Nursing graduate Anthony Paredes plays crucial role in integrating medical services into Greater Boston’s only Bilingual/Bicultural Behavioral Health Clinic.
Just two years after earning his Master of Science in Nursing degree from the MGH Institute, Anthony Paredes is playing a key leadership role in helping change the way substance abuse disorder is treated in the Commonwealth. And his organization has the platform to do it.
Paredes is the new Lead Medical Director of Casa Esperanza, a behavioral health treatment agency that is looking to become the state’s first under one roof model that covers all phases of substance use disorder treatment – from detox to clinical stabilization, residential treatment, mental health counseling, primary care, recovery support, and supportive housing.
“The idea is really treating the patient where they are and not necessarily putting them through these different levels in different facilities,” said Paredes. “We want to do it differently because we think it will be much more effective.”
Currently, the model for delivering substance use disorder treatment in Massachusetts involves patients moving from program to program, often starting with a detoxification facility or urgent care, and if successful, enrolling in a two-to-four-week clinical stabilization program followed by a six-to-twelve-month stay at a residential facility before moving to long-term outpatient care. Each transition introduces barriers as services are in high demand and beds are limited. Patients may find themselves on waitlists for months waiting for an opening to transition to step-down care.
“So, there's this huge gauntlet, right?” said Paredes, a 34-year-old who is the IHP’s inaugural alumni trustee and the board’s youngest-ever member. “There are all these different steps, all these areas of weakness, where individuals can just start relapsing because it's extremely difficult to stay sober. That’s what needs to be fixed.”
Casa Esperanza, Inc. is a Boston-based bilingual and bicultural behavioral health center that specializes in providing integrated, evidence-based, trauma-informed behavioral health, primary care, prevention, and urgent care services to the Latinx community in Massachusetts.
The center is one of four organizations in Massachusetts selected for Certified Community Behavioral Health Clinic (CCBHC) planning, development, and implementation funding in 2022. Casa will receive up to $4 million from the Substance Abuse and Mental Health Services Administration (SAMHSA) to establish the first CCBHC in Eastern Massachusetts focused on serving the Latinx community. Paredes will play a key role in developing and integrating primary care and preventative care medical services as part of Casa’s strategic growth to align with federal certification criteria for Community Behavioral Health Centers.
Paredes and the leadership at Casa Esperanza, Inc. see CCBHC funding as an opportunity to address barriers and close gaps that leave patients in early recovery vulnerable to risks associated with relapse. Casa’s continuum of care already includes a range of programs from early interventions like Urgent Care for Behavioral Health and Clinical Stabilizations services to long-term outpatient recovery support and supportive housing between the organization’s locations in Roxbury and Tewksbury.
“We want to add detox, we already have clinical stabilization, residential treatment, and outpatient care,” said Paredes with a hopeful gleam in his eyes. “It's all in there, and with Casa’s ‘any door’ policy, we're meeting the patient where they are, so that we can treat them where they are. So, if they’re right off the street and just had a relapse, ‘Okay, come on in. We'll help you.’ Or if there’s someone who's gone through all these different steps, and they're still looking for help. ‘Sure, come on in. We can continue helping you.’”
In the meantime, the $4 million from SAMHSA to plan, develop, and implement expansion to align with CCBHC criteria provides an opportunity to integrate more medical services and add more lifetime support for patients throughout their recovery journey. Casa’s plans include adding a Detox program to provide key support before patients enter Clinical Stabilization Services. The hope being that patients coming out of detox will be able to remain at Casa Esperanza throughout their recovery. Patients will receive consistent support to help maintain a patient’s sobriety including medication assisted therapy, counseling, information on sexually transmitted diseases and infections, sober social opportunities, wrap-around recovery support, and frequent one-on-one and group meetings with Paredes and his nursing team.
The last year has been a busy one; Casa Esperanza has already expanded recovery support services and outpatient mental health services to serve more than 500 individuals and families. The addition of telehealth has extended access to outpatient services for patients from anywhere in the state suffering from substance use disorder. At Casa’s main campus in Roxbury - which includes two residential recovery programs, supportive housing, and Casa’s Outpatient clinic - enrollment includes a steady stream of traffic coming from the nearby “Mass and Cass,” the epicenter of Boston’s opioid crisis.
“We’ve definitely seen a steady amount of people from ‘Mass and Cass’ needing our help,” said Paredes. “Even at our Tewksbury site, we’re seeing a ton of individuals from that area coming to us.”
Big Steps in Short Amount of Time
Paredes is based at Conexiones Clinical Stabilization Services in Tewksbury, the state’s first bilingual/bicultural clinical stabilization services program, and a satellite clinic of Casa Esperanza. After graduating from the IHP in 2020, he immediately began as a full-time nurse practitioner at the non-profit where he worked as a part-time RN during graduate school. It didn’t take long to make his mark and rise through the ranks. Paredes successfully pitched the idea of expanding and integrating more medical services to the nursing, substance use disorder and mental health services already available to patients. During his time at Conexiones, Paredes has held positions as Clinical Supervisor and now, Lead Medical Provider - a position that has him supervising a staff of five nurses and two nurse practitioners - one psychiatric nurse practitioner and one family nurse.
Paredes will lead the integration of additional medical services and create standard operating procedures for his team. He will work with Casa’s Clinical Leaders to standardize procedures across all levels of care and in identifying access barriers and unmet needs among the population Casa serves.
“We have a big vision on what we want substance use disorder treatment to look like in Massachusetts, and we're trying to really combat that,” said Paredes. “It’s such a focal point in the news, and it's obviously a hot topic because it's so relevant right now. There are so many individuals that are dying out there.”
State health officials reported a record 2,290 people died of a drug overdose in 2021, up almost 9% from the previous year. The need for accessible, effective behavioral health care focused on Latinx patients continues to climb at an alarming rate. Latinx households in MA face steep inequity across education, income, housing, and other social determinants of health. Economic segregation, driven by structural racial and ethnic bias, leads to high levels of poverty, violence, and instability in Latinx communities. As a result, long-term, stress-related health concerns can stay with Latinx families for generations. Research shows that Latinx patients are significantly more likely to benefit from care if it is attuned to their cultural needs. Casa's goal is to build a strong foundation for closing equity gaps in behavioral health access and outcomes.
Paredes says he soaked up a lot of how to efficiently run healthcare facilities during his time at the IHP, where his clinical rotations took him through the Dana Farber Cancer Institute, the Cambridge Health Alliance, and Massachusetts General Hospital along with stand-alone clinics in Rhode Island.
“That all allowed me to create the foundation and identify what the strengths are from each operation, and how it ran,” recalled Paredes. “I took in all of that information, and then created my own idea of what a good model would be.”
The IHP’s model of interprofessional education was another bonus for Paredes, who earned his Bachelor of Science in Biology with a focus on research from Syracuse University.
“There are so many different areas of a hospital involved in patient care. You have OT, PT, nursing. And it sometimes can appear there’s a disconnect between everyone. But in reality, we really are all working hand-in-hand, and we need to just identify where everyone's strengths are. That way, we can leverage it for the betterment of the patients.”
Improving access to evidence-based treatment for culturally and linguistically diverse patients is part of Casa’s core strategic vision. Paredes chose to work with the organization because it aligns with his own values and vision of equitable access to medical care.
“’Why do I do it?’” Paredes asked rhetorically. “Because there aren't a lot of providers who want to work with individuals who are displaced and/or suffering from substance use disorder. There aren't providers who really want to work in that of kind of field because it's rough.
“But every day, I see my patients, and they're looking for a second chance,” he continued. “As providers, we are that opportunity. We can provide that second chance and sometimes it's a third chance, but they are just there looking for a re-do in the game of life. It's a great feeling when you're able to see someone about a year later. They recognize you. They remember you, and they just thank you profusely for everything that you did for them.”
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