Substance Use Navigator (SUN)
A SUN is a care coordinator and an integral team member working to improve access to Medication for Addiction Treatment (MAT). The SUN is a hospital employee embedded within either an emergency department or an inpatient setting in order to assist someone who has been administered buprenorphine treatment with beginning and remaining in addiction treatment via motivation, resources, and encouragement.
GOAL: Ensure that people with substance use disorder receive 24/7 high-quality care in every California health system by 2025
SUNs assist the increase in access to treatment for substance use disorders within the acute care setting:
Patient with Substance Use Disorder (SUD) is identified
SUN communicates with patient
SUN consults with provider to start treatment
SUN guides patient through next steps of ongoing care
SUN FAQs (PDF) - Responses to frequently asked questions (download PDF)
To understand the power of a successful SUN and buprenorphine intervention, please listen to this episode of the ED Pulse podcast produced by UC Davis Health featuring Bridge Program Assistant Director of ED Services Dr. Aimee Moulin. ED PULSE PODCAST (11 minutes)
REFERENCES AND OTHER SUPPORTIVE MATERIALS
Cost savings associated with providing screening, brief intervention, and referral to treatment for substance use disorder in emergency departments - The Urban Institute Health Policy Center
What is the role of a SUN?
SUNs conduct initial brief assessments, introduce patients to MOUD programs and services, expedite appointments at MOUD-capable clinics, serve as the primary coach for their clients, and maintain ongoing contact with their panel. They also assist with access to other services such as financial counseling, primary care, mental health services, social services, and residential treatment facilities.
SUNs are the link to the community. They outreach to treatment partners and facilitate transitions from the ED to outpatient treatment. SUNs also outreach and provide a link to organizations and individuals seeking treatment.
A SUN is sometimes known as Treatment Navigator, Treatment Coordinator, Medication for Opioid Use Disorder Navigator Navigator, MOUD Navigator, Patient Navigator, Linkage Coordinator, Care Coordinator, etc
What credentials should the SUN have?
There is no specific degree, certification, or training requirement. The SUN might have a designation such as certified drug and alcohol counselor or licensed clinical social worker but it is most important that they are nonjudgmental, energetic, positive. A sample job description is available here.
Who employs the SUN?
The SUN can be employed by a hospital, health system, staffing group or Bridge clinic as a 1099 contract worker, full time or part time employee or per diem.
Who supervises the SUN at my health care facility?
The SUN can be supervised in a number of ways. Possible models include:
A nurse manager acts as direct manager and manages activities such as hiring and administrative duties; ED Champion co-supervises day to day activities.
A staffing group manages activities such as hiring and administrative duties; County Department of Public Health MOUD program manager provides day to day supervision. (e.g. San Mateo Behavioral Health & Recovery Services IMAT (Integrated Medication Assisted Treatment).
In the case that a clinical team already has embedded staff in the ED, grant funding is used to add staff & hours to provide full coverage embedded service.
The SUN can be embedded into an existing team such as case management or social work.
How much and what kind of training is required for SUNs receiving support from the Bridge program?
SUNs across the state are participating in an ongoing and intensive training program with the CA Bridge team that includes motivational interviewing training and other specialty support through the Harm Reduction Coalition (HRC) and Mentoring in Medicine and Science (MIMS).
Within the CA Bridge Program, SUNs are offered a comprehensive set of trainings and materials that include:
In-person trainings throughout the course of the SUN Training Series;
Coaching calls with Bridge regional directors and other subject matter experts
Travel support is determined specifically via CA Bridge program participation. In addition, the SUN should participate in any site-specific training in order to onboard with their health care facility, including orientation with the emergency department, computer system, EMR and other training as required for new personnel.
What are some legal considerations for SUNs?
In addition to full compliance with HIPAA when working with a patient’s provider and medical record to ensure treatment plan adherence, the SUN must also remain in full compliance with 42 CFR Part 2, which guarantees confidentiality for people seeking treatment for substance use disorders from federally assisted programs. More information on this law is available here.
What should a new SUN do first?
Besides hospital-specific orientation as required by the site, SUNs will need to connect with their clinical champion and with other site resources such as case management and social services before beginning patient interaction activities. They will also be expected to adapt to the culture of their site. For further refinement of this initial activity list, we suggest working with the California Bridge program regional director assigned to your site for individualized guidance.
Is the SUN considered a medical provider?
Hiring a SUN as part of participation in the Bridge program relates to but is not legally considered medical care. Although Bridge funds can be used to hire the SUN, any actions that are directly related to patient care, such as the SUN’s cell phone, need to be provided by sites in accordance with individual site policies and cannot be funded by the Bridge grant.
What supplies will a SUN need to operate?
The substance use navigator will need a cell phone with service provided by the health care facility. They will also need access to their health system EMR. The California Bridge Program will provide sample documentation in the EMR and a template is available in EPIC.
Is this person expected to travel within the community surrounding their site?
Yes. The function of this role is to connect patients with resources in the community and tie into the hospital when people are identified who need help. SUNs may be eligible for travel cost reimbursement based on the policies of their site. SUNs will receive significant training to help them identify the most important stakeholders in their community to support their work.
How do SUNs track the patients they see?
For sites participating in the CA Bridge program, SUNs are generally accountable for reporting data to the California Bridge Program. With guidance from each site’s Regional Director, SUNs and clinical champions will develop a site-specific system. We also recommend a referral system for the SUN to follow up with patients seen in the ED after hours and on weekends. Some options include a secure message line, a shared patient list in the EHR, or secured physical list in the ED.
How do I recruit a SUN for my site?
There are many organizations that can help identify an exceptional candidate for this role. Your regional coordinator also may be able to advise on resources for your organization. Some resources to consider include:
Harm Reduction Coalition - https://harmreduction.org
California Opioid Safety Network - https://californiaopioidsafetynetwork.org
Mentoring In Medicine and Science - https://www.mimscience.org
Local MOUD/MAT clinic, FQHCs, Departments of Public Health etc.
Patient Care Navigators, Scribes, Case Managers, Community Outreach Workers, Health Coaches, etc can be trained into the role
Local CADC/CDAC/CATC (Certified Alcohol and Drug Counselor/Certified Drug and Alcohol Counselor/Certified Addiction Treatment Counselor) training programs (as long as training is based on the medical model, evidence based, & supportive of MOUD / as opposed to training and approach based on the social model or abstinence-based model)
Does Medi-Cal reimburse for services provided by SUNs?
Services provided by ED-based navigators and counselors are not reimbursable under Medi-Cal. Several funding opportunities have been opening up to support activities in California related to increasing access to treatment including California Bridge, Sierra Health Foundation’s MAT Access Points, and Department of Health Care Services (DHCS) California MAT Expansion Project. While ED-based navigators or counselors can support ED-based buprenorphine starts, they are not required in order to begin prescribing buprenorphine for OUD.
Will a SUN save my health system money?
Most likely. Research has proven the cost-effectiveness of screening, brief intervention and referral to treatment, with some variability based on patient and SUN characteristics.