing the capacity for continued operation in case of an emergency, including those on top of the current COVID-19 situation.
  • Assessing program structure and workforce capacity to accommodate the potential need for supplies, an increased number of private rooms or isolation areas, and the potential decrease in staffing availability.
  • Developing or expanding plans for telehealth implementation to help patients access timely and appropriate services.
    • Establishing guidelines and policies to promote clarity and consistency in the delivery of services.
    • Gathering data and providing analysis to verify that the telehealth delivery system is reaching patients in isolation/ quarantine and the flexibility to meet the changing circumstance of COVID-19 and other service delivery disruptions.
  • Developing and implementing plans to monitor staff absenteeism.
  • Cross-training personnel to perform essential functions so the site can operate even if key staff are absent1, recognizing that staff who are COVID-19 positive may be able to work remotely in some capacities.

Treatment programs and practices should assess potential needs related to:

  • Personal protective equipment and other supplies, facility capacity in the context of physical distancing requirements, and space ventilation considerations needed to control and mitigate the spread of the coronavirus.
  • Staff training.
  • Staff support, including:
    • Access to mental health, stress management and wellness services
    • Frequent and open communication with management regarding staff needs and concerns
    • Considerations for more flexible work options, blending in-person with remote work, when possible
    • Technology to support telehealth
    • Policies and procedures written to maintain HIPAA compliance, recognizing federal relaxation of regulations
  • Addressing the evolution of the pandemic, rate of COVID-19 positivity in your community, rates of overdose and addiction-related treatment needs in your community, and how to prepare for changes in the pandemic, including arrival of a vaccine and post-pandemic operations.

Addiction treatment clinicians and programs should continue to monitor federal and state legislative and administrative developments for additional opportunities to access emergency relief funding, such as through the Health and Human Services’ Provider Relief Fund, as well as the possible inclusion of new liability protections related to re-opening in the next COVID-19 federal legislative package.