Michigan DHHS Implementation Training Packet 2019€¦ · Averhealth Training Slide Deck ..... 15 Substance Use Testing Guidelines . INFORMATION FROM PSM 713-07 • Positive substance

Michigan DHHS Implementation Training Packet

2019

Table of Contents MDHHS Substance Use Testing Guidelines ................................................................................................... 1

Oral Fluid Panel ............................................................................................................................................. 2

Urine Panel .................................................................................................................................................... 3

Specimen Types ............................................................................................................................................ 4

Comparing Specimen Options ...................................................................................................................... 5

Quick Guide: Adding a Donor in Aversys ...................................................................................................... 6

Setting Your Dashboard Preferences ............................................................................................................ 8

Scheduling Exceptions................................................................................................................................... 9

Custom Panel .............................................................................................................................................. 10

Oral Fluid Collection Process....................................................................................................................... 11

Accessing and Changing Testing Locations ................................................................................................. 13

2 Ply Forms .................................................................................................................................................. 14

Averhealth Training Slide Deck ................................................................................................................... 15

Substance Use Testing Guidelines INFORMATION FROM PSM 713-07

• Positive substance use and alcohol screens should not detract from the primary focus, which is assessment of

the safety and risk to the child not the habits of their parents or caregivers.

• Substance use screening is not appropriate when the client is in a substance abuse treatment program that includes screens as a part of the treatment program. Use the DHS 1555-CS, Authorization to Release Confidential Information, to request the results from the treatment program.

• Confidentiality issues related to substance abuse information must be addressed as outlined in SRM

131, Confidentiality – Substance Abuse Records.

SCREENING PARAMETERS

• Substance use screening with the client must be random, not scheduled in advance. This ensures accuracy of the client’s current use.

• Screening frequency need not exceed twice monthly unless there is an urgent need to verify use or abstinence, e.g.,

observations indicating that an acceptable environment for the child appears to be changing and deteriorating. • Substance use and/or alcohol screening may be provided only while a case is open.

ADDITIONAL INFORMATION

• PSM 716-7 indicates: Substance use, alone, is insufficient reason for investigation or confirmation of abuse or neglect of

the child. Parents use legally or illegally obtained substances (including prescribed medications) to varying degrees and remain able to safely care for the children. If other adults residing in the child’s home are using substances/alcohol, the parent/caretaker’s capacity to care for the child and ensure his or her safety and well-being must be evaluated.

• If additional screening of a client is needed, conduct a case conference with supervision regarding the screening needs,

and enter the contact into MiSACWIS. If the screening is court ordered, add a social work contact into MiSACWIS indicating this.

• Do not make referrals for more than six months at a time. If substance use screens are still necessary, another

referral must be made.

• Workers must end substance use screenings by completing the necessary documentation through the Averhealth website, indicating the service(s) were ended in MiSACWIS, and contact the client to inform them not to continue to complete screens.

• When making a referral for substance use screens, complete the first step of the DHS-93, Examination

Authorization/Invoice for Services.

• Upload all results of substance use screens into the documents section in the ongoing case in MiSACWIS. Name the file: Client Name - Substance Abuse Screen - date. Example: John Doe - Substance Abuse Screen - 10-02-2017.

Smarter solutions. Better outcomes. averhealth.com 2

Oral Fluid Panel Standard Panel comprised of the following ten (10) Drugs.

Standard Panel

Assay Detection Window Cut-off Level Amphetamines (Amphetamine, Ecstasy, Methamphetamine)

2 days 3 ng/ml

Buprenorphine 2 days 1 ng/ml Benzodiazepines 3 days 1 ng/ml Cannabinoids (THC) 1-2 days 0.5 ng/ml Cocaine <1 day 1 ng/ml Methamphetamine 2 days 3 ng/ml Opiates (morphine, heroin, hydrocodone, hydromorphone, oxycodone, oxymorphone)

1-2 days 3 ng/ml

Fentanyl 1 day 0.5 ng/ml Oxycodone 1 day 3 ng/ml Tramadol 1 day 10 ng/ml

Additional Options Assay Detection Window Cut-off Level

Methadone 4 days 5 ng/ml PCP 2 days 1 ng/ml Meperidine 1 day 5 ng/ml

*Please note: Detection Windows depend on the drug dose, frequency of use, and individual’s metabolism. Detection of some drugs will vary from person to person.


Urine Panel **Urine tests can only be performed by court order. Email the court order to

[email protected]

Standard panel comprised of the following ten (10) drugs.

Standard Panel Assay Detection

Window Screening

Cut-off Level Confirmation Cut-off Level

Amphetamines (Amphetamine, Ecstasy, Methamphetamine)

3 days 500 ng/ml 100 ng/ml

Buprenorphine 3 days 5 ng/ml 5 ng/ml Benzodiazepines 1-7 days 200 ng/ml 50 ng/ml Cannabinoids (THC) 3-5 days 20 ng/ml 5 ng/ml Cocaine <1 day 150 ng/ml 50 ng/ml Methamphetamine 3 days 500 ng/ml 100 ng/ml Opiates (morphine, heroin, hydrocodone, hydromorphone, oxycodone, oxymorphone)

1-3 days 300 ng/ml 50 ng/ml

Fentanyl 2 days 2 ng/ml 1 ng/ml Oxycodone 3 days 100 ng/ml 50 ng/ml Tramadol 1 day 200 ng/ml 50 ng/ml

*Please note: Detection Windows depend on the drug dose, frequency of use, and individual’s metabolism. Detection of some drugs will vary from person to person.

mailto:[email protected]


Comparing results of different specimen types is like comparing a Cadillac to a Tesla — such

comparisons have no basis in fact.

• Blood & Breath: 8 to 12 hours • Oral fluid: 5 to 48 hours • Urine: 0.5 to 5 days • Sweat: 5 to 10 days • Hair: 2 weeks to months

Con

cent

ratio

n

Hours Days Weeks Months

Cutoff

Source: Cone, E. J. (2011). Oral Fluid Drug Testing Workshop: Pain Management. Society of Forensic Toxicology.


Specimen Options

What difference does a biological specimen make to drug test results?

Specimen Options

Specimen Breadth of Detectable

Drugs

Detection Window

Collection Process Primary Use

Blood Broad 8-12 hours Invasive DWI, Postmortem

Breath Narrow 8-12 hours Non-Invasive DWI

Oral Fluid Moderate 5-48 hours Non-Invasive Abstinence Monitoring

Urine Broad 2-3 days Moderately Invasive

Abstinence Monitoring

Sweat Narrow 5-10 days Non-Invasive Special Situations, Rural

Hair Moderate 2 weeks – 3 months

Non-Invasive to Invasive

Child Custody, Rural


Getting Started with Averhealth 1. Log in to https://aversys.averhealth.com/ with your username and password

a. Your username will be your email address b. You will have received a temporary password via email. Please check Spam/Junk folders

Quick Guide: Adding a Donor in Aversys

1. Navigate to Accounts > Patients 2. Click “Add patient”

3. Fill in required information, as indicated by red text: Name, Program, Sex, Ethnicity, Birth Date,

Frequency Group, Case Manager 1.

https://aversys.averhealth.com/


4. If desired, complete the optional information such as Patient ID 2, Case Manager 2, Approved Medications, etc.

5. Click “Save” at the bottom of the page

6. Once the page has saved and refreshed, reference the “PIN” field in the top portion of the profile. Distribute the PIN to the patient as soon as possible.


Setting Your Dashboard Preferences

1. From the Dashboard, click on the green gear icon 2. Adjust setting per program you have access to 1. Drop down: Select the donors you want to see by

assigned case manager 3. Select your notification preferences – Daily Summary or Immediate Notification


Scheduling Exceptions

1. Search for the Client in Aversys

2. Navigate to the Client’s “Testing” tab and scroll down to “Scheduling Exceptions”

Click on the and click “Add Exception”

3. Add Exception notes and dates. Save.


Custom Panel 1) Navigate to Accounts -> Donors 2) Search for the Patient by name

3) In the Patient profile, navigate to ‘Testing’ 4) Under the section ‘Custom Panel(s)’ click the ellipsis and ‘Add Custom Panel’

5) Select the Panel Template (Panel you wish to customize) 6) Select the Expiration Type

a) # Orders – custom panel will run for the next defined number of orders b) Date – custom panel will run every order until defined date c) Never – no expiration, custom panel continues to run

7) Select / de-select the assays you would like to add or substitute


Oral Fluid Collection Process Materials Needed:

• A sealed collection kit • Latex/Non-latex gloves suitable for medical use • A timer capable of keeping time in 10-minute increments

Oral Fluid Collection Procedure:

1. Ensure the Client has not had anything to eat or drink in the last ten minutes, including chewing gum and chewing tobacco.

2. Peel open package and remove collection device. a) To expedite the collection process, have client move tongue side to side to accumulate

saliva in mouth before starting b) Keep the tip of the device pointed down

3. Instruct client to position collection device under tongue and close mouth. Keep head down to allow gravity to help with saliva collection. IMPORTANT: ensure client does not chew on pad, talk, or remove collection device from mouth until indicator turns BLUE, or until 10 minutes have passed.

4. Start the time and ensure the maximum duration of test is 10 minutes 5. The Collector must remain in view of the client during this process in its entirety. 6. Once the applicator turns blue or 10 minutes has expired, remove the applicator from the

Client’s mouth 7. Hold transport tube in an upright position and uncap by pushing up with thumb(s). Do not

stand tube on table. Do not spill or empty the liquid from tube. Insert the collection device into the provided vial according to the contents of the package.


8. Insert collection device into the uncapped transport tube and replace cap a) SNAP CAP firmly for transport

9. Place center of tamper seal on top of tube and press down both sides. 10. Client and collector initial tamper seal. 11. Confirm the Client’s name by requesting they verbally announce their name. 12. Affix the label to the vial. 13. Require the Client visually confirm that their label is affixed to the vial.


Accessing and Changing Testing Locations 1. Search for the client and pull up their profile

2. In the Patient profile, navigate to ‘Testing’

3. Scroll to the bottom of the page to ‘Collections Locations’ and click the ellipsis and ‘Manage Locations’

4. Click the location you would like to make their primary testing location and click ‘Make Primary’. Click

‘Save’.


2 Ply Forms

1. Collector should complete Steps 1 & 2 of the 2 Ply requisition form. a. Collector will select ‘Oral Fluid, Temperature not applicable’ in Step 2

2. Once the collection is complete, Collector removes the Tamper Proof seal from the bottom of the requisition form and secures it on the Oral Fluid transport tube.

3. Collector & client initial and date the tamper proof seal 4. Client signs and dates in Step 4 5. Collector completes step 5 6. Collector will separate the top and bottom sheets of the requisition form.

a. Collector retains top sheet b. Bottom sheet is sent to the Lab with the collected sample

MDHHS | Aversys Training Session

Averhealth Overview

MDHHS Policy

Implementation Timeline

Customer Service, Supply Orders, & Resources

Aversys Demo & Collection Process

agenda

15

AverhealthIntroduction

4444

Overview

• Over 25 years of helping people overcome substance use disorders

• Care for 180,000 Clients in over 1,500 treatment programs across 22 states

• Evidenced-based, Client centered care proven to result in sustained sobriety

• Turnkey substance use monitoring delivered locally via certified procedures

People: Facing Forward

• Physical or virtual ‘first-mile’ community presence

• Work side-by-side with local care team

• Prosocial Client environment

Science: Super Laboratory

• Integration of suite of individualized treatment support

• SUD focus testing for >1,500 substances

• Evidenced-based treatment decisions

Technology: Aversys

• Automation. Not administration

• Daily Client engagement

• Individualized Client treatment plan.

• Incremental cognitive therapy

16

5555

Nationally Certified Laboratory

State-of-the-art instrument-based technology.

Operated by PhD and Master level toxicologists.

Scientifically valid and forensically defensible.• Satisfy Daubert and Frye standards.• Supported by established case law.

Test for over 1,500 substances.

The ability to easily customize a panel that is individualized to each client and each sample collection is simply unique to averhealth.

666 6

Random Selection & Individual Notification

Daily calls support cognitive therapy and promote client motivation and engagement.

Clients randomly selected to test on any day of the week:• Test selection has no correlation with treatment, group, medication disbursement or other

scheduled appointments.• Reduces test frequency and cost.

Individualized Selection:

Care team provided real-time access to call log compliance, providing an early warning and allowing for early intervention.

17

MDHHS Policy

8888

Substance Use Testing Guidelines

Information from the PSM 713-07• Positive substance use and alcohol screens should not detract from the

primary focus, which is assessment of the safety and risk to the child not the habits of their parents or caregiver

• Substance use screening is not appropriate when the client is in a substance abuse treatment program that includes screens as part of the treatment program. Use the DHS 1555-CS, Authorization to Release Confidential Information, to request the results from the treatment program.

• Confidentiality issues related to substance abuse information must be addressed as outlined in SRM 131, Confidentiality – Substance Abuse Records.

Screening ParametersSubstance use screening with the client must be random, not scheduled in advance. Screening Frequency need not exceed twice monthly unless there is an urgent need to verify use or abstinence

Additional testing can be done with Supervisor or Court’s approval

18

9999

Substance Use Testing Guidelines

Additional Information• PSM 716-7 indicates Substance use, alone, is insufficient reason for

investigation or confirmation of abuse or neglect of the child. Parents use legally or illegally obtained substances (including prescribed medications) to varying degrees and remain able to safely care for the children. If other adults residing in the child’s home are using substances/alcohol, the parent/caretaker’s capacity to care for the child and ensure his or safety and well-being must be evaluated.

• If additional screening of a client is needed, conduct a case conference with supervision regarding the screening needs, and enter the contact in MiSACWIS. If the screening is court ordered, add a social work contact to MiSACWIS indicating this.

• Do not make referrals for more than six months at a time. If substance use screens are still necessary, another referral must be made.

• Workers must end substance use screening by updating the Averhealth website and change the client to a manual frequency group, indicate the service(s) were ended in MiSACWIS, and contact the client to inform them that they no longer need to interact with the notification system.

“Review Date” in Aversys will help remind you to review and renew referrals

ImplementationTimeline

19

11111111

Summary Implementation Timeline

[1] Private Agency Partners and/or TPAs

Date MilestoneInvolvement

DHHS Averhealth

Other[1]

Week of 05/27 Begin User Training (St. Clair & Sanilac on 5/28) X X X

06/03 Phase I Go Live – BSC #2 X X X

06/18 Phase II Go Live – BSC #4 & #5 X X X

07/17 Phase III Go Live – BSC #3 X X X

08/05 Phase IV Go Live – BSC #1 X X X

Ongoing Service Optimization X

12121212

Phase 1

County Notification Training Go LiveSt. Clair 5/14 5/28 6/3

Sanilac 5/14 5/28 6/3

Huron 5/15 5/29 6/4

Tuscola 5/15 5/29 6/4

Lapeer 5/16 5/30 6/5

Genesee 5/16 5/30 6/5

Shiawassee 5/17 5/31 6/6

Gratiot 5/17 5/31 6/6

Ingham 5/21 6/4 6/10

Eaton 5/22 6/5 6/11

Clinton 5/22 6/5 6/11

Bay 5/23 6/6 6/12

Arenac 5/23 6/6 6/12

Gladwin 5/24 6/7 6/13

Midland 5/24 6/7 6/13

Saginaw 5/25 6/10 6/16

Genesee 5/16 6/10 6/5

Clare 5/28 6/11 6/17

Isabella 5/28 6/11 6/17

20

13131313

Phase 2

County Notification Training Go LiveWayne-South 5/29 6/12 6/18

Wayne-South 5/30 6/13 6/19

Oakland 5/31 6/14 6/20

Wayne-North 6/3 6/17 6/25

Wayne-North 6/4 6/18 6/25

Wayne-Western 6/5 6/19 6/26

Wayne-Western 6/6 6/20 6/26

Livingston 6/7 6/21 6/27

Washtenaw 6/7 6/21 6/27

Jackson 6/12 6/26 6/28

Monroe 6/26 7/9 7/15

Lenawee 6/26 7/9 7/15

Branch 6/25 7/10 7/16

Hillsdale 6/25 7/10 7/16

14141414

Phase 3

County Notification Training Go LiveCalhoun 6/27 7/11 7/17

Kalamazoo 6/27 7/11 7/17

Cass 6/28 7/12 7/18

St. Joseph 6/28 7/12 7/18

Macomb 7/1 7/15 7/22

Berrien 7/2 7/16 7/23

Van Buren 7/2 7/16 7/23

Allegan 7/3 7/17 7/24

Barry 7/3 7/17 7/24

Kent 7/4 7/18 7/25

Ottawa 7/4 7/18 7/25

Ionia 7/5 7/19 7/26

Montcalm 7/5 7/19 7/26

Muskegon 7/10 7/24 7/30

Mecosta Osceola 7/10 7/24 7/30

Lake 7/11 7/25 7/31

Newaygo 7/11 7/25 7/31

Oceana 7/12 7/26 8/1

Mason 7/12 7/26 8/1

21

15151515

Phase 4

Aversys Demo &

Collection Process

22

171717171717

Aversys Demo

• Dashboard

• Entering new Clients

• Custom Test

• Client Check-in

• How to perform a collection

• Results retrieval

• Help section

18181818

User-Specified Dashboard

Quick Access to Case Load.

Real-time schedule &

call-in compliance.

Real-time test results.

Case Load Reminders.

23

19191919

Setting your Dashboard

1. From the Dashboard, click on the green gear icon

2. Adjust setting per program you have access to

1. Drop down: Select the clients you want to see by assigned case manager

2. Select your notification preferences – Daily Summary or Immediate Notification

20202020

Adding a New Client

1. Go to Accounts -> Patients2. Click ‘Add Patient’

3. Fill in required information:Name, Sex, Ethnicity, Birth Date, Frequency Group, and Case Manager 1.

4. Click ‘Save’

24

21212121

Oral Fluid Base Panel Options

Standard Panel comprised of the following ten (10) Drugs.

Standard Panel Additional Options• Amphetamines (Amphetamine, Ecstasy,

Methamphetamine) • Benzodiazepines• Cannabinoids (THC)• Cocaine• Methamphetamine• Opiates (morphine, heroin, hydrocodone,

hydromorphone, oxycodone, oxymorphone)

• Oxycodone• Fentanyl• Buprenorphine• Tramadol

Standard Drugs• Barbiturates• Methadone• PCP• Cotinine

Specialty Drugs• SOMA• Gabapentin• Zolpidem• Alcohol (coming soon)

22222222

Urine Base Panel Options (Special Order)*

*Urine tests can only be performed by court order, email the court order [email protected]

Standard Panel comprised of the following ten (10) Drugs.

Standard Panel Additional Options• Amphetamines (Amphetamine, Ecstasy,

Methamphetamine) • Benzodiazepines• Cannabinoids (THC)• Cocaine• Methamphetamine• Opiates (morphine, heroin, hydrocodone,

hydromorphone, oxycodone, oxymorphone)

• Oxycodone• Fentanyl• Buprenorphine• Tramadol

Specialty Drugs• EtG

25

23232323

5. Select the Panel Template (Panel you wish to customize)

6. Select the Expiration Type• # Orders – custom panel will run for the next

defined number of orders• Date – custom panel will run every order until

defined date• Never – no expiration, custom panel continues

to run7. Select / de-select the assays you would like to add

or substitute

Customize a Panel

1. Navigate to Accounts -> Patients2. Search for the Client by name3. In the Client profile, navigate to ‘Testing’

4. Under the section ‘Custom Panel(s)’ click the ellipsis and ‘Add Custom Panel’

24242424

TPA Referral

All new Clients assigned to a random Frequency Group should be provided a Testing Card and PIN.

If Random, proceed to Results Reporting

26

25252525

Benefits of Electronic Chain of Custody

The electronic COC reduces the specimen collection check-in time. Specimen collectors can quickly verify client identity, verify collector identity, and verify collection location. On average, the check-in process requires less than twenty (20) seconds and is meaningfully faster and less error-prone than the traditional-paper based COC.

• CAP-FDT approved

• Ability to track a sample throughout the entire process

• Reduced MDHHS officer time

• Client privacy and wait time

• Improved accuracy due to reduced human error

• No penmanship issues

• Time-stamped audit trails

• More timely results reporting

The transition from a paper to an electronic chain of custody is the single most relevant change. Initially this change will require a small investment of your time that will soon lead to many benefits.

How to Check in a Client via Aversys

1. Navigate to Care Center > Patient Check-in

2. Search for client by name or PIN3. Click the green clock icon next to their name

27

How to Check in a Client via Aversys

4. Review Client’s information and verify their identity

5. Verify the Order information and Collection information. Click ‘Process Order’

Client Check-in | 1 Ply form

• The Electronic Chain of Custody will print out on the provided 1-ply form

• Collector and client complete the form together after the collection.• Collector marks if the client

refused or was unable to provide a sample

• Collector indicates if the sample collected was an Oral Fluid

• Collector and Client signs and dates

• Collector and Client initials tamper seal

28

29292929

Collection Process – 2 Ply form

1. Collector separates the top sheet of the completed Drug Testing Requisition form from the bottom.

2. Collector retains the bottom portion of the Drug Testing Requisition form for their records.

3. Collector places the top portion of the Drug Testing Requisition form into the back pouch of the specimen baggie.

30303030

Oral Fluid Collection Procedure

1. Ensure the Client has not had anything to eat or drink in the last ten minutes, including chewing gum and chewing tobacco.

2. Peel open package and remove collection device.a) To expedite the collection process, have client move tongue side to side to accumulate

saliva in mouth before startingb) Keep the tip of the device pointed down

3. Instruct client to position collection device under tongue and close mouth. Keep head down to allow gravity to help with saliva collection.IMPORTANT: ensure client does not chew on pad, talk, or remove collection device from mouth until indicator turns BLUE, or until 10 minutes have passed.

4. Start the time and ensure the maximum duration of test is 10 minutes5. The Collector must remain in view of the client during this process in its entirety.6. Once the applicator turns blue or 10 minutes has expired, remove the applicator from the

Client’s mouth7. Hold transport tube in an upright position and uncap by pushing up with thumb(s). Do not

stand tube on table. Do not spill or empty the liquid from tube. Insert the collection device into the provided vial according to the contents of the package.

29

31313131

Oral Fluid Collection Procedure

8. Insert collection device into the uncapped

transport tube and replace cap.

SNAP CAP firmly for transport.

9. Place center of tamper seal on top of tube and

press down both sides.

10. Client and collector initial tamper seal.

11. Confirm the Client’s name by requesting they

verbally announce their name.

12. Affix the label to the vial.

13. Require the Client visually confirm that their

label is affixed to the vial.

32323232

Shipping Samples

• Place each collected sample in the front pouch of a specimen baggie, along with the bottom portion Requisition form in the back pouch.

• Place all sealed, bagged samples into the FedEx Clinical Pak

• Place the FedEx Billable Stamp onto the outside of the clinical pak in the area indicating “Place shipment Information on the center of pak.”

• Deposit the FedEx Clinical Pak into a FedEx drop box or location. To find a location near you: https://local.fedex.com/

30

33333333

Reviewing Results

1. Non-negative results on the Dashboard

2. Client’s Test History

34343434

Reports

31

Customer Service, Supply Orders,

& Resources

36363636

Supply Orders

• County Coordinators will beresponsible for the supplyorders.

• Complete the Supply Order requestform

• Email the completed form [email protected]

• Supplies will be shipped to theappropriate location

32

37373737

Customer Service Contact Information

MDHHS Customer [email protected]

(866) 246-1321

Local Area ManagerMatthew Leslie

38383838

Testing Cards

• All new Clients are provided a Testing Card that provides a road map to success.• Provide structure: you are in a recovery process, start everyday off in the right

way by calling the message line.

• If you feel the urge to use, pull out the card as a reminder that you have to call the message line tomorrow morning .

• Built-In Excuse: if a friend is pressuring you to use drugs, use the Testing Card as an excuse to say no.

33

39393939

Metabolite Guide

Questions?

Additional questions and feedback can be emailed to

[email protected]

34

Documents

Michigan DHHS Implementation Training Packet 2019€¦ · Averhealth Training Slide Deck ..... 15 Substance Use Testing Guidelines . INFORMATION FROM PSM 713-07 • Positive substance