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After Hours Project (AHP) is proposing a program to expand/enhance access to medication-assisted treatment (MAT) services for persons with an opioid use disorder (OUD) seeking or receiving MAT; AHP will primarily focus on African Americans and Latinos in New York City (NYC). AHP will serve 250 unduplicated individuals annually with grant funds and 750 over the entire project period. Project name. After Hours Project’s MAT-PDOA Program Populations to be served. AHP’s populations of focus (POF) will be will be African Americans and Latinos with persons with an OUD seeking or receiving MAT. AHP will engage individuals with OUD through its harm reduction programming, including its Syringe Exchange Program (SEP). The catchment area where services will be delivered will be NYC, with a focus on underserved areas of Central and Eastern Brooklyn, South Bronx and Southern Queens; these areas have some of the highest rates of substance use and OUD in the state. Strategies/interventions. AHP’s program activities will include: 1) provide MAT in combination with comprehensive OUD psychosocial services; 2) conduct screenings and assessments for OUD, and co-occurring substance use and mental disorders; 3) develop outreach and engagement strategies; 4) Provide RSS, including peer recovery support services; and 5) Use telehealth services, or other innovative interventions, to reach, engage, and retain clients in treatment. AHP will also provide education, screening, care coordination, risk reduction interventions, screening, testing, and counseling for HIV/AIDS, hepatitis, and other infectious diseases for people with OUD who are receiving MAT, and will develop tobacco cessation activities. AHP will implement two EBPs: SBIRT and Motivational Interviewing (MI). Project goals and measurable objectives. The program’s goals are 1) Increase in the number of POF with OUD receiving MAT; and, 2) Decrease in illicit opioid drug use and prescription opioid misuse at six-month follow-up. The program’s objectives are to conduct outreach activities, recruiting at least 280 persons from the POF per year; conduct screening and assessments of substance use disorders with 250 persons from the POF per year; provide MAT and comprehensive OUD psychosocial services to 250 enrolled clients per year; provide MI to at least 90% of program participants; conduct telehealth services with at least 55% of program participants to encourage retention in services; provide pre-discharge MAT education and counseling for 10 incarcerated individuals within 4 months of release; provide recovery support services for at least 95% of program participants; provide tobacco cessation programming for at least 95% of program participants screening positive for tobacco use; and provide education, screening, care coordination, risk reduction interventions, screening, testing, and counseling for HIV/AIDS, hepatitis, and other infectious diseases programming for at least 90% of program participants.

This project will establish a program to provide medication-assisted treatment with buprenorphine to individuals incarcerated at the Baltimore County Detention Center (BCDC). The project will provide maintenance treatment for individuals sentenced to greater than six (6) months at BCDC, beginning four (4) months prior to scheduled release. Individuals participating in this program will receive buprenorphine maintenance therapy, Peer Recovery Support Specialist Services, individual and group counseling, and assistance to transition to community-based medication-assisted treatment providers to continue their treatment following their release from incarceration.

Baystate Medical Center, the Hampden County Sheriff’s Department, Providence Behavioral Health Hospital, Mercy Medical Center, and the Center for Addiction Recovery will collaborate on Project MOTION - Maintaining Opiate Treatment to Improve Outcomes and Next Steps, expanding access to medication-assisted treatment (MAT) in jail and after release for adult offenders/ex-offenders with an Opioid Use Disorder (OUD) in western Massachusetts. The population of focus is males and females over 18 years of age with OUD who are incarcerated and are within four months of scheduled release. Our desired outcomes are: 1) an increase in the number of incarcerated and post-incarceration individuals receiving MAT; and 2) a decrease in illicit opioid drug use and prescription opioid misuse at three and six-month follow-up. Our population suffers from opioid use disorders at rates vastly higher than the general population. The Sheriff’s Department electronic medical record system shows an opioid use disorder prevalence of 40% for men and 53% for women. Over two-thirds of the newly released persons with an opioid disorder will seek to engage in treatment services when they return to their home community. Risk of opioid overdose is markedly increased following release from incarceration. Our population of focus needs state-of-the art Medication Assisted Treatment (MAT) embedded in a network of mental health, recovery, and sobriety maintenance services. We will provide MAT using several FDA-approved medications; Case Management staff will serve as the crucial link to comprehensive psychosocial and health care support services, including primary health care, mental health care, and peer support programs to sustain treatment and recovery. We will continue to use the evidence-based Critical Time Intervention (CTI) program model. The intervention involves two components: (1) strengthening the individual's long-term ties to services, family, and friends and (2) providing emotional and practical support during the transition back to the community. Our specific objectives are that by the end of the Project MOTION 3-year grant period, we will have: 1) determined what factors enhance MAT treatment initiation and maintenance during incarceration and post-release into the community; 2) demonstrated effective strategies for maintaining MAT during shorter incarcerations and resuming community-based treatment; 3) measured the impact of MAT and case management on patients’ activities during incarceration and patients’ substance use and health status after release back to the community. In Year 1 of the grant period, we will serve 50 participants who will be incarcerated; of those 50 individuals, 30 participants will be serving sentences and 20 will be pre-trial. In each of Year 2 and 3 of the grant period, we will serve 75 participants; of those 75 individuals, 50 will be serving sentences and 25 out of the 75 will be pre-trial. The total number of unduplicated individuals (all of whom will be within 4 months of release from jail) we will serve over the three-year grant period is 200.

This proposal is submitted by Benefis Hospitals, Inc. in Great Falls, MT. We intend to establish a regional opioid treatment system using the hub-and-spoke model of service delivery. The program responds to a compelling need for treatment and recovery support for individuals with opioid use disorder in north central Montana. Drug overdose deaths, the vast majority of which are opioid related, are now the third leading cause of injury-related deaths in the state. Because of unique circumstances, the epidemic has hit north central Montana especially hard. Native Americans, who make up nearly 20% of the entire population, are hit particularly hard prompting three of the state’s seven reservations to declare a state of emergency. There is a serious provider shortage with only three waivered providers in the entire region actually prescribing. Behavioral health services are limited with every county designated by HRSA as a Health Professional Shortage Area for mental health. Poverty rates exceed 25%, and distance and geographic isolation further compound the problem. Our population of focus includes rural individuals as well as Native American Indians. Benefis Hospitals will serve as the hub with two spoke sites located strategically in the region to improve access. Spoke sites consist of one federally qualified health center serving primarily northern counties and one Native American Indian reservation-based clinic serving Native Americans. Our program is modeled after the Vermont hub/spoke program, which integrates programs providing higher levels of care for opioid treatment with programs offering treatment in general medical settings or spoke sites. The Benefis hub site is staffed by an addiction medicine specialist and recovery support staff. The hub site will provide training, guidance, and mentoring to spoke sites as well as provide direct care for complex cases and recovery support services as needed. Our goals are: 1.) To increase utilization of MAT for individuals with OUD in north central Montana; 2.) To decrease illicit drug use and improve patient outcomes; and 3.) To ensure a sustainable approach to improved MAT access and outcomes for people with OUD in north central Montana that can be replicated in other rural areas. We intend to serve 372 people over the course of the three-year project.

Bighorn Valley Health Center’s MAT-PDOA project, entitled “Expanding Access to Integrated Medication Assisted Treatment in Frontier Montana,” will fund infrastructure development and direct service delivery for an expanded hub and spoke model of opioid use disorder (OUD) treatment, medication assisted treatment (MAT), and recovery support services within a model of integrated behavioral health, primary care and oral health care delivery. Building on Montana’s STR project, this work will deliver services to the 32,044 residents of six frontier counties (Rosebud, Blaine, Judith Basin, Fergus, Petroleum and Wheatland) and will include a focus on the following special populations: American Indians and pregnant women. American Indians comprise the largest racial minority in Montana with 6.3% of residents identifying as Native American. These groups suffer from disproportionately high rates of substance use disorder, including OUD, which is often criminalized instead of treated medically. It is estimated 90% of the individuals in jail are there for SUD related offenses. Drug use in pregnancy is a serious public health problem in Montana, and despite evidence that the problem is on the rise, Montana has a severe shortage of treatment for pregnant women with substance use disorders. The number of Montana children in foster care more than doubled since 2011: out of more than 3,200 children in foster care in 2016, 64% were removed from the home for reasons related to parental substance use. To improve Montana's response to the opioid epidemic the project will focus on the primary goal of expanding access to comprehensive, evidence-based services for OUD treatment within an integrated care setting. The project will involve the formation of a coalition of three Federally Qualified Health Centers (Bighorn Valley Health Center, Sweet Medical Center and Central Montana Community Health Center) implementing a Hub and Spoke model for OUD treatment. The four Spokes (Chinook, Harlem, Lewistown and Colstrip) will agree to implement an integrated model of MAT and Recovery Support Services within the primary care setting (involving medical, behavioral health and oral health care), with the assistance of the MAT providers at the Hub site (Hardin). Our project intends to serve 581 clients with MAT treatment at 5 Hub and Spoke Sites by the end of the project period, with 90% of these individuals (523 total) receiving recovery support services.

Expanding Access to Medication-Assisted Treatment for Incarcerated Individuals in Massachusetts Recognizing the high prevalence of opioid use disorder among incarcerated individuals and their dramatically elevated risk of fatal overdose upon release, this project is a partnership between a federally qualified health center and a county jail in Suffolk County, Massachusetts, to expand access to medication assisted therapy (MAT) for pre-release incarcerated individuals and to effectively bridge them to community-based opioid treatment upon release. About two-thirds of inmates are non-white; about 89% are male; and the average age is 35 years. Project goals: (1) Expand access to MAT services for incarcerated and post-incarcerated persons with OUD in Suffolk County; by delivering integrated MAT services; providing peer recovery coaching and care coordination to ensure participants are effectively bridged to community-based OUD treatment post-release; facilitating enrollment in insurance coverage prior to participants’ release; and providing continued MAT services and care coordination support post-release for participants to bridge them to care at community-based treatment programs. (2) Reduce illicit opioid use & prescription opioid misuse, as well as concomitant overdose deaths, among post-incarcerated individuals in Suffolk County; by providing peer recovery coaching; providing care coordination to support reentry, identify community resources, and connect participants to services post-release; and aiming to achieve a 50% rate of abstinence from illicit opioid use and prescription opioid misuse at 6-month follow-up. (3) Foster a seamless continuum of OUD care for those involved in the criminal justice system by improving collaboration between pre-release and post-release opioid treatment providers; by developing partnerships and MOUs with community-based opioid treatment programs; facilitating transitions of MAT care upon participants’ exit from custody; and supporting the replication of this continuum of OUD care throughout MA; and (4) Ensure program participants are connected to care for co-occurring medical and behavioral health conditions; by screening participants for co-occurring conditions; ensuring they have received services for HIV/AIDS & hepatitis C; delivering tobacco cessation education sessions; and connecting participants to post-release appointments with primary care, behavioral health, and specialty care, if clinically indicated. The project will serve a total of 100 unduplicated individuals in Year 1, an additional 50 individuals in Year 2, and finally 50 more unique individuals in Year 3, totaling 200 unduplicated individuals over the 3 year grant period.

The Massachusetts Model of Medication-Assisted Treatment (MAT) for Patients with Co-Occurring Mental Disorders, or 4MD, at Boston Medical Center (BMC) will increase access to MAT, mental health services, and peer recovery support through an innovative, fully integrated model based in the BMC Department of Psychiatry. The population of focus is individuals with co-occurring opioid use disorder (OUD) and mental disorders living in the Boston Metropolitan Area, a geographic region with one of the highest rates of of opioid-related mortality in the nation. In Massachusetts, more than 2/3 of patients discharged from inpatient detoxification report having previously accessed mental health services, suggesting that co-occurring mental disorders are highly prevalent in patients with OUD. This target population, which is especially prone to poor adherence to MAT and relapse, is six times more likely than those in the general population to die of an opioid overdose. As a result of system and individual level barriers, this population struggles with inadequate access to treatment that meets their complex needs. The 4MD Program will expand access to treatment through implementation of the Nurse Care Management (NCM) model of office-based addiction treatment (OBAT) in BMC's psychiatric MAT clinic, which presently serves 120 patients. Under the direction of a DATA 2000 waivered psychiatrist, our enhanced model will employ an interdisciplinary treatment team to provide MAT induction and management; mental health assessment, diagnosis and treatment; peer recovery coaching and relapse prevention planning. The goals of the project are: 1) to identify, engage and retain new patients with co-occurring OUD and mental disorders in MAT; 2) to provide training, case conferences and consultation to mental health clinicians on treating co-occurring disorders in Massachusetts community health centers; 3) to evaluate the clinical effectiveness and return on investment of the 4MD program; and 4) to standardize clinical protocols and disseminate the 4MD program to other academic medical centers. To achieve our enrollment targets, 4MD will form referral relationships with area detoxification programs, correctional facilities, and other programs serving individuals with OUD and co-occurring mental disorders. The model program will deliver regular ""MAT Chats"" using web-based videoconferencing to disseminate the 4MD model. The program is expected to increase BMC's OBAT caseload by 100 patients by the end of Year 1, bringing the total caseload to 220, and maintaining that caseload through the project's three years. The process evaluation will assess project implementation in relation to timelines and enrollment targets. The outcome evaluation will include a pre/post comparison of patient scores on standardized measures of mental health symptoms and quality of life, as well as on selected GPRA measures. We will also compare rates of retention and opioid-related mortality in 4MD to matched controls. Findings will be presented in at least one scholarly article and one national presentation.

Brandywine Counseling and Community Services, Inc. will implement Community Outreach and Prevention Education (COPE) a mobile outreach and medication-assisted treatment (MAT) service to expand access to MAT services for adults with an opioid use disorder (OUD) residing in rural and underserved counties in Delaware. COPE will expand MAT services currently available only in New Castle County to 75 adults annually (225 over 3 years). Population of focus (POF) is adults with an OUD or co-occurring mental health disorder (COD) in need of OUD treatment. Priority will be given to adults with prior unsuccessful opioid detoxifications or history of accidental drug overdose experiences; those reentering the community from jail/prison; those who are homeless, military veterans, women with children, LGBTQ; and those with or high risk for HIV/AIDS/Hepatitis. The project will place special emphasis on recruiting racial and ethnic minorities to reduce the impact of behavioral health problems and disparities. Interventions: COPE will enhance our newly opened integrated care MAT Clinic with the development of a mobile outreach and MAT treatment service to provide OUD integrated care in Kent and Sussex County. Evidence based practices include but are not limited to: ASAM assessment, motivational enhancement therapy, cognitive behavioral therapy, and 12 step and other self-help approaches. These will be integrated with outreach, education, and care coordination to facilitate access to OUD/MAT services and transition between various levels of OUD/MAT treatment and incorporate relapse prevention therapy; trauma informed care; wrap-around and recovery support services; HIV/hepatitis testing and linkage to services for those who test positive, aftercare and peer recovery coaching. Goals: Overarching goal is to increase the number of individuals with OUD receiving MAT and reduce or eliminate illicit opioid drug use and prescription opioid misuse, the spread of infectious disease and overdose fatalities at six-month follow-up among adults living in rural, medically underserved counties in Delaware. COPE’s measurable outcomes include: 1. Increase access to and retention in behavioral health treatment for 225 adults with an OUD. 2. Increase abstinence use of opiates, alcohol, marijuana, and other substances by 75%. 3. Improve of maintain behavioral/medical outcomes for participants for at least 65% of clients related to health, housing, educational, medical/health, social connectedness, employment and health, and behavioral/social consequences. 4. Increase recovery support services and retain 75% of participants in recovery support services for at least 6 months. 5. Reduce new HIV and viral hepatitis infections among 80% of clients with an OUD.

BronxCare Health Integrated Service System Inc. (BLISS) Family Medicine proposes to expand and enhance its Medication Assisted Treatment Program in the South and Central Bronx, culminating in the establishment of a MAT Center of Excellence. The program will use evidence-based practices to identify, screen and offer treatment and counseling to individuals with Opioid Use Disorder in the primary care setting. BLISS’s five Family Medicine clinics will be the originating sites for MAT screening, using SBIRT to offer individuals the opportunity to participate in the treatment program. In year two, the screening program will be rolled out to BLISS Ambulatory Care. Other departments within BLISS’s affiliated larger health system – BronxCare Health System – will be able to easily refer patients through the integrated system, and in year three, education and outreach to the community will encourage and support referrals. Project staff include an addiction psychiatrist, a project director, a behavioralist, data analyst/evaluator, and community health worker. BLISS will utilize the services of an AmeriCorps Opioid Response Corps Member in Family Medicine’s Comprehensive Pain and Integrated Health Clinic to provide preventive education and outreach to the community. The BLISS Family Medicine Medication-Assisted Treatment Program will focus on adults in the community, 98.7% of whom are racial, ethnic or social minorities, who screen positive for Opioid Use Disorder. It is estimated that between 5% and 6% of the service area’s adult population has an Opioid Use Disorder. Of New York’s 62 counties, the Bronx has the highest rate of opioid-related hospitalizations and the second highest frequency of opioid-related emergency department visits. Program goals include: The expansion and enhancement of the use of medication assisted treatment (MAT) in the South and Central Bronx. Bliss aims to increase its program by 500%, providing MAT to 100 additional patients in year 1, 200 additional patients in year 2, and 300 additional patients in year three; 600 additional patients in all; and the expansion of community partnerships to support community wide referrals and provide appropriate support services to facilitate long term recovery. Program objectives include: establishing a gradual roll out of SBIRT and other screening and assessment tools; establishing a plan to mitigate risk of buprenorphine diversion; establish a centralized MAT Center of Excellence at the Fulton Family Clinic; integrating SBIRT into the intake process at Family Medicine locations to identify and refer patients with OUD for MAT; and enhance community recovery supports, preventive education and outreach. BLISS, a FQHC, will use the expertise of an addiction psychiatrist, as well as two Family Medicine site administrators and two Family Medicine, DATA 2000-waivered physicians to champion the MAT program and serve as mentors.

Project Excel proposes to expand BPMC’s existing MAT services, psychological and supportive services, SBIRT and TSF EBPs, targeting formerly incarcerated individuals and Black and Latino adults in the service area with an opioid use disorder (OUD). The project will be implemented at two of BPMC’s health centers, with the overall goal of expanding access to and retention in MAT and wraparound supports for the population of focus. Project Excel will serve high-need residents of the underserved neighborhoods of Northwest and Central Brooklyn, with a focus on Black and Latino adults and formerly incarcerated individuals. The majority of the residents in the service area are non-White: 32% are Black; 14% are Latino; and 7% are Asian. Residents living in BPMC’s service area contend with disproportionately high rates of poverty, unemployment, incarceration, substance use and mental health issues. The death rate by drug overdose has steadily increased in the service area, from 8.2/100,000 in 2013 to 14.1/100,000 in 2016. People of color and those in poverty are adversely affected by the opioid epidemic. Black New Yorkers had the largest increase (80%) compared with all other races/ethnicities. Project Excel will implement MAT, which is a combination of psychosocial support services and Federal Drug Administration (FDA)-approved medication, with the goal of reducing opioid use and opioid related overdoses over time. In addition, the project will implement two evidence-based practices: 1) TSF Therapy, a 12-session, outpatient treatment program for clients with substance abuse conditions; and; 2) SBIRT, a series of screens and brief interventions to address behavioral health needs in a primary care setting. Project Excel’s goal is to 1) an increase in the number of individuals with OUD receiving MAT and 2) a decrease in illicit opioid drug use and prescription opioid misuse. To do so, it will accomplish the following objectives by the end of the program: 1) 65% of enrolled clients will have been retained in MAT services for six months; and 2) 65% of enrolled clients report a decrease in illicit opioid drug use and prescription opioid misuse at six-month follow-up. Project Excel will serve 100 unduplicated clients in the first program year, and 150 unduplicated clients annually thereafter, for a total of 400 unduplicated clients over the entire project period.

This MAT-PDOA proposal entitled MAT Expansion through Law Enforcement and Multidisciplinary Team Outreach will provide access to MAT for criminal justice involved individuals using an innovative strategy of law enforcement outreach and recovery model. A multidisciplinary outreach team of law enforcement, clinician, and peer navigator, will provide services to adults involved in the criminal justice system to prevent recurrences that further embed individuals with an OUD into the criminal justice system by providing access to MAT. Population to be served: Services will be provided to criminal justice system involved adults in RI who and are eligible for medication assisted treatment (MAT) for opioid use disorder (OUD) from three points of contact: awaiting trial commitments who are inducted onto MAT while incarcerated at RI Department of Corrections (RIDOC), RIDOC commitments appropriate for MAT but released at 6th District Court prior to receiving medication, and those involved with the Rhode Island Adult Drug Court (RIADC) diversion program. This population is 85% male, 43% White, 29% Black and 25% Hispanic, with 73% being single and 3% identified as veterans. The geographic region served encompasses the entire state. Interventions: All participants will receive OUD and mental health screening and assessment, MAT, intensive counseling and recovery support services. Peer Recovery Specialists will provide guidance, support and information making follow through with MAT treatment more likely. To reduce barriers immediately following release transportation will be provided. The following evidence based practices will be used: MAT, cognitive behavioral therapy (CBT) integrated with the principles of Motivational Interviewing (MI), and Moral Reconation Therapy (MRT). Project goals and objectives: The objective of this proposal is to create an intensive outreach team that includes a member of local law enforcement to prevent recurrences that further embed individuals with an OUD into the criminal justice system. Achievement of these goals and objectives will result in increased access to MAT for a population at high risk for overdose and treatment non-compliance. By ensuring access to MAT to criminal justice involved individuals, levels of relapse/overdose and recidivism will decline, leading to lower crime, more intact families, higher levels of employment, and increased community engagement.

MAT-PDOA: FOA#TI-18-009 Access to Medication-Assisted Treatment (MAT) Services for Homeless and Veterans with Opioid Use Disorder in Middle Tennessee This project will address the worsening opioid abuse crisis in the state of Tennessee by expanding access to medication-assisted treatment (MAT) for 270 rural homeless and veterans with Opioid Use Disorder (OUD) in a 25-county catchment area, including 19 counties targeted by the local Homeless No More (HNM) Continuum of Care (CoC) in middle Tennessee. The project will incorporate a novel, comprehensive care model that integrates a variety of evidence-based approaches, comprising of medication, counseling, psychosocial therapies, and recovery support services to facilitate full recovery for this underserved population. This project will address a critical service gap in treatment services for those with OUD by offering accessible and effective care for homeless and veterans in primarily rural counties of Tennessee which are hard hit by the opioid crisis but has limited access to MAT services for OUD. In 2016, approximately 1,600 TN residents died as a result of an opioid overdose –- an increase from just over 1,400 in 2015; similarly, synthetic opioid deaths increased from 169 in 2015 to 294 in 2016. These figures are reflective of a larger trend in TN. The 2018 TN Dept. of Health Prescription Drug Overdoses Program reports that the age-adjusted overdose death rate (per 100,000 residents) increased from 17.8 to 24.6 between 2013 and 2016. The specific goals of this project are to increase in the number of individuals with OUD receiving MAT and a decrease in illicit opioid drug use and prescription opioid misuse at six-month follow-up. In working toward these goals, our care delivery model will provide assessment for OUD, illicit drug and alcohol dependence, co-occurring mental health, and physical health; and deliver a full continuum of services including integrated MAT with mental and physical health care, counseling, recovery support services (RSS), case management, transitional and permanent housing owned by the Buffalo Valley across middle Tennessee. Clients will also receive detox, inpatient and outpatient treatment, vocational training, transportation services, and relapse prevention counseling. In order to provide these expansive services, we will partner with other service providers, hospitals, ERs, law enforcement, faith-based entities, and employment agencies. The Buffalo Valley, Inc., with its large treatment infrastructure in Hohenwald, TN, 6 satellite facilities, and 603 housing units in surrounding areas, is well-positioned to serve this hard-to-reach population in middle Tennessee. The main goals of the project are: 1. To develop outreach and engagement strategies for recruitment of 270 primarily rural homeless and veterans with OUD (90 per year); 2. To conduct screening and assessments to deliver medication-assisted treatment (MAT) and OUD recovery services for primarily rural 270 homeless and veterans; 3. To expand evidence-based medication-assisted treatment (MAT) and psychosocial and recovery services for primarily rural 270 homeless and veterans with OUD, 4. To decrease illicit opioid, prescription opioid misuse, illicit drugs, and alcohol at six-month follow-up for 270 primarily rural homeless and veterans with OUD.

Casa Esperanza Inc.’s proposed “CasaCare-OBOT: Office-Based Opioid Treatment for Latinos with Co-Occurring Disorders” program will reduce illicit opioid drug use and related overdoses for individuals with co-occurring opioid use and mental health disorders (CODs) by expanding access to MAT and using Integrated Dual Diagnosis treatment model to provide culturally-competent and trauma-informed substance use disorder and mental health treatment and related recovery support services for Latinos in Greater Boston. Over 3 years, CasaCare-OBOT will serve 200 individuals (40 in YR 1 and 80/yr for YR 2 & Yr3). Based on current demographics, we anticipate 97% of clients will have a co-occurring mental illness in addition to their SUD; 64% of our clients will identify as male, 35% as female, and less than 1% as transgender; 40% will be monolingual Spanish speakers with limited or no English skills, and limited written literacy in either English or Spanish. Nearly all of our clients (93%) lack a source of income, 95% are homeless or under-housed, and 61% lack a GED. More than 95% have been court involved, with 79% incarcerated in the past five years. Nearly all (96%), have at least one significant medical condition, with 25% having HIV/AIDS. Based on data from previous SAMHSA-funded projects we also anticipate only 54.3% have received MAT and only 31% received mental health treatment previously, despite 97.7% reporting at least one co-occurring mental health disorder. Of these, 98% will meet criteria for serious mental illness; 95% will have a PTSD diagnosis; 55.2% will report recent depression, 61.4% will report recent anxiety, 15% will report recent thoughts of suicide, and 3% will have recently attempted suicide. CasaCares’ goals are to hire a Psychiatrist to add to our Multidisciplinary team in order to: 1) Expand access to MAT for Latinos with co-occurring disorders; 2) Improve access to integrated mental health, opioid use treatment, and primary care for Latinos; 3) Provide case management services to support clients’ full engagement in the development, implementation and completion of goals in their care plan; and 4) Provide recovery support services to help increase knowledge of community resources; increase capacity for self-management; and identify and reduce risky behavior.

Population of focus - Adults with Opioid Use Disorders many of whom may also have co-occurring mental health and primary physical health care treatment needs. Since July 1, 2017 Cascadia Behavioral Healthcare has treated 171 individuals who presented with opioid use disorder; 91 of who identified as male, 78 as female and 2 as other gender. The age distribution varied, 11 were ages 18 to 24; 22 were ages 25 to 29; 92 were ages 30 to 44; 28 were ages 45-54 and 18 were ages 55+. Caucasian community members represented 75% of those seeking services, African American representing 7%, Hispanic/Latino representing 5%, Native American representing 2% and Asian/Pacific Islanders representing 1% and 10% were of unknown race. Geographic Catchment/ Service Location –Tri County Metropolitan Portland (Multnomah, Clackamas and Washington Counties), Oregon Goals and Objectives - The goal of our MAT PDOA proposal is to: increase the number of individuals with OUD receiving MAT in Oregon; decrease illicit opioid drug use and prescription opioid misuse at six-month follow-up. Cascadia will implement Buprenorphine/ Naloxone as the FDA-approved medication for the maintenance treatment of opioid use disorder as a required activity of the program. To help address the gaps in treatment described above, Cascadia will provide MAT in combination with comprehensive OUD psychosocial services, including, but not limited to: counseling, behavioral therapies, Recovery Support Services (RSS), and other clinically appropriate services required for individuals to achieve and maintain abstinence from opioids. The objectives of Cascadia Behavioral Healthcare’s MAT PDOA proposal are: o By end of year 1, September 30, 2019, we will have eight waivered providers each serving 30 individuals for MAT services for a total of 240 individuals served. o By end of year 2, September 30, 2020, our panel of providers will have increased individuals served within MAT services to 528. o By end of year 3, the entire project period, September 30, 2021, we will have served up to 800 unduplicated individuals and seek to maintain that level of programming and services ongoing. Required Activity: Cascadia will achieve these goals and objectives by implement the Required Activities as stated in Section I.2. of FOA NO. TI-18-009 as outline in our proposal. Specifically Cascadia will implement Buprenorphine/Naloxone as the FDA-approved medication for the maintenance treatment of opioid use disorder as an Office Based Outpatient Treatment (OBOT) provider. We currently provide a broad continuum of outpatient services. The MAT team is made up of SUD counselors, psychiatrists, nurse practitioners, nurses, Certified Recovery Mentors and a Care Coordinator/panel manager. We provide induction as well as ongoing maintenance services, ambulatory detox and have relationships with community partners for individuals who require a higher level of care. In addition to the medication specific services, the above mentioned integrated team extends a full range of psychosocial services including individual counseling, case management, group counseling and support by mentors and counselors for connecting to communities of recovery support. As a provider of a full range of behavioral health services Cascadia will extend additional services and programming.

The Integrated Recovery Innovations (IRI) program provides Medication Assisted Treatment (MAT), clinical and Recovery Support Services to Sussex County, NJ adults diagnosed with a moderate or severe opioid use disorder. IRI integrates a comprehensive service delivery system, using Peer Recovery Coaches and evidence-based clinical modalities to engage high-risk individuals in the community. IRI includes collaboration with the county jail to identify inmates for the program. The goal of IRI is to increase capacity for sustained recovery and improvement in overall health and wellness for individuals who have an Opioid Use Disorder in Sussex County. MAT-PDOA funding to expand and implement this program will serve 125 unduplicated clients in the first year of program implementation, 170 in the second year and 190 in the third year for a total of 485 unduplicated clients over the duration of the entire project. IRI includes a variety of measurable objectives related to engagement, retention and long-term recovery, including utilizing MAT to 75% of clients in OP and IOP services and increasing use of MAT a minimum of 100% overall within the agency; decreasing illicit and prescription opioid use by 60% six months after discharge from treatment engaging 70% of incarcerated individuals in treatment upon release with 80% continuing Vivitrol injections for up to three months. Additionally, objectives include reducing recidivism by 75% while in treatment and by 60% six months post discharge; 75% of clients achieving opiate related treatment goals upon discharge and 80% achieving health and wellness related goals upon discharge, with 80% of IRI program participants showing an 80% increase in their Global Assessment of Functioning from admission to discharge. 100% of program participants will be educated on signs and symptoms of an opiate overdose and provided with Narcan. There are also objectives related to Recovery Support Services, including 80% of IRI participants utilizing Peer Recovery Coaches and 85% of participants attending weekly peer recovery support meetings. 100% of program participants will receive information on nicotine/tobacco cessation and a minimum of three evidence-based cessation programs will be offered to participants over the course of a year. 100% of participants will be given a lab slip by the Medical Director to screen for Hepatitis B, Hepatitis C and HIV, and 100% of program participants will be screened for co-occurring mental health disorders. IRI utilizes a service delivery model in our rural county to reach at-risk individuals through ""on-demand"" peer recovery coaches to introduce them to MAT and to engage them in clinical programming. Evidence-based behavioral interventions in the substance use treatment component include Peer Support Services, CBT, MI, MET, DBT skills training, Interactive Journaling, telephone support, contingency management and empowerment workshops. These interventions will increase motivation for change and provide individuals with skills to manage cravings/triggers, manage high-risk situations, improve relationships, increase recovery supports, build recovery capital, and improve quality of life in long term recovery.

Center Point, Inc. (CPI) is requesting $522,328 per year for up to three years from the SAMHSA CSAT to implement the delivery of combined buprenorphine-naloxone and other FDA-approved Medication Assisted Treatments (MAT) in combination with integrated primary care and behavioral health, substance abuse treatment, case management, care coordination and aftercare services for persons with an opioid use disorder (OUD). Project activities will take place in Marin County, CA, and the primary target population will be low-income adult men and women with an OUD and/or co-occurring mental health disorder who 1) are high-risk IV drug users and/or prescription opioid users, and 2) who are clients of CPI’s adult residential, outpatient and/or intensive outpatient substance use and mental health disorder treatment programs. CPI’s project will increase access to MAT services and lead to a decrease in illicit opioid drug use and prescription opioid misuse for 100 unduplicated individuals annually and 300 over the entire project period. CPI will provide MAT within a comprehensive, integrated substance abuse treatment and recovery support system that includes residential, outpatient, continuing and aftercare, transitional housing, and vocational and employment services. MAT Project services will be coordinated with psychosocial therapies and recovery supports, and clients will be directly linked into ongoing MAT and primary care in partnership with local Federally Qualified Health Centers (FQHCs) and Opioid Treatment Programs (OTP). The treatment and service plans that result from this project will be implemented and monitored by certified counselors, medical and mental health clinicians, and case managers acting within their appropriate scope of practice. CPI’s programs will utilize evidence-based practices including providing integrated services so that MAT, substance use and mental health disorders, and trauma and abuse can be treated in the most effective manner. CPI is a CARF Accredited DHCS licensed and certified program (DHCS designated ASAM Level of Care 3.1 and 3.5; 1.0 and 2.1 outpatient programs) and is a DMC Certified provider. Over the three-year grant period, CPI will establish on-site MAT services for 300 people with OUD enrolled in residential, outpatient and/or intensive outpatient substance abuse treatment program; enhance CPI’s comprehensive, multi-modality treatment model to accomplish positive outcome for adults with OUD; and enhance CPI’s service delivery model to improve substance use and mental health services and coordinate services necessary for MAT patients to achieve and sustain recovery. Outcomes for participants will include increased MAT access and participation, decreased substance abuse, decreased criminal justice system involvement, and overall improvements in emotional and mental health.

Centerstone MAT Services (C-MAT) will expand MAT services for 200 unduplicated adults (18+) with an opioid use disorder (OUD) who are seeking or receiving MAT in the 11-county Middle Tennessee catchment area (Yr 1:50; Yrs 2-3:75, annually). C-MAT will provide comprehensive, evidence-based services, including the delivery of FDA-approved medications, screening/assessment, psychosocial services/interventions, care coordination, telehealth services, wraparound/recovery support services, etc. C-MAT’s catchment area includes Bedford, Coffee, Davidson, Dickson, Franklin, Marshall, Maury, Montgomery, Rutherford, Sumner, and Williamson counties in Tennessee. C-MAT’s focus population encompasses an anticipated 4,520 catchment area adults (18+) with OUD seeking (3,259) or receiving (1,261) MAT. Focus population demographics are expected to mirror those of Centerstone clients with OUD in the catchment area, with 42% male, 58% female, 79% White, 6% African American, 2% Hispanic, and 16% unemployed individuals; 52% are expected to be insured by Medicaid. C-MAT’s subpopulations include the 377 who are Veterans, 2,947 involved in the criminal justice system, and 4,247 who have a co-occurring substance use and/or mental disorder (COD). Only 7% of those with COD will receive both substance use and mental health services; 3% will receive only SUD treatment and 38% will receive only mental health services. From 2014-2016, catchment area overdose deaths for all substances had increased by 58% and opioid overdose deaths by 63%, significantly above state rates (29% and 38%, respectively). C-MAT will deliver evidence-based Medication-Assisted Treatment (MAT) according to NIDA’s Principles of Drug Addiction Treatment, and SAMHSA’s Treatment Improvement Protocol (TIP) 43: Medication Assisted Treatment for Opioid Addiction in Opioid Treatment Programs and TIP 63: Medications for Opioid Use Disorders, providing FDA-approved medications in conjunction with behavioral health therapies, including Hazelden’s Co-occurring Disorders Program,Seeking Safety, and DIMENSIONS: Tobacco Free Program. Key C-MAT strategies/interventions include community collaborations; assembly of Advisory Council; development of program policies/procedures; outreach/engagement; screenings/assessments; development of Individual Treatment Plan; provision of MAT, OUD/COD treatment/psychosocial services/interventions, tobacco cessation, care coordination, Peer support, and recovery support (e.g., housing/employment, benefits enrollment, transportation); HIV/VH testing/linkages; telehealth services; sustainability planning; and dissemination of comprehensive evaluation. C-MAT goals include: Enhance/expand access to MAT services, OUD treatment, wrap-around/recovery support, etc.; Develop infrastructure/ capacity to expand, enhance, and sustain services; Improve clients’ health status and outcomes; and Develop/ disseminate a replicable service model. C-MAT will achieve the following measurable objectives: Conduct outreach/engagement to 1,000 individuals to increase participation in/access to services and system-wide knowledge/skills; Provide training/workforce development for 100 staff/community providers; Increase substance use abstinence by 60%; Reduce mental health symptomatology by 50%; Assist 100% in need with resources to identify/secure stable housing and employment; Reduce criminal justice involvement among 60% with histories; Reduce tobacco use by 30%; Reduce costly service utilization by 50%; Increased social connectedness by 70%; and Achieve 80% client retention. C-MAT has secured commitments from partners dedicated to the project’s success, and will collaborate with community providers, law enforcement/courts, coalitions, social service agencies,key stakeholders, etc.

Cherokee Nation Behavioral Health’s Medication-Assisted Treatment Project Hope program seeks to decrease opioid overdose deaths through enhanced treatment and recovery support services to adult Native Americans with opioid use disorders in the Cherokee Nation Reservation located in Northeastern Oklahoma. The project will provide comprehensive MAT and recovery services to 30 individuals in Year One, 60 in Year Two, and 90 in Year Three; a total of 180 unduplicated clients over the course of the three-year project. Key components of this project are: medication-assisted treatment, cognitive-behavioral individual and group counseling, recovery support, peer coaching program development, workforce development to increase best practices, and a public health education campaign to reduce stigma. Key objectives include: • 90% of MAT clients engaged in comprehensive case management services • 75% of MAT clients engaged in recovery support services • Increased formal community agreements with local referral services. • A tribal-wide town hall to reduce stigma of medication-assisted treatment • 10 new physicians will obtain waivers to prescribe medications for treatment • 100 mental health professionals receiving professional education training specific to medication-assisted treatment and recovery support best practices. • Development of a comprehensive peer recovery coaching program In addition to providing treatment and recovery services, this project will create Recovery-Oriented System of Care in order to sustain a long-term continuum of care system for Native Americans in Cherokee Nation.

Cherry Health is expanding access to Medication Assisted Treatment (MAT) for adult patients in rural Montcalm County, Michigan who are seeking to recover from Opioid Use Disorder (OUD). The program, titled the Montcalm Medication Assisted Treatments Program (MMATP) provides whole-person treatment, including primary care, Cognitive Behavioral Therapy, non-clinical peer support, and two Food and Drug Administration-approved medications for treating OUD, Suboxone and Vivitrol. Using evidence-based practices for MAT, Cherry Health will realize the following objectives through the MMATP: • Identify patients eligible for MMATP services through comprehensive, culturally-competent screening. • Screen 1,100 patients annually, and serve 100 patients over the grant period with MAT. • Reduce opioid use among MMATP patients. • Reduce overdose deaths in Montcalm County, Michigan. These outcomes will be realized through a multi-faceted implementation approach, including screening and service delivery. Cherry Health will begin providing SBIRT screening for every Cherry Health Montcalm Area Health Center patient. To support universal SBIRT screening, Cherry Health will train every MAHC staff member in the use of SBIRT (Screening, Brief Intervention, Referral to Treatment) screening tools. Supplementary training will be provided to promote culturally competent care for veterans. By the end of the first project year, Cherry Health aspires to provide SBIRT pre-screening to 85% of MAHC patients, with 90% of patients demonstrating risky substance use completing full SBIRT screening. The MMATP care team will be modeled after Cherry Health’s successful MAT programs and will provide holistic recovery support. The care team will benefit from telehealth psychiatric consultation provided by Pine Rest, a Grand Rapids-based provider of behavioral health services. Patients will also be connected to civil legal services through a medical-legal partnership between Cherry Health and Legal Aid of Western Michigan, a nonprofit law firm committed to assisting under-served individuals. The MMATP care team will work closely with community agencies offering recovery services and basic needs assistance (e.g. housing, food, transportation) to promote a strong network of recovery resources. Through a continuum of support offered through the MMATP and community resources, patients will be empowered to achieve and maintain abstinence from opioids.

CLARE Foundation (CLARE), an experienced MAT provider headquartered in Santa Monica, CA will expand Medications Assisted Treatment (MAT)to address escalating rates of opioid use disorders (OUD)in San Bernardino County (SBC) among residents ages 18+. The program will serve 75 adults annually (225 total), providing MAT and concurrent OUD psychosocial services Towards this goal, the renown Matrix Institute on Addictions, a MAT specialist provider, has formally merged into CLARE Foundation to strengthen our mutual efforts to expand and enhance evidence-based behavioral health treatment in Southern California, particularly MAT. MAT programs are critically needed to address the growing opioid epidemic in San Bernardino County (SBC) – one of California’s “MAT deserts”. California’s illegal drug market has been historically dominated by stimulants (methamphetamine), but that pattern has changed and our state was unprepared to prevent the 67% increase in opioid deaths California has experienced since 2006. The San Bernardino County Department of Behavioral Health reports that opiates now comprise 31% of local treatment admissions, ranking second behind stimulants for the first time. CLARE’s Matrix division is part of California’s MAT Expansion Project as a Hub and Spoke provider in Los Angeles, but only 03 MAT programs are operating in San Bernardino County – an area with 2 million+ residents. CLARE and other treatment boots on the ground are experiencing a groundswell of clients with OUD – local residents, as well as people coming from rural California counties and other states. Heroin is in close proximity here. It crosses the Mexican border on “heroin highways” bound for national distribution from L.A. and other hub cities. Mexican labs also send us cheap, illicit fentanyl (a painkiller so powerful it can kill even in small doses) which is being laced into stimulants here (cocaine, meth, and club drugs), or disguised as oxycodone or Percocet. The “dark web” has emerged as an additional source for illicit fentanyl and fentanyl analogues and in California, fentanyl-related deaths jumped nearly 1000% from 2013 to 2017. Also at issue is the fact that oxycodone and hydrocodone are more easily found in family medicine chests as California’s massive baby boomer population ages and copes with increased pain. Many CLARE treatment clients who began with costly pain pills are turning to street heroin as a cheap substitute. As a result, ER visits for heroin have increased here, especially among young adults, and local deaths from heroin have increased by 57% since 2012. The extent of California’s growing opioid crisis is further seen by a 50% jump in the number of newborns diagnosed with opioid withdrawal syndrome over the past decade. Moreover, California has the highest poverty rate in the nation, and our poorest communities are being hardest hit by the new opioid crisis, including San Bernardino County. SBC ranked as the poorest county in America in 2013, and not much has changed. Once a sturdy, blue-collar community, this region has become a symbol of America’s worst urban miseries. Although 31% of our county residents are White, we are a minority majority community (53% Latino; 9.5% Black; 7.4% Asian and 2% American Indian), and persons of color here are at high risk for opioid use disorders. CLARE Foundation and our Matrix division will work with our partners, including Aegis (California's largest opioid treatment provider)to increase local access to methadone, as well as buprenorphine/buprenorphine combination products, and injectable naltrexone (Vivitrol). The MAT project will provide intensive psychosocial OUD and recovery support services delivered concurrently with MAT. These services will include: clinical assessment; treatment planning; case management; Matrix Model treatment (developed by our Matrix division); trauma-informed care; gender-specific services; 12 Step Facilitation Therapy; and Relapse Prevention Therapy.

Indiana has one of the highest rates of primary treatment admissions for heroin and opioids per capita, with significant drug overdose mortality rates and an ongoing opioid crisis in certain areas of the state. Three years ago, Indiana University (IU) Health—the largest comprehensive health system in the state—formed a statewide Behavioral Health Collaborative to address the opioid crisis and other behavioral health challenges. As part of this work, IU Health established an Addictions and Pain Management Program at its academic health center in Indianapolis. The program has been well-attended with favorable outcome indicators. The overall goal of this request is to improve access to Medication Assisted Treatment (MAT) among persons with opioid use disorder (OUD) by replicating IU Health’s successful Addictions and Pain Management Program in the IU Health West service area—an area of the state with considerable opioid misuse and limited treatment options. The comprehensive, evidence-based program includes 12 step/self-help meetings, intensive outpatient program (IOP) therapy, and MAT (focusing on naltrexone). Program completion is defined as participation in all therapy groups, attending three support groups per week, negative daily BAL, negative random urine drug screens, participation in daily physical therapy, and compliance with medication management for at least a six-week period. Over half of patients typically continue the program (on a less intense basis) after the six-week period. Specific objectives of the “Addictions and Pain Management Program at IU Health West” project are to (1) Increase the number of individuals with OUD receiving MAT from a current baseline of zero to 75 per year; (2) Increase the number of individuals with OUD receiving IOP (including MAT as necessary) from a current baseline of zero to 100 per year; (3) Facilitate program completion for at least 55% of patients admitted to the Addictions and Pain Management Program at IU Health West; (3) Decrease illicit opioid drug use and prescription opioid misuse between baseline and program completion (including an average reduction of 25% of patients reporting any past 30-day illicit drug use, 40% of patients reporting any past 30-day opioid use, and 25% of patients reporting any past 30-day injection drug use); (4) Decrease illicit opioid drug use and prescription opioid misuse at 6-month follow-up among at least 40% of program completers; and (5) Improve self-reported quality of life between baseline and program completion (specifically; at least 20% of patients will report gains in any form of employment between intake and program completion). In addition, IU Health will offer (and encourage) Hepatitis C and HIV testing to all patients.

Columbia River Mental Health Services (CRMHS), in partnership with the Clark County Sheriff’s Office (CCSO) and NPC Research, proposes to implement the ‘Strategic Treatment Approach to Reentry’ (STAR) program; providing comprehensive medication assisted treatment (MAT) and psychosocial services for persons with an opioid use disorder (OUD) that are incarcerated in the Clark County Jail (CCJ). The CCJ has an average daily population of 715 inmates with 84% male, 16% female and less than 1% other. In 2017, 74% of Medicaid-enrollee inmates booked into CCJ also had a SUD indicator--13% higher than the state average; identified service gaps include limited MAT bridging services, and no process for new MAT inductions. CRMHS will implement MAT with buprenorphine sublingual tablet/film in combination with comprehensive OUD psychosocial and recovery support services to eligible inmates in the CCJ; CCSO will provide screening for eligible persons during time of booking. NPC Research will assist with performance measurement and conduct a process, outcome and cost evaluation. This program will increase MAT capacity and number of patients served in Clark County, Washington by implementing a new prescriber in the CCJ; increasing capacity of current bridging services and providing the first, new patient induction process for CCJ inmates. CRMHS will complete screening, clinical and medical assessments to determine program eligibility. Annually, the program will serve 150 unduplicated participants; 450 over the life of the grant. The STAR program will enhance the level of integrated, post-release care and improve retention rates of clients who begin MAT treatment while incarcerated with individualized post-release planning, coordination, and continued case management services. Psychosocial services while in-custody will include individual counseling, group counseling, and recovery support services, as determined appropriate based on clinical assessment. The program SUD counselor will provide program participants with individual counseling, and group counseling. Group counseling will follow level 1.0 treatment guidelines, as outlined by ASAM, and will consist of no more than 9 hours a week. CRMHS will provide 100% of program participants with individualized post-release planning to ensure continued MAT services and integration with additional community resources and recovery support. Recovery support services will be provided by certified peer case managers; this support is integral to improving access, increasing retention in MAT and facilitating long-term recovery. The proposed program will utilize certified peer mentors to connect MAT participants to Reentry program services while the person is incarcerated and coordinate access to specialized services for six months following release. The pre and post-release support from peer case manager will reduce adverse outcomes related to OUD such as housing, employment and recidivism rates.

Ohio is the second leading state in the country in deaths attributed to drug overdose. As part of the approach to addressing the Opioid Epidemic in Ohio, PrimaryOne Health (P1H) intends to expand screening and treatment options across the P1H federally-qualified health center system of 8 locations. Patients identified across the P1H system who are at-risk-of and/or meeting criteria for Opioid Use Disorder (OUD) and their families will be offered a continuum of assessment and treatment option depending on their individual needs. The patient populations on whom P1H will focus include pregnant women, urban or rural Appalachian, and African American individuals. Further, given the prevalence of a likely significant trauma history among the populations with OUD, P1H will focus efforts on patients with a co-morbid diagnosis of post-traumatic stress disorder (PTSD) including veterans. All care provided under this grant at P1Hwould be practiced with a trauma informed approach. To increase identification of OUD symptomatology, using software that feeds into the electronic health record, P1H will launch a system-wide tablet screening for all new patients and for ongoing patients annually. Through the use of this screening intervention, patients with at-risk substance use behaviors can receive same-day brief intervention, comprehensive behavioral health assessments, be offered Medication Assisted Treatment and begin their journey with recovery. If needed, P1H can provide psychiatric evaluation and treatment for patients with OUD comorbid with complex mental health disorders. Additionally, patients will have access to on-site individual and group counseling as well as Recovery Support Services. Patients will receive comprehensive care for both their medical and behavioral health conditions in the P1H embedded model of integrated behavioral health and primary care practice. Further, to increase the number of patients being identified with at-risk substance use behavior within Pickaway County, P1H will train physicians in a partner health system (Berger Health) in SBIRT, Trauma-Informed Care, Brief Negotiated Interview, (a Motivational Interviewing approach) and Motivational Interviewing. Further, to close the gap between services needed and services offered, five (5) additional Berger Health physicians will obtain their DATA 2000 Waiver.

The Barnstable County Sheriff’s Office (BCSO) proposes to enhance an existing MAT program by increasing Vivitrol injections to sentenced and pre-sentenced men and women diagnosed with Opioid Use Disorder (OUD) prior to release from the Barnstable County Correctional Facility (BCCF). The existing program will be further enhanced by the addition of community based support staff and a data collection / design evaluation plan. The name of the intended enhanced MAT program will be the Vivitrol Increased Participation and Services (VIPS) Program. The evidence-based design of a Critical Time Intervention (CTI) model implemented by the VIPS Program will provide a step-down support process for program participants released into the community from jail. The VIPS Program proposes to address the specific needs of a justice involved population by assessing for mental health issues, opioid use, and criminogenic needs. The VIPS Program will provide for a six-month post-release involvement with program participants. Post-release involvement is currently an unachievable goal due to the lack of available resources available to provide continuing community support. The VIPS Program will establish four specific goals: 1) increase the number of Vivitrol recipients in the currently under-served pre-sentenced population by increasing MAT educational programs designed to motivate those assessed with OUD; 2) reduce opiate use rates for justice involved individuals in the community by providing continuing post-release treatment provided by VIPS staff; 3) reduce adverse outcomes related to opioid use disorder for justice involved individuals by addressing specific needs assessed through use of a risk/needs assessment; 4) improve ease of access and increase retention in community based services for justice involved individuals by increasing collaboration with community based providers. The VIPS model will provide for measurable objectives within participants’ individualized treatment plans. Some objectives will be universal and some will be relative to an individual’s assessed needs. The VIPS Program intends to increase the annual current number of clients receiving Vivitrol and released to Barnstable County for the first year to 73; the second year to 83; and the third year to 94. The VIPS Program intends to serve 250 people over the lifetime of the project. In addition to the increase in recipients of Vivitrol, all participants will be receiving community support from recovery coaches and a licensed mental health clinician who will be proficient with cognitive-behavioral and motivational interviewing skills.

Community Renewal Team's Response to SAMHSA 2018 MAT-PDOA RFP Community Renewal Team, Inc. (CRT), Connecticut's largest and oldest community action agency, seeks to expand access to and the capacity of its Behavioral Health Services (BHS) to provide Medication Assisted Treatment (MAT) for Opioid Use Disorder (OUD). CRT-MAT will serve individuals in the Hartford region and will prioritize recently released ex-offenders and individuals involved with the criminal justice system. While only the third largest city in Connecticut, Hartford has the highest rate of opioid-related deaths (24.1 per 100,000) and the greatest number of ex-offenders in the state. Currently, the city does not have a program that focuses on individuals recently released from prison, who are at particularly high risk of overdose. In Year 1 of the grant, 75 eligible clients will be engaged and 50 enrolled in MAT. After that 150 will be engaged and 100 enrolled per year for a three-year total of 375 engaged, 150 enrolled in MAT. Of these individuals, most will be male, 95% will be at or below 200% of the federal poverty level, 60% will be people of color, 60% between the ages of 24 and 54, and 70% will have co-occurring disorder. Goals for CRT-MAT include increasing staff capacity, increasing the number of clients receiving integrated care (MAT plus support and recovery support services, and a decrease in the percent of opioid use at a six-month follow-up. Currently, CRT can provide all MAT services other that the administration of buprenorphine or methadone at its licensed and Joint Commission accredited behavioral health clinics. Present services include use of vivitrol, psychosocial assessments, counseling for mental health, substance use, and co-occurring disorders, medication management, development and updating of treatment plans, case management, instruction on Narcan usage, linkage with internal services such as HIV/Hep C testing, veterans' programs, tobacco cessation, supportive housing, basic needs and financial literacy. Our agency also has developed close collaborations with regional clinics and hospitals, legal service providers, and employment and vocational training programs, among others. Through this grant, we will retain a physician who can already provide buprenorphine, obtain waivers for two other medical providers (a physician and an APRN), and obtain certification for our agency. Our clinical services will be enhanced by the use of numerous evidence-based practices including, but not necessarily limited to Motivational Interviewing, Cognitive Behavioral Therapy (""Thinking for a Change""), Helping Men Recover, Dialectical Behavioral Therapy Treatment, Motivation Enhancement Therapy, Anger Management, and Post-Acute Withdrawal Symptoms Treatment. Further, our clinicians reflect the clients that we serve. Of BHS Division's 26 employees, nearly 70% are Black, Hispanic or Asian and staff includes providers who are fluent in English, Spanish, Korean, Cambodian, Vietnamese, and Akan (a language of Ghana). Many of CRT's BHS staff also has more than a decade working with individuals with histories of incarceration.