Our Five principles
The success of our Low-Barrier Buprenorphine program is due to the principles our team embodies, enabling us to deliver on the city’s promise of Whole Person Care. While every context is unique, we share these principles as recommendations and considerations for organizations and agencies working to improve the health outcomes of people with substance use disorders.
1. Put the Patient First
Know your population.
The first step towards creating a successful program is to identify the patient population and work to understand individual motivations and concerns.
Assess your barriers.
Each community has its own set of barriers preventing patients from accessing effective care. Understanding and addressing those challenges will enable your team to create systems to meet the needs of your patients. In our experience, patients often don’t have identification or insurance coverage, and they often have difficulty keeping appointments. Additionally, different goals between patients and prescribers create a barrier for the patients to engage and there is often an overall lack of trust in medical systems.
Let your patient set the goals.
Use motivational interviewing techniques to identify and set specific and achievable goals, one at a time. One of our team member’s favorite question for patients “What can I do to help you?”
2. Build an empowered team
Keep the hierarchy flat.
Our team is made up of navigators, nurses, health workers, and buprenorphine-waivered clinicians. Our multidisciplinary medical team honors each members’ clinical expertise irrespective of degree or title.
Engage each team member in all aspects of the program.
Every team member is empowered to support the patient to the best of their abilities in each moment of engagement. Team members have a clear understanding of what decisions they can make in the moment, and know when to ask for additional support.
3. Build a complete ecosystem of formal & informal partners
Build a relationship with a Pharmacy.
We have a close working relationship with San Francisco’s Behavioral Health Services (BHS) Pharmacy. BHS has extensive experience in educating and counseling high-risk patients and working closely with community-based providers. They can offer up to five days a week dispensing or direct observed therapy and are co-located with a clinical program that can provide point-of-care urine drug screening and therapeutic monitoring for buprenorphine.
Show up where your participants are.
We operate at locations where our patients are already comfortable. Preventative health care settings such as needle exchanges and street-based health fairs are important partnerships as well.
4. Practice Harm Reduction
Embrace harm reduction principles.
We believe in respecting the dignity of our patients. In doing so, we can help them to achieve their health-related goals and transition to a more healthy state of life.
Build a trusting relationship.
In the words of one of our team members, “be very patient and very persistent.” It may take several visits over a period of months to establish rapport with patients.
5. Take a new approach
Meet patients where they are.
This is an approach to patient-goal setting as well as tactical location strategy. We meet our patients where they physically are: this includes needle exchanges, encampments, shelters, and homeless health fairs.
Make your clinic open access.
Recognizing that appointments can be difficult for people living on the street and using substances, we stopped using set appointments. That means, patients can come to the clinic during any of our open hours and get what they need that very day, and they never have to worry that they have missed an appointment.