Nashua Doorways program triples service with new contract

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Nashua’s Doorway has tripled in service since changing hands. Courtesy Photo


In May, Catholic Medical Center and Southern New Hampshire Health took over the Doorway programs, through which people suffering from substance use disorder in Manchester and Nashua can access treatment. Since then, there’s been an increase in the number of people connected with treatment through the Doorways program in both cities. 

“When you look at the full volume of services that are being provided both in-person and telephonic, we’re seeing three times as many as were there before,” said Steve Norton, chief strategy officer for SolutionHealth, the parent organization formed by the summer 2018 merger of Southern NH Health and Elliot Hospital. “Which for us felt like hitting it out of the park.”

The change in partnership comes after a contract with Granite Pathways, which initially oversaw the Doorways program in Manchester and Nashua, was terminated. An audit by DHHS found a number of problems with how Granite Pathways was performing as the Doorway operator in Nashua and Manchester and concluded it was not meeting its contract requirements, according to a report published in February.  

That left the state looking for new partners, which it found in Catholic Medical Center for Manchester and Southern New Hampshire Health for Nashua. 

Nashua Doorways Program Triples Number Of People Connected With Treatment

In January 2019, New Hampshire created a statewide system of nine regional hubs — known as Doorways — which were access points to treatment, mostly managed by local hospital organizations. Since then, the program has helped roughly 2,900 people connect with treatment for substance use disorder, according to DHHS. 

This state-wide program came after Safe Station launched in 2016, as the brainchild of Manchester firefighter and EMT Chris Hickey, as a new program that invited people suffering with substance use disorder to begin their road to treatment at any of the city’s fire stations at any time of the day or night.

Nashua Fire replicated a version of the program in the Gate City soon after. For the last four years, these programs served as key access points for people with substance abuse issues to find treatment. But the Nashua program was shut down at the end of June, putting an additional burden on the Doorways program. 

Despite that additional challenge, coming at the same time as COVID, the state considers the partnership with Southern NH Health to be a success. 

“Despite the need to respond to the COVID-19 pandemic, Southern was able to successfully stand up the program and collaborate with the city and with community service providers, especially since the closure of Nashua’s Safe Station Program on June 30, 2020,” DHHS spokesman Jake Leon said in an emailed statement. 

Under Granite Pathways, from January 2019 to April 2020, the Nashua Doorway served an average of 43 individuals monthly, which includes folks who interfaced with the program exclusively over the phone. Since Southern NH took over, it has averaged 127 per month, between May and August, according to data published by the state.

A Troubled Start To The Doorway Program In Nashua

In the first year of the program, Chief Rhodes in Nashua said he was hearing from folks in the local treatment and recovery community that Granite Pathways wasn’t doing well, and though they had an existing presence in Manchester, they were new to the Nashua community when the contract was awarded.

An audit by DHHS found a number of compliance issues with the contract. Critically, the report states Granite Pathways didn’t establish formalized coordination agreements with the Integrated Delivery Networks (which are existing behavioral health and SUD treatment networks established by DHHS to serve as regional anchors) in either Greater Manchester or Greater Nashua, as required by the state contract, in part to reduce duplication of services and to use existing integrated care programs. The IDNs for those regions are managed by CMC and Southern NH Health, which is why the state approached them to take over the contracts.

While the hospital organizations did ultimately agree to manage the Doorways, that was not the first time the state approached them for the job.

In late 2018, the state asked CMC and Southern to run the Doorways when it was quickly setting up a system, then referred to as hub-and-spoke, in order to meet a deadline to obtain the federal State Opioid Response Grant (SOR), which funds the program.

But at the time, Southern NH had some doubts about taking it on, according to Norton.

“Originally I think there was some question to the longevity of the Doorway program and the state’s commitment to it that made the health systems pause at that time,” Norton said.

Norton said they weren’t sure they would be able to sufficiently staff a program given the uncertainty of whether the funding would be ongoing, and the narrow timeline given to stand up the program.

“It’s hard to bring people into these types of jobs that don’t have an unlimited time horizon,” Norton said.

It had also been less than a year since the merger and Norton said the SolutionHealth board of directors had not yet established its expressed focus on behavioral health.

Granite Pathways’ State Director Patricia Reed told the Granite State News Collaborative by email that her organization did its best, when other organizations weren’t willing to take the contract. 

“Stepping up when asked to do so reflects our philosophy of service, of partnership with the State and our commitment to actively participate in meeting community needs,” she said. “I strongly believe that people in crisis who came to us for help received skilled, supportive and compassionate care.”

She acknowledged that there were problems with the program, while it was run by Granite Pathways. 

“Unfortunately, due both to abbreviated planning time and the severity of the problem in these locales, community alignment was difficult,” she said. “In retrospect, that could well have made a significant difference in the overall outcome. However, the Doorways contract required a rapid start-up for a complex service in the most heavily populated part of the State.”

The Doorways program was always meant to have hospital partners, Reed said. By the time the state returned to ask for Southern NH to help with the Doorway again, the calculus had changed, and it looked like the state was going to fulfil its end of the bargain by increasing treatment capacity, Norton said. And so, the contract switched hands.

Manchester Doorway Switches Hands As Well

The current numbers in Nashua are more in line with what has been seen in the Queen City since the start of the Doorway program. The program averaged 181 clients per month under Granite Pathways, and has seen only a slight increase to 192 during the first four months of Catholic Medical Center (CMC) stewardship.

Like Southern NH, CMC was approached about taking the Doorways contract when the program first started, and declined. CMC spokesperson Lauren Collins-Cline said at the time, the existing infrastructure for connecting people with treatment was working well in Manchester. In addition, CMC was concerned about its ability to staff the Doorways program without using subcontractors, she said by email. 

“When the State began to lose faith in Granite Pathways, CMC was again approached and was in a much better position to work with our key partners… to improve on the model and serve the population needing help,” Collins-Cline said.

Collins-Cline said the city has not seen a large increase in people getting services since the contract switched hands, because the need for care has remained consistent and the services and access in Manchester have remained essentially unchanged.

Hope For The Future of Doorways

The state has proposed a $2.5 million budget for the Greater Nashua Doorway for fiscal year 2021, according to Norton, which includes no-cost extension funds from the initial grant round, SOR II funds, and the Governor’s Commission funds.

“You could see how the system was going to evolve to meet the needs in the community,” Norton said. “This is part of an ecosystem. The question was always ‘a Doorway to where?’ We’re supposed to bring people to treatment, but what if treatment isn’t there, what if respite beds aren’t there?”

Norton said they have since seen new treatment programs approved by the state open up over the past year, as well as an increase in state-funded respite beds and improved recovery housing standards.

He’s optimistic that the program can continue to help a higher number of clients connect with treatment. 

He said that the program’s new location at Southern NH Medical Center at 268 Main Street is easier for people to find and access. In addition, the organization has a large existing infrastructure already in place, with compliance and legal teams, and more than 25 years of experience developing and operating successful outpatient clinics, Norton said. They appointed an experienced social worker as director of the Greater Nashua Doorway, and that person was able to hire staff for the program. Ultimately, Southern NH’s reputation in the community went a long way toward bringing more people toward the Doorway program, according to Norton.

“It’s difficult to compare as we weren’t involved with the Doorway before,” Norton said. “However, we have very strong relationships with our community partners making it easier to direct patients to the care they need. We are consistently expanding and strengthening our program’s role with not only our community partners, but our larger catchment area.”

Stepping into this program in the middle of a pandemic was challenging, as the program was “busier than ever,” Norton said, with increasing patient needs. But they were able to meet those needs because Southern NH committed to providing in-person services throughout the crisis while following CDC safety guidelines, and by completing many telehealth intakes and followups, he said.

In addition, the Nashua Doorway recently began offering 24/7 coverage when it launched a respite service partnership with GateHouse Recovery Solutions, according to a Nov. 16 press release. That fills a critical gap left when the city’s Safe Stations program, which allowed people to get help any time at the fire station, ended its partnership with Harbor Homes and began working with a Doorways program with limited hours at the start of 2019. Nashua Fire Chief Brian Rhodes advocated for Doorways to provide 24/7 services. 

“At the end of the day, if I’m being totally honest, we’re not going to save everyone,” he said. “Everyone may not be ready for recovery. But I think the ones who are ready for recovery… when we’re not there when that person is seeking help, then, more times than not, we’ve lost them. And who knows when that next time will be?” 


These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org