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The East Tennessee Comprehensive Opioid Recovery Center addresses the epidemic of prescription drug and opioid addiction for adults living in the healthcare shortage areas of Appalachian Tennessee through the expansion and enhancement of treatment services capacity. The Center will provide a recovery-oriented system of care and a vast continuum of harm reduction, treatment and recovery support services. Over a four year period, the treatment capacity expansion is expected to serve an additional 375 adults who are un/underinsured and unable to afford quality services through alternate means. The national opioid crisis has had an unequivocal impact on the rural Appalachian areas of East Tennessee. Higher rates of poverty, in combination with a historical shortage of outpatient medical providers, lack of public transportation in the region and stigma surrounding substance use and co-occurring mental health issues has created disproportionate disparities in access to care. The program’s goal is to address those disparities and alleviate unmet needs of individuals struggling with an Opioid Use Disorder who have otherwise been unable to access quality care. Specific focus will be placed upon timely, low-barrier access to MOUD services in underserved counties and access to recovery support services to address SAMHSA’s Four Dimensions of Recovery. Priority populations include IV drug users, pregnant and post-partum women, individuals with co-occurring mental health disorders and those transitioning into the community from incarceration. A Recovery-oriented, trauma-informed and equity-based approach will be utilized via an integrated services team consisting of a Physician, Nurse Practitioner, RN, Recovery Specialist/Case Manager, Peer Recovery Specialist and a Certified Peer Recovery Specialist Supervisor. Center participants will have access to comprehensive substance use and co-occurring treatment services, including coverage of medication, outpatient therapy, detox and residential services, and intensive case management. Harm reduction services will provide HIV/HCV testing and Naloxone distribution and recovery support services will be provided through a network of recovery support specialists. While approved medications will be used to address the physiological components of addiction, the Community Reinforcement Approach and Assertive Continuing Care will address the psycho-social determinants and will teach clients and families how to build the recovery skills needed to support positive change and strengthen the individual’s natural support system. The program will result in the following positive outcomes: abstinence or significant reduction in substance use, improved social connectedness, engagement in mental health or pre-natal services when needed, and improved level of psycho-social functioning as evidenced by acquisition of skills, stability of housing and/or employment.

Mountain Comprehensive Care Center will implement Mountain Center to provide a full spectrum of treatment, harm reduction, and recovery supports to address the opioid epidemic and ensure access to all 3 FDA approved medications for Opioid Use Disorder. The population of focus includes individuals with substance/opioid use or co-occurring disorders, and who are not covered by public or commercial health insurance or for whom coverage has been formally determined to be unaffordable, or for services that are not sufficiently covered by an individual’s health insurance plan. Population: The catchment area includes KY’s 120 counties with an emphasis on the 54 rural counties within Appalachia which have rates of age-adjusted drug overdose deaths well above the U.S. average. Demographics of the population are anticipated to include: 94.9% White, 2.2% Multiracial, 1.8% Black, 0.5% other race, 1.7% Hispanic, 0.7% with LEP; 53% men, 46% women, 1% transgender, 8% LGBTQ+, and 100% ages 18+. The targeted area experiences economic disparities with use of opioids, stimulants, and polysubstances along with co-occurring depression and/or anxiety. It is deduced that most will be uninsured or underinsured regarding needed treatment and/or recovery supports. Interventions: MCCC will provide a full continuum of treatment, harm reduction, and recovery services directly through Mountain Center. All clients will enter the residential program with transfer of care to onsite intensive outpatient treatment or discharge to the community and participation in outpatient treatment and/or recovery groups. Interventions across all levels of care include trauma-informed care, Motivational Interviewing, MOUD, individual and group therapy, parenting classes, anger management, family counseling (upon request), participation in support groups, peer/recovery supports, and aftercare planning. EBPs include MI, MOUD, Cognitive Behavioral Therapy (Seeking Safety, Living in Balance), and peer support services. MCCC will integrate mental and primary health care, care coordination, enrollment in benefits, peer/recovery supports, and offer follow-up upon exit. Further, staff will educate on overdose prevention/medications as well as distribute medications to the population, families, and community while also conducting outreach and disseminating project information. Goals: MCCC will serve 120 clients yearly in Years 1 & 4 with 180 in Years 2 & 3 (total 600). Goals for the targeted population include: 1) Improve health by providing trauma-informed and evidence-based harm reduction services, comprehensive behavioral health treatment/access to MOUD, and integrated primary care; 2) Improve stability by providing and/or coordinating comprehensive family/person-centered recovery services; and 3) Establish an equitable and effective infrastructure, and ensure provision of inclusive and high-quality services. Objectives achieved by end of each project year include: 1.1) conducted outreach/harm reduction so 120 are served in Years 1 & 4 and 180 in Years 2 & 3; 1.2) coordinated access to individualized OUD/SUD treatment (FDA medications) so 60% report a reduction in substance use [at 6-month follow-up]; 1.3) integrated mental disorders treatment so 50% or less report any MH symptoms; 1.4) provided linkages to primary care so 65% report health as “good” or above; 2.1) provided and/or coordinated access to peer supports so 60% report positive social connections; 2.2) coordinated access to family/recovery supports so 50% report engagement in employment/education, and/or benefits enrollment; 2.3) provided person-centered care coordination so 50% report housing stability and 60% no further arrests; 3.1) ensured public access to SUD/OUD/COD resources; 3.2) monitored indicators of enrollees each quarter to ensure equity/inclusion and revise engagement as needed; 3.3) conducted meetings quarterly to coordinate services, monitor goals/objectives, CQI, and develop a sustainability plan.