Budget Writers Question Doorway Program Success And Hampstead Hospital Staffing

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CONCORD, NH — State budget writers questioned the success of the Doorway program for substance abuse treatment, and the staffing plan for the Hampstead Hospital after the state purchases the facility but both requests had bipartisan support for approval.

The Doorway program for substance abuse treatment has been in place for about three years, and several members of the Joint Legislative Fiscal Committee Friday wanted to know how Department of Health and Human Services officials measured its success.

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The Doorway program consists of nine regionally located centers associated with regional hospitals or community mental health centers, and provides an entry point to the state’s system of care, distributes naloxone, and assists with treatment and basic needs.

Sen. Cindy Rosenwald, D-Nashua, asked how successful is the program when overdose deaths have gone up more than 30 percent in the state’s two largest cities.

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She noted the agency says it has helped 27,000 clients, but are they different people or some repeat clients. “How do you answer if this program is helping,” she asked.

Katja Fox, director of the Division of Behavioral Health, said the program serves between 800 to 1,000 new clients each month and does assessments after six months, 12 months and when they are discharged. But the agency is finding it is difficult to keep in touch with people over the entire period as some move, she said, or relapse or recover and move away.

She said the goal is to increase contacts so there is a more robust accounting.

“Becoming a program access point appears to be working by the numbers and the surveys,” Fox said. “We need a more robust evaluation and that is in the works.”

The agency sought to use $4 million in money it did not use last fiscal year for prevention by purchasing and distributing naloxone and fentanyl test strips.

Sen. Bob Giuda, R-Wentworth, asked if the agency had any information showing the number of those impacted before and after the program began.

Committee chair Karen Umberger, R-Kearsarge, said that question is so important.

“Most of us were hoping with Doorway we’d be able to have a better handle on the problems with drug overdoses.”Fox said a national survey would indicate the program is more successful and would share that information with the committee.

Sen. Gary Daniels, R-Milford, asked what the agency is doing to prevent overdoses.

“From 2019 to current the number (of overdoses) has been relatively steady,” he said. “All the money we’ve thrown into this is not bringing the numbers down.”

Fox said they have put a great effort into prevention, but it is difficult to quantify how many lives are saved and you don’t see an immediate impact like you do with naloxone.

“Prevention is hard to fund and the investment is not a quick turnaround,” Fox said, “but it does make a difference in the lives of people we serve.”

The committee voted 10-0 to approve the transfer.

Hampstead Hospital

The Department of Health and Human Services sought approval for using $1.76 million in federal American Rescue Plan Act funds to pay the salaries of six top officials to oversee the operations of Hampstead Hospital once the state closes on the purchase. The facility will serve as the state’s children’s mental health hospital, moving them from New Hampshire Hospital to free up beds in that facility.

The state currently contracts with Hampstead Hospital to provide in-patient mental health services for children.

The positions would include a chief executive officer, a chief operating officer, a chief financial officer, a compliance officer, a general counsel and a contract manager.

Health and Human Services Commissioner Lori Shibinette said a contract will be awarded for the remaining staff including nurses.

The top six officials will be unclassified state employees and the others would not work directly for the state.

Shibinette said the agency will determine after two years if that is the best model or if some other arrangement would be better. State officials have said they hope to make Hampstead a state-of-the-art facility.

Several members of the committee were concerned the arrangement would be problematic.

The New Hampshire Hospital contracts with Dartmouth for clinicians but the nurses and other staff are state employees several members noted.

“I see a potential for conflict,” said Rep. Robert Lynn, R-Windham.

Shibinette said the hospital will be one part of the state’s children’s system of care, which is linked to other state systems.

“This is the reason to have a leadership team,” she said. “You need accountability to more than just that particular hospital.”There are currently 45 beds at the hospital, but the state hopes to expand that number once it takes ownership.

Shibinette said one reason to contract for nursing services is the state cannot pay market rate for wages.

“That is one of the reasons why there is a 38 percent vacancy rate for nurses,” she said, while an independent contractor could pay a competitive wage.

“The state could fix its wage scale,” Shibinette said, “but that would take years, and we want to be up and running Hampstead in the next few months.”

HHS officials said they will present an operating budget to the committee once they have finished reviewing the facility’s finances.

An attempt to table the item was voted down, and then approved on a 9-1 vote.

Senate President Chuck Morse said he would support approving the request, but the agency needs to work with legislators so they could provide input on the project and asked the agency to return next month with more details.

Garry Rayno may be reached at garry.rayno@yahoo.com.

This story was originally published by InDepth NH.

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