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Our team will establish a Indian Country Opioid/Addiction ECHO that will (1) Increase the number of AI/AN patients receiving MAT, by increasing organizational linkages and professional learning opportunities for providers who work in I/T/U clinics and OTPs, (2) Increase the number of DATA 2000-waivered providers who are actively prescribing buprenorphine to AI/AN patients at I/T/U clinics OTPs and (3) Cultivate a learning community that will contribute to guide best practice and policy to decrease illicit opioid drug use and prescription opioid misuse at six-month follow up and reduce the health consequences of opioid use in Indian Country using evidence-based strategies and interventions. The project will expand access to integrated services, reaching critically underserved AI/AN people living across the United States using the strong network of Tribal Health Boards, Tribal Epidemiology Centers and Indian Health Service regional networks, with a specific focus on Tribes in States that have the highest primary treatment admissions for heroin and opioids per capita in AI/AN people. The overarching aim of the Indian Country Opioid ECHO is to prevent opioid use disorder, increase access to treatment and recovery services and overdose reversal capacity (focusing on MAT services for persons with an opioid use disorder), and reduce the health consequences of opioid use disorder in tribal communities using evidence-based interventions. Objectives include, but are not limited to, expanding MAT services to at least 60 clinics and providing DATA-2000 training to at least 75 clinicians, and provide consultation to at least 175 AI/AN patients. The Indian Country Opioid ECHO Project will use three Evidence-Based/Evidence-Informed Practices (EBPs), spread throughout our target states including (1) the Echo model of learning, (2) MAT with methadone for opioid use disorders and (3) MAT with Buprenorphine/Naloxone for opioid use disorders. The Indian Country Opioid ECHO team will include two American Board of Addiction Medicine addiction experts who are also trained in internal medicine, a psychiatrist, a master's level social worker with addiction training, and a peer in recovery. This panel of staff will allow ECHO to promote integrated medical and mental health care in addiction care, a known EBP. The team will also invite guest speakers from the Addiction Technology Transfer Center (ATTC) Network, as well as guest speakers on topics such as trauma-informed care, naloxone, and related policy and practice issues.

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

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

Our team will establish a Indian Country Opioid/Addiction ECHO that will (1) Increase the number of AI/AN patients receiving MAT, by increasing organizational linkages and professional learning opportunities for providers who work in I/T/U clinics and OTPs, (2) Increase the number of DATA 2000-waivered providers who are actively prescribing buprenorphine to AI/AN patients at I/T/U clinics OTPs and (3) Cultivate a learning community that will contribute to guide best practice and policy to decrease illicit opioid drug use and prescription opioid misuse at six-month follow up and reduce the health consequences of opioid use in Indian Country using evidence-based strategies and interventions. The project will expand access to integrated services, reaching critically underserved AI/AN people living across the United States using the strong network of Tribal Health Boards, Tribal Epidemiology Centers and Indian Health Service regional networks, with a specific focus on Tribes in States that have the highest primary treatment admissions for heroin and opioids per capita in AI/AN people. The overarching aim of the Indian Country Opioid ECHO is to prevent opioid use disorder, increase access to treatment and recovery services and overdose reversal capacity (focusing on MAT services for persons with an opioid use disorder), and reduce the health consequences of opioid use disorder in tribal communities using evidence-based interventions. Objectives include, but are not limited to, expanding MAT services to at least 60 clinics and providing DATA-2000 training to at least 75 clinicians, and provide consultation to at least 175 AI/AN patients. The Indian Country Opioid ECHO Project will use three Evidence-Based/Evidence-Informed Practices (EBPs), spread throughout our target states including (1) the Echo model of learning, (2) MAT with methadone for opioid use disorders and (3) MAT with Buprenorphine/Naloxone for opioid use disorders. The Indian Country Opioid ECHO team will include two American Board of Addiction Medicine addiction experts who are also trained in internal medicine, a psychiatrist, a master's level social worker with addiction training, and a peer in recovery. This panel of staff will allow ECHO to promote integrated medical and mental health care in addiction care, a known EBP. The team will also invite guest speakers from the Addiction Technology Transfer Center (ATTC) Network, as well as guest speakers on topics such as trauma-informed care, naloxone, and related policy and practice issues.