Table 1

ACT Members, Roles and Responsibilities

Team memberNeeds addressedWorkflowResponsibilities
LVN
2.9 FTE
  • Assessment of unhealthy substance use

  • Motivational interviewing and counselling

  • Visit triggered if patient screens positive for smoking or unhealthy alcohol use

  • 7-day a week coverage

  • Assess people with unhealthy alcohol use for alcohol use disorder

  • Assess interest in naltrexone for alcohol use disorder and nicotine replacement therapy, varenicline or bupropion for tobacco use disorder

  • Refer to California Smokers’ Hotline and groups

  • Communicate with primary teams when patients express interest in medications for alcohol or tobacco use disorder

  • Provide motivational interviewing for substance use

  • Request ACT patient navigator, fellow and/or attending consult when patient requires specialty motivational interviewing, outpatient linkage, initiation of medication for stimulant or opioid use disorder or extended-release naltrexone

  • Administer extended-release naltrexone

Patient navigator
1.0 FTE
  • Discharge planning

  • Motivational interviewing and counselling

  • Coordination with social work to refer to mental health support

  • Visit triggered if primary team consults for postdischarge linkage or ACT fellow, attending or LVN request

  • Weekday coverage

  • Use motivational interviewing to evoke patient goals and guide patients towards healthier behaviours

  • Provide harm reduction counselling

  • Refer to outpatient primary care and addiction treatment including peer support groups, harm reduction, intensive outpatient and residential treatment programmes

  • Provide postdischarge navigation support for barriers encountered by providing patients ACT phone number

  • Follow-up with patients who have a phone once via phone after discharge to check in regarding care transition

  • Communicate and coordinate plans with primary teams and outpatient programmes

  • Refer to outpatient mental/behavioural health services

  • Call patients who have a phone once after discharge to check in regarding care transition

Fellow
0.75 FTE
  • SUD evaluation and diagnosis

  • Motivational interviewing and counselling

  • Treatment recommendations

  • Staff and provider education

  • Visit triggered if primary team consults or LVN requests

  • Weekday coverage

  • Conduct comprehensive substance use evaluation

  • Make or confirm SUD diagnosis

  • Motivational interviewing

  • Model non-stigmatising language and behaviour

  • Recommend medications to treat substance withdrawal symptoms and evidence-based medications for addiction treatment based on patient preferences

  • Work with patient navigator and primary team on discharge planning

  • Educate staff and providers

  • Lead daily interprofessional huddles

Attending
0.5 FTE
  • Supervision

  • Motivational interviewing

  • Treatment recommendations

  • Staff and provider education

  • Billing

  • Visit triggered if primary team consults or LVN requests

  • Weekday in person coverage

  • Weekend home call

  • Support ACT members

  • Supervise fellow

  • Carry fellow responsibilities as above when fellow absent

  • Educate rotating fellows and trainees and ACT members

  • Lead brief multidisciplinary teaching at daily huddles

    .

  • ACT, Addiction Care Team; FTE, full-time equivalent; LVN, licensed vocational nurse; SUD, substance use disorder.