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Bucks County Connect. Assess. Refer. Engage. Support (BCARES)

A warm handoff from the emergency department to treatment and recovery services by a peer recovery specialist for an opioid overdose survivor in Pennsylvania

Recognizing that the emergency department (ED) can be a vital touchpoint to engage people into treatment and recovery services, Bucks County Connect. Assess. Refer. Engage. Support (BCARES) uses certified recovery specilalists (CRS) to provide a warm handoff from the ED to services for those who have experienced an opioid overdose. BCARES is a collaboration between three treatment agencies and six hospitals in Bucks County, Pennsylvania.The CRS is a person with lived experience.  

BCARES is available 24 hours a day, 7 days a week. The ED will make a referral directly to the CRS. The CRS will meet face-to-face with the individual who experience the overdose, and will connect them directly to resources, recovery supports, and treatment options. If the person accepts direct treatment from the hospital, the CRS will locate a treatment provider and arrange for transportation. The CRS will continue to follow-up with the person for 30 days following the overdose.

In addition to linking overdose survivors to services, BCARES also serves any individual with a substance use disorder (SUD) who are in a Bucks County hospital as well as family and significant others. Family support includes access to BCARES Family Connect, which supports families and loved ones of individuals suffering with SUD by sharing lived experiences (i.e. mutual support) and connecting loved ones to resources.

A secondary goal of the program is to train medical professionals who interact with overdose survivors in the ED on opioid use disorder and treatment with the goal of reducing addiction-related stigma and correcting associated misperceptions.

More details on the program can be found in the presentation here and the journal overview here. Contact information can be found here.  

160 individuals were placed in treatment, and 84 families were provided with resources in Bucks County, Pennsylvania.

Continuum of Care
Treatment
Recovery
Type of Evidence
Report with evaluation
Response Approach
Family Support
Post-overdose response
Recovery coaching
Peer-reviewed Article
BCARES: Saving Lives, Second Chances, and Recovery
Related Resources
Recovery Coaches in Opioid Use Disorder Care
Peer Support Workers in Emergency Departments: Engaging Individuals Surviving Opioid Overdoses
A Scoping Review of Post Opioid-Overdose Interventions
A Novel Social Work Approach to Emergency Department Buprenorphine Induction and Warm Hand-Off to Community Providers
Routes of Non-Traditional Entry into Buprenorphine Treatment Programs
A Scalable, Automated Warm Handoff from the Emergency Department to Community Sites Offering Continued Medication for Opioid Use Disorder: Lessons Learned from the EMBED Trial Stakeholders
Guidelines for Medication for Addiction Treatment for Opioid Use Disorder within the Emergency Department
Hospitals’ Role in Addressing the Opioid Crisis: Buprenorphine in the Emergency Department
Emergency Discharge Protocols for Patients with Substance Use Disorders and Opioid Overdoses in Maryland’s Hospitals

Evidence of Program Effectiveness

This program has been independently evaluated. The evaluation showed that:

  • Of the 158 nonfatal overdoses identified in the emergency department (ED) during the study period (seven months during 2018), 108 (68%) spoke with a certified recovery specialist (CRS). Of those 108 individuals, 47 (44%) accepted treatment. In all, 36 individuals entered treatment through the BCARES program during the study perioid.
  • Having a family member in the ED predicted that a patient was more likely to accept the warm handoff
  • A recommendation of the evaluation was to integrate electronic health record (EHR)-automated triggers for a warm handoff and remove the need for patient consent to speak with a CRS wherever possible to increase engagement.

More recent self-report data: In 2018-2019 there have been 356 BCARES referrals, 160 of those individuals were placed in treatment, and 84 families were provided with resources in all of Bucks County.