Implementation Science Project Mid-Year Progress What We Know Two - PowerPoint PPT Presentation

Implementation Science Project Mid-Year Progress

What We Know • Two systems focused on antagonist MAT, two with agonist MAT (and also initiating antagonist as well) • All four systems have some state funding for MAT • Most have been challenged by data collection • Many sites extending MAT to all detainees, be they pre-sentenced or sentenced

Data Reports • For those reporting: – Population of Focus ranges from 40-350 – Screening Rates range from 49% to 100% – Opioid SUD positive screen range from 27%-65% – MAT provided to 9-61% with opioid SUD – Generally, all leave with community referrals – 35-100% of those with appointments keep appointments

Screening Trends 120 100 80 A B 60 C D 40 20 0 1-May 1-Jun 1-Jul

Percent with SUD treated with MAT 70 60 50 40 A B C 30 D 20 10 0 1-May 1-Jun 1-Jul

Number of persons treated with MAT 80 70 60 50 A B 40 C D 30 20 10 0 May, 2016 June, 2016 July, 2016 August, 2016

Implementation Science Quick Review

Implementation Science • Gregory Aaron’s evidenced based model of implementation in public sectors • Four phases of implementation: exploration, preparation, implementation, and sustainability Julie White 7/13/16 8

Progress Reports

Project Statements • “By July 1, 2017, … screen all incoming inmates for SUD, and offer all three forms of MAT. …include maintenance for those already in treatment for 6-12 months and begin treatment before release.” • “Increase Vivitrol treatments.” • “Ensure those with SUDs are consistently identified, referred and treated.”

Exploration • “developing a structured MAT program for pre-sentenced inmates.”

Preparation • “Team is meeting every 2 weeks to plan…including protocol development.” • “Program streamlined data collection… requiring all community based providers to send measures directly to evaluator.” • “Put out an RFA to SUD providers in community to provide onsite MAT services.”

Implementation • “Decision made to invest in part time staff member to reduce administrative workload on MAT navigator.” • “Holding focus groups among inmates to better understand why they are not choosing Vivitrol.” • “Developing MAT education groups.” • “Developing re-entry group meetings with inmates and staff.”

Implementation • “Warden wrote an SOP for how meds will be administered in the facilities.” • “MOU has been developed for all licensed SUD treatment providers.”

Sustainment • “Calling returning citizens to ensure compliance of treatment within the community.”

Who are the External Stakeholders? Government Healthcare • Governors* • Community Based Health Care Providers* • Legislature* • Medicaid* • Judges • Probation and Parole • Public Safety Executives • Correctional Administrators* Julie White 7/13/16 17

What is needed from external partners? • Buy In • Funding • Contracts & MOUs • Legislation/Policies • Commitment to Training and Resources Julie White 7/13/16 18

Internal Stakeholders • Sheriff* • Nursing* • Warden/ Superintendent* • NPs and Pas* • Director of Treatment* • Medical Director* • Director of Medical • Treatment Staff* Services* • Caseworkers* • Director of Reentry* • Policy and Government Affairs Staff • Correctional Officers* • Research Staff* Julie White 7/13/16 19

Internal Stakeholders • Internal leader facilitates multi-disciplinary team and ultimately responsible for key decisions: – Screening and Assessment for Treatment – Treatment & Medical Administration – Community Reentry – Tracking & Data Collection – Sustainability Julie White 7/13/16 20

Developing a process map Tool for organizing program

22 Julie White 7/13/16

What is the process? • Screening & Assessment – Where – Who – When – Tool used – Criteria to screen in vs. out Julie White 7/13/16 23

Where • Where does the screening for a Substance Use Disorder (SUD) physically take place? – Courtroom office/ bullpen – Booking cell/office – Classification office/cell Julie White 7/13/16 24

Who does the screening? • Court evaluator • Nursing staff in booking • Classification caseworkers Julie White 7/13/16 25

Who is screened? • Drug Court participants • All detainees • All sentenced inmates • All inmates with ____ length of stay (los) Julie White 7/13/16 26

When does the screening take place? • While still in court • During booking • In orientation and classification unit • Once classified • Prior to release Julie White 7/13/16 27

Tool used to do the screening • Evidence based • Short SUD screener • Medical intake • Risk/Needs assessment Julie White 7/13/16 28

Screening & Assessment Criteria for treatment History of use Who gets Substances used in last 12 screened? months History of treatment and Who screens? Process types of treatment Where? History of MAT Issues Overdose history Instrument? Comorbid issues Length of sentence Accessibility upon release Screened for Decision Process SUD including Booking for Treatment Dependence Inner/Outer Inner/Outer Implement context dynamics context dynamics Issues Innovations? Innovations? Facilitators? Facilitators? Barriers? Barriers? Julie White 7/13/16 29

Treatment How are decisions for different treatment modalities made? What kind? Care coordination Where? Medical screening Education and consent How long? Process Lab tests Criteria? Issues Urine tox screens Team communication Indicators of Procedure for med success? administration Timing for starting med Discontinuation criteria MAT Decision Process MH (e.g. CBT) Will treat for Treatment SUD (e.g. 12 step) Inner/Outer Inner/Outer Implement context dynamics context dynamics Issues Innovations? Innovations? Facilitators? Facilitators? Barriers? Barriers? Julie White 7/13/16 30

Reintegration / Reentry • Who (medical, casework services) • What – Health insurance – Appointment – Accessible care • Information to be shared with inmate/ detainee • When • Where Julie White 7/13/16 31

Reentry/Reintegration What are processes prior to and during release? Care coordination MOU/Contract? Data collection CJ status at release Payment model Data sharing a factor? Process Other therapeutic community Who helps with Issues or street? Coordination with insurance?? probation/parole/court CBO onsite/offsite? Mental health treatment Sign up for Medicaid Meet provider Make appointment Reentry plan Initiate treatment Care coordination Inner/Outer Inner/Outer Implement context dynamics context dynamics Issues Innovations? Innovations? Facilitators? Facilitators? Barriers? Barriers? Julie White 7/13/16 32

Community based partner(s) • Who • Where • Accessibility • Information needed from correctional facility • Ease of scheduling • Payments accepted/ reimbursement Julie White 7/13/16 33

Insurance • Eligibility • When to fill out • When active • Steps to take once released Julie White 7/13/16 34

Data • Tracking • What • Who • How • When Julie White 7/13/16 35

Sustainability What are you looking to sustain? What is your strategy regarding • • sustainability? What evidence do you have that • supports sustainability? Who’s support do you need? • What do you need to sustain Who can provide you the support • • MAT ? needed? Legislature – Staffing – Governor – – Funding Private Foundations – – Grant writer Government Grants – – Lobbyist Community partners – – Executive level support Julie White 7/13/16 36