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Project Engage

Updated: Jan 14, 2022

Early Engagement Gets Big Results

Early intervention can make all the difference in getting treatment for someone suffering from a substance use disorder (SUD).  Delaware’s Christiana Care Health System was a pioneer in utilizing peers in recovery to engage patients while they are in the hospital with the primary objective of assisting those interested in treatment for their SUD.

Founded by Dr. Terry Horton, Project Engage started over ten years ago on a trial basis in partnership with a community drug treatment provider and a single peer counselor, Engagement Specialist, embedded in Wilmington Hospital. The results were encouraging and the program was embraced by both staff and patients.  The program was expanded to Christiana Hospital in 2012 and social work support was added to facilitate discharge planning. Today with their partner, Connections Community Support Programs, Inc., they have a team of 15 caregivers that successfully connected over 800 patients into treatment for their SUD last year.  Also, a recent analysis shows a reduction in readmission rates for Emergency Department (ED) patients connected to SUD treatment.

“The value to getting the individual into treatment is immeasurable,” says Dr. Terry Horton, Project Engage’s Medical Director. “The embedded Engagement Specialists provide an important benefit. The shame and guilt felt by people battling addiction are immense. So Engagement Specialists act as recovery ambassadors and break down barriers. By being part of the team, they help to remove stigma.”

Most recently Project Engage was expanded to provide 24/7 coverage in three EDs and participate in a pilot program with ED providers to offer medication-assisted treatment (MAT) to patients in opioid withdrawal.  Previously, patients were sent to detox for their opioid use disorder. “Now they can receive an induction in the emergency room,” Dr. Horton explains.

Project Engage is also a key part of Christiana Care’s Opioid Withdrawal Pathway implemented in 2015.  The Pathway screens for and identifies patients who are in withdrawal. “People were leaving before treatment was initiated,” Dr. Horton says. “We didn’t want to lose the opportunity to reach them while they’re here. So we ask them on the front end, ‘Do you use heroin or prescription drugs? Do you get sick if you don’t?’ About five patients every day say ‘yes.’ We see all sorts of medical issues, such as a 101% increase in the number of spinal infections and endocarditis directly related to drug use. Once they’re identified, we can then treat those conditions as well in addition to helping them engage into ongoing drug treatment.”

Project Engage’s approach keeps producing results. About 50% of the patients engaged are referred to SUD treatment and over 70% of those patients are successfully connected to care.  With the expansion to 24/7 coverage in the ED the number of engagements conducted each year is growing from 2,000 to 3,000. Over 10,000 patients have been served since Project Engage’s inception.

Dr. Horton says he recently received a letter from a mother whose son lost his battle with addiction. “The young man had a lot of medical problems as a result of his addiction. His mother wrote, ‘Thank you and his nursing staff for treating my son with dignity and compassion, and for your hard work and dedication. This should be the gold standard for how to care for someone with an addiction.’ A letter like that will make you tearful. This is a fatal disease. It’s more like cancer than a crime. It’s a medical condition. The important thing is that because this young man experienced care with dignity, the mother can recover in her grief.”

And that mother’s wish is also coming true. Project Engage, “the gold standard,” is now being shared widely with other medical centers throughout the country.

Project Engage was a featured award winner in the 2019 Innovation Now project of the Addiction Policy Forum.


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