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Abstract: The Minnesota Department of Human Services, Alcohol and Drug Abuse Division (Single State Authority) proposes to build on its comprehensive Minnesota State Targeted Response to the Opioid Crisis (MN Opioid STR) through this Minnesota Targeted Capacity Expansion of Medication Assisted Treatment Services to target under-served African-American and American Indian high-need communities not reached through MN Opioid State Targeted Response grants. In 2015, Minnesota ranked first among all states when measuring the age-adjusted disparity rate ratio (DRR) of deaths due to drug poisoning among American Indians/Alaska Natives relative to Whites (out of 16 states for which data are available) and Blacks relative to Whites (out of 38 states for which data are available). In May 2017, Minnesota received SAMHSA’s Opioid State Targeted Response funds and implemented its strategy immediately upon of receipt of funds. SAMHSA’s Opioid State Targeted Response grants enhanced collaborative planning efforts between The Minnesota Department of Human Services Alcohol and Drug Abuse Division, Health Care Administration and Office of Indian Policy along with the Minnesota Department of Health (MDH) and increased the state’s capability to reduce disparities by 1.) Laying a foundation for a statewide ECHO educational system to increase availability OBOT/MAT providers; 2.) Funding key opioid-response statewide coordinating staff and community based resources as part of a comprehensive strategy. 3.) Giving the state greater ability to map remaining geographic and community-based gaps for opioid treatment and recovery services. With this SAMHSA Targeted Capacity Expansion grant, Minnesota plans leverage its Opioid State Targeted Response (Opioid STR) to target high-need, under-resourced communities not served by the Opioid STR sub-grants, specifically two American Indian communities - White Earth Nation and Red Lake Band of Chippewa Indians - and African American Minnesotans in the Twin Cities metro area. These communities, while experiencing the highest need for services, did not have the capacity to apply for the Opioid STR sub-grants. The purpose of this proposal is to fill that critical gap by building the capacity of these targeted high-need communities to provide high-quality services. Minnesota expects to serve 740 American Indian and African American people in the State of Minnesota through the Minnesota Targeted Expansion of Medication Assisted Treatment for Prescription Drug and Opioid Addition. Measurable outcomes include: 1) An increase in the number of admissions for MAT in the targeted communities; 2) An increase in the number of clients receiving integrated care/treatment in the targeted communities; 3) A decrease in illicit opioid drug use at six-month follow-up for clients served; and 4) A decrease in the use of prescription opioids in a non-prescribed manner at six-month follow-up for clients served.

Abstract The Ohio MAT-PDOA Project is an opportunity to further expand access to medication assisted treatment beyond the 27 Alcohol, Drug Addiction and Mental Health (ADAMH) Service Boards covering 47 counties that were specifically targeted by Ohio’s 21st Century Cures Act Opioid STR grant application. The Ohio MAT-PDOA Project will provide resources to nine additional ADAMH Boards encompassing 17 of Ohio’s 88 counties in order to implement locally-determined high priority opioid use disorder treatment and recovery services projects. The Ohio MAT-PDOA Project will take advantage of efforts already underway in Ohio to address the state’s opioid epidemic including Ohio SBIRT and Ohio Opioid STR. MAT-PDOA boards will have access to prevention services and on-line training/workforce development components of Ohio Opioid STR that were designed to be implemented statewide to bring additional prescribers on board. This includes prescriber access to ECHO model support that will be developed as part of the Opioid STR grant. In addition, as with the rest of the state, these boards can access training and technical assistance through the Ohio SBIRT grant to improve screening, referral mechanisms and enhance integrated care. MAT-PDOA funded board projects will focus on treatment and recovery support efforts that will contribute to the desired outcomes of this grant. Projects include: 1. The development of quick/crisis response teams. 2. Using funds to on-board prescribers. 3. Paying for medications where no other source of funding is available. 4. Utilizing recovery supporters to improve treatment access and retention. 5. Expanding treatment services for OUD clients such as ambulatory detox and residential treatment, where that expansion demonstrates greater access to MAT. 6. Partnering with facilities such as a hospital, community health center, FQHCs that enhance integrated care. Evaluation efforts will assess both the process and impact of the MAT-PDOA project, and provide stakeholders with information needed to ensure continuous quality improvement.

The proposed project seeks to improve medication assisted treatment (MAT) access, quality, and outcomes for Pennsylvanians through an integrated, flexible, and sustainable hub and spoke model of care for those with opioid use disorder (OUD). This model will leverage existing substance use engagement and treatment resources in Erie, Blair, and Lycoming-Clinton Counties, Pennsylvania (PA), to create a more robust and integrated continuum of care and resources for 600 individuals with OUD. We propose to embed the integrated hub and spoke model within these communities using three overlapping components to rapidly identify, engage, and retain individuals in evidenced-based MAT treatment: 1) a super hub, 2) three regional hubs (one in each community), and 3) integrated spokes, including primary care physicians, substance abuse providers, mental health centers, emergency departments, peer supports, and the criminal justice system, among others. Western Psychiatric Institute and Clinic (WPIC), an academic teaching center and part of the University of Pittsburgh Medical Center (UPMC), will act as the super hub and provide clinical training and oversight to the three regional hubs and evaluation of program implementation. For each of our selected communities, the Single County Authority (SCA), which is responsible for regional planning and coordination of all substance use treatment, has agreed to serve as the regional hub to manage and expand existing outreach teams, ensure the availability of primary MAT services, and triage individuals to spoke agencies. Multiple spokes will be linked to the regional hub to provide ancillary services or stepped-down MAT, such as primary care and mental health practices in these settings, including one or two existing treatment providers per community who have received “Centers of Excellence”, supplemental financial support from the PA Medicaid program to provide enhanced integrated medical, psychiatric, and substance use treatment for individuals enrolled in Medicaid. The goals of the project are to: 1) increase the number of providers and settings that offer MAT; 2) create an integrated and coordinated continuum of care for individuals with OUD by standardizing MAT assessment and protocols, creating engagement protocols, and increasing the use of peers; 3) increase the quality of MAT services by implementing comprehensive training and quality indicators for providers; and 4) increase the sustainability of MAT services by implementing payment model reform and implementation support. We will enroll a total of 600 individuals with OUD seeking MAT services (190 in Year 1, 270 in Year 2, 140 in Year 3). This project aligns with other existing state initiatives, including PA Coordinated Medication Assisted Treatment (PacMAT), funded by the 21st Century Cures Act. Lessons learned will be used to rapidly embed integrated hub and spoke models in additional communities across PA.

The Alabama Medication Assisted Treatment – Prescription Drug and Opioid Addiction (MAT-PDOA) project proposes to direct grant funds to non-profit substance abuse treatment providers in two counties (Jefferson and Walker) to provide (1) Recovery Support Services, (2) Care Coordination, (3) MAT, and (4) Detoxification Services. In total, approximately 768 individuals will be served over three-year grant period. Project goals include: (1) expanding access to MAT for treatment of opioid use disorder (OUD), (2) increase the number of peer support specialists (PSSs) involved in MAT, (3) improve OUD treatment retention rates, and (4) decrease rates of prescription and illicit opioid drug use and overdose related deaths in Jefferson and Walker Counties. The selected counties have rates of opioid-related overdoses that far exceed the state and national averages (49 per 10,000 in Jefferson County and 52 per 10,000 in Walker County) and rates of OUD-related hospital admissions has increased by 37 percent in Alabama (2011 to 2016), with these counties having some of the highest admissions rates in the State. To reverse this alarming trend, the Alabama Department of Mental Health (ADMH) will use MAT-PDOA grant funds to contract directly with the Fellowship House in Jefferson County, a residential substance abuse treatment provider, that will in turn contract with (1) The Crisis Center (the administrator of the Jefferson County Recovery Resource Center) for intake, assessment and peer support services, (2) Cooper Green Mercy Health Services (the county’s indigent care clinic) for MAT services, and (3) the UAB Addiction Recovery Program for provision of detoxification services. In Walker County, ADMH will contract with Northwest Alabama Mental Health Center (NWAMH), a community mental health center, which will in turn will contract with Capstone Rural Health Center, an FQHC, for provision of MAT services and with Walker Baptist Hospital, a non-profit community hospital, for detoxification services. Operating within the principles of Alabama’s Recovery Oriented System of care, ADMH has selected four evidence-based practices to aid in accomplishment of the treatment outcomes for this grant: (1) MAT; (2) Peer Support Services; (3) Motivational Interviewing; and (4) Shared Decision Making. Through the use of grant funds, PSSs and care coordinators will be hired to identify, recruit and retain individuals with OUD through contact with the jail, emergency department and other referral sources; (2) availability of MAT services (buprenorphine/naloxone, Vivitrol, and oral naltrexone) will be expanded, and (3) detoxification services will be provided with Vivitrol injection at the point of release for individuals choosing this option. The addition of a full-time outreach worker will aid in dissemination of information related to OUD and the negative impact on the user and family, as well as how to access treatment services. An advertising campaign and public service announcements will further support information dissemination.

The New York State Office of Alcoholism and Substance Abuse Services “Centers of Treatment Innovation” (COTI) proposes to create three county-specific Substance Use Disorder (SUD) models of care that will provide comprehensive SUD medication assisted treatment (MAT) services to individuals who either historically have not received SUD treatment services or were not able to access MAT specifically towards reducing the potential for overdose and relapse in these targeted communities. These COTIs will be established in 3 target NYS counties which demonstrate a high need for opioid treatment. They will enhance existing SUD services and build a robust capacity to provide the full range of medication assisted options, evidence-based practices (EBPs), as well as peer support services. The primary target population to be addressed by this project is adult men and women between the ages of 18-65 who have had a reversed opioid overdose as well as individuals currently unable or possibly unwilling to currently seek SUD services. Through a targeted and comprehensive outreach model, individuals will be engaged and supported to enter treatment with the ultimate goal of treatment retention, stabilization and recovery. The COTI project’s intent is to build SUD and community agency competencies, capacity and increase the knowledge, skills and attitudes of the workforces in both settings regarding the effective use of addiction medications, EBPs including an effective family engagement model and peer support services. The COTI workforce will be trained in Motivational Interviewing, CRAFT, and Seeking Safety EBPs. The number of unduplicated individuals to be served in Year One is 1,863 individuals across all 3 counties and 2,664 individuals in Year Two and in Year Three for a total number of 7,191 individuals minimum to be served during the grant. This project will address the opioid epidemic in NYS achieving these goals of the COTI project: (1) Establish three SUD Centers of Treatment Innovation (COTI) to provide individuals with Opioid Use Disorder comprehensive MAT and access to integrated care, (2) Increase MAT admissions to individuals in crisis as well as high risk, high needs populations of focus with opioid use disorder, (3) Provide MAT and integrated care to 7,191 individuals with opioid use disorder over the three-year project, (4) Reduce the barriers that adult individuals suffering from Opioid Use Disorder face in accessing medication assisted treatment in the COTI communities, and (5) Document key elements of program implementation barriers and successes and disseminate throughout the State.

The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) proposes to close the gap in access and delivery of evidence-based, medication-assisted treatment (MAT) services for persons with opioid use disorders (OUDs). Through Targeted Efficacy and Capacity Building in Opioid Treatment-TN (TECBOT-TN), TDMHSAS will provide funding for MAT services to 660 underserved adults (i.e., underinsured or without insurance) with OUD in the Tennessee counties of Davidson, Hardin, Lewis, Shelby, Sullivan, and Washington over a 3-year-period, serving 220 patients each year. TECBOT-TN is TDMHSAS’ initiative to ensure that MAT will be delivered in the right way in our state. Research has shown that it is important to implement the right strategy at the right time and that a variety of strategies must be used to adequately address the state’s opioid use epidemic. TECBOT-TN is a multifaceted MAT approach to treating opioid addiction. It is designed to provide a person-centered, accessible, effective, comprehensive, coordinated/integrated, culturally competent, evidence-based MAT service model that incorporates education (including opioid overdose prevention), psychosocial, medical (including tobacco cessation and screening for infectious diseases), family planning/prenatal care, and recovery supports for adults with moderate to severe OUD. Veterans/military personnel and women of childbearing age will be priority populations. The MAT component of the service, which encompasses counseling and/or behavioral therapy, will be offered through three substance use treatment (SUT) providers and one opioid treatment program (OTP). The Department has collaborated with the Tennessee Department of Health (TDH) and its affiliates to provide the integration of services needed by persons with OUD. Hence, the whole person will be the focus of treatment. There will be cross-system referrals and a plethora of warm hand-offs. Treatment hubs will make referrals to health departments and vice versa, ensuring that each participating adult receives appropriate, recovery-focused, integrated care. The TECBOT-TN model will further provide a wealth of patient education and information. Among the goals of the project will be the enhancement of quality patient care and improved communication and collaboration across systems. TDMHSAS is convinced that the extent of care and support provided through TECBOT-TN will help individuals, families, and communities become stronger and more successful in their recovery. The anticipated benefits of this project with respect to the knowledge obtained will be significant. The evaluation design will fully document implementation of TECBOT-TN and its efficacy related to clinical outcomes, treatment process, and societal costs. TDMHSAS expects that TECBOT-TN will result in patients achieving the desired outcomes of this grant at 6-month follow-up: 1) increased numbers receiving MAT, 2) increased numbers receiving integrated care, and 3) decreased tobacco use, illicit drug use, and non-prescribed use of prescription drugs.