Mountain Comprehensive Care Center (MCCC) will conduct the Big Sandy MAT Program to expand and enhance access to medication-assisted treatment (MAT) services for persons with an opioid use disorder (OUD) seeking or receiving MAT in Floyd, Johnson, Magoffin, Martin and Pike counties (Big Sandy region) as situated in eastern Kentucky and the Central Appalachian region. MAT will be supported by psychosocial services, integrated primary care, and wraparound services to support access to and retention in recovery. Population: MCCC will serve persons with an opioid use disorder (OUD) seeking or receiving MAT in the Big Sandy region of eastern KY, a region of significant economic and behavioral health care disparities including among the highest regions in the state and country for opioid overdoses, risks, and hospitalizations. It is anticipated that all clients will be 18 years of age or older. Within the targeted population, it is anticipated that some clients may also have co-occurring mental health disorders and co-morbid medical conditions. Interventions: In addition to MAT, the project will utilize the following evidence-based practices as part of adjunct psychosocial services: Comprehensive Opioid Response with Twelve Steps (COR-12), Cognitive Behavioral Therapy (CBT), Seeking Safety, a trauma-informed CBT, as well as use of Motivational Interviewing and trauma-informed care. These EBPs have been shown to be effective for the targeted population, including adult rural individuals with OUD. The project will also integrate case management/care coordination and peer support services to ensure a holistic treatment and services approach while offering 90 days of follow-up upon exit. Goals & Objectives: MCCC will serve 60 unduplicated participants in Year 1 moving to 120 annually in Years 2-3 for a total of 300 served over the 3-year period. Goals are to improve the health of the targeted population by expanding access to evidence-based MAT along with comprehensive OUD psychological services; improve stability by enhancing access to these services; and improve effective project implementation and evaluation by conducting continuous quality improvement (CQI). By the end of the 3-year period, program participants of the targeted population will meet the following objectives: 1) 70% will decrease their illicit opioid drug use and prescription opioid misuse; 2) 65% will improve their housing status; 3) 60% will increase their employment status (and/or income); 4) 70% will increase their retention in care; and 5) 70% will increase their social connectedness. Throughout the 3-year grant period, the Project Director will conduct at least quarterly Advisory Board meetings with MCCC and community agencies to coordinate and monitor treatment/systems linkages, and goals, objectives, and outcomes. Morehead State University will conduct the performance assessment which will focus on GPRA measures; implementation; achievement of project goals, objectives, and outcomes; fidelity to treatment models and cultural competence; and CQI.
The criminal justice system is struggling to address the needs and manage individuals with Opioid Use Disorders (OUD). Most U.S. correctional facilities do not continue or initiate Medication Assisted Treatment (MAT). As a consequence, the highest rates of opioid overdose occur after release from incarceration. Incarcerated individuals with an OUD are a captive audience, often highly motivated to voluntarily agree to MAT enrollment as an opportunity for court diversion, or upon discharge from jail. Our proposal aims to increase MAT access and other supportive services to individuals with OUD in the criminal justice system. The comprehensive program will include a full array of treatment, coordinated and integrated care, recovery support services, and prevention activities to increase the treatment rate of individuals with OUD encountering the criminal justice system. The population served includes individuals with OUD who are justice involved with the Maricopa County criminal justice system, constituting a very large concentration of individuals with OUD. Maricopa County is the fourth largest county in the United States and home to Phoenix, AZ as well as the fourth largest jail system in the nation. This project will serve 200 persons with OUD annually and 600 persons throughout the lifetime of the project. We have assembled an exceptional partnership dedicated to improving outcomes for both individuals and systems through the use of MAT services. Relevant stakeholders have exceptionally strong commitment and include: the presiding chief justice, the sheriff, chief probation officer of Maricopa County probation, and the medical director of the correctional health system along with community behavioral health providers. Using the Collective Impact Model, the partnership will work to build funding mechanisms and service delivery models to provide improved treatment and recovery support services that effectively treat individuals with OUD and facilitate long-term recovery. There are six major goals that will be accomplished: 1) Increase capacity to identify individuals with OUD in Maricopa County Jail, the Municipal Court, and community probation to provide MAT education/connection to services; 2) Increase early engagement for detained individuals with OUD by Recovery Support Staff (RSS); 3) Increase the number of detained individuals who leave jail with a warm transfer to a MAT provider for immediate connection to an intensive engagement model; 4) Increase identification of incarcerated Native Americans with OUD to increase MAT education and treatment engagement with a culturally informed service model that incorporates traditional healing practices as well as a full continuum of services; 5) Develop an infrastructure for early release and diversion programs with the City of Phoenix Municipal Court for individuals with OUD; and 6) Within the Sequential Intercept Model, implement a successful collective impact initiative. A number of measurable objectives are identified and will be evaluated through a comprehensive, formative, and summative evaluation.
The Wright Center (TWC) will focus on four populations: individuals involved with the criminal justice system, pregnant women, veterans, and the elderly. Over 1,550 patients and 302 professionals will be served at the end of the three-year project. The project focuses on but is not limited to Lackawanna County (pop. 214,437), which had the worst Total Rank Score in PA’s 2015 MAT Underserved Areas list. TWC’s Opioid Use Disorder Center of Excellence will increase the number of individuals receiving MAT and supported in long-term recovery services and decrease the number of individuals using an illicit drug or misusing a prescription opioid after six months by providing a comprehensive integrated approach to addressing the opioid epidemic that builds upon its established Vermont hub-and-spoke model and infrastructure, which support a coordinated systematic response to the complex issues of opiate and other addictions. Project activities extend throughout the criminal justice system, emergency departments, and first responders. Partners include Lackawanna County (Court of Common Pleas treatment courts, prison, Agency on Aging, Department of Human Services Office of Drug and Alcohol Programs, and Single County Authority), Maternal and Family Health Services, Veterans Affairs, the Veterans Justice Outreach Program, and the Scranton Police Department. Objectives: by the end of the three-year project, 1) MAT and recovery support services will be provided to over 1,200 individuals involved with the criminal justice system using the Vermont hub-and-spoke model to deliver a whole-person intervention including mental and physical healthcare, case management (navigation), self-help, pain management, and referrals for social supports such as housing, job training, and life skills with a smooth, efficient, and reliable means of transferring patients between care modalities; 2) approximately 100+ women and babies will be provided pregnancy recovery care and support services using the Magee Women’s Hospital pregnancy recovery center model; 3) 150+ veterans with an OUD and/or involved with the criminal justice system will have received MAT and supporting services; 4) 90% of staff in Area Agency on Aging will have participated in training and education to better understand, respond to, and prevent OUD in seniors; and 5) 24/7 access to certified recovery specialists for warm handoffs for treatment and resources will be integrated into Scranton Police Department first responder functions and Scranton emergency departments, especially for those revived with NARCAN, linking 300+ individuals to MAT and support services. Continuous quality improvement and formative evaluation is embedded in activities. Data collection and monitoring is compliant with federal, state, local, and human subjects protection in research regulations. Sustainability will be achieved through third-party billing and institutionalizing positions and functions. TWC has a comprehensive risk mitigation plan and treatment regimen in place that is less susceptible to diversion and requests the 5 additional points.
Addiction Treatment Centers of New England MAT Expansion for Persons with Co-Occurring Mental Health Disorders and SUDs Addiction Treatment Centers of New England (ATCNE) will expand capacity to increase its daily census by 150 more persons in the Boston and Greater Boston area. The target population will be persons with Opiate User Disorders (OUDs) and co-occurring mental health disorders and co-occurring substance use disorders. ATCNE will serve this population with Cognitive Behavioral Treatment and Contingency Management evidence-based practices and reduce the waiting lists for MAT in Boston. ATCNE will hire an outreach coordinator and two recovery support specialists to complement a staff of credentialed clinicians. They will meet regularly with area hospitals, other SUD providers, and behavioral health providers to ensure timely access to MAT and the comprehensive clinical model of care that includes CBT and CM as evidence-based practices. ATCNE will complement these staff efforts with a web site that highlights same day access and the comprehensive clinical model of weekly treatment consisting of one individual and two group counseling sessions. ATCNE will target persons with OUDs who have co-occurring mental health disorders such as anxiety, post traumatic stress disorder, and depression. ACTNE’s clinical model is unique in the greater Boston area and meets a need for an underserved population that has a high drop out rate and relapses frequently. The program already uses CBT as an evidence-based approach. ATCNE will hire an outside trainer for design and implementation of the CM for all staff to use with the targeted population. The program will start with CBT upon award and with the CM program beginning on January 1, 2019. ATCNE will expand capacity to serve and expanded census by 40 clients daily by October 1, 2109, by 100 by July 1, 2020, and by 150 by January 1, 2021. With the SAMHSA grant funding ACTNE will enhance existing programming with three licensed clinicians, two recovery support specialists, and an outreach coordinator. The grant funds will also pay for initial and ongoing training for Contingency Management to maintain and update staff competencies in this model. The CM is an evidence-based practice that involves token rewards for attendance, compliance with treatment goals, and abstinence of other substances. The reward system will begin with small rewards of $1 - $5 in gift cards at local coffee shops and supermarkets. Over time the rewards will expand to passes on public transportation that can reach a monthly total of $50-60.
JWCH will provide MAT services to patients including street outreach, monitored drug therapy (buprenorphine and naltrexone), individual counseling, group therapy, and case management services. The target population is individuals in economically disadvantaged regions of Los Angeles (including Downtown LA and East Hollywood) with high populations of homeless individuals. These are among the most heavily impacted regions of Southern California in terms of the number of individuals with opioid use disorder who are homeless or otherwise lack access to substance abuse treatment and medical care. The program has several stages of treatment intensity: Green, Yellow, Orange, and Red. Generally, patients start in Orange, and they remain at the intensity for eight weeks, then Yellow at 16 weeks, and Green for as long as MAT is appropriate. To determine appropriate treatment intensity, clients and SAC/CM have ongoing collaborative discussions, with input from the client’s medical provider and the mental health professional. Program staff will utilize evidence-based and evidence-informed treatment interventions including Motivational Interviewing (MI), Seeking Safety, Intensive Case Management (ICM), and Prize-based contingency management. MI is an evidence-informed intervention that allows clinicians to gauge a client’s current motivation to change their behavior (i.e. addiction), and assists patient’s in overcoming their ambivalence. Whereas, Seeking Safety is a trauma-informed substance misuse intervention that facilitates cognitive, behavioral, and emotional healing through manualized group therapy. In addition, ICM has been shown to augment patient care, particularly among high need patients, by providing patients with a single point of contact to navigate health and social service systems. In this program, Prize-based contingency management will be used to incentivize program and treatment compliance, and will include rewarding clients with a raffle ticket each time they complete specific goals (i.e. pre-set number of group sessions) to potentially win a modest prize like a new backpack or shoes. Prize-based contingency management adds an element of fun which has been shown to keep individuals engaged in care, and increase program completion rates. The proposed project will target Service Planning Area 4 “SPA 4”, including the Los Angeles Metropolitan Area with Downtown Los Angeles and Hollywood. To facilitate the delivery of services, LA County Health Agency has divided LA County into eight service planning areas. SPA 4 is 93 sq. miles and has a population of 1,190,448, with a population density of 12,786 people per square mile, the highest in LA County. JWCH’s population of focus is individuals who are economically disadvantaged including those who are homeless, at-risk of being homeless, or formerly homeless. In our current MAT program, 75% of individuals are homeless, and we will continue to focus on this population, and also provide services to non-homeless low income patients. JWCH Institute is the only community clinic that currently offers MAT, and we are committed to serving individuals regardless of ability to pay. There is a high unmet need for MAT in the SPA 4, and an estimated 6,100 individuals with OUD lack access to treatment. Through this project we will be able to expand our capacity to provide MAT services from 100 to 150 patients per year in total.
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