Through this inaugural grant program, $2.3 million is being made available over two years to fund pilot or existing collaborations among medical, behavioral, and local community organizations to identify, assess, and immediately initiate treatment for individuals with opioid use disorder where they live, with a focus on populations at highest risk for overdose and death.
The goals are to 1) establish or expand a system of low threshold community-based, on-demand treatment to immediately stop the death toll from opioid overdose, and 2) support long-term treatment to improve health and quality of life.
The grant will be implemented in two phases.
• Phase 1: Six-month grants for up to six applicants at $50,000 each to design innovative treatment-on-demand models or expand existing programs that provide immediate treatment to reduce overdose deaths.
• Phase 2: Two-year grants awarded to up to four of the grantees from the Phase 1 cohort that demonstrate the greatest potential in fulfilling the goals of the program. Awarding of these grants is contingent upon the efficacy of the planning models.
DESIGN GRANTS ANNOUNCED – ABOUT THE GRANTEES
A 2013 study revealed drug overdose to be the single largest cause of death among people served by Boston Health Care for the Homeless Program (BHCHP). BHCHP health care teams are responding to 2-5 overdoses each week. Amid a rising number of fatal and non-fatal overdoses, BHCHP, Pine Street Inn, and St. Francis House have witnessed firsthand the need among homeless and newly housed individuals for accessible treatment on-demand, as well as harm reduction services.
BHCHP will partner with the Pine Street Inn and St. Francis House to increase access to treatment and harm reduction services for homeless and formerly homeless individuals with opioid use disorder (OUD). BHCHP will expand access to its SPOT Program (Supportive Place for Observation and Treatment) to provide safe medical monitoring for people at imminent risk of overdose. (SPOT served 500 patients, with over 3,500 encounters in its first year, approximately 13% of whom engaged in treatment.) BHCHP, Pine Street Inn, and St. Francis House will work together to develop new approaches to reduce harm and increase access to medication for addiction treatment for high-risk individuals in shelters and home-based environments.
Brockton, a federally designated, medically underserved area, had a rate of opioid-related overdose death of 50.4 per 100,000 in 2015, nearly five times the national average of 10.3 per 100,000, and nearly double the statewide rate of 26.7 per 100,000. Between January and October 31, 2017, Brockton Hospital treated 421 overdoses; 405 were nonfatal.
Brockton Neighborhood Health Center (BNHC) will build a collaboration with the city of Brockton’s Champion Plan (a police-assisted recovery program that encourages those with substance use disorders to visit the police station, where they are paired with a recovery coach), the Plymouth County Sheriff’s Office, the Gandara Center, and High Point Treatment Center. Working together, the group will aim to better coordinate OUD treatment and recovery services, while establishing BNHC as a medical home for patients with OUD. BNHC plans to focus on high-risk populations including those newly released from correctional facilities and individuals who are homeless.
Postpartum women are among those at highest risk of opioid overdose. Statewide overdose rates among women with OUD demonstrate an 340% increase in the year after giving birth, yet few programs focus on this population.
Cambridge Health Alliance (CHA) serves as a local and primary care provider including Outpatient Addiction Services throughout Boston’s Metro North. In 2015, CHA began a partnership with MySafeRx®, MedicaSafe, and Dartmouth Center for Technology and Behavioral Health to integrate their innovative technology platforms for enhancing buprenorphine adherence in opioid use disorder (OUD) treatment. The program delivers Mobile Recovery CoachingSM in conjunction with daily remotely supervised medication-taking via videoconferencing. The MySafeRx android application facilitates supervised dosing and release of medication from a secure electronic pill dispenser (Medicasafe 3000). Recovery coaches support patients via videoconference and use confidential text messages to communicate, helping patients stay in contact during periods of instability. The program is popular among women with young children because it provides daily support in early recovery and allows them to fit treatment into their busy lives. CHA will use the grant to enhance capacity for remote treatment to allow for addiction treatment continuity postpartum and to partner with new providers to expand to more postpartum women.
CENTER FOR HUMAN DEVELOPMENT – Western Massachusetts
Rural Western Massachusetts demonstrates a high need in a low-resourced area. The region has a lower rate of admissions into DPH-funded treatment programs, and has been disproportionately affected by the opioid epidemic. The Center for Human Development (CHD) is the largest social service agency in Western Massachusetts and delivers social and behavioral health services to 25,000 people per year, including outpatient counseling for substance use disorder and a residential recovery program for women.
In collaboration with the Community Health Center of Franklin County in Greenfield, CHD will use the grant funding to develop a rural based comprehensive treatment plan using the “hub and spoke” model. This program would support a network of primary care providers using medication assisted treatment and create a hub to coordinate complex OUD and co-occurring disorder care. CHD will also plan comprehensive treatment programs for individuals reentering the community from correctional facilities.
COMMUNITY HEALTHLINK – Worcester
Worcester County experienced 238 opioid overdose deaths in 2016, and the Massachusetts Health Policy Commission identified Worcester as one of seven “hotspots” in the Commonwealth with the greatest rate of inpatient admissions for opioid use.
Community Healthlink (CHL), which operates one of only three state-funded opioid urgent care centers in Massachusetts, provides a comprehensive array of services for substance use disorder and mental illness, and through this grant will explore expanding its Behavioral Health and Addiction Urgent Care. With the proposed expansion, CHL hopes to provide a new option for patients — immediate access to medication-assisted treatment. CHL will also explore ways that medically-complex patients can get the care they need at Urgent Care by convening stakeholders and collaborating with partners including the Worcester Police Department and UMass Memorial Medical Center emergency department.
Lynn had one of the highest rates of opioid overdose deaths at 49.8 per 100,000 in 2016, almost double the state rate of 28.4, and almost five times the national rate of 10.3 for 2015. Lynn Community Health Center (LCHC) served more than 40% of Lynn residents in 2016 and is a leader in Integrated Primary Care and Behavioral Health, including their Integrated Addictions Program. Through this grant, they seek to improve care for homeless individuals who are among those at greatest risk for overdose.
LCHC is partnering with the Lynn Police Department, Lynn Shelter Association, Bridgewell, Inc. and Healthy Streets Outreach Program to design, develop, and implement a care model to improve access to treatment and long-term recovery programs. The team will redesign outreach and engagement strategies to serve specific locations and initiate immediate treatment for homeless individuals. The program would also expand LCHC’s Homeless Medical Outreach Program to provide integrated opioid use disorder treatment, including medication assisted treatment and behavioral health services.
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