Position: Director of nursing
Organization: Hill Alcohol and Drug Treatment, Temecula, Calif.
Quote: “What is required of California RNs is 10 hours of substance abuse training. That is a disproportionate amount of time for a serious and chronic illness. Can you imagine if diabetes or pulmonary training was no more than 10 hours?”
Comment from a colleague: “A highlight of her career has been her tireless work to ensure that no nurse was allowed to complete the [Mount San Jacinto Junior College] RN program without understanding the nature of addiction and its impact on the family.”
Deborah Hill relishes the opportunity to serve as an attitude adjuster when she trains young nurses to be prepared for their inevitable encounters with addicted patients in emergency rooms or other settings. “I should have been a teacher,” Hill muses. Then she quickly adds, “But nursing is teaching.”
Nursing students at nearby Mount San Jacinto Junior College traditionally spend part of their psychiatry rotation at Hill Alcohol and Drug Treatment in Temecula, Calif., an outpatient program that Hill calls uncommon in its emphasis on nursing in day-to-day operations. She has the students' attention for only a two-hour orientation (“It's jam-packed with Debbie on her soapbox,” she says) and another six hours of time after that, and she knows she has to overcome obstacles in getting her message across.
“The nursing students who come in have had previous jobs in healthcare on some level,” says Hill. “They have a negative attitude about the addict before they even sit in the chair. I get to tell them about the impact they can have on patients and families. The point of crisis is a time for change.”
Hill, 60, who was one of the pioneering influences in the establishment of the adult children of alcoholics movement, has been at the forefront of several treatment innovations in her community. It has been a relatively short time since California has recognized ambulatory detox as a stand-alone level of care, but Hill Alcohol and Drug Treatment has seen significant success with the practice for individuals at mild to moderate levels of withdrawal who do not require hospitalization.
“We're helping insurers to understand ambulatory detox; it's relatively new for reimbursement,” says Hill. She devised a safety protocol for medical withdrawal that can take place without an individual having to leave his/her family system. This caught the attention of a prominent managed care payer in the region, and Hill became involved by conducting a pair of trainings by teleconference for the managed care company's doctors and managerial staff.
Hill is working to reinforce integration with medical care on a number of levels. While Hill Alcohol and Drug Treatment is not a medication-assisted treatment program per se, she says that if a patient wants to be on buprenorphine, for example, after learning about the medication's properties and potential benefits, they will be completely behind that.
“What we have been able to do effectively is use community resources and support putting them where they choose to go,” she says. “The best care is client-centered care. Each person is an individual, and preferences matter.”
Hill Alcohol and Drug Treatment is most certainly a family affair, with Deborah and Rocky Hill's daughter now involved in the organization as well. “I want the program to continue,” she says, and retirement is not in this teacher's thinking.