Meeting a Life or Death Moment With Care: How Meritus Health Built Their Crisis Model

Published: August 31, 2026
Facility: Meritus Health
Region: Western Maryland
Featuring: Alan Twigg, Behavioral Health Leadership, Meritus Health

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Western Maryland
Linkage to ongoing SUD care
Identification and engagement

Inclusion is not an endorsement

The Maryland Department of Health shares this account to highlight practices other facilities may find useful. Appearing in this series is not an endorsement, recommendation, certification, or approval of any hospital, health system, provider, vendor, or program by the Maryland Department of Health or the State of Maryland. Descriptions and figures are provided by the participating facility.

“I kind of say the peer group is sort of the secret to a lot of the success of this program, and I think that’s known in the state, that model actually works.”

— Alan Twigg, Meritus Health

Allen Twigg has spent nearly a decade at Meritus Health, long enough to have watched the region's approach to substance use disorder move through several distinct eras. There was a time when intervention meant alcohol detox for inpatient only. Then came a shift toward a fee-for-service model for addiction treatment, which, Twigg says, created real barriers to care for anyone without insurance. Around 2019, just before the COVID-19 pandemic, Meritus began absorbing the community's largest outpatient substance use programs. By 2022, at the peak of the opioid overdose epidemic, that groundwork had positioned them to build something more ambitious.

By 2022, near the peak of the opioid overdose epidemic, the pattern in Meritus's emergency department had become familiar and grim: multiple overdoses a day, and patients asking for help that staff had no good way to provide. "We could give them a referral even for the next day to an outpatient program in the community," Twigg said, "but the likelihood of them following through is pretty low." So the team built something else—a pilot program, co-located on the hospital's behavioral health unit, built on a simple premise: if someone walks in wanting help, Meritus isn't going to turn them away.

The pilot paired one-on-one counseling with direct coordination into residential treatment intake, and the results were immediate enough to reshape how Meritus thought about the entire continuum. In its first year, the program linked more than 300 people directly into treatment—about 75 percent of everyone engaged. What struck Twigg even more was what happened afterward. The team tracked patients for 30 and 90 days, and the readmission rates came back at 22 percent and 27 percent. "I'm more used to numbers like 55, 60 percent return within 30 days," Twigg said. That gap between expectation and outcome was enough evidence to secure grant funding and hospital investment for a permanent six-bed crisis unit—a home base that now blends addictions counseling, psychiatric care from doctors with an addiction medicine background, buprenorphine induction, and a warm handoff into Brook Lane's five-day-a-week intensive outpatient program for people who live locally.

The Peer as the Secret Ingredient

Ask Twigg what actually makes the model work, and he doesn't point to the beds or the psychiatrists first. He points to peer support. Peers stay in daily contact with patients for the 30 days after discharge, doing the less glamorous work of navigating 12-step meetings, community resources, and warm handoffs to Potomac, the area's primary case management provider. "I kind of say the peer group is sort of the secret to a lot of the success of this program," Twigg said, "and I think that's known in the state, that model actually works." Medicaid reimburses that work in 15-minute increments—not much, Twigg admits, but enough to cover part of the position's cost and keep it standing.

The harder problem is structural. The level of care Meritus built simply doesn't have a home on the American Society of Addiction Medicine (ASAM) continuum used to define treatment intensity; it sits somewhere between intensive outpatient and inpatient rehabilitation. The program has grown anyway, on the strength of its outcomes rather than a matching reimbursement code.

Building the Workforce behind the Beds

Twigg is equally focused on where Meritus's next generation of clinicians will come from. The health system stood up a psychiatry residency last year, now in its second class, alongside its longstanding family medicine residency. Underneath that sits a recruitment pipeline built almost entirely on proximity: University of Maryland students spend a full semester embedded in the Meritus emergency department before becoming counselors themselves, which Twigg calls the hospital's most successful means of recruiting into that role. Over the past year, 1,702 people—hospital staff, first responders, and community members—completed mental health first aid training or one of Meritus's free continuing-education sessions, taught by clinicians from within its own system.

What Other Maryland Hospitals Can Take Away

Twigg's advice starts with a posture, not a program: meet people where they are, and don't make them fit a category before you'll help. "We're not going to verify if they have health insurance or don't have health insurance—it doesn't matter at that moment," he said. "It's really sort of a crisis, life-or-death situation." He's just as insistent that trauma-informed care isn't a training you complete once - staff need ongoing coaching to hold space for all of it.

By the numbers

300+people linked directly into treatment in the program’s first year, about 75 percent of those engaged
22% / 27%readmission at 30 and 90 days, against an expectation closer to 55–60 percent
1,702people completed mental health first aid or continuing-education training in the past year

Figures reflect what the interviewee reported and are provided by the participating facility.

What other Maryland hospitals can take away

Meet people where they are. “We’re not going to verify if they have health insurance or don’t have health insurance—it doesn’t matter at that moment,” Twigg said. “It’s really sort of a crisis, life-or-death situation.”
Treat trauma-informed care as ongoing coaching, not a training you complete once. Because so many patients have been through what Twigg calls horrific circumstances, staff need continuing support to hold space for all of it.
Grow your own workforce. Embedding students in the emergency department before they become counselors has been Meritus’s most successful recruiting pathway.

More impact spotlights

How Meritus Health Builds Recovery Infrastructure on a Scarce Budget — Meritus Health, Western Maryland
Hope as a Strategy — ChristianaCare Union Hospital, Upper Eastern Shore
A Standardized Response to Medetomidine — ChristianaCare Union Hospital, Upper Eastern Shore

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