Shawn LaFrance

Shawn LaFrance, who is overseeing the rollout of Cheshire Medical Center’s new recovery services referral hub in Keene, discusses the state’s hub and spoke model at a public forum at the hospital Monday morning.

About 50 area residents and professionals — including community leaders and service providers — gathered Monday at Cheshire Medical Center to learn about Keene’s new recovery services referral hub.

Attendees peppered presenters with questions about the logistics of the new model being rolled out statewide, and also wanted to know how New Hampshire plans to sustain the system.

The Dartmouth-Hitchcock affiliate opened the local center, known as The Doorway, at 640 Marlboro Road (Route 101) on Jan. 2, as part of the state’s $48.5 million effort to create a “hub and spoke” system to screen, assess and refer people struggling with substance misuse to treatment and support services in their communities. Berlin, Concord, Dover, Hanover, Laconia, Littleton, Manchester and Nashua also host hubs.

The hubs come in the midst of a substance-misuse epidemic that killed 488 people in New Hampshire in 2017. Statistics for 2018 aren’t finalized, but state officials most recently forecast 437 drug-related deaths for the year.

Monday’s meeting in Keene, which filled a hospital auditorium almost to capacity, was as much an effort to explain the nascent system as it was to market the new service. Shawn LaFrance, who is overseeing the hub’s rollout, gave a short presentation about the model, explaining that the hub will refer clients to “spokes” of all kinds, including peer support organizations, treatment facilities, housing agencies and more. Clients can access the hub either by calling the state’s 211 hotline or by walking into the Keene office.

LaFrance said the Marlboro Road location is a temporary one, and that the hub will move to 117 Railroad St. in downtown Keene in mid-April.

Area service providers, including those from the Cheshire County jail, the Keene Serenity Center, the Keene Police Department and the Cheshire County Sheriff’s Office, asked questions Monday pertaining to holes in the state’s current recovery-treatment infrastructure.

Some of them wanted to know how the hub will address the needs of uninsured clients. Others pointed to recovery-service gaps, such as low Medicaid reimbursement rates for residential treatment facilities and waiting times for beds.

At least two people alluded to worries that the hub and spoke system — funded by a two-year grant from the federal Substance Abuse and Mental Health Services Administration — will crumble when these funds run out.

LaFrance, who fielded most of the questions, said the model’s sustainability will depend on the hubs’ effectiveness in coming months.

He also acknowledged that the hubs are, in many ways, a work in progress. Cheshire Medical Center is still formalizing its relationships with some of the support organizations that serve as regional spokes, he said, and is still in the process of hiring all the staff it needs for the new center.

Also in the room Monday was Katja Fox, director of the division for behavioral health at the N.H. Department of Health and Human Services, who answered questions about the state’s role in the project.

Since the model is based on sustained, individualized interactions with people seeking services, there are still details to work out, LaFrance said. For example, some clients may need home visits, and hub staff may hold some kind of support activity, such as group discussions, with clients waiting to be seen by community organizations, he added.

In the meantime, the hub is already assisting clients. In an email Monday afternoon, hospital spokeswoman Kristen Bernier said hub staff have worked with 12 clients since the center opened.

At Monday’s meeting, LaFrance said the rollout has focused on putting the system in place, and the state will market the hubs in the coming weeks.

After learning that the center is open five days a week from 8 a.m. to 5 p.m., N.H. Sen. Ruth Ward, R-Stoddard, asked about the waiting period between referral and treatment.

LaFrance acknowledged there may be some waiting, but said staff will support clients and check in with them as often as needed during that time. As part of the project, he said, the state is also investing funds to further develop addiction treatment and supports, so that clients who come to the hubs will have more options.

Fox said hub staff will help clients identify the right treatment avenue for them.

“So everyone always says, ‘I need a bed, we need a bed,’ and it may not be that that person’s level of care is deemed to be a bed,” she said. “It may be intensive outpatient services, it may be other types of services. So the idea is although they may not go immediately down the street and get transportation and go into a treatment center, at least they have a sense and they know how they can follow up.”

Speaking to one of the current recovery infrastructure’s shortcomings, Alison Welsh, drug court coordinator for Cheshire County, asked if the state has plans to create a database of available beds at different facilities in real time so the referral process takes availability of services into account.

Fox said the state could not create a bed-tracking system as part of the hub and spoke model, but that this type of system may be developed in the future.

Cheshire County Sheriff Eliezer “Eli” Rivera asked how the hub will assist clients who are either underinsured or have no health insurance.

LaFrance said clinicians will work with them to find options that work for their insurance, if they have any, and can also refer to agencies that assist with health insurance signups.

“We’d love to go to a computer screen in real time and know bed availability, insurance, all that kind of stuff for every treatment slot — that doesn’t exist yet, that will be hard to create, but that’s our goal is to do that,” he said. “In the short term as the hub evolves, we’re going to wrap our head around it in terms of our own region.”

The Doorway at Cheshire Medical Center is at 640 Marlboro Road in Keene (the Curran Building on Route 101) and is open Monday through Friday, from 8 a.m. to 5 p.m. Support through the state’s 24/7 hotline is available at 211.

Liora Engel-Smith can be reached at 352-1234, extension 1439, or lsmith@keenesentinel.com. Follow her on Twitter @LEngelSmithKS.