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 roject  SSERT is a Boston Medical Center
Emergency Department Service to facilitate access of patients
to primary care, clinical preventive services, and when needed,
to the drug and alcohol treatment network. Under its aegis, five
culturally competent Health Promotion Advocates (HPA's) function
in the Boston Medical Center ED as community-outreach workers.
Their role is to detect substance abuse and other preventable
conditions, intervene, and refer patients to treatment. The Health
Promotion Advocates have been trained to conduct a fifteen minute
questionnaire-based interview (the Health Needs History) with
all non-critical patients presenting for medical treatment in
the ED. This survey of patients' health and safety needs provides
the basis for detection of substance abuse and other health needs.
Through a brief negotiation interview (BNI) technique, HPA's establish
rapport, raise the subject of drugs and alcohol, and assess patients
readiness to change.
From April 1, 2002 through March 31, 2004, BMC ED
Project ASSERT's HPA's consulted on 6,838 patients referred by the
Adult and Pediatric ED and Urgent Care staff. Appointments to BMC Clinics
and affiliated Neighborhood Health Centers were given to 1656
patients, 984 of whom did not have a prior primary care physician.
Health education brochures were distributed to 1,196 patients, and 334
patients were referred to smoking cessation programs. During this period,
4,703 patients had an acute alcohol or illicit drug problem, and 2,269
were placed in a detox program with transportation provided. There
were also 634 referred to outpatient treatment. Unfortunately no beds were
available for 656 persons seeking detox, an increase from 7% of patients
to 22% of patients compared to the previous year before the cutbacks in
treatment beds and funding.
Project Assert was originally funded by CSAT
(Center for Substance Abuse Treatment) as a demonstration program
in 1993. Project ASSERT’s Health Promotion Advocates are dedicated
to provide exceptional care without exception, as demonstrated by the City
of Boston Management Consortium's Liberty Mutual Customer
Service Award in 1996, the Boston Public Health Commission’s Outreach
Award in 2002, and the Massachusetts Organization for Addiction Recovery
Services Award in 2003.
The RWJ funded Join Together
Organization has supported the dissemination of this model to other
EDs, and Project ASSERT staff members have provided consultation and
hands-on training to their funded projects. Project ASSERT has provided
consultation to researchers in the field, and tested its model among
cocaine and heroin users in a 5 year randomized trial funded by NIDA.
Project Assert’s staff also provide mentorship to
City
Schools
and BAHEC
students. Recently, as a outgrowth of the Project ASSERT model, the BUMC
has received three NIH NIAAA/NIDA grants: Project RAP-Reaching Adolescents
for Prevention; Project SAFE to reduce STDs among cocaine and heroin users
and an the Academic Emergency Medicine Screening, Brief Intervention and
Referral to Treatment, SBIRT, Research Study.
For more information on
BNI/alcohol and drug abuse, call 617/534-4388 and see:
For more information on
Clinical Practice and Public Health Initiatives in the Department of
Emergency Medicine see:
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