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The five tribal communities in Maine, Aroostook Band of Micmac; Houlton Band of Maliseet Indians; Passamaquoddy – Pleasant Point; Passamaquoddy – Indian Township; and Penobscot Nation, are known as the Wabanaki, the People of the First Light- located in Maine’s three most rural counties: Penobscot, Washington, and Aroostook Counties. The impacts of generational trauma, oppression, racism, and other societal challenges are clearly visible and felt in tribal communities in Maine. Overall life expectancy for Wabanaki people is approximately 50 years of age, more than 20 years less than their non-Native Maine counterparts. Native American (NA) adults also report higher rates of substance use disorder, drug-related mortality, commercial tobacco use, behavioral health disorders, and many chronic health conditions. For this project, we are proposing a project that will provide continual substance use recovery services to tribal citizens primarily in Maine, as well as throughout them greater New England area. This Wellness Center would be the first of its kind, a collaborative effort between each Tribe in Maine, offering the first treatment and recovery services in Maine for indigenous people.

Northern Arizona Communities Comprehensive Opioid Recovery Solutions Interagency Project and Treatment Center Network

Centerstones Comprehensive Opioid Recovery Center (C-CORC)

McDermott Center, dba Haymarket Center, Chicago’s largest community-based substance use disorder (SUD) treatment center, proposes Comprehensive Opioid Recovery Center – Chicagoland project (CORC2) to reduce opioid-related overdoses by expanding outreach and direct treatment services to 350 individuals over four years in opioid “hot spots” in Cook and DuPage Counties, focusing on hospitals, drug courts, and homeless encampments. At least 3/5 of CORC2 participants will be Hispanic/Latinx or black/African American, and 3/5 recently homeless in some form. Participants may also be experiencing co-occurring mental disorders and speak languages other than English. The projects goals include Goal 1: reduce opioid OD deaths by expanding outreach visits to 500 persons. Objectives include outreach to two Cook County hospitals and three DuPage County medical centers. Haymarket will make project staff available 7 days/week to the 5 medical facilities for transportation of patients to Haymarket (“hot handoff”). The project will secure outreach in all Cook County’s six municipal drug courts, and share best practices learned via Haymarket’s website and at workshops. Goal 2: reduce opioid OD deaths by expanding treatment, including using MAT, to 350 participants. Objectives include admitting 350 participants to withdrawal management or residential treatment; providing intensive outpatient treatment to 90% of participants who desire and are appropriate for it and aftercare outpatient treatment to 90% who desire and are appropriate for it; provide medication-assisted treatment (MAT) to 90% of participants who elect it; and providing mental health counseling and/or psychiatric care to 90% of all participants who are assessed as having a MH condition. Goal 3: reduce opioid OD deaths by expanding comprehensive recovery services to 250 participants. Objectives include providing case management and care coordination to 90% of participants in residential treatment; providing linkage to community-based and peer-recovery support services to 90% of participants in residential treatment; ensuring access to family counseling and services to 70% of participants in residential treatment and to 80% of participants in intensive outpatient, as needed; and ensuring 80% of participants in L’s 2.1 and 1 treatment who wanted recovery home housing were connected to on- or off-site recovery homes. Goal 4: reduce opioid OD deaths by disseminating opioid overdose reversal drugs and training to 175 persons. Objectives include distributing naloxone to 175 participants; and training 160 participants in naloxone use. Lighthouse Institute-Chicago will provide process and outcome evaluation, data reporting, and assist with ongoing performance improvement. Lighthouse Institute has one of the best follow-up rates in the country for SAMHSA-funded projects.

The Volunteers of America Southwest Comprehensive Opioid Recovery Center (CORC) project will address the opioid epidemic by offering an all-inclusive array of opioid-specific treatment services to adults suffering from Opioid Use Disorders (OUDs) in San Diego County, California. The program will incorporate residential and outpatient treatment, with withdrawal management, medication-assisted treatment (MAT), wraparound supports, and aftercare and relapse prevention services for participants. Project participants will be men and women who are identified through outreach efforts and community referrals and who are identified through screening and assessments as being good candidates for non-methadone MAT. The project will serve 100 participants each year for 4 years. The project is designed to meet three interrelated goals, each of which is tied to objectives that will allow measurements of success over time. First, the project will expand community-based services to include MAT programming for individuals with SUD and COD who are suffering from opioid addiction. Second, it will reduce opioid use among adults with opioid addiction by providing a phased-treatment approach that incorporates evidence-based treatment services including MAT and psychotherapies. Finally, the project will increase the overall quality of life among participants by providing treatment, wraparound services, and aftercare support they need to enter sustained recovery, develop skills and resources necessary for self-sufficiency, and increase their overall well-being. For this final goal, success will be evaluated by tracking participants' progress in the four main areas: 1) substance use/sobriety, 2) employment/income and housing stability, 3) mental health and social functioning, and 4) criminal behavior. Over the life of the project, project staff will collect, monitor, and analyze data tied to project objectives and requirements to ensure consistently high service quality and continuous progress toward goals. As with all VOASW's extensive programming for vulnerable people, this program will be constructed around client-driven, strengths-based, goal-oriented individualized care and treatment for project participants. Experienced staff will use validated tools to complete comprehensive assessments of each participant and gain a thorough understanding of that person's strengths, needs, and challenges. Case managers will collaborate with each person to develop an individualized treatment plan designed to meet his or her own goals for recovery and stable living and will coordinate comprehensive care chosen from a broad array of treatment and supportive services to meet participant goals. Effective evidence-based practices, including MAT, Cognitive Behavior Therapy, Motivational Interviewing, Contingency Management, and Trauma-Informed Care will be used in treatment. Participants will be supported with comprehensive wraparound services including assistance with income, housing, and employment, family social supports, and six months of aftercare and relapse prevention services.

Southwest Behavioral Health Services, SBH is proposing a Comprehensive Opioid Recovery Center, CORC with an Integrated Systems Approach within Mohave County, Arizona. The proposal enhances capacity and service options in the small clinic SBH currently operates, targets those uninsured and underinsured, and reaches out from a Central Treatment Hub, the CORC, across systems and regional locations to integrate and strengthen the County's ability to address worsening problems with its Opioid Epidemic; multiple internal provider locations, local hospitals, local Tribes, Police, Probation, Fire Department, Behavioral Health Providers, and local community groups will participate. A key problem issue in Mohave County is the large Rural Expanse of the region, scattered uncoordinated treatment efforts, and limited access to MAT services. Additional problems exist with economic repression and rising serious risk factors, crime and violence. The region is made up of the cities of Kingman, Bullhead City, Lake Havasu City, and Colorado City as well as 22 unincorporated communities, the Fort Mohave Indian Community, Hualapai Nation, and the Kaibab-Paiute Indian Community. In 2019, the death rate in Mohave County was 29.9 opioid overdose deaths per every 100K people in the County, 10.1 higher than the National Average of 19.8- Today's News-Herald May 13, 2019. Mohave County has been experiencing a long term study rise in mental health and substance abuse problems from 14 per 100K in the year 2000 to 24.7k per 100k in 2019. While general services, resource, access to mental health care, and MAT for Opioid treatment are severely limited, Opioid drugs are rampant. According to the CDC, U.S. County Prescribing Rates, 2017, area residents are being prescribed opiates at an alarming rate of 111.8 prescriptions per every 100 persons in the County. One for every man, woman, and child times 204,691 persons. The Goals of the Project are to expand capacity and services options with a holistic and enhanced comprehensive treatment clinic providing MAT services that address the needs of the whole person, individuals, families, and communities in order to help residents of Mohave County seek relief and recover. Services will include all MAT's currently available combined with best practice treatment options for Co-Occurring, Co-Morbid disorders, including recovery based housing resource, family services, community outreach, and much needed transportation services. Through coordination with many local community services, local health Indian health services and extensive outreach intervention planning, the project will be able to reach and provide services to the target population, better stabilize and follow through with families, and offer a viable community resource from which to fight back the Opioid Epidemic in Mohave County. The expected outcome is that the project will be able to reach and improve the lives of the County's most vulnerable and needy uninsured and underinsured who have not before been able to access care for Opioid Use Disorders. The project will also enhance the County's ability to take back their community, focus more attention on creating healthier happier living for everyone.

Centerstone of Indiana’s Comprehensive Opioid Recovery Center (C-CORC) will ensure operations of a comprehensive center in Southeastern Indiana, providing a full spectrum of treatment and recovery support services to address the catchment area’s opioid epidemic. C-CORC will serve 400 unduplicated adults with opioid use disorder (OUD) and other substance use disorders (SUD), including co-occurring disorders (COD), in 9 predominantly rural counties in southeastern Indiana (Yr 1: 50/yr; Yrs 2-3: 125/yr; Yr 4: 100/yr). C-CORC’s focus population is expected to mirror those of the catchment area counties (Bartholomew, Decatur, Jackson, Jefferson, Jennings, Lawrence, Monroe, Morgan, and Scott), comprising 50% male, 50% female, 89% white, 2% African American, and 4% Hispanic/Latino individuals. The focus population is expected to include pregnant/postpartum women (1.4%) and Veterans (2.7%). The project’s catchment area is among the hardest hit by the opioid crisis. Six of the catchment area counties exceed the state’s average for drug poisoning deaths, 4 counties exceed the state’s average in ED visits for non-fatal opioid overdose, and 2 of the 9 counties (Scott and Jennings) are among the 220 counties at highest risk for an HIV or Hepatitis C outbreak based on the Center for Disease Control’s National Vulnerable Counties list. Approximately 37,712 catchment area individuals have SUD, 4,700 with OUD and 18,457 with COD. An estimated 36,265 individuals in the catchment area need, but did not receive treatment. Opioid users in the catchment area experience Hepatitis C above the state average at 139.9/100,000, with individuals in Scott (242), Jefferson (161.5) and Jennings (152.1) having the highest incident rates. From 200-2014 rates of Neonatal Abstinence Syndrome or neonatal opioid withdrawal syndrome of pregnant women with OUD increased from 1.5/1000 to 8/1000. An estimated 14% of Indiana’s newborns test positive for opioids and 20% for multiple substances. C-CORC will coordinate with other federal and state funding streams/activities in the catchment area to provide a full spectrum of sustainable/comprehensive services for the focus population and strive to eliminate duplication of services and programs. C-CORC’s evidence-based interventions are numerous and include Matrix Model, Motivational Interviewing, Medication Assisted Treatment, Seeking Safety, Helping Men Recover, Living in Balance, and more. C-CORC will accomplish the following goals: 1) Implement/establish a comprehensive project/full spectrum of community-based OUD/SUD/COD treatment and wraparound/recovery support services among the focus population; 2) Develop/enhance a community-based infrastructure/capacity to maintain/sustain a comprehensive continuum of C-CORC care/supports via an individualized, recovery-oriented, participant/family-centered approach; 3) Improve health status and psychosocial outcomes among C-CORC patients; and 4) Develop/disseminate a documented sustainable service model for statewide/national replication/adoption. To support these goals, C-CORC will achieve the following measurable objectives: Decrease substance use by 60%; Decrease mental health symptomatology by 50%; Decrease criminal justice involvement by 50%; Increase social connectedness among 70% of patients; Increase employment skills/readiness by 75%; Assist 100% of patients in need to identify/secure housing; and Achieve 80% patient retention. Key C-CORC strategies include assembling a multidisciplinary/culturally competent treatment team; convening an Advisory Board; expanding/establishing access-to-care linkages with local providers; and conducting a comprehensive evaluation.