A presentation delivered this week to members of the SouthWest Opioid Response District council indicated that it would be possible to offer inpatient substance use treatment at the former Robert E. DeNier Youth Services Center.
However, such an outcome is unlikely, given obstacles stemming from workforce shortages and long-term sustainability concerns.
The SWORD group, organized as a part of the Region 9 Economic Development Alliance, has representation from Archuleta, Dolores, La Plata, Montezuma and San Juan counties. The district will aggregate the counties’ allocations of funds from the state’s settlements with opioid pharmaceutical manufacturers.
In 2021, SWORD hired Health Management Associates to conduct a feasibility study examining the needs of counties and what solutions might be viable. The study focused specifically on whether the DeNier building could be converted to deliver resources for those with substance use disorders.
The Southwest region of Colorado is largely isolated from some of the more robust substance use treatment options that exist in larger, Front Range communities. People in need of recovery housing, medical detox and residential treatment – all levels of care beyond 12-step meetings and outpatient therapy available in the area – must uproot their lives, if they can afford to do so.
La Plata County has said it would be willing to donate use of the DeNier building, and set aside $5 million in the 2023 budget to remodel the former jail. There is also $1.8 million available in congressionally directed spending for a conversion.
Health Management Associated consulted both providers and key community informants in conducting the feasibility study.
The results indicated that a 44% plurality of 48 respondents said that low-intensity residential treatment was the unmet need that should be prioritized, followed by intensive outpatient therapy and then early prevention services.
Based on data from the Mercy Hospital emergency room, there would be an estimated 240 annual admissions to an inpatient facility, with an average daily population of 20 people.
The revenue associated with that service, generated by Medicaid per diems and a mix of commercially insured and uninsured patients, would likely generate a budget shortfall ranging from $440,000 to $2.2 million per year.
That project does not include any money available from the state’s settlements with the makers of prescription opioid painkillers. The region is estimated to receive $4,237,406 over the next 18 years.
The budget shortfall itself does not present a huge obstacle.
“It is not undoable,” said La Plata County Commissioner Marsha Porter-Norton, who is also the SWORD treasurer.
Still, SWORD facilitator Heather Otter said she is not optimistic that an inpatient facility will be built in DeNier.
The feasibility study found that two-thirds of respondents said that workforce-related challenges are a barrier in delivering care, leaving leaders concerned about the long-term sustainability of an inpatient model.
“Recruiting qualified staff is just tricky, and because you need a variety of staff, it might not be doable to have people move from out-of-area if the workforce isn’t here,” said Haley Leonard-Saunders, senior director of development at Axis Health System.
However, SWORD members are also optimistic that the resources at their disposal – several million dollars, a building and a robust picture of the needs at hand – will enable them to make an impact.
“From a regionwide perspective, substance use disorders are considered high-priority for addressing across our entire region,” Otter said. “ … Every single government signed onto this (memorandum of understanding) to pool the funds to do something regionwide, and that’s pretty significant. There aren’t many topics that our different jurisdictions will agree on.”
The study outlines a broad array of other services that are also needed, including medication assisted treatment, such as a methadone clinic, a short-term crisis stabilization center and recovery housing.
Once the council has the final written report in hand later this month, Otter said members will begin to discuss the next steps, including how to use DeNier, what levels of care to pursue and how exactly the funds allocated to the district will be used.