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

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]

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]

Personal Experiences with MaineCare Services from People Who Use Elder and Adults with Disabilities Waiver and Private Duty Nursing/Personal Care Services.

This report provides the results from a survey and personal interviews that were conducted with MaineCare members who use long term services and supports -- specifically those who are on the Elder and Adults with Disabilities Waiver and those using Private Duty Nursing (PDN) Services. People who are eligible for these services generally need nursing care and assistance with a combination of activities of daily living (e.g. eating, toileting, mobility, transfer) and instrumental activities of daily living (e.g. meal preparation, grocery shopping, housework). People on the Waiver are medically eligible to be in a nursing home. The purpose of the survey and interviews was to provide information on the experience of members and their use of medical services; the coordination between the medical and home care systems; care transition services (e.g. from the hospital to home); home care services; and use of transportation services. The surveys also include information on the satisfaction of members with their workers, their use and need for assistive technology devices, and their access to other community resources

SUPPORT for ME Needs Assessment Summary.

Maine Department of Health and Human Services contracted with the Catherine Cutler Institute at the University of Southern Maine to conduct a baseline needs assessment. The overall goal was to better understand the current capacity to address substance use in Maine; find barriers to receiving and utilizing SUD treatment and recovery services; and identify any gaps in SUD-related services in the state. The Cutler team conducted interviews, surveys, community listening sessions and focus groups with healthcare key informants (leadership from health systems, residential care, recovery housing, behavioral health agencies), providers (medical, behavioral health, first responders, residential treatment, law enforcement, opioid treatment), youth ages 12-21, and community members across Maine. The team also analyzed health claims data to identify how common substance misuse is among MaineCare (Medicaid) members and what types of substance use disorder (SUD) treatment and support services MaineCare members use. For more information, please contact the principal investigator, M. Lindsey Smith, PhD, at [email protected]