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Texas Goes Big with "ORN Online Grand Rounds" Targeting FQHCs


Dr. Roxana Cruz, Director of Medical and Clinical Affairs for the Texas Association of Community Health Centers (TACHC)
Dr. Maher Karem-Hage, a TA consultant and an addiction psychiatrist

With the many challenges facing communities around the opioid crisis, Texas took charge and created the "Texas ORN Grand Rounds" to help providers through the use of evidence-based practices address their local needs around the prevention, treatment and recovery of opioid use disorders.

Every two weeks, the SAMHSA-funded STR-TA grant supports the Opioid Response Network (ORN) to convene an online forum for Texas clinicians, many who work at Federally Qualified Health Centers (FQHC) and are often located in rural underserved areas. These bi-weekly, one-hour forums, are structured as an online live video grand rounds for clinicians, focusing on topics they encounter in preventing and treating opioid use disorders (OUD), providing valuable insights and information targeting their local needs. Participants can dial in to a conference call or link through webinar video platform.

These "Texas ORN Grand Rounds" started with an ORN TA (technical assistance) consultants for the STR- TA grant wanting to identify local providers who are not treating OUD and might benefit from local support. The ORN TA consultants, all with a minimum of two years of experience prescribing medications for treating addictions and some addiction specialists, were enlisted to help provide education and training at the local level for clinicians. Dr. Maher Karem-Hage, a TA consultant and an addiction psychiatrist, took the lead with his colleagues in reaching out to all clinicians in the state who had their waiver to prescribe medications to treat addiction whether they were prescribing or not. The idea was to let them know that there was help and local support available to answer questions and provide educational resources to meet their needs.

One of those clinicians contacted was Dr. Roxana Cruz, Director of Medical and Clinical Affairs for the Texas Association of Community Health Centers (TACHC). TACHC, a nonprofit membership association, is the federally designated primary care association for the state and is the link between federal, state and local entities providing healthcare for the state's most vulnerable populations. TACHC’s membership includes 75 FQHCs in the state, which operates more than 300 sites and serves over 1.4 million people. Many of the providers at these centers are either just beginning to treat OUD or are interested in increasing their capacity to provide MAT services. "Because this is an expansion of the services they currently provide, FQHC's need support from prescribers seasoned in MAT, as well as a forum to discuss clinical cases and related systems issues," said Beth Hutton, MS, LPC, ORN Technology Transfer Specialist for Texas.

Dr. Cruz found the idea of an online grand rounds refreshing and timely. As a result, she submitted a request via the ORN website to target the rural communities in Texas with video grand rounds. “Our goal is to use as much technology as possible to get information out to our health centers,” Dr. Cruz said. Working in a state as large as Texas, with vast rural areas, is a challenge and one that is being met with this approach. Ms. Hutton, Dr. Karem-Hage and other ORN TA consultants have worked with Dr. Cruz to set up this series of video conferences, which allow clinicians from across the state of Texas and beyond to meet and learn on a variety of topics related to OUD.

Before beginning the process, Dr. Cruz through TACHC surveyed all its health centers in Texas to see what their needs were and collect a list of priorities. A high number of their responses mentioned the need for behavioral health as it relates to treating OUD with medication, she said. With that information, Dr. Cruz formed her request to ORN and says, "It's been a great collaboration among the various individuals and organizations, that’s for sure."

Dr. Cruz has been working with Dr. Karam-Hage to expand the "Texas ORN Grand Rounds" series, which launched November 2018 . This online series targets all staff working at the health centers and primary care providers who are involved in providing services to persons with OUD or at risk for OUD, including physicians, nurse practitioners, medical directors, behavioral health clinicians, recovery coaches, and peer support specialists.

As a result of the survey, they have developed a list of topics for the "Texas ORN Grand Rounds," which are scheduled through October 2019. If the interest and participation continues to grow, it could become a once-a-week program, which may soon include case presentations in addition to current didactics, stated Dr. Karam-Hage. "What is interesting to me is the questions that people are asking during the discussion time following the presentation. I didn’t expect so much interaction. They’re asking very good questions. The interaction is useful and actually fun."

The "Texas ORN Grand Rounds" live video conference is currently hosted on a rotating basis by the Texas ORN treatment consultants. It was originally scheduled for once per month, "but by the third month, attendance for the calls increased to about 60 participants each time and the decision was made to increase the frequency to bi-weekly," Ms. Hutton said.

Topics for Upcoming Sessions Include:

For more information on this program or help with starting your own "ORN Grand Rounds" in your community, contact str-ta@aaap.org.