[Noozhawk’s note: First in a series sponsored by the Hutton Parker Foundation.]
The Bridge Clinic in Santa Barbara provides individuals with substance use disorders a chance to create paths forward to recovery with therapeutic interventions and medically assisted treatment.
The SBNC is vital to providing quality integrated health care on the South Coast. In addition to a Bridge Clinic, the organization consists of four medical clinics, two dental clinics, an integrated care clinic and health promotion services.
The Bridge Clinic program serves patients from Santa Barbara Cottage Hospital, other hospital patients and local community clinic patients who are diagnosed with substance use disorders, according to the SBNC.
This year, the clinic at 2320 Bath St., Suite 201, moved into a bigger facility to service the greater community need.
The Bridge Clinic meets the full range of patients’ needs such as pain management, psychosocial support, medical and substance use disorder treatment, and psychiatric and psychotherapeutic treatment.
The Bridge Clinic is a one-stop shop for people to get a broad range of help and get connected to longer-term resources, said Dr. Paul Erickson, medical director for psychiatry and addiction medicine at Santa Barbara Cottage Hospital and the Bridge Clinic’s psychiatrist and medically assisted treatment consulting specialist.
“The idea of a bridge is we make it easy to access treatment,” Erickson said. “Then, we bridge them until they are connected with longer-term treatment.”
The program in Santa Barbara is designed to address barriers to patient care related to a lack of insurance, co-morbid conditions, and the need for missed appointments or sobriety, according to the SBNC’s latest impact report.
“Our goal is to not become the permanent home in substance use disorder patients,” Erickson said. “It’s to give them immediate access to a wide range of resources.”
Patient services include physician evaluation and treatment, plus medically assisted treatment, social work counseling and case management, according to the SBNC. It also offers flexible follow-up services such as daily visits and telehealth if needed, and connection to community resources such as outpatient treatment and residential programs.
“The demand for this service has been steady and hasn’t dropped off during COVID-19, and hasn’t declined even as we expanded hours and available slots,” Erickson said, noting that the Bridge Clinic shifted to more telehealth offerings when the COVID-19 pandemic first hit the region in mid-March.
Nancy Tillie, chief operating officer and chief financial officer for the SBNC, said the Bridge Clinic has received grant funding, patient fees and private donations.
The Bridge Clinic isn’t currently a designated “drug” Medi-Cal provider, so the SBNC is not eligible for the funding that Santa Barbara County receives from the State of California for substance use disorder treatment, and works to provide those services without that money, Tillie said.
The Bridge Clinic does have memorandums of understanding with “drug” Medi-Cal-certified providers who have contracts with Santa Barbara County, such as the Sanctuary Centers of Santa Barbara and the Council on Alcoholism and Drug Abuse.
“Santa Barbara Neighborhood Clinics does not turn anyone away, regardless of ability to pay,” Tillie said.
As a federally qualified health center, the SBNC is a “safety-net” provider, and the Bridge Clinic is included in that axiom, according to Tillie.
The SBNC offers a sliding-fee discount based on income level and payment plans, and the organization has contracts with many commercial insurance carriers and is willing to bill insurance with or without a pre-existing contract, she said.
The SBNC accepts Medi-Cal and Medicare, as well as patients without insurance, Tillie said, adding that 30 percent of SBNC’s patients are uninsured.
“We also serve a high number of patients with ‘exchange’ coverage, high deductibles like Covered California, who are ‘functionally’ uninsured due to the high deductibles that must be met before any payment kicks in,” Tillie said.
A member of the Bridge Clinic staff is a wellness navigator. The position is a patient services/resources coordinator and a certified Medi-Cal and Covered California enrollment agent, Tillie said.
“They can work with patients to determine eligibility for assistance in various insurance products and assistance programs public and private,” Tillie said.
The Bridge Clinic is a services-related program, therefore the highest expenses are in staffing at 92 percent, she said. The remaining 8 percent in large part covers laboratory testing costs for drug tests that are necessary to ensure patients are taking the prescribed medications and not indulging in other “medications,” and then office supplies, Tillie said.
“Our partnership with Cottage Health keeps the occupancy expenses low,” Tillie said.
She said it previously cost $600,000 to keep the Bridge Clinic operational.
The clinic added provider hours with its move to a location double the size, and program officials expect the costs to be $1 million annually, according to Tillie.
“The Bridge Clinic is saving lives every day,” Tillie said. “That is not glib or an over-exaggeration.”
Many patients arrive via the Cottage Hospital emergency room because of a substance use-related trauma visit, Tillie said.
“We are able to connect with someone who may be ready to address their substance use disorder because it has risen to a life-threatening event offering medically assisted treatment to reduce the ‘dope sicks’ or withdrawal-related symptoms based on the provision of medication assistance,” she said. “Education to the community regarding substance use disorders continues to inform that this is a disease just like diabetes, or hypertension.
“The use of substances alters the brain to provide for the need of these substances in order to function. Our providers meet patients where they are at in their recovery mode and are nonjudgmental towards how they arrived at the Bridge Clinic.”
Tillie said the Bridge Clinic’s mission is promoting recovery and resilience against the disease and have patients convert to a healthy, productive life through treatment, which may include behavioral health and therapeutic means, including whole person care as exercise, diet, pain management and acupuncture.
Of most concern is the number of young people arriving at the Bridge Clinic, people in the 17-to-21 age group, Tillie said.
This year, she said, the SBNC had been an awardee of a youth opioid response grant of more than $500,000 to address opioid use disorders for people in the 12-to-24 age group.
The Bridge Clinic saw an increase in younger patients since local schools transitioned to online education because the coronavirus physically shut down institutions and extracurricular activities were halted, said Alexandra Taylor, a psychiatric nurse practitioner and lead clinician at the clinic.
SBNC’s Dr. William “Joel” Paule is the Bridge Clinic’s pain management specialist who also provides acupuncture, and Dr. Sarah Nasir, a medication-assisted treatment certified provider, joined the team to treat patients with substance use disorders.
The Bridge Clinic staff are often coordinating with local residential treatment facilities and help set up with housing options if it’s a priority, as well as assists with basic laboratory tests.
“The most important thing is shelter,” Paule said. “Often people don’t have a place to live.”
Substance use disorders typically begin in adolescence and continue throughout a lifetime, Erickson said.
“We see a fair number of adolescence at the Bridge Clinic,” Erickson said.
Alcohol and opioid use disorders are the most common substance use disorder that Bridge Clinic staff see, Erickson said.
The Bridge Clinic offers treatment for individuals facing other substance use disorders with methamphetamine, Valium, occasionally hallucinogens, marijuana and others.
“Sometimes people don’t think marijuana leads to addiction problems,” Erickson said, “but it can.”
The Bridge Clinic sees people of all ages and across socioeconomic roots, Erickson said, adding that it is open to the entire community.
“Any person who would like help or any doctor who would like to refer a patient can,” Erickson said.
The clinic offers walk-in availability in a primary care setting adjacent to Santa Barbara Cottage Hospital at 400 W. Pueblo St., and clinic staff work in conjunction with the hospital.
Cottage Hospital will walk patients to the Bridge Clinic, and the patients recently had been discharged from the emergency department or inpatient unit, Taylor said.
“They come straight to us to establish substance use treatment,” Taylor said. “Our role is to catch patients at their most vulnerable and provide stability, and we do that by addressing all of the facets of the person.”
The Bridge Clinic provides stability, so an individual feels “secure enough that we can move them out into the community,” Taylor said.
For 53-year-old Hal Preston, there is no other place like the Bridge Clinic.
A psychologist referred Preston to the Bridge Clinic after he sought assistance at a local hospital emergency room in 2019.
“I was addicted to numerous substances, some of which are dangerous to withdraw from cold turkey,” said Preston, who was born in New Jersey and raised in Santa Barbara. “I had checked myself into the ER (emergency room) at (Santa Barbara) Cottage (Hospital), and the only recommendation they had for me was to not relapse, which wasn’t the plan.”
About a week later, Preston followed up with the referral once learning that some of his friends in recovery had mentioned their success through the Bridge Clinic.
Preston was a walk-in patient the first time he stepped into the Bridge Clinic. He sat inside the Bridge Clinic waiting room.
“I was feeling — for the better part of the day — cynical and not a lot of hope,” Preston said. “I was assuming I’d get the brushoff and kind of treated to the typical addict experience in the medical system, which is kind of assembly line-style and one-size-fits-all.”
However, Preston said he was surprised. He recalled the polite staff at the Bridge Clinic.
“I did get seen the first day,” Preston said.
He added that he was impressed when he met the clinic’s addiction specialist.
“He was kind and had empathy,” Preston said of Dr. Paule. “It was clear that he wanted to help. It was the first time I felt any hope from the medical community, in general, as an addict.”
Preston said he has been seeing the Bridge Clinic staff for almost a year and is continuing with follow-up appointments.
“It is a bridge,” Preston said of the program. “It’s a bridge from that initial choice to recover — to get clean and to get sober — it kind of bridges the gap between recovery programs and baseline medical treatment.
“We need to bridge the gap just to keep people safe and get people stable to the point where they are physically safe and clear-headed enough to continue with their recovery. They literally bridge that gap. They are keeping us safe and stable to where we can move on with our recovery, and the rest of our life.”