CA Bridge and Adventist Health Implement New Models for Navigating Substance Use Treatment

In 2018, CA Bridge set out to improve the model for substance use treatment. The program provides training, coaching and grant funding to expand access to medication-assisted treatment (MAT) for substance use withdrawal. Patients also engage with a substance use navigator who helps connect them to immediate and ongoing treatment, if desired.

CA Bridge was founded on three core pillars:

1. Treatment through immediate access to low-barrier MAT
2. Culture of harm reduction
3. Connection to additional resources through trained substance use navigators

Originally, funding for CA Bridge provided resources for 52 hospitals statewide, seven of which were Adventist Health facilities. “We commend Adventist Health leadership for their initiative in implementing the program—they've paved the way statewide,” shares Elizabeth Keating, clinical program director for CA Bridge. “We’re really pleased with the system-level engagement.”

The team at Adventist Health Ukiah Valley, in particular, has been a shining example of successful implementation. “Ukiah Valley has reinvented the idea of patient navigation for substance use treatment,” says Keating.

A new model for navigating substance use treatment

Mendocino County has the highest number of opioid overdose deaths per capita in the state, explains Erica Valdovinos, MD. Dr. Valdovinos is an emergency medicine physician at Adventist Health Ukiah Valley and an implementation leader with CA Bridge.

“Patients in our area often struggle to access medical care in general and travel great distances to get treatment,” Dr. Valdovinos says. “In our community, we have built a reputation that patients can come to us for substance use treatment. All our staff are strong in their ability to care for patients with substance use disorder.”

With CA Bridge, patients in the emergency department can request treatment for substance use, and a trained navigator helps them get a follow-up appointment within days. The navigators assist with a myriad of other tasks, such as enrolling in health insurance or helping patients figure out where to pick up medications.

“What makes Ukiah’s program so special is the dedication of our substance use navigators,” says Elvia Hamner, project manager for the substance use navigators at Adventist Health. “They are true advocates when patients can’t advocate for themselves.”

Emphasis on stigma reduction

Marika Martinez and Austin Peterson, the substance use navigators at Adventist Health Ukiah Valley, share that their work can be incredibly rewarding, albeit its challenges. “One of the most rewarding parts of my job is building a relationship with someone who started out very angry and guarded,” Martinez says. “Some patients feel like they’ve been written off and that everyone is against them—we get to be the voice who helps change that perception.”

Peterson notes that a key part of their role is to screen patients for their willingness to engage in treatment. “We’re not here to talk about the risks or harms of substance use, or even to try to convince them to stop,” he explains. “A lot of folks in the medical setting are taking on that conversation. As substance use navigators, we do our best in a crisis situation to build rapport, and through that relationship, allow patients to ask for help.”

This approach is an outgrowth of CA Bridge’s emphasis on stigma reduction. “Substance use disorder is a chronic illness and it is treatable, much like diabetes or hypertension,” says Dr. Valdovinos. “An approach that combines medications and intervention from the substance use navigators has demonstrated success. Just as in the treatment of diabetes or hypertension, shame and stigma have no role. Our navigators are shining examples of treating people with compassion and respect.”

Meeting patients where they are

Today, navigators supported by CA Bridge have seen 333,625 patients across California for substance use disorders, and nearly one-third have been prescribed or administered MAT. “We would eventually love to be so successful that we don’t have to exist,” says Keating. However, CA Bridge and the substance use navigators are still filling a critical need. “After five years, we still haven’t ‘fixed it,’” Peterson says. “That fact alone illustrates the necessity of this job for our community.”

The substance use navigators are currently deployed at 19 of the Adventist Health hospitals in California. Fourteen of those sites have received funding to continue supporting the navigators’ work for the rest of the year. In Mendocino County, Adventist Health has made the navigators into sustained positions, regardless of grant funding.  

All involved agree that connecting with and supporting patients is the most impactful parts of CA Bridge. “Clinicians, often want to fix things. In my previous role as a substance use navigator, there were times I felt I wasn't doing enough,” says Hamner. “But it always goes back to meeting patients where they are to get them the help they need.”

Learn more about CA Bridge.