SUPPORT for ME: Provider Focus Group Summary

This summary highlights feedback from focus groups with providers across Maine who currently address the needs of persons with substance use disorder (SUD). These providers represent individuals working in the following organizations: Health Systems, Behavioral Health Agencies, Residential Treatment, Community Recovery Programs, Opioid Treatment Programs (OTP), Emergency Medical Services (EMS), First Responders (EMT, fire, police), and law enforcement (e.g., Sheriff’s Office, Corrections). This summary report is designed to provide feedback to the Office of MaineCare Services to help inform their strategic planning process to increase statewide capacity for SUD treatment and recovery service capacity to better meet the needs of individuals with SUD in Maine. The focus group interview guide was designed to assess critical domains of interest for the state, which include current and potential provider capacity; referral capacity; access to care & service delivery; provider willingness; and administrative & procedural policies. Key Highlights from the interviews indicated that: Telehealth has emerged as a major facilitator to treatment access at all levels of care and should continue to be a reimbursed service for SUD treatment, where appropriate. Emergency rooms and jails are at the forefront for Medication Assisted Treatment (MAT) induction for OUD. While these are excellent models for care in Maine, particularly for engaging vulnerable populations in treatment, they should be used in concert with a broad spectrum of community-based services. Co-located services and effective communications across service providers are integral to creating a robust continuum of care for SUD in Maine. Staffing shortages coupled with reimbursement rates for some SUD services including outpatient therapy, residential treatment, medically supervised withdrawal services and intensive outpatient treatment programs affect the quality as well as availability of providers, and impact access to services statewide. The need for medically supervised withdrawal services is dire in Maine. Increased awareness and training opportunities to help alleviate stigma, including peer mentorship from other providers and colleagues, would help build provider capacity to treat and refer patients with SUD. For more information, please contact M. Lindsey Smith, PhD., at [email protected]

SUPPORT for ME: Key Stakeholder Interview Summary

This summary feedback report is organized to inform the Office of MaineCare Services goal of addressing barriers and finding new and/or improved ways to increase capacity in Maine for people who seek treatment and recovery services for substance use disorder. Interview protocols were designed to assess critical domains of interest for the state, which include: current and potential provider capacity, access to care & service delivery provider willingness, and financial/ administrative policies. Key Highlights from the stakeholder interviews indicated that: While there have been improvements in the integration of care for persons with behavioral health (BH) diagnoses, this integration has not fully synced with substance use disorder (SUD) services in Maine; better integration of BH and SUD is needed. Behavioral Health Homes and Opioid Health Homes are regarded as excellent models of care, and many key stakeholders would like to see this model of care expand for all members with a diagnosis of SUD. Low reimbursement rates for some SUD services including outpatient therapy, residential treatment, medically supervised withdrawal services and intensive outpatient treatment programs affect the quality of workforce, available services, and hinders capacity building efforts. Stigma exists regarding serving the population with SUD, at all levels- from state policymakers, to providers, and to the community. Maine lacks what some consider as basic SUD service options available elsewhere (e.g., variety of medication assisted-withdrawal services, plus intermediate levels of care). For more information, please contact M. Lindsey Smith, PhD, at [email protected]

Medication Assisted Treatment: Prescription Drug and Opioid Addiction Expansion Project

Greater Portland Health (GPH) in collaboration with Preble Street Resource Center was awarded a Medication Assisted Treatment: Prescription Drug & Opioid Addiction (MOUD-PDOA) grant from SAMHSA. The GPH MOUD-PDOA project will include a mixed-methods evaluation led by Catherine E. Cutler Institute. The evaluation team will build knowledge and provide feedback to inform the implementation and refinement of the GPH MOUD-PDOA Program. Evaluation Goals: Document program strategies and identify barriers and facilitators to implementation Examine the efficacy of using a continuum of treatment services to increase access to MOUD among vulnerable populations in underserved communities Assess the impact of the intervention strategies on patient engagement and outcomes This report highlights the process and outcome evaluation data collected during Year 1. For more information, please contact M.Lindsey Smith or Kat Knight

HOUSE: Homeless Opioid User Service Engagement Program. Year 1 Report

Homelessness and lack of stable housing is often a barrier to achieving stability for individuals who are experiencing homelessness (IWAEH) with an OUD. In order to meet the complex needs of IWAEH with OUD, the Department of Health and Human Services funded a pilot program in 2021, the Homeless Opioid Users Service Engagement (HOUSE) Program; clinicians at Greater Portland Health provide clients with low-barrier Medication Assisted Treatment (MAT), while staff at Preble Street provide casework support and rapid housing assistance to individuals who have been identified as being at high risk of overdose, are experiencing homelessness, and are diagnosed with an OUD. . The services resulting from this pilot are intended to provide comprehensive treatment, case management, housing services and peer support in an effort to support long-term recovery and reduced opioid related morbidity and mortality among IWAEH with OUD. The primary goals of the HOUSE Program evaluation are to: (1) document implementation strategies and identify barriers and facilitators to implementation; (2) evaluate the efficacy of the intervention strategies at increasing access to prevention, treatment and recovery supports for IWAEH with OUD; (3) examine the impact of housing liaison services and Assistance Funds on housing stability among IWAEH with OUD; (4) assess the cost effectiveness and return on investment of the intervention strategies and (5) examine the impact of the intervention strategies on participant engagement and outcomes. Early learnings from the mixed methods approach indicate that the first year of the initiative demonstrate that while there remain challenges to engaging this population, the use of evidence-based treatments in combination with intensive case management and peer supports can be an effective way to maintain stabilize patients and address both their medical and housing needs