Sarah Bagley: The CATALYST program is a multidisciplinary program at Boston Medical Center 

that developed because Boston Medical Center has this long history of taking 

care of adults with substance use disorder and primary care and does an 

excellent job in doing that. They care for patients in primary care and the 

emergency department and in OB and obstetrics. 

There was really a gap though in terms of the services that were being offered 

to adolescents and young adults. We recognize that that was actually a gap that 

was felt across our city. So CATALYST was created to address the need of 

ongoing substance use in adolescents and young adults. 

We have a team that's composed of physicians, social workers, nurses, program 

manager. We also work really closely with our child and adolescents 

psychiatrist. Importantly we have added a recovery coach to our model which is 

a little bit different so that individual has a background in what's called, 

recovery coaching and can address patients specific needs to their recovery in 

addition to their social determinant. 

We see patients in both the adolescent center of Boston Medical Center and 

also in adult primary care. So we're able to match our patients to sort of where 

they fit developmentally. 

When a patient calls or a family member calls or we receive a referral for a new 

patient, we set up an appointment with a physician and a social worker so we 

can do a first visit and an assessment of what's going on with the patient. 

We then, the following week develop a treatment plan. We meet every week as 

a team to talk about what's going on with our patients and there we'll discuss 

new patients and ongoing issues with existing patients. 

We feel like the team base approach that we have is really important. I think 

another really important part of our model is that there we try to have basically 

no hierarchy and everyone's really contributing to the treatment plan in an 

equal way. 

We recognize that addiction is a complicated disease and although it's a brain 

disease there are a lot of other things going on in that person's life that need to 

be addressed. That each team member's specific training is there to be able to 

address those different issues. 

We started seeing patients in the CATALYST program in May of 2016. At this 

point we are putting together a database so that we can start to track out 

outcomes because we recognize that there's so few programs like this in the 

United States that it's important that we figure out what we're doing well but 

also different things that we need to do to improve so that we can share our 

models with other programs. 
I'm gonna talk about some of the biggest challenges that we face in treating 

teens and young adults with substance use disorder. The first is ambivalence. So 

the teenage years and young adulthood is really characterized by ambivalence 

and difficulty in making decisions. So we find that it can be very difficult to 

engage our patients and have them agree with us that they may need treatment 

for their substance use disorder and this can be a huge barrier to care. 

Another significant challenge that we face everyday in our work is the stigma 

associated with both the disease of addiction and the medications that we're 

using to treat addiction. This can be ... make it difficult to get patients to come 

into care for the first place or it can make patients and families resistant to 

accepting the kind of treatment that when we wanna offer them. 

The third challenge that we see commonly and this is particular to my practice 

are issues around social determinant of health. So such as housing and 

employment, school issues, transportation, being able to pay for bills. We've 

heard from our patients and their families time and time again that if those 

basic needs aren't being met, it's really hard for them to focus on their recovery. 

So we do everything that we can in our program to try to address those needs, 

but we're an outpatient based program [inaudible 00:06:51] and there are 

limited resources. 

There are different ways that you can involve parents and family members and 

treatment for a substance use disorder with their teen or their young adult. We 

invite all parents or family members into visits and sometimes have family 

meetings. This is of course done with the permission of the patient. The patients 

can provide guidelines for how those visits are gonna go and what information 

is gonna be shared. But we try to explain to our patients that it's really 

important and it's really critical to their success to have their families involved 

as much as possible. We also provide referrals for families to mutual help 

groups which really means support groups that are led by other parents and 

family members who have loved ones who are struggling with addiction, or to 

family therapy. In our program, we plan to start parent groups and so these are 

gonna be educational sessions for parents and other family members who are 

affected by substance use, specifically targeted for those who have loved ones 

not willing to engage in treatment.

It can be a lot to be telling a 18 or 19 year old that they have a chronic illness 

that they're gonna be living with for the rest of their life. Once they start to hear 

that message, they may not wanna come into clinic to receive treatment. 

What we try to do is we tell our patients from the start that we're there for 

them no matter what. We try to identify other things that are going on in their 

lives that might be challenging. So issues around school or a job or with 

transportation and sometimes by addressing some of the other challenges that 

they have going on in their life we're able to then engage them in treatment for 

their substance use. 
When caveat to this is that when we're taking care of patients who are less than 

18 years old, sometimes other challenges come up and because of their age. So 

for example, if we have a patient who is 16 and we know that that person may is 

injecting heroine or other opioids and is really at acute risk, then sometimes we 

may have to break confidentiality and engage other agencies to assure the 

safety of that child. 

It's really important when working with teens and young adults who have 

substance use disorder or who are using substances, to spend a lot of time 

building trust and building rapport. A lot of these teens and young adults might 

be coming from families where there are issues around communication or they 

might have a lot of other experiences in their life where their trust was broken. 

So spending some concentrated time, really explaining, reassuring and 

demonstrating through having open doors, calling back quickly, having other 

members of the team sort of address their other social needs, can make a real 

difference in terms of engaging with them. 

I think it's also important to recognize with teens and young adults because they 

may be ambivalent. That they might not show up initially to an appointment or 

they might stay engaged and then drop out of care. But we have also found that 

by giving them this message that we're there no matter what. That a lot of our 

patients, even if it's been a couple of months will come back to us and they will 

tell us and their parents will tell us, that they felt that it was important to come 

back to us because we were safe, we had told them that no matter what was 

going on, this was a place that they could come to.