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

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

Percent with SUD treated with MAT

10 20 30 40 50 60 70 1-May 1-Jun 1-Jul A B C D

Number of persons treated with MAT

10 20 30 40 50 60 70 80 May, 2016 June, 2016 July, 2016 August, 2016 A B C D

Implementation Science

Quick Review

• Gregory Aaron’s evidenced based model of

implementation in public sectors

• Four phases of implementation: exploration,

preparation, implementation, and sustainability

Implementation Science

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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

• Governors*
• Legislature*
• Judges
• Probation and Parole
• Public Safety Executives
• Correctional

Administrators*

Healthcare

• Community Based Health

Care Providers*

• Medicaid*

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• Buy In
• Funding
• Contracts & MOUs
• Legislation/Policies
• Commitment to Training and Resources

What is needed from external partners?

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Internal Stakeholders

• Sheriff*
• Warden/ Superintendent*
• Director of Treatment*
• Director of Medical

Services*

• Director of Reentry*
• Policy and Government

Affairs Staff

• Correctional Officers*
• Research Staff*
• Nursing*
• NPs and Pas*
• Medical Director*
• Treatment Staff*
• Caseworkers*

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• 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

Internal Stakeholders

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Developing a process map

Tool for organizing program

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• Screening & Assessment

– Where – Who – When – Tool used – Criteria to screen in vs. out

What is the process?

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• Where does the screening for a Substance Use

Disorder (SUD) physically take place?

– Courtroom office/ bullpen – Booking cell/office – Classification office/cell

Where

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• Court evaluator
• Nursing staff in booking
• Classification caseworkers

Who does the screening?

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• Drug Court participants
• All detainees
• All sentenced inmates
• All inmates with ____ length of stay (los)

Who is screened?

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• While still in court
• During booking
• In orientation and classification unit
• Once classified
• Prior to release

When does the screening take place?

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• Evidence based
• Short SUD screener
• Medical intake
• Risk/Needs assessment

Tool used to do the screening

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Screening & Assessment

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Booking Screened for SUD including Dependence Decision Process for Treatment Process Issues Who gets screened? Who screens? Where? Instrument?

Criteria for treatment History of use Substances used in last 12 months History of treatment and types of treatment History of MAT Overdose history Comorbid issues Length of sentence Accessibility upon release

Implement Issues Inner/Outer context dynamics Innovations? Facilitators? Barriers? Inner/Outer context dynamics Innovations? Facilitators? Barriers?

Treatment

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Will treat MAT MH (e.g. CBT) SUD (e.g. 12 step) Decision Process for Treatment Process Issues What kind? Where? How long? Criteria? Indicators of success?

How are decisions for different treatment modalities made? Care coordination Medical screening Education and consent Lab tests Urine tox screens Team communication Procedure for med administration Timing for starting med Discontinuation criteria

Implement Issues Inner/Outer context dynamics Innovations? Facilitators? Barriers? Inner/Outer context dynamics Innovations? Facilitators? Barriers?

• Who (medical, casework services)
• What

– Health insurance – Appointment – Accessible care

• Information to be shared with inmate/ detainee
• When
• Where

Reintegration / Reentry

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Reentry/Reintegration

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Reentry plan Sign up for Medicaid Make appointment Care coordination Meet provider Initiate treatment Process Issues MOU/Contract? CJ status at release a factor? Who helps with insurance?? CBO onsite/offsite?

What are processes prior to and during release? Care coordination Data collection Payment model Data sharing Other therapeutic community

• r street?

Coordination with probation/parole/court Mental health treatment

Implement Issues Inner/Outer context dynamics Innovations? Facilitators? Barriers? Inner/Outer context dynamics Innovations? Facilitators? Barriers?

• Who
• Where
• Accessibility
• Information needed from correctional facility
• Ease of scheduling
• Payments accepted/ reimbursement

Community based partner(s)

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• Eligibility
• When to fill out
• When active
• Steps to take once released

Insurance

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• Tracking
• What
• Who
• How
• When

Data

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Sustainability

• What are you looking to sustain?
• What evidence do you have that

supports sustainability?

• What do you need to sustain

MAT? – Staffing – Funding – Grant writer – Lobbyist – Executive level support

• What is your strategy regarding

sustainability?

• Who’s support do you need?
• Who can provide you the support

needed?

– Legislature – Governor – Private Foundations – Government Grants – Community partners

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