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The Essex Medication Assisted Treatment (EMAT) project is a collaborative initiative between Volunteers of America Massachusetts (VOAMA) and the Essex County Sherriff?s Department (ECSD) to address the growing need to expand and enhance medication assisted treatment (MAT) services for incarcerated individuals with an opioid use disorder (OUD). The goal of this project is to decrease illicit opioid drug use and prescription opioid misuse, and prevent the re-incarceration of individuals receiving services through this project by building the capacity of ECSD to expand/enhance access to medication-assisted treatment (MAT) and other psychosocial supports and integrated care services for a total of 250 clients over the three-year project period (70 in Year 1, 90 in Year 2 and 90 in Year 3). These individuals must be participating in drug courts, probation, parole, and/or be within four months of release from an ECSD detention facility in Essex County (Middleton House of Corrections, Essex County Pre-release and Re-entry Center or Women in Transition). The project will expand infrastructure and build capacity for state, county and local collaborators to expand MAT and establish additional psychosocial supports and integrated care services. Education and training on signs of opioid use and overdose, as well as the nature, application and implementation of MAT services will also be provided to ECSD officers in order to reduce stigma and promote MAT. Evidenced-based practices for planning, screening and assessment, and treatment include Level of Service/Case Management Inventory (LS/CMI), Comprehensive Addictions and Psychological Evaluation-5 (CAAPE-5), peer recovery support team approaches, cognitive behavioral treatment (CBT), trauma-informed care (TIC), motivational interviewing (MI) and strength-based case management (SbCM). Objectives focus on building the capacity of VOAMA and ECSD to: (1) identify, screen, assess, enroll and retain individuals into the full continuum of MAT-services, and establish an integrated system of care among 13 public and private Task Force partners; (2) increase the number of incarcerated individuals with OUD receiving MAT and other psychosocial supports and integrated care services; (3) decrease illicit opioid drug use and prescription opioid misuse among the project participants; and (4) reduce the recidivism rate of the project participants through the provision of an integrated system of care that is specifically designed for each individual participant?s needs. As required by SAMHSA, participants will complete a six-month follow-up assessment. Advocates for Human Potential (AHP) will serve as the grant evaluators for the project. Key staff are the project director, reentry coordinator, case manager, electronic health record analyst, a team of peer recovery coaches, nurse, phlebotomist and grant evaluator. VOAMA has been working collaboratively with the ECSD for the past five years.

WellSpan Medication Assisted Treatment (WSMAT) will expand and enhance access to MAT services for persons with an Opioid Use Disorder (OUD) seeking or receiving MAT in the south-central Pennsylvania region. WSMAT will increase the number of DEA-X prescribers, expand entry points, use Evidence Based Practices, improve support and education for pregnant OUD patients, and create workflows that support increased access to treatment for 1200 new (400 new patients in each grant year) MAT patients by 9/29/2021. The target population is patients with opioid use disorder (OUD) who live in the Adams, Franklin, Lancaster, Lebanon, or York counties and are receiving medication-assisted treatment (MAT) and recovery support through WellSpan (WS), Family First Health (FFH), The RASE Project or Lancaster Health Center (LHC). The 3,552-square mile area is home to 1,365,130 people of which 1,014,071 are age 20+. Ten percent have no health insurance, 53% live below poverty level, 10% are veterans, 9% identify as Hispanic, 90% are white, 5% black, and 2% Asian. WellSpan (WS) recognizes the devastating impact the epidemic of opioid use has made on the south-central Pennsylvania. WS has been surveilling the opioid crisis closely and deploying significant time and resources to address the problem. Leadership teams are intimately involved in Heroin Task Forces across all counties we serve, and have worked to gather data, share best practices, and implement innovative models of care. WS has forged relationships with community organizations who partner to support patients and families affected by OUD. The goal of the WSMAT project is to expand and enhance access to Medication Assisted Treatment(MAT) services for persons with an Opioid Use Disorder seeking or receiving MAT. As a result of this project the following will be accomplished: 1) increased number of DEA-X waivered prescribers to 50, 2) 1200 new patients with OUD initiating MAT in combination with comprehensive OUD psychosocial services; 3) increased screening of WS patients receiving physical and/or behavioral health services for OUD in at least 5 primary care practices, 10 behavioral health practices, and at least 3 WS acute care hospitals; 4) increased screening for OUD and recovery support; 5) increased screening for communicable diseases, co-occurring mental health conditions, and other substance abuse disorders); 6) expanded points of entry for vulnerable patients through direct partnership with 2 area prisons that will result in at least 20 released individuals being provided with MAT and recovery support services; 7) implementation of the Yale-protocol in at least two WS acute care hospitals, 8) 80% of participants in program 6 months+ decrease opioid abuse.

Kentucky Medication Assisted Treatment - Together Eradicating Reliance on Substances (KY MATTERS) will increase access to medication-assisted treatment (MAT) for individuals with opioid use disorder (OUD) in resource-limited, rural Pike and Estill Counties in Kentucky and help decrease illicit opioid drug use and prescription opioid misuse. WestCare Kentucky, Inc. (WC-KY) proposes to expand and enhance access to medication assisted treatment (MAT) services for individuals with an OUD through existing outpatient and residential treatment programs, court diversion projects, and offender reentry programs. The focus population of adults includes heterosexual, LGBTQ, previously incarcerated adults, those with criminal histories, veterans, and homeless people. WC-KY will serve 134 individuals with OUD in year 1, 200 in year 2, and 200 in year 3. A total of 534 unduplicated individuals will be served over three years. Goal 1: Increase the number of individuals with OUD receiving MAT services in Estill and Pike County, KY. Strengthen/expand engagement/outreach strategies with community partners to implement, increase and maintain MAT services to OUD individuals. 100% of individuals receiving MAT will have a treatment plan that includes FDA-approved medication, dosage, and frequency based on clinical assessment. 80% of clients who achieve stabilization and elect medical withdrawal will abstain from opiates. Goal 2: Decrease illicit opioid drug use and prescription opioid misuse at six-month follow up to program admission. 85% of clients enrolled in MAT will receive evidence-based practices, weekly medical management, urine screens, counseling, behavioral therapy, and case management services. 80% of persons enrolled in KY MATTERS will successfully complete the program. 80% of clients will be free from illicit drug use and prescription drug misuse at six months post intake. 70% of clients facing OUD challenges will adjust their dosage of medication. 100% of clients enrolled in the program will receive a screening/assessment for co-occurring substance use and mental disorders. Goal 3: Provide FDA-approved medications for the maintenance treatment of OUD in combination with comprehensive psychosocial and peer recovery support services (RSS). Provide strength-based case management to 534 clients across the three-year funding period. 80% of clients will have stable living situations at discharge and 6 months post-intake. 80% of clients who successfully complete treatment and had mental health symptoms at admission will exhibit decreased symptoms at discharge and 70% will maintain improved mental health functioning at 6-six months post intake. 80% of the clients who successfully complete MAT will not engage in new criminal activity at discharge, and 70% will not recidivate at six months post intake. 100% of clients who smoke will be referred to tobacco cessation programs. 100% of clients at risk or living with HIV/AIDS, viral hepatitis, or other infectious diseases will be referred for testing or counseling as indicated in their case management plan.

PROJECT ABSTRACT SUMMARY: WestCare Tennessee (WC-TN) provides evidence-based, medication assisted treatment (MAT) using FDA-approved medications & recovery support services (RSS). The program decreases prescription drug and illicit opioid misuse for 210 clients over three years, reducing overdose mortality and addiction in Eastern TN. PROJECT NAME: TN MATTERS (Tennessee Medication Assisted Treatment - Together Eradicating Reliance on Substances) POPULATION: TN MATTERS serves male and female adults (18 and over) who are prescription drug and opioid abusers (PDOA) in the rural Roane and Morgan counties of TN. Clients are offenders referred by the jails and drug courts; family and self-referred addicts, veterans and the homeless; and, primarily White, poverty-level clients. Clients have a moderate to severe opiate use disorder and co-occurring mental health disorders. . INTERVENTIONS: TN MATTERS will provide MAT services and RSS. MAT will offer FDA-approved medications, Vivitrol and Suboxone, prescribed and maintained by an APRN who will adjust and reduce frequency and dosage as needed. Medical withdrawal and abstinence will be managed by the APRN, treatment team and client. As the lead applicant and treatment provider, WC-TN will provide direct outpatient MAT services, as well as recovery support services including employment services, case management, relapse prevention, housing assistance, life skills, formal and substance use education. Provider partners offer medical care, HIV testing, Hepatitis testing, tobacco cessation and transportation to and from services. GOALS & OBJECTIVES: TN MATTERS will serve 60 unduplicated clients annually (Year 1), 70 (Year 2) and 80 (Year 3), serving 210 clients over the entire project period). Goals are: (1) Increase numbers receiving MAT services; (2) Decrease PDOA; and, (3) Provide FDA-approved medications for the treatment of PDOA using RSS. Objectives include: (1.1) Strong outreach strategies; (1.2) provide MAT services in rural, resource-limited counties; (1.2.1) individualized treatment plan (90%); (1.3) self-sufficiency and abstinence from opiates (80%); (2.1) Outpatient MAT to 60, 70 and 80 clients in Years 1-3 (210 across three-year funding period); (2.1.1.) Successful program completion (80%, GPRA); (2.2.) client-free illicit drug abuse, prescription misuse and diversion of medication six months post intake (80%, GPRA); (2.2.1) clients adjust or reduce their dosage (70%, COWS); (2.3) clients receive needed COD services (90%); (3.1) case management to 210 clients; (3.1.1) stable living situations (80%); (3.1.2) decreased mental health symptoms (80%), improved mental health functioning (70%, GPRA); (3.1.3) No new criminal activity (80%), and no recidivism (70%. GPRA); (3.1.4) clients who smoke, with HIV/AIDS, hepatitis and other infectious diseases referred for tobacco cessation, testing and counseling.

The Wheeler New Britain Medication Assisted Treatment (NB MAT) Program will expand and enhance access to MAT services and recovery supports by extending culturally appropriate community outreach and engagement; nurse care management; integrated MAT substance abuse, mental health treatment, and primary health care services; and peer recovery supports for adults with opioid use disorders in the greater New Britain community. Wheeler Clinic, a leading behavioral health services provider in Connecticut, will implement the NB MAT Program at its Health & Wellness Center at 75 North Mountain Road in New Britain for adults with opioid use disorders who live in the community or are returning to the area following incarceration. New Britain?s overall poverty rate (22.9%) is more than double the statewide average and the city is diverse with 40.1% of residents identifying as Hispanic/Latinx, 10.9% as African-American, and 68.3% as Caucasian. Connecticut experienced 1,038 accidental overdose deaths in 2017, a 191% increase over 2012 and the fifth year in a row overdose deaths have gone up. The City of New Britain had 169 accidental overdose deaths from 2012 to 2017 and there is a critical need for services. The NB MAT program will enhance and expand services available at the New Britain Health & Wellness center by increasing MAT services and adding care management and peer supports. Services will include: community outreach, engagement, and awareness; walk-in comprehensive clinical assessments for co-occurring disorders; provision of MAT (Buprenorphine, Extended Release Naltrexone, and other FDA approved medications) utilizing strategies to increase compliance and reduce the risk of diversion; connection and linkages to community services to address social determinants of health; innovative interventions such as the use of the myStrength digital behavioral health application to engage and retain clients in treatment; peer supports; tobacco cessation services; and coordination of care with Ryan White HIV/AIDS services. A high quality process and outcome evaluation will determine the effectiveness of the implementation and client outcomes utilizing focus groups and key informant interviews as well as GPRA and other data from the electronic health record. Outcome objectives include: all NB MAT participants will have a comprehensive recovery plan fully integrating MAT, behavioral health, primary health, and recovery support services to promote and sustain recovery; at least 85% of participants will increase retention and achieve favorable treatment outcomes; at least 85% of participants will reduce substance abuse; and at least 85% of participants will improve primary and mental health symptoms and treatment compliance. The NB MAT Program will serve 100 adults each year for a total of 300 adults over the three year grant period.

Project Abstract Summary Grantee Contact Name: Bob Caetano Grantee Contact Mailing Address: 2204 Pacific Ave N Long Beach, WA 98631 Grantee Contact E-Mail Address: caetanob@willapabh.org Project Abstract Willapa Behavioral Health was awarded a Medication Assisted Treatment-Prescription Drug and Opioid Addiction grant in the amount of $717,291.02 over three years from the SAMHSA. The project goals are to expand and enhance access to medication-assisted treatment (MAT) services for persons with an opioid use disorder (OUD) seeking or receiving MAT in Pacific County, Washington. This will include individuals experiencing an opioid overdose, clients of community based substance use treatment programs, incarcerated individuals, and patients receiving long term MAT through their primary care provider. Our goal is to: 1) Increase the number of individuals in Pacific County with OUD receiving medication assisted treatment (MAT), 2) Decrease illicit opioid drug use and prescription opioid misuse at six-month follow-up, and 3) Improve coordination of care and referral mechanisms along the intervention-treatment-aftercare continuum of care for OUD. Objectives of the project include implementation of the BNI-ED program and MAT DATA Waiver to ensure MAT is initiated in the Emergency Room and Jail and that referrals to treatment occur. We will double treatment provider capacity to prescribe MAT by supporting at least one additional treatment prescriber, 2 ED providers, and three additional primary care providers obtain DATA waiver. We will implement the aftercare EBP: Recovery and Training Self Help for Opioid Use for 50% of individuals upon treatment completion. We will increase the number of SUD counselors trained and implementing Moral Reconation Therapy and Dialectical Behavior Therapy and increase implementation of both programs. We will implement Peer Support services for at least 50% of individuals receiving MAT and will facilitate care coordination meetings with providers, to ensure a smooth transition of care as patients move along the COC. Annually we will train at least 50% of all providers in Pacific County about local SUD resources, including distribution of naloxone kits and information regarding local OUD treatment options and MAT, and how to make referrals. We will serve 50 individuals in year one and 200 in subsequent years. All services provided under the grant will be provided in Pacific County, WA. Pacific County has a population of just under 21,000 and is located in the far southwest corner of Washington state.

Expanding MAT Services in Mingo County, WV ? The Heart of the Nation?s Opioid Crisis Williamson Health & Wellness Center will significantly expand its ability to support substance use disorder prevention, treatment, and sustained recovery for individuals suffering from addiction throughout southern West Virginia by launching a comprehensive Medication-Assisted Treatment program. The program is located in Mingo County, WV, which has a drug overdose death rate that is 4 times the national average and will serve 360 individuals over 3 years. According to the 2018 County Health Rankings, Mingo County has a drug overdose rate of 81 deaths per 100,000 residents (increasing 25% in just one year from 65 / 100,000) and has the second highest rate in WV. This rate greatly exceeds the state of West Virginia (52 / 100,000) and the nation (19.8 / 100,000) according to the most recent Centers for Disease Control and Prevention data for drug overdose death rates. The City of Williamson, in Mingo County, is home to the largest coal marshaling yards in the world where billions of dollars worth of coal has passed through and has left behind one of the poorest and unhealthiest regions in the nation as coal production has declined. Residents in the service area have experienced significant job losses, have a high unemployment rate and suffer from poverty rates that exceed both the state and nation. In order to address the high rates of prescription drug and opioid addiction, WHWC has outlined two project goals: 1) Increase capacity to serve more individuals who are experiencing prescription drug or opioid addiction with comprehensive MAT services through expanded provider FTE and evidence-based peer recovery, counseling, and care coordination staffing and 2) Increase the success of MAT program participants to overcome SUD / OUD and sustain recovery using evidence-based interventions in an integrated primary care setting. These goals will be measured with number of new staff hired, number of DATA waivered providers, number of unduplicated individuals served, as well as sustained recovery measures at 3 month, 6 month and 18 month follow-up visits. WHWC will enroll 90 new clients into its MAT program by the end of the Year One, 90 new clients (180 total) in Year Two, and 180 new clients (360 total) in Year Three for a total of 360 unduplicated MAT clients served at any given time by the end of the Project Period. Planned evidence-based interventions include the use of Medication-Assisted Treatment, Motivational Interviewing/Enhancement, Cognitive Behavioral Therapy and Trauma-Informed Care, as well as additional strategies to include peer recovery coaches, telehealth and a strong evaluation component.

Abstract The University of Iowa Hospitals and Clinics (UIHC) proposes to expand medication assisted treatment (MAT) in eastern Iowa, with the project title of Co-MAT-IA. The funds for the project will be used to assist the growing number of adults in eastern Iowa with opioid use disorder (OUD) begin the process of recovery. The goals are to increase the capacity of clinicians affiliated with UIHC to provide and monitor medication assisted treatment for OUD, increase the number of people with OUD in eastern Iowa who get MAT, and decrease illicit opioid drug use and prescription opioid misuse and improve client outcomes. These goals will be accomplished by providing training to increase the number of clinicians in eastern Iowa who offer MAT resulting in expansion of MAT to rural clinics, criminal justice populations, and other communities in Iowa. Partnerships will be formed between UIHC, including Departments of Psychiatry, Emergency Medicine, and Family Medicine, and: River Hills Community Health Center in Ottumwa; Mercy North Iowa Family Medicine Residency Clinic in Mason City; Iowa Department of Corrections & 6th Judicial District Department of Correctional Services; Veterans Affairs (VA) Medical Center in Iowa City and VISN 23; Iowa Harm Reduction Coalition. The objectives of the project are to: ? Build a team of medical professionals to collaboratively deliver MAT services. ? Expand MAT services at UIHC. ? Increase the number of clinicians in eastern Iowa who offer MAT in their practice. ? Construct a patient registry to provide ongoing information about patient treatment and outcomes to assist in guiding treatment modification when patients are not meeting treatment goals. ? Expand to rural clinics. ? Expand to serve criminal justice populations. ? Expand to other communities. ? Decrease heroin and other opioid use by 50% at 6-month post project enrollment. ? Reduce injection opioid drug use by 50% at 6-month post project enrollment. ? Improve quality of life, life satisfaction and social connectedness for people with OUD. The program will create a network for sharing information and expertise to ensure the sustainability of MAT in eastern Iowa beyond the 3 years of grant funding. Services will be provided to 140 unduplicated clients using evidenced based practices as part of the project.

Project Title: EMATTA: Expanding MAT Access through a Team Treatment Approach This project will expand an existing multispecialty opioid-use disorder (OUD) treatment program to provide medication-assisted treatment (MAT) to an additional 240 postpartum and early-parenting women in KY. The project will decrease illicit opioid use and prescription misuse, coordinate MAT and comprehensive OUD treatment, and enhance utilization of ancillary and wraparound services to retain women in treatment and reduce relapse. Goal 1: Increase access to MAT and comprehensive psychosocial services for postpartum and early-parenting women with OUD. 1a) Enroll 240 new clients into the Beyond Birth pro-gram over 3 years (80 per year); 1b) Establish 10 new MAT prescribing treatment groups by the end of year 3; 1c) Obtain 3 new DATA waivers for nurse practitioners (1 by Dec. 2018 and 2 by the end of year 2), and 1d) Provide clients with transportation assistance for 100 MAT treatment visits by the end of year 3. Measured by clinic records. Goal 2: Decrease illicit opioid drug use and prescription misuse among the target population. 2a) Provide comprehensive services for women with OUD resulting in improved treatment outcomes; 2b) Integrate MAT with COR-12, peer support services, and evidenced-based therapies designed to increase retention in treatment and facilitate long-term recovery by the end of year 1. Measured by GPRA metrics for days of self-reported drug use, urine drug screens, pill counts, client retention and clinic service records. Goal 3: Establish a partnership between Beyond Birth (BB) and Chrysalis House (CH) to coordinate services and ensure access to MAT and comprehensive OUD treatment for clients at all levels of SUD and mental health care. 3a) Designate a shared Medical Director between CH and BB by Dec. 2018; 3b) Conduct weekly care coordination meetings comprised of BB and CH project staff and ancillary providers; and 3c) Refer clients and coordinate transitions between CH and BB. Measured by project documentation. Goal 4: Enhance utilization of ancillary and wraparound services for women receiving MAT to reduce relapse risk. 4a) Screen 100% of clients for HCV and initiate treatment for 25% of eligible clients by year 2 of the project; 4b) Discuss the benefits of and offer the use of long-acting contraceptives to 100% of clients within 30 days of enrollment; and 4c) Screen 100% of enrolled clients for co-occurring disorders with standardized tools and provide appropriate intervention as needed. Measured by clinic and medical records. Goal 5: To ensure that the project implementation and evaluation adhere to objectives and facilitate continuous quality improvement (CQI). 5a) Initiate the project within four months of funding award; and 5b) Conduct monthly CQI team meetings comprised of BB and CH project staff, evaluation team members, and ancillary service providers in the first year and bi-monthly meetings in years 2 and 3. Measured by project documentation and reporting.

Penn Medicine ENGAGE: Emergency Engagement for Opioid Use Disorder Our overall objective is to increase treatment of individuals suffering from Opioid Use Disorder (OUD) in West Philadelphia by providing early engagement, increased access to substance use assessment, and withdrawal management to all Opioid Use Disorder patients presenting in crisis at Penn Medicine with symptoms of overdose or withdrawal. We will also increase our outreach in order to attract more such patients to our center. In order to meet the objective of increasing treatment, we intend to develop a model of Emergency Engagement and Ambulatory Stabilization at our facility, which will provide the needed services at hours most critical to our intended population to reduce the incidence of overdose. We will increase access to care by housing Certified Recovery Specialists (CRS) or Care Coordinators (CC) in our Emergency Department 24/7, increasing the number and availability of buprenorphine waivered providers, making 23-hour observation available, and using the CRS or CC to complete a warm handoff to the next level of care. In addition, we will add several Certified Peer Recovery Specialists to our team of providers. This will provide urgent and timely access to emergency substance use intervention assessment and will increase services by incorporating outpatient withdrawal management and warm hand-off to next level of care, which will include ongoing medication management and intervention until clients link to the appropriate level of care. The continuity of care will also make it possible to track information on patients at 3 months and 6 months after initial presentation, allowing us to assess the progress of individuals and the program and make any needed changes and improvements in our approach or implementation. We expect to engage, at a minimum, 1000 unique individuals with funding from this grant, with at least 200 of those entering MAT treatment. Specific goals for our program are: 1. Add up to 3 Buprenorphine Waivered providers within our ED and outpatient program by November 2018. 2. Have a CRS or CC engage with 100% of overdose and withdrawal patients who present to the ED. 3. Once contact is established, we aim to have 20% of the number of contacts (those connected with a CRS) within the ED translate into MAT induction, and of those inducted, for 75% to be maintained on MAT at 30 days. 4. Improve opioid use outcomes in the study sample out to the 6-month follow-up, as indicated by (1) retaining 50% of the participants in MAT, and (2) at least 50% of the participants providing opioid free urine toxicology samples. 5. Our addictions program will participate in at least 5 community events per year and increase its public presence through additional routes.

The proposed Commonwealth Opioid Medical Medication Assisted Treatment Integration and Training Program (COMMIT) will implement an innovative medication assisted treatment (MAT) hub-and-spoke (H&S) model in Washington County (Wash) Pennsylvania. This is an application to Funding Opportunity Announcement (FOA) TI-18-009 from the Substance Abuse and Mental Health Services Administration (SAMHSA). The population of focus includes adult patients over the age of 18 years of age with opioid use disorder (OUD) in Wash. This project is a collaboration between, University of Pittsburgh, School of Pharmacy, Program Evaluation and Research Unit (PERU) ? the primary applicant, Washington Drug and Alcohol Commission, Inc. (WDAC), Echo Treatment Center (Echo), The Care Center (TCC), Washington Behavioral Health (WBH), Beacon Health, Jarus Health, as well as the criminal justice system, emergency departments, primary care providers, and substance use disorder and mental health providers located in Washington. Key objectives and goals of this project are to increase the number of patients with OUD receiving MAT services in the catchment area, and decrease the number of patients misusing opioids. To achieve these objectives, the project will do the following, (1) PERU will implement and coordinate services between all project entities to provide a comprehensive continuum of care for patients receiving MAT services; (2) Echo, TCC, and WBH will act as MAT hubs to receive patients and induct them on either methadone, buprenorphine, or naltrexone as needed and then refer patients to PCPs for maintenance therapy as appropriate; (3) WDAC will act as a care coordination hub and receive patients referred by PCPs, EDs, the criminal justice system, or the community and assess them for appropriateness for MAT, assess them for SUD/MH and community support needs, and connect them with these resources as appropriate; (4) PCPs will be trained on screening, brief intervention, and referral to treatment (SBIRT) services, how to utilize the prescription drug monitoring program (PDMP), and how to educate patients on opioid use, specifically fentanyl; (5) the project team will institute diversion and misuse mitigation strategies to improve patient treatment compliance; (6) the project team will collect qualitative and quantitative data to evaluate outcome and improve the provision of MAT services to patients; (7) the project team will create an innovative patient mobile phone application to improve engagement and retention; and (8) the project team will institute a sustainable funding mechanism with Beacon Health. This project will span from September 2018 to September 2021.

The current practice of providing emergency department (ED) patients with opioid use disorder (OUD) with only a referral to treatment elsewhere is a missed opportunity to engage patients in medication assisted treatment (MAT). We propose establishing a new intervention, that will initiate buprenorphine-naloxone (bup/nal) treatment presenting at the ED with OUD, and transfer these patients to ongoing community treatment with bup/nal within 24 to 72 hours. This project, titled: Emergency Department Initiated Buprenorphine to Expand Medication Assisted Treatment for Opioid Use Disorder will be conducted at three medical centers in Vermont [University of Vermont Medical Center in Burlington (UVMMC), Central Vermont Medical Center in Berlin (CVMC) and Porter hospital in Middlebury]. The project will recruit 50 patients in year 1 and another 150 in years 2 and 3, for a three-year total of 200 patients. The patient sample will reflect the population of Vermont, with over 90% of the sample white, Non-Hispanic with approximately 2% Asian, 2% Hispanic and 2% African American. The patient population in Vermont opioid treatment populations are almost 50/50 female to male ratio and we expect the project patient sample to be similar. Patients will receive a dose of buprenorphine in the ED and a staff person will ""link"" the individual to MAT in an outpatient site with immediate admission. Patients will receive ongoing care in the Vermont Hub and Spoke treatment system which provides a full array of MAT and, if needed, residential care. Patients are assessed for mental health disorders, infectious diseases and are provided with medical care. By the end of year 3 of the project 200 individuals will have been inducted onto bup/nal across all three EDs 160 individuals will have taken a second dose of bup/nal in an outpatient treatment setting 135 individuals will be retained on bup/nal for at least 30 days 105 individuals will remain in treatment for a minimum of 6 months. 80% of individuals who complete baseline GPRA forms will be followed up at 3 months, 6 months and discharge. 75% of individuals who are interviewed at 6 months after baseline will report no opioid use for the previous 90 days. This includes individuals in and out of treatment. 90% of individuals interviewed at 6 months will report a reduction in stigma from baseline 80% of individuals interviewed at 6 months will report treatment was very useful in 4 domains.

Project HOUDINI LINK (Hospital Opioid Use Disorder treatment INItiation and LINKage to care) will provide medication assisted treatment (MAT) and comprehensive psychosocial services to 150 individuals aged 18 and older with opioid use disorder (OUD) who present to Zuckerberg San Francisco General (ZSFG). The population of focus will be hospitalized patients who are initiated on MAT for OUD, San Francisco residents and referred to one of six diverse outpatient MAT programs. Patient navigators will work closely with the ZSFG medical teams to link and retain each enrolled patient in outpatient care using contingency management and motivational interviewing. ZSFG is the largest safety net hospital in San Francisco and currently offers MAT on-demand to hospitalized patients, but linkage to outpatient care is low. The population of focus is at high risk of treatment drop-out and drug overdose due to co-occurring mental illness, stimulant use and homelessness. Three evidence-based practices, known to be effective with the population of focus, will be used to overcome these barriers: MAT pharmacotherapy (methadone, buprenorphine, or extended-release naltrexone), patient navigation with motivational interviewing, and contingency management. The project?s goals are (1) increase treatment retention amongst patients initiating MAT at ZSFG; (2) reduce the impact of OUD on enrolled patients; (3) increase access and engagement with mental health and primary care; and (4) establish and maintain patient satisfaction with patient navigators. Multiple performance indicators will be measured via patient report, project staff report, and clinical and administrative records to evaluate progress towards project goals. The project will serve 150 patients over the three-year funding period (50 in Year #1, 67 in Year #2, 33 in Year #3). The majority of patients are expected to be male and African American or Latino. Project HOUDINI LINK staff will come from the Division of Substance Abuse and Addiction Medicine (DSAAM) in the UCSF Department of Psychiatry which has over 40 years of serving the population of focus and providing comprehensive care management to complex, underserved populations. DSAAM will also partner with the UCSF Departments of Family Medicine, Medicine, Emergency Medicine and the ZSFG inpatient Addiction Medicine Consult Service. Project staff are highly trained individuals who are state and nationally recognized leaders in the treatment of OUD. The project will link patients to six separate outpatient OUD treatment programs, including an opioid treatment program, a buprenorphine induction and stabilization clinic, and four primary care clinics with office-based OUD treatment. Referrals to residential treatment, primary care and treatment of mental illness will also be available to provide a continuum of care individualized to meet patients? needs.

Summit County Combined General Health District, DBA Summit County Public Health (SCPH), is seeking funding for a Community Medication Assisted Treatment Program to serve 50 unduplicated individuals each year for a total of 150 adults with an opioid use disorder. Buprenorphine and naltrexone products will be utilized in conjunction with two evidence based models of treatment: Motivational Enhancement Therapy and the Community Reinforcement Approach. Participants will be 18 years or older, male, female, or transgender individuals who reside in Summit County, Ohio. Based upon the demographics of the county, participants will be predominately Caucasian, although all ethnic groups, cultures and minorities are encouraged to participate. Services to be provided in this project include outreach services, individual and group counseling, case management, peer recovery coaching and medical/somatic services. Project goals and objectives are as follows: Goal 1: To increase the number of professionals in Summit County who are able to provide medication assisted treatment to individuals with an opiate use disorder (OUD). Objective 1: Five prescribers will complete DATA 2000 training in three years and provide buprenorphine products to 75 individuals with OUD by September 29, 2021. Objective 2: Five providers who utilize MAT will utilize Naltrexone with 75 adults with OUD by September 29, 2021. Goal 2: To provide evidence based treatment to adults, ages 18 and older with an opiate use disorder to promote longer term recovery from OUD Objective 1: To provide trauma informed care 150 adults and trauma treatment to 75 adults who have experienced trauma and have a co-occurring (OUD) by September 29, 2021. Objective 2: To increase the number of professionals in the Summit County workforce trained in at least one evidenced based practice by September 29, 2021. Objective 3: To provide at least 50 hours of continuing education credits for counselors, social workers, marriage and family therapists in addiction, opiates, and evidence based practices ) by September 29, 2021. Goal 3: Provide treatment and supportive services so that 50% of the people enrolled in the program maintain abstinence for six months following completion of the program Objective 1: To recruit 200 people to participate in the program by September 29, 2021. Objective 2: To provide at least four individual counseling sessions of MET to 80% of the people enrolled in the program by September 29, 2021 Objective 3: To provide CRA to 60% of the people enrolled in the CRA phase of the program to completion by September 20, 2021.

Tarzana Treatment Centers, Inc. (TTC) will expand access to quality, evidence-based medication assisted treatment (MAT) for individuals in Los Angeles County (LAC) with opioid use disorder (OUD), especially vulnerable populations being released from LAC hospital emergency departments (EDs) and jails. TTC?s MAT-Expansion Project (Project MAT-E) will offer participants a constellation of critical services, including MAT, counseling, recovery and peer support, co-occurring mental health services, HIV/Hepatitis screening and comprehensive case management with referral and linkage to TTC?s primary medical care and HIV/Hepatitis specialty medical care and prevention services. The project will provide outreach, screening, intake and assessment services to a minimum of 150 individuals with OUD in Year 1 and 180 in Years 2 and 3 for a total of 510 unduplicated individuals served during the life of the project. The population of focus will be adults, over age 18, with an OUD referred from LAC EDs and Jails; participants will be reflective of the current OUD patient population in LAC, who are primarily White and/or Hispanic males whose primary drug of choice is heroin. As an expert in MAT and integrated healthcare, TTC will ensure a comprehensive response to the complex treatment needs of participants by leveraging its integrated treatment model, developed over the past 45 years, to create a broad system of care for individuals suffering from OUD. TTC will provide all required services at its Central treatment facility and co-located Opioid Treatment Program in Tarzana, CA, including: 1) Comprehensive Assessment and Individualized Treatment Planning; 2) Medication Assisted Treatment (buprenorphine/naloxone, methadone, and naltrexone); 3) Individual and Group Counseling; 4) Co-occurring Mental Health Services; 5) Case Management Services, including benefits screening and enrollment and referral and linkage to TTC?s primary care, housing, and transportation services; 5) Recovery and Peer Support Services; 6) Prescription Drug Monitoring; 7) Overdose Education and Naloxone Distribution; 8) Pharmacological Consults for chronic pain management; 9) Adherence Monitoring; 10) Linkage to higher levels of SUD Care; 11) Telehealth Services; 12) HIV/HCV Prevention and Treatment Services; and 13) Tobacco Cessation Services. The specific goal of Project MAT-E is to increase access to MAT in LAC by: 1) Strengthening existing referral networks with LAC hospital EDs and jails; and 2) Enhancing TTC?s capacity to enroll OUD patients in MAT services. Measurable objectives include: 1) 80% enrollment of participants in MAT services; 2) 30% enrollment of participants in co-occurring mental health services; 3) 100% screening of participants for HIV/Hepatitis; 4) increased length of stay in MAT programs; 5) increased abstinence from illicit drug use; 6) decreased criminal justice involvement; and 7) reduced ED visits due to opioid overdose.

Targeted Efficacy & Capacity Building in Opioid Treatment-TN.Expansion (TECBOT-TN.X), as proposed by the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), will close the gap in access and delivery of evidence-based (EB), medication-assisted treatment (MAT) services for patients with opioid use disorders (OUDs) who need an MAT referral instead of an inpatient bed. Using a care-coordination model, TECBOT-TN.X will facilitate appropriate, high quality treatment for opioid addiction for 132 underserved adults receiving services in a state-funded psychiatric hospital (PH) in Blount County over a 3-year period. Acute patients with OUD will be transitioned to an outpatient MAT provider in Knox County. (Both facilities are located in the Knoxville metropolitan statistical area [MSA]). Behaviors exhibited in emergency departments (EDs), lack of disclosure about opioid/other substance use, failure of medical staff to ask about substance use, and/or lack of information about substance use treatment (SUT) options or resources all contribute to the inpatient stay. However, the result is an undertreated person with OUD. As an inpatient, withdrawal symptoms appear and hospital staff ask for additional days. Because the state-funded PH is designed to serve severely and persistently mentally ill (SPMI) at or below the poverty line, requests for extended lengths of stay (LOSs) involving substance use are denied. In addition, many of the denials show back up as readmissions. TECBOT-TN.X?s care-coordination model can enhance the quality of care for these individuals. Case management and/or care coordination staff at the PH and SUT will collaborate to successfully coordinate care for acute patients with OUD who need and express a desire for EB-MAT in the form of buprenorphine/naloxone (Suboxone) film or extended release, long-acting injectable naltrexone (Vivitrol). Veterans/military personnel will be a priority population. Case management/coordination staff at the PH will provide appropriate screening, assessment, and patient education to address any questions the patient may have regarding MAT. A standardized checklist will be used at discharge. TECBOT-TN.X picks up medication services at discharge and facilitates seamless transition to outpatient services.by providing a 3-day supply of medication and Narcan at discharge. Every reasonable effort will be undertaken to complete a coordinated transition to the SUT within 24-48 hours of discharge from the PH. Once connected to the SUT, patients will be encouraged to participate in a full range of wraparound and recovery support services, including counseling, behavioral therapy, and integrated care, along with the MAT. TECBOT-TN.X expects to: 1) increase the number receiving MAT/integrated care services; 2) decrease tobacco use, illicit/non-prescribed drug use, inpatient days, and healthcare utilization costs; and 3) increase the number of DATA-2000 waivered physicians.

Project Name: Terros Health Comprehensive Medication Assisted Treatment (MAT) Program Terros Health, a community-based organization with 49 years of experience providing health services in the greater Phoenix metropolitan area, proposes to increase the number of uninsured and under-insured individuals with opioid use disorder (OUD) residing in Maricopa County who receive medication assisted treatment (MAT), behavioral therapies, and associated recovery services. According to the Arizona Department of Health Services (ADHS), for the 12-month period ending June 14, 2018, there were a total of 5,316 opioid overdoses among Maricopa County residents ? nearly 15 overdoses per day. Statewide, 16% of all opioid overdoses resulted in death, and more than 800 babies were born with possible drug-related withdrawal symptoms. Nearly 60% of opioid overdoses were among males, and individuals between 25 and 34 years of age were most likely to overdose. The project goal is to improve health outcomes among uninsured or under-insured individuals with OUD by enhancing internal and external systems to identify and engage individuals in evidence-based MAT services and recovery supports. In the first project year, we intend to provide MAT services to 75 uninsured or under-insured individuals with OUD. Over the course of the three-year project period, we intend to serve a total of 250 individuals. A key project strategy will be to increase the identification and engagement of individuals with OUD into the evidence-based care and treatment offered through Terros Health. This includes an emphasis on reaching those individuals and populations facing difficulties in accessing care, including Latinos, individuals re-entering the community from the correctional system, and military veterans. To this end, Terros Health intends to expand the number of organizations that refer individuals with OUD to its MAT services, enhance referral from within its own programs (e.g., crisis services, family services and HIV/AIDS programming), and utilize peer outreach for recruitment. Terros Health has been offering comprehensive evidence-based MAT to individuals with OUD since July 2017 and employs 13 providers certified to prescribe Suboxone, Buprenorphine and Naltrexone. Individuals requiring methadone treatment are referred to our partner, Community Medical Services. Our MAT services are accompanied by individual and group therapy to address addiction. A Recovery Specialist assists individuals in accessing services that support the recovery process.

The Center for Great Expectations? Outpatient Program (CGE) in New Brunswick, New Jersey is applying to the Substance Abuse and Mental Health Services Administration (SAMHSA) sponsored Medication Assisted Treatment ? Prescription Drug and Opioid Addiction (MAT-PDOA) project. The purpose of the project is to expand Medication Assisted Treatment (MAT) to 80 persons annually with Opioid Use Disorders (OUD) in New Jersey, resulting in 240 clients being treated throughout the three year project. As a result of this funding, CGE proposes to provide Suboxone, Buprenorphine, and Methadone (through partnership with New Brunswick Counseling Center ? NBCC) to a wide range of adults with OUD including pregnant and breastfeeding women, Hispanics through CGE?s Bilingual program, and those who are legally involved with entities such as Probation, Drug Court, Parole, and the Division of Protection & Permanency (DCP&P). As supported by research, CGE will provide MAT accompanied by evidence-based, trauma-informed group and individual psychosocial services in order to provide a holistic approach to OUD treatment. In addition to the evidence-based, Helping Women/Men Recovery & Beyond Trauma curriculums, CGE will be using the evidence-informed Attachment, Regulation & Competency (ARC) Model to provide treatment. The goals for this project specifically include: Goal 1: Increase the number of CGE client admissions who use opioids and receive MAT from approximately 10 to 80 yearly, a 700% increase. Goal 2: Increase access to MAT for pregnant and/or breastfeeding women. Goal 3: Decrease the use of opioids ? at six-month follow-up, less than 5% of CGE MAT clients will have relapsed to opioid use. Goal 4: Decrease the use of all illicit drugs ? at six-month follow-up, less than 10% of clients will report using any illicit drug. Goal 5: Increase the number of clients earning income from wages at six-month follow-up to 65% of clients. Goal 6: Decrease the instance of trauma symptoms experienced by OUD clients by 50% between intake and successful completion of treatment. While there are many measureable objectives being instituted to allow attainment of these goals, the following are the most essential: Continue to collaborate with the state-funded opioid Overdose Recovery Program (OORP) at RWJBarnabas Hospital to obtain referral of opioid overdose survivors identified by OORP specialists in hospital emergency departments (ED); offer MAT to all clients with an OUD who are having difficulty attaining abstinence or are at high risk for relapse; provide evidence-based, trauma-informed group therapy based on a client?s assessed ASAM level of care; provide weekly individual, trauma-informed therapy by a licensed clinician; increase length of treatment episode based solely on clinical need; include recovery support services provided by existing staff Peer Specialist throughout treatment episode; perform data measurements at admission, discharge, and six-month follow up to measure improvements; provide case management services to connect clients to vocational resources such as The New Jersey Division of Vocational Rehabilitation Services (DVRS), New Jersey Reentry Corporation, and New Jersey One-Stop Career Centers; provide case management and peer support services including resume building, felony-friendly job searching, job applications, and interviewing skills; use a strengths-based perspective through therapeutic relationship in order to assist client in determining their strengths and abilities; conduct trauma screening using the UCLA-PTSD assessment of all clients at intake and discharge by December 2018; fully implement ARC into all IOP groups and individual sessions; implement Helping Women/Men Recovery in Phase II OP groups. The above-mentioned goals and objectives will help position CGE to assist clients with OUDs to attain abstinence through a person-centered, all-encompassing treatment approach led by MAT.

Abstract MISSION-MAT (MMAT) proposes to provide medication-assisted treatment (MAT) and an evidence-based co-occurring mental and substance use disorders (COD) wraparound intervention to assist 180 homeless individuals in Worcester, Massachusetts, a city where homeless individuals with OUD are at higher risk for overdose and have limited access to specialized co-occurring wraparound supports to enhance engagement with MAT. MMAT clinical services will be provided by Community Healthlink (CHL), and in collaboration with the City of Worcester?s Department of Health and Human Services (DHHS) whom coordinate and oversee the City's substance use, mental health, and homeless services. The evidenced-based practices to be used in this model are: MAT and a wraparound service model, Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking (MISSION), which was previously developed to address the behavioral health and housing needs of chronically homeless individuals with a COD. MISSION is delivered by care teams which include case managers, peer support specialists, a nurse and a psychiatrist, and systematically integrates Critical Time Intervention case management, Integrated Mental Health and Substance Abuse Treatment, Peer Support, Vocational Rehabilitation, and Trauma-Informed Care. MISSION has been extensively researched and is listed in the Substance Abuse and Mental Health Service Administration- National Registry for Evidence Based Programs and Practices (SAMHSA-NREPP). In this proposed project, the University of Massachusetts Medical School (UMASS) is the Local Lead Agency and Evaluator and will work closely with Community Healthlink, a Worcester clinical provider and UMASS affiliate who has delivered MISSION in prior SAMHSA grants, along with the City of Worcester?s Department of Health and Human Services, a key city department involved in identifying, tracking, and linking homeless individuals, especially those with OUD, to MAT and needed services. MMAT clinical teams funded through this grant will deliver MISSION services, including rapid assessment, linkage, and engagement with MAT along with 6 months of wraparound support to 180 individuals (Year 1=60, Year 2=60, Year 3=60). MMAT participants will also receive linkages; community-based, state, and federal mainstream benefit programs such as MassHealth (the MA Medicaid program); City of Worcester DHHS services; and Massachusetts Department of Mental Health and Public Health services. All services will enhance MAT access, utilization, and service delivery, and will integrate telehealth strategies as needed. We anticipate the 180 homeless individuals who receive MISSION-MAT services will have: 1.) increased MAT utilization; 2.) fewer days of illicit opioid drug use and prescription opioid misuse and other substance use; and 3.) improvement in mental health from baseline to follow-up. This project has been developed with input from local and state agencies, providers and consumers, the Massachusetts Interagency Council on Housing and Homelessness and is consistent with the Massachusetts? Comprehensive Strategy to End Opioid Abuse.

Seattle Indian Health Board (SIHB) is an urban Indian organization (UHO) proposing to implement MAT-PDOA services at four sites located in Seattle/King County in Washington State. Our goal is to expand access to MAT and comprehensive care to help underserved, high-burdened populations with an emphasis on American Indians/Alaska Natives (AI/ANs) with Opioid Use Disorders (OUD). We will reach 780 new, unduplicated patients with OUD over the course of the 3-year project period, which will increase our total caseload to 1,000 patients receiving MAT. To achieve this goal, SIHB will continue delivering MAT at our Federally Qualified Health Center and expand access to MAT through outreach at Chief Seattle Club, residential care at Thunderbird Treatment Center, and capacity building with Cowlitz Tribal Health. All three disbursement sites to be active by the end of the first quarter of the award period. We plan to dispense MAT to people with OUD using buprenorphine/naloxone (Suboxone) primarily, due to its low risk of diversion and effectiveness in treating OUD. SIHB expects that by the end of each year, 75% of people with OUD receiving MAT will also receive integrated care and recovery support services. SIHB will incorporate Indigenous Traditional Knowledge into our MAT expansion approach by giving patients the opportunity to explore Traditional Indian Medicine such as talking circles, drumming, and sweat lodge, proven strategies for promoting wellness and recovery. By the end of each program year, SIHB expects 80% of patients on average to be retained in MAT at 6-months post-intake, as demonstrated by a completed GPRA questionnaire. We have extensive staffing support and partnership capacity to achieve this objective and we are proposing robust aftercare services to increase patient retention and enhance their treatment outcomes.

The Brockton Office-based Addiction Treatment (BOBAT) Program will expand Medication for Addiction Treatment (MAT) in one of the most underserved and economically disadvantaged regions in Massachusetts, the Brockton geographic catchment area (GCA). Comprising Brockton and 12 surrounding towns, this region has an estimated prevalence of 11,938 individuals with OUD. Although 6.5% of opioid-related deaths in the state occur the GCA, only 2.7% of the waivered providers in the state (38 of 1,410) practice in the region, leaving this population with inadequate access to buprenorphine, as well as naltrexone. The BOBAT Program is an initiative of the Signature Healthcare Brockton Hospital (BH) and its affiliate, Signature Medical Group (SMG). SMG offers one of the few buprenorphine programs in the GCA. Located at SMG?s primary care practice on Liberty Street, in close proximity to the hospital, the program has 100 treatment slots. It operates at full capacity, turning away as many as four to five individuals a week. With SAMHSA funding, we will double our capacity to provide MAT with buprenorphine in three primary care sites, including our Outpatient Department (OPD) on the BH campus, our Liberty Street group practice, and our Raynham group practice 15 miles to the south of Brockton. To this end, we will implement the Nurse Care Manager (NCM) Model of Office-based Addiction Treatment (OBAT), or the ?Massachusetts Model.? Developed by our project partner, Boston Medical Center, the model uses trained nurse care managers to oversee MAT for patients with an opioid use disorder overseeing the induction through long-term maintenance in collaboration with the patient?s waivered primary care provider. It has been shown to expand capacity and reduce the burden on waivered providers. The model has a high rate of retention (65% at one year) and has been shown to reduce utilization of emergency services by 46% and inpatient admissions by 61%. It generates net revenue of up to $250 PMPM. As part of this grant-funded program, we will establish an interdisciplinary team (1.0 FTE Nurse Care Managers, 1.0 Licensed Mental Health Clinician, 1.0 Medical Assistant and 1.0 Peer Recovery Coach). Induction and stabilization will take place in OPD, as well as a multi-disciplinary assessment and development of a care plan. MAT maintenance will take place in the patient?s medical home, with support from the BOBAT Team. The use of this adapted NCM model will increase our MAT capacity while ensuring the coordination of mental health, MAT and primary care services. Peer recovery coaching will be instrumental in helping retain patients and in re-engaging those who relapse. The program will increase our OBAT caseload by 100 patients by the end of Year 1, bringing the total caseload to 200. The process evaluation assess project implementation in relation to timelines and enrollment targets. The outcome evaluation will examine a pre/post patient scores on selected GPRA measures and the BOBAT?s return on investment.

Siyan Clinical Research (SCR), a nonprofit clinic headquartered in Santa Rosa, CA, will expand Medications Assisted Treatment (MAT) to target crisis rates of opioid use disorders (OUD) among residents ages 18+ in rural areas of Northern California ? specifically, in the opioid hot spot of Lake County, as well as Mendocino, Sonoma, and Marin Counties. Lake County is a particularly disadvantaged rural community where one in four people lives in poverty and 25% of residents are disabled (vs. 10.6% statewide). SCR is a division of Siyan Clinical Corporation, one of the largest psychiatric practices in Northern California. We deliver outpatient behavioral healthcare in an atmosphere of respect and compassion, with belief in the innate value of every individual. MAT programs are urgently needed to address the opioid epidemic in rural Northern California where opioid death rates are in shocking excess of the state average of only 11 deaths per 100,000. Lake County has been the hardest hit area here ? the local opioid death rate was 36.6 persons per 100,000 population last year (double the number in 2014). This ranks Lake County as #5 in the U.S. in the number of opioid deaths. That exceeds opioid deaths in three of the most troubled eastern states ? New Hampshire (36.3), Ohio (33.6), and Washington, D.C. (30.6), and it is nearing West Virginia (45.2) which has America's highest opioid death rate. Of all drug deaths here, 91% involved opioids. Lake County has also been identified by the CDC as one of 220 U.S. counties at risk for outbreaks of HIV and/or hepatitis C as a result of the opioid epidemic. The need for MAT programs here extends to Mendocino County, which has two deaths from unintentional opioid overdoses each month, and Sonoma County, where a resident dies of an opioid overdose every eight days. Our service region has a critical lack of publicly-funded opioid treatment facilities. To address the epidemic here, it's imperative that we increase the number of individuals with OUD receiving MAT and decrease illicit opioid drug use and prescription opioid misuse. In the state of California, even if all our waivered physicians prescribed MAT up to their limit, 100,000 Californians would still be without access. In our catchment area, the problem is an emergency. This region has 917,436 residents (Lake, Sonoma, Mendocino, and Marin Counties), and we have only one Hub and Spoke system (California?s new MAT Expansion Project) in Marin County and one in the city of Santa Rosa (Sonoma County). Dr. Anish Shah, M.D. (Chief Executive Officer of Siyan Clinical Research), will expand the SCR clinic's MAT program serving rural, underserved Northern California communities. This project will treat 300 adults with OUD from 9/29/2018 to 9/30/2021; an average of 100 annually. The program will use Suboxone (buprenorphine/naloxone daily tablet), Vivitrol (naloxone monthly injection), or naltrexone daily oral tablets to help patients manage opioid cravings and control opioid withdrawal. MAT will be delivered in conjunction with comprehensive, evidence-based psychosocial and recovery support services. These interventions will include: Motivational Interviewing/Motivational Enhancements (supported by use of the Stages of Change model; Cognitive Behavioral Therapy (individual and group; trauma-informed and gender-specific care; with Intensive Case Management, 12 Step Facilitation Therapy; and Relapse Prevention Therapy. All services will be guided by the current literature, including SAMHSA's Treatment Improvement Protocol 63: Medications for Opioid Use Disorder, as well as California state regulations for Office-Based Opioid Treatment (OBOT).

Support Wellness is an innovative program at the South End Community Health Center that provides patients suffering from OUD with medication assisted treatment in an integrated primary care setting that the program also includes extensive mental health treatment and case management co-located with medical services. Support Wellness was initiated in October 2016 as a HRSA funded harm reduction program and has expanded its services to provide STI screening, including HCV and HIV, as well as treatment, for all patients receiving primary care and OUD treatment. With an understanding of the high prevalence of chronic health problems impacting individuals suffering from OUD and mental illness, Support Wellness ensures that patients receive comprehensive treatment for all chronic conditions including COPD, asthma, diabetes, heart disease, and chronic pain. The program was designed as a nursing-led multidisciplinary model offering individualized community-based care to a growing number of patients (now 170) living with SUD. The program and its patients are located in a dense urban area where homelessness, drug use and drug dealing are extensive. Within the first year of its inception, the program grew to capacity with respect to the size of its staff and the number of patients. Currently the staff includes two registered nurses, a nurse practitioner, a medical director who is a board certified physician in both Internal Medicine and Psychiatry and Neurology, a psychologist, a licensed social worker, a navigator/case manager, and a program coordinator. A physician with HCV and OUD expertise has recently joined the team and is dedicating 12 hours a week to provide comprehensive primary care to our patients exclusively. The location of the program, as well as its excellent reputation and open capacity has resulted in a high number of referrals. Support Wellness grows by an average of three new patients a week. The program is designed to have the flexibility to see patients for same day appointments and to see existing patients in the same week should they miss their scheduled appointments. As a result of open access and same day treatment, as well as the program?s popularity, the team nurses are seeing a large number of patients daily and are in need of support from additional nursing staff to be available to continue to deliver high level and flexible care. SAMHSA funding would support the department?s rapid growth and expansion of care to successfully meet the urgent needs of patients with OUD and thus prevent the number of overdoses in this community. As part of its ongoing expansion and innovation, the Support Wellness team visits the Suffolk County House of Correction on a weekly basis to provide education directly to female and male inmates regarding health issues, including primary care, HCV and HIV treatment, medication assisted treatment, and overdose prevention, The team also provides pre-release treatment planning to ensure that incarcerated individuals are connected directly to medical services upon release. Support Wellness proudly offers its services to everyone regardless of race, sexual orientation, gender identity, or socio economic status and cultivates a safe space for all of those enrolled in the program.

In order to respond to the opioid epidemic currently affecting central Ohio, Southeast, Inc. will deliver expanded medication assisted treatment (MAT) services to individuals living with opioid use disorder (OUD) in Franklin County, focusing on zip codes in Columbus with the highest rates of opioid overdose deaths. The project will serve 200 patients during the first year, and 600 patients over the three-year project period. Southeast will focus on serving the homeless and low-income populations who often lack access to MAT and healthcare services. With a goal of decreasing illicit opioid drug use and prescription opioid misuse at six-month follow-up among program participants, the program outcomes will be: 1) At the 6-month follow-up interview, 40% of program participants will report a decrease in illicit opioid drug use and/or prescription opioid misuse; 2) at the 6-month follow-up period, urine drug screenings will demonstrate decreased use of opioids among 40% of program participants who are still actively participating in the program; 3) at the 6-month follow-up interview, 7% of program participants will report abstinence from all illicit drug use; 4) At the 6-month follow-up period, urine drug screenings will demonstrate 7% of program participants who are still actively participating in the program are abstaining from all illicit drug use. Southeast will employ a person-centered approach to link program participants to several in-house services which are expected to facilitate the achievement of individual goals and overall program effectiveness. Additional program performance measures will be tracked related to number of patients linked to housing services, vocational services, primary healthcare, and alternative pain management services, among others. Performance targets will be set for these measures after baseline data are collected during year 1 of the project. The MAT program combines pharmacological medications Buprenorphine (Suboxone or Subutex) or Naltrexone (Vivitrol) with counseling and behavioral therapies to provide a ?whole patient? approach to the treatment of substance use disorders. The program will be structured as an intensive outpatient program (IOP), with patients moving to less intensive levels of treatment as they progress though the program. Southeast will use the American Society of Addiction Medicine (ASAM) criteria to establish the level of care appropriate to meet the needs of the patient. For each participant, Southeast will conduct a clinical assessment to verify that the individual meets the diagnostic criteria for OUD relative to MAT. Southeast will hire staff with dual capacity to treat individuals who are dually diagnosed with mental health and substance use disorders.

With a drug use death rate of 52.0 per 100,000 and $8.8 billion or 12% of the state GDP spent on the opioid crisis annually (both highest in the US), West Virginia has been hard hit by the opioid epidemic. Transportation is a consistent barrier to treatment access for rural WV. Southern Highlands Community Mental Health Center along with FMRS Health Systems & Seneca Health Services will combine telemedicine, free transportation, & MAT to make an exponential impact. MAT Access for Rural Appalachians (MARA) focuses on adults ages 18+ with an opioid use disorder (OUD) who are seeking or receiving MAT. A continuum of existing services is available for family members & children. The geographic service delivery area is the heart of the state's opioid epidemic in southern WV (11 of WV's 55 counties) Wyoming, Mercer, Monroe, McDowell, Fayette, Raleigh, Summers, Nicholas, Greenbrier, Pocahontas & Webster) that comprise WV DHHR Region 6). The goal of MARA is to reduce opioid drug use & prescription opioid misuse by improving access to a culturally competent, sustainable system of Opioid Use Disorder (OUD) treatment for rural Appalachians with OUD utilizing MAT. Ten measurable objectives accompanied by subsequent activities focus on eliminating barriers to treatment access/improving service retention, increasing treatment capacity, decreasing stigma associated with MAT, identifying and engaging those needing services, mitigating MAT diversion risks, improving overall client physical and mental health advancing treatment retention, decreasing illicit opioid drug use and prescription opioid misuse, connecting family members to needed services and sustaining services post grant funding. MARA will serve 225 in Year 1; 425 in Y2 & 550 in Y3 for a total of 1,200 unduplicated clients over the project period. Considering evaluation costs, a total of $1,260,000 is available for direct client services or a cost of $1,116 per client served. Just two days in detox (@ $575/day), exceeds the per client cost of MARA. A unique feature of this initiative is the partnership between the three licensed, comprehensive, community based behavioral health centers. Thru combined efforts, telemedicine will be available throughout the 11-county catchment area, providing clients with access to services 5 days per week, regardless of the catchment county of residence. To further mitigate the transportation barriers experienced by rural clients, six vehicles (2/agency) will be purchased to transport clients to MAT services. West Virginia culture is characterized by strong family ties and the opioid epidemic runs deep within WV families. Therefore, a continuum of care will be provided to engage and link families with treatment and support services. Care coordination and peer support assure assistance in hometown communities and bolster treatment engagement.