Dover Health Care Provider Expands Behavioral Health Services for the LGBTQ Community

NEW CASTLE (Feb. 21, 2022) – A Dover primary care office is expanding behavioral health services for LGBTQ individuals thanks to federal grant funding. A Peaceful Place Integrated Care is using the grant to support the addition of a certified drug and alcohol counselor, a licensed clinical social worker, and a peer navigator to help treat patients with substance use disorders and co-occurring mental health issues. The funds also support the use of telehealth to help patients continue accessing treatment.

A Peaceful Place is a minority-owned, woman-owned primary care office run by Ericka Daniel, a psychiatric nurse practitioner and family nurse practitioner. Daniel decided to open a practice that focuses on the unique needs of the LGBTQ population after she completed training in transgender health and non-binary gender education and realized there are few service providers with this specialized knowledge in Delaware.

“I would go to refer patients to LGBTQ-affirming health providers and realized there were hardly any,” Daniel said. “So, I decided to start my own practice.”

Daniel’s office provides primary care and wraparound behavioral health support services. Although she accepts all patients for primary health care, she seeks to create an environment that is especially LGBTQ-affirming. For example, the practice provides gender-affirming hormones for transgender individuals.

The practice also welcomes those who have substance use disorders and those diagnosed with hepatitis C. Daniel prescribes buprenorphine in both the oral and injectable forms, as well as naltrexone and vivitrol.

The Delaware Division of Substance Abuse and Mental Health (DSAMH) oversees the $37 million State Opioid Response (SOR) grant from the federal Substance Abuse and Mental Health Services Administration (SAMHSA), the source of the funding for A Peaceful Place. Rick Urey, Chief of Addiction Services at DSAMH, said that partnering with LGBTQ-friendly health care providers is critical to ensuring a pathway for all patients who need treatment for substance use disorders.

“We want anyone who needs treatment services to feel like they have places they can go where they are welcomed and respected,” Urey said. “Having an LGBTQ-friendly primary care office that also offers behavioral health services is a huge asset for our community. Not all health care providers understand how to prescribe medication for opiate use disorders, let alone how to integrate it with the specific health care needs of LGBTQ patients, especially those on hormone therapy.”

Daniel’s decision to integrate behavioral health services with primary care is driven by the frequent co-occurrence of mental health and substance use disorders in the LGBTQ community, as well as first-hand experience with her patients’ needs.

“LGBTQ patients have often suffered a series of traumatic experiences that can have a substantial effect on their physical and mental health,” Daniel said. “Due to perceptions about their lifestyle, it might have been separation, abandonment, and being ostracized by their faith communities. This causes a lot of trauma and people begin to self-medicate to numb that pain, which can lead to addiction and other risky behaviors.”

According to SAMHSA’s National Survey on Drug Use and Health, sexual minority adults are nearly twice as likely as their heterosexual counterparts to suffer from substance use disorder. Moreover, there were huge treatment gaps: less than 14% of lesbian, gay, and bisexual adults with SUD reported not receiving treatment during the 2019 survey. A recent study from the University of Pittsburgh found that nearly 1 in 10 gay/lesbian youth reported a history of heroin use compared to 4.1% of bisexual and 1.1% of heterosexual young people.

Some of the contributing factors to a higher prevalence of substance use among sexual minorities may include social exclusion, physical abuse, rejection by family or community, or other types of discrimination. A widely cited study from the University of Michigan found that LGB adults who have experienced multiple forms of discrimination are four times more likely to experience substance use disorder.

“I don’t want them to have to worry about facing rejection by another health care provider,” Daniel said. “It’s critical that they can have their needs met for their opiate use disorder and/or hormone replacement therapy in a setting that is respectful and nonjudgmental.”

Trust built over time is critical for developing the best health care plans with her patients. “Some patients initially try to hide their addiction from their primary care physician, but when they come to us, we take a holistic approach to talking about their health, and over time they become comfortable talking with me about more aspects of their health,” Daniel said.

When clients faced financial problems, Daniel has applied for the state’s Opioid Impact Fee Fund scholarships to ensure their recovery is not jeopardized. “I’ve used this fund for hotel stays and to pay for utilities for patients who were struggling financially,” she says. The fund, established through Senate Bill 34, was signed into law in 2019 and has been administered by DSAMH. Nearly 600 scholarships for housing, transportation, basic necessities, and other needs have been awarded to date to support the recovery of people with substance use disorders.

“This is a judgment-free zone,” Daniel said of A Peaceful Place. “Everyone has a messy life, so don’t let that stop you from coming in. We just want you to be healthy, to be well, to live how you want to live, according to your own yardstick.”

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Learn more about health care services provided by A Peaceful Place at www.apeacefulplaceintegratedcare.com or by calling 302-264-9436.

If you or a loved one is struggling with substance use disorder, you are encouraged to call DHSS’ 24/7 free and confidential Delaware Hope Line at 1-833-9-HOPEDE or text CONNECT to 55753.

Funding for these initiatives is supplied by grant number 5H79TI083305-02 from the Substance Abuse and Mental Health Services Administration (SAMHSA). The content of this publication does not necessarily reflect the views or policies of SAMHSA or the U.S. Department of Health and Human Services (HHS).


DHSS Releases 2018 Study Showing a Continuing Decline in Primary Care Physicians Across the State

NEW CASTLE (Jan. 2, 2019) – The number of full-time equivalent primary care physicians providing direct patient care in Delaware in 2018 declined about 6 percent from 2013, a trend that resulted in a slightly lower percentage of physicians statewide who are accepting new patients, according to a new University of Delaware study of the primary care physician workforce commissioned by the Department of Health and Social Services (DHSS).

The study, done by UD’s Center for Applied Demography & Survey Research, also found that the reduction in primary care physicians likely will continue, with a declining percentage of primary care physicians expecting to be active in five years, especially in Kent County. Kent has the highest percentage (25 percent) of physicians 65 and older, compared with Sussex County (16 percent) and New Castle County (13 percent). Only 60 percent of primary care physicians in Kent County reported that they will be active in five years, compared to 70 percent in Sussex County and 78 percent in New Castle County.

Despite the workforce trends, the UD study found that there are a sufficient number of primary care physicians in Delaware, “although their location and specialty is probably not optimal.” In 2018, there were 815 individual primary care physicians practicing in Delaware, down from 862 in 2013, and a full-time equivalent of 662 physicians statewide in 2018 vs. 707 in 2013. The study found that the 2018 numbers are at the upper range of what is desirable. Both Kent County – 2,069 patients per primary care physician – and Sussex County – 2,014 patients per physician – are above the 2,000-to-one ratio used by the U.S. Health Resources and Services Administration (HRSA) to designate shortage areas.

DHSS Secretary Dr. Kara Odom Walker, a board-certified family physician, said the trends point to the need to strengthen the dwindling primary care workforce in Delaware.

“The best preventive care and the most cost-effective care is provided by a strong and coordinated primary care workforce,” Secretary Walker said. “Primary care providers know their patients and their medical histories best and can provide the most effective, high-value, longitudinal care for chronic health conditions and other preventable diseases. As state government officials, our priority is to find ways to incentivize front-line care to perform as coordinated teams that are ultimately accountable for population health. We also need more primary care physicians to remain in practice and find ways to encourage new doctors, including those from minority and rural backgrounds, to choose primary care as their specialty.”

State Sen. Bryan Townsend and Dr. Nancy Fan, Chair of the Delaware Health Care Commission, are Co-Chairs of the Primary Care Collaborative, which is working on long-term solutions to support primary care in the state. The collaborative was created through Senate Bill 227, which aimed to strengthen primary care through a series of changes, including requiring insurers to reimburse primary care physicians and other front-line practitioners at the Medicare rate for the next three years. The collaborative, which has been meeting since September, is expected to issue its long-term recommendations by Jan. 8.

“It is vital that the State of Delaware, for the sake of Delawareans’ health, take steps to promote and strengthen primary care,” said Sen. Bryan Townsend, who sponsored Senate Bill 227 with Rep. David Bentz. “The declining rates of primary care providers practicing in Delaware or offering access to new patients are alarming. We have implemented immediate measures, and we have developed long-term solutions. The health and well-being of Delawareans, and the Delaware economy, cannot afford for us to delay in implementing those solutions, or for us to lack the courage to tackle complex policy and political issues.”

“This survey is very timely and demonstrates with supporting data the primary care physician crisis currently in Delaware,” said Dr. Nancy Fan, Chair of the Delaware Health Care Commission and an obstetrician/gynecologist in Wilmington. “Recognizing that primary care is foundational to effective, quality health care, the Health Care Commission is working through the Primary Care Collaborative to develop policy recommendations that will strengthen and maintain the current workforce and increase attractiveness of practice in Delaware for the future physician workforce. If something is not done immediately, these numbers will only get worse.”

“This DHSS study illustrates the poor access to primary care experienced by Delawareans,” said Dr. James Gill, a family medicine physician in Wilmington and a member of the Medical Society of Delaware who advocated for Senate Bill 227. “Increasing access to primary care will require increasing payment for primary care services by commercial payers in our state, which is currently 40 percent to 50 percent below the rest of the country. Senate Bill 227 has begun to move Delaware in that direction, and the Primary Care Collaborative is working to continue the work necessary to reduce the cost of care and improve the quality of care and the health of Delawareans.”

Among the other findings in the Primary Care Physicians in Delaware 2018 Survey:

  • In 2018, accounting for the time that primary care physicians offer direct patient care, the estimated full-time equivalent (FTE) was 662 physicians, with 461 FTEs in New Castle County, 89 in Kent and 112 in Sussex.
  • About 60 percent of Delaware’s physicians went to high school in the region; over half graduated from a medical school in the region; and about 80 percent completed their medical residency in the region.
  • The breakdown by gender statewide is 52.9 percent male and 47.1 percent female.
  • Delaware has a disproportionately low percentage of African-American (6.6 percent) and Hispanic (4.3 percent) primary care physicians statewide, compared with the state’s general population of 22.8 percent African-American and 18.1 percent Hispanic/Latino.
  • About 82 percent of physicians were accepting new patients in 2018, compared with 86 percent in 2013, but the proportion accepting new Medicare patients (72 percent) and new Medicaid patients (78 percent) was lower.
  • Average wait times statewide for new patients was 23 days in 2018, compared with 32 days in 2013, and six days for established patients in 2018 vs. 17 days in 2013.
  • The percentage of primary care physicians who employed non-physician services – advanced practice nurses, physician assistants and others – climbed to about 62 percent in 2018, up from 56 percent in 2013.
  • About 80 percent of physicians participated in a pay-for-performance reimbursement model including shared savings (34 percent), shared risk (19 percent), capitation model (14 percent), and concierge model (6 percent).

Data collection for the Primary Care Physician in Delaware 2018 Survey was done during the spring and summer of 2018, with 2,533 physicians contacted by mail who have an active license with a Delaware address or an address with a ZIP code adjacent to Delaware. Of those contacted, 957 responded and provided usable data. Primary care physicians practice in one of five specialties: family practice, general practice, internal medicine, pediatrics or obstetrics/gynecology.

Download the study here from the DHSS website.