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Healing Hands Ministries was founded to provide compassionate, accessible, quality medical care to the Dallas community. As a nurse, Founder Janna Gardner understood the critical difference that quality medical care can make in someone’s life. Healing Hands is a patient-focused community health center capable of caring for a patient from birth to the end of their life. Healing Hands Ministries focuses on empowering the community by improving access and delivery of healthcare, providing education to help maintain improved lifestyles and inspires others to take responsibility for their own health. Today, Healing Hands Ministries has rebranded to HHM Health, beginning an exciting new chapter of expansion. As an FQHC, HHM Health offers family practice, women’s health, pediatrics, dental, vision and behavioral health services to patients regardless of ability to pay. HHM Health is dedicated to delivering cost-effective, high-quality medical services to residents of Dallas County, Texas, guided by their mission of providing healthcare to all with love, compassion, and respect. HHM Health is applying for SAMHSA Overdose Treatment funding to expand access to naloxone and other FDA approved overdose reversal medications through the establishment of evidence-based training of trainers (ToT) programming that focus on policies, procedures and models of care for prescribing, co-prescribing and expanding access to medications. The need for this project stems from an increase in reported mental health conditions among the target population and an increase in substance use related mortality due to the impacts of the pandemic, poor access to behavioral health care and general impacts of society on mental health. HHM Health will conduct the following project activities (more detail behind each activity is included in the project narrative): - HHM Health will implement a scalable training of trainers (ToT) program, conducted via a hybrid model, that will promote the training of additional providers and population types throughout the Dallas community - HHM Health will secure community partners who will be engaged in sending their team members to the HHM ToT initial training and will provide this training in their respective market(s) - HHM Health will coordinate with the Project Lead Trainer and clinical staff to identify evidence-based practices for prescribing a drug for emergency treatment - HHM Health will coordinate with the Project Lead Trainer and clinical staff to establish and identify an implementation plan for connecting patients with treatment who have experienced an overdose - HHM Health will gather feedback from community partners and clinical team members to establish a sustainability program that will carry the ToT program beyond grant funding - HHM Health will utilize the first 6 months of funding to establish an evidence-based ToT framework that will be adjusted through quality improvement practices Through SAMHSA funding, HHM Health will coordinate training of trainer programming that will expand access to Naloxone and additional FDA approved overdose reversal medications to special populations throughout the Dallas community. This program will also help HHM Health lead the charge in identifying a safety net of providers who are committed to this ongoing work and aligning efforts to reduce opioid overdoses throughout the community. Through programming, HHM Health will look to engage the following number of trained individuals. Number of Unduplicated Individuals to be Trained with Award Funds: Year 1: 50, Year 2: 100, Year 3: 150, Year 4: 200, Year 5: 250, Total 750.

Odyssey House Louisiana, Inc. (OHL) proposes a comprehensive opioid overdose access treatment training program, including a training of trainers (ToT) program, at three hubs across Louisiana: urban centers of Orleans Parish, and Calcasieu Parish, and rural St. Mary Parish. OHL project staff will directly train 475 healthcare and social services providers during the five-year grant period. Included in this population of focus, OHL will provide ToT training to 20 organizations, who will in turn commit to provide the learned education to peers and colleagues in their regions. This program will include training for a wide array of health care providers, including pharmacists, prescribers, licensed clinical social workers, medical assistants, and licensed clinical professional counselors, as well as employees at organizations serving marginalized groups or vulnerable populations. OHL will leverage its local community connections in these three locations, as well as additional statewide networks to expand the project’s reach and train as many professionals as possible. Project staff will include a Lead Trainer and one additional Trainer to conduct sessions virtually and in-person. The Lead Trainer will work with the Project Director and Project Coordinator, both currently employed at OHL, to develop an engaging, evidence-based curriculum. Presentations will include facts about opioid use disorders (OUD), overdoses, FDA-approved overdose reversal medications (e.g., naloxone), and the opioid epidemic through the framework of cultural humility. Using the most recent available data on the opioid crisis in Louisiana and most current best practices, program staff will convey the importance of understanding the science behind these topics. The Lead Trainer and Trainer will also be onboarded into OHL’s progressive messaging around inclusive, destigmatizing language and other anti-bias measures, ensuring that trainees will be empowered to conduct essential internal and external anti-bias work at their jobs. All sessions will also include visual aids (e.g., PowerPoint presentations) and interactive segments such as digital or printed worksheets to encourage participation and retention of the lessons. OHL will also purchase naloxone to distribute to trainee organizations as needed. OHL will provide linkages to treatment for people with opioid use disorders or who have experienced an opioid overdose. The agency is the largest substance use disorder treatment facility in Louisiana and has measures in place to provide comprehensive, compassionate OUD treatment to state residents, whether on-site or through local partners. These services are vital to the health and wellbeing of OHL’s communities and include medication assisted treatment and medication for opioid use disorders, counseling, individualized case management, primary and other physical healthcare, and residential treatment. OHL’s Overdose Treatment Access program will expand opioid-related education for healthcare and social services providers in Louisiana and across the country. Through a structured curriculum informed by industry best practices and cultural humility, this program will help providers understand and empathize with their patients while learning life-saving essentials about opioid use and overdoses.

The NeuroMusculoskeletal Institute at Rowan University School of Osteopathic Medicine, the West Virginia School of Osteopathic Medicine, and the Philadelphia College of Osteopathic Medicine will train medical students to train 35 physicians in 7 healthcare settings in communities with high overdose rates in New Jersey, West Virginia, and Philadelphia who will train 1,250 additional healthcare providers who will then train 400 patients on naloxone. The geographic catchment area will be 5 counties with the highest overdose rates in New Jersey, Pennsylvania, and West Virginia. In New Jersey, the project will focus on training healthcare providers in the City of Camden, located in Camden County, which had the second-highest number of fatal overdoses in 2022. The project will also target healthcare providers in the Kensington and Allegheny section of Philadelphia, Pennsylvania, the largest open-air drug market on the East Coast. Three counties in West Virginia, which had the highest confirmed overdose death rate in the nation (81.4 per 100,000) in 2020, will also be targeted, including rural Cabell, Wayne, and Lincoln counties located in the southwest region of the state. In 2021, Cabell County had an overdose mortality rate of 130.60 per 100,000 residents, over four times the US rate of 32.4. The population of focus will be osteopathic medical students, physicians, and pharmacists working in seven healthcare settings in these high overdose areas. The goals are 1) Expand access to overdose treatment by implementing a train-the-trainer model with prescribers of naloxone in high overdose communities in New Jersey, Pennsylvania, and West Virginia to build competency in co-prescribing naloxone to persons taking opiates. 2) Decrease overdose in communities in the five-county region by co-prescribing naloxone and training patients on how to train a peer on how to administer naloxone. 3) Continually expand access to overdose treatment through sustainability planning, adding additional healthcare systems to the project, and creating resources for national replication. Rowan University School of Osteopathic Medicine, which operates the Southern New Jersey MAT Center of Excellence, will partner with the West Virginia School of Osteopathic Medicine and the Philadelphia College of Osteopathic Medicine to form a Northeast Collaborative to Improve Access to Overdose Treatment. The collaborative will train healthcare professionals in the five counties of New Jersey, West Virginia, and Pennsylvania with the highest overdose rates in the nation. The project will use a train-the-trainer approach and a diverse group of osteopathic medical students in each of the three schools to form an Osteopathic Taskforce for the Treatment of Overdose called Project OTTO. Students will identify 35 physician champions in health care settings where they rotate in the five-county area during their clinical years and train them on a naloxone training curriculum called M5PM. The students will then ask the physician champions to train 1,250 additional physicians and pharmacists. Those physicians will, in turn, train 400 patients taking opiates and co-prescribed naloxone using M5PM. The evaluation will be performed by staff in the Office of the Dean for Research at Rowan SOM.

The University of Iowa Addiction and Recovery Collaborative (UI ARC) at the University of Iowa Hospitals and Clinics will implement the Iowa Naloxone Expansion and Training (IA-NEXT) Project to expand access to naloxone for emergency treatment of known or suspected opioid overdose. The project will implement a training of trainers (ToT) program for 100 students in the University of Iowa College of Pharmacy. The students will then educate pharmacists, nurses, other healthcare professionals, and school staff throughout the State of Iowa about opioid overdose, overdose reversal, and naloxone to improve outcomes for individuals in Iowa at risk of fatal overdose. The IA-NEXT Project will serve both rural and urban counties: of the 99 counties in the State of Iowa, 12 counties are identified as urban counties and 87 are rural counties according to the Federal Office of Rural Health Policy. In 2023 in Iowa, there are 2,955 practicing pharmacists and 389 pharmacy students enrolled at the University of Iowa College of Pharmacy. There are 50,629 Registered Nurses with active Iowa licenses. For the 2023 school year, there are 1,304 public schools, serving 498,629 students and 237 private schools serving 45,817 students in Iowa. Goals and objectives of the IA-NEXT Project include 1) Increase the number of Iowa Pharmacists who are trained to provide education about opioid overdose and overdose reversal with naloxone. The project will develop a Train the Trainer curriculum for student pharmacists, who will then provide educational sessions covering opioid overdose, overdose reversal, and naloxone. The sessions will occur in community-based sessions, targeted to pharmacists, school nurses, and other interested healthcare providers and stakeholders. Student pharmacists will also provide ToT training to 15 pharmacists practicing in rural areas who can then provide trainings to community stakeholders. 2) Increase access to naloxone, along with education about opioid overdose and the use of naloxone in overdose reversal, in Iowa schools. The IA-NEXT Project will expand the Naloxone in Schools protocol (a volunteer project increasing education and training for school nurses and staff across the State of Iowa and increasing access to naloxone in schools). The student pharmacists will provide training to 150 school nurses and training to staff in 120 public or private schools in rural and urban counties. The student pharmacists will also provide ToT training to 20 school nurses, who will then go on to deliver training in schools, including schools in rural Iowa counties.

UI Health Mile Square Health Centers will increase access to overdose reversal medication to reduce opioid related morbidity and mortality, including overdose deaths, through the expansion of comprehensive training and recovery services. To address critical overdose service gaps in the community, Community Overdose Treatment Access (COTA) will increase access through our comprehensive community training of trainers (TOT). MSHC will expand opioid overdose treatment services to those in the most impacted communities through in-person and virtual trainings on overdose treatment and harm reduction, expansion of buprenorphine and naltrexone prescriptions and recovery support services. MSHC will expand this COTA training to all eight primary care clinics and five school-based clinics communities. MSHC is one of the only FQHCs in the United States and the only FQHC in Illinois that has partnered with a community OTP to create a collaborative, integrated model of primary care, addiction, and behavioral health services within the FQHC clinical setting. SAMHSA funding will support a comprehensive TOT that will 1) increase access to overdose treatment to reduce illicit opioid use and deaths; 2) expand overdose prevention and harm reduction services to clinicians to reduce death and disease; 3) expand overdose prevention and harm reduction services to the community with the COTA training of the trainers; and 4) increase access to recovery support services.

CLARE MATRIX (C M) is proposing the Overdose Treatment Access for Pregnant and Postpartum People (ODTx-PPP) project to focus on serving California's South and Central Los Angeles area. The geographical catchment area is part of Los Angeles (LA) County Service Planning Area 6 (SPA 6) and is comprised of 8 urban communities. The goal of the project is to expand access of naloxone to pregnant and postpartum people (PPP) residing in the south and central LA area, by 1) expanding SPA 6's prenatal and birthing care practitioners and providers, pharmacists, and social service providers, awareness and knowledge of overdose prevention, reversal, and Naloxone prescribing, 2) providing them with support and resources that will facilitate them to develop training and feedback peer networks, and 3) improving their attitude towards prescribing Naloxone to PPP by reducing stigma and provider bias against PPP using substances, and destigmatizing Naloxone prescription to nurture a landscape of more equitable access to OUD harm reduction and treatment for PPP. Through this project, C M will use its expertise in opioid use disorder treatment, overdose prevention and response, and its outreach and training infrastructure to establish a Training of Trainers (ToT) model. C M has secured the commitment of one partner, thus far, UCLA ISAP, to provide consultation for curriculum and training development and to participate in the Community Engaged Advisory Board. C M will train 200 prenatal and birthing care practitioners and providers, pharmacists, and social service providers over the five-year period of this grant. To successfully implement this project, C M will use 1.30 FTE from existing staff, who will seamlessly integrate project priorities into daily operations. The staffing plan includes a Project Director and Lead Trainer as key personnel and an Evaluator as support with data and tracking.

The misuse of opioid medications has been a significant public health concern in many states including Arkansas (AR). Per the Arkansas Department of Health, AR has experienced a 50% increase in deaths from opioid overdose from the years 2018 to 2021. Arkansans urgently need access to lifesaving medications to prevent death from opioid overdose. Naloxone is a lifesaving medication that can reverse symptoms of respiratory depression during an opioid overdose to help prevent death. The proposed project will create the UAMS Arkansas Naloxone Education (ANET) program, which is a train-the-trainers program to provide naloxone education training to AR healthcare providers. Trainer education will include information on the administration of naloxone, patient counseling for naloxone use, additional harm reduction resources, and available options for local treatment for those struggling with misuse of opioids. After completing training, trainers will then deliver naloxone education to their respective communities using information and resources provided by the UAMS ANET program. The trainers will target AR populations likely to benefit from increased knowledge and access to naloxone including individuals who are at high risk of opioid overdose, such as people who struggle with misuse of opioids, and those who may be more vulnerable to accidental opioid poisonings, such as adolescents and older adults taking opioids acutely or chronically. In addition to the primary target populations, this project will work with Arkansans acquainted with someone at high risk for opioid overdose. This includes friends or family members of those who may be struggling with misuse of opioids, or who have a medical reason to use opioids chronically. The single overarching goal of this project is to increase access to naloxone including knowledge of how to administer this life-saving medication for emergency treatment of known or suspected opioid overdose to prevent death. During each year of funding, the UAMS ANET Program will aim to train 25 new naloxone education trainers. With the recruitment of 25 new trainers per year across the five-year project period, a total of 125 trainers will be trained through this project. Each naloxone trainer will be expected to deliver two community-based naloxone education classes per year, utilizing a 60-minute training module that will be prepared by the UAMS ANET Program team. Trainers will receive class materials and naloxone kits to deliver to class participants, and gift card incentive from the UAMS ANET Program. Trainers will be encouraged to train at least 10 or more individuals during each class, resulting in a total of 7,500 Arkansans receiving naloxone education across the five-year project period. During these community-based naloxone education classes, information will be shared about local centers and healthcare providers that manage treatment for people diagnosed with opioid use disorder. Multiple healthcare organizations in AR have committed to help with the implementation of the UAMS ANET Program. Collaborations have committed to providing additional naloxone kits and resources for community-based classes, recruiting trainers for the program, and developing helpful resources to be included in the training curriculum. We strongly believe that the UAMS ANET Program will help decrease opioid overdose deaths and improve patient outcomes in AR.

Tarzana Treatment Centers, Inc. (TTC) will expand access to opioid overdose (OO) education and naloxone distribution (OEND) in Los Angeles County (LAC) through the development and implementation of two scalable training of trainers (ToT) programs: 1) OEND Best Practices for FQHCs, Community Clinics and Pharmacies ToT Program (OENDCCP); and 2) OEND Best Practices for College Campuses ToT Program (OEND CC). The OENDCCP will recruit healthcare "Champions" or providers (doctors, physician assistants, nurse-practitioners, nurses, medical assistants, community health workers, etc.) and pharmacists for a half-day, in-person training on innovative practices, policies, procedures, and models of care for prescribing/co-prescribing and otherwise expanding access to naloxone in communities with high rates of OO deaths. Particular focus will be placed on culturally informed approaches that address social stigma, medical mistrust, and other barriers to naloxone access in the predominantly racial/ethnic minority populations served by the trainees. OEND "Champions" will then return to their site to train other staff and build site-specific capacity to provide effective OEND services that are culturally responsive to the population served. At least two (2) trainings will be held each year (1 during Year One) with 30-40 providers each for a minimum of 270 OEND Champions trained during the 5-year project. The OEND CC will recruit "College Ambassadors" or student leaders and campus health center personnel from local community colleges and universities throughout LAC for a half-day, in-person training on innovative practices, policies, procedures, and models of engagement for increasing access to OEND on college campuses. Focus will be placed on culturally informed approaches for Hispanic-Serving Institutions (HSIs) where the same cultural barriers to naloxone access may prevail as in predominantly Latinx communities. At least two (2) trainings will be held each year (1 during Year One) with approximately 25 trainees each for a total of 225 OEND College Ambassadors or trainers trained during the 5-year project. Between the two ToT Programs, a total of 495 unduplicated individuals will be trained as trainers with award funds. Each OEND Champion or trainer completing the ToT Program will commit to training a minimum of 5 providers at their site for a total of 150-200 individuals trained in Year 1 and 300-400 trained annually in Years 2-5 for a total of 1,350-1,800 individuals trained in OEND best practices for FQHCs, community clinics, & pharmacies by the end of Year 5. Meanwhile, each OEND College Ambassador completing the ToT Program will train a minimum of 5-10 students/health center staff at their campus for a total of 125-250 individuals trained in Year 1 and 250-500 trained during Years 2-5 for a total of 1,125-2,250 individuals trained by the end of Year 5. TTC's ToT Programs will address service gaps in LAC where higher rates of area poverty were associated with higher OO death rates. The specific goals of the ToT Programs are to: 1) Increase capacity of local FQHCs, community clinics, and pharmacies to develop effective OEND programs, including innovative and culturally responsive practices, in high-need communities; and 2) Increase capacity of local HIS community colleges and state universities to develop effective and innovative OEND programs, including culturally responsive practices, among diverse student populations. By the end of Year 5, the rate of ED visits and hospitalizations due to OO will be reduced by at least 25% from baseline (2022). Annually during Years 1-5, at least 533 naloxone nasal spray kits will be distributed to OEND Champions for distribution to patients at highest risk for OO, and approximately 5-10 patients who have experienced an OO will be linked to OUD treatment each year through an enhancement of linkage to treatment protocols with participating FQHCs and community clinics.