Implementation Part 2: Focus on MAT Implementation Aimee Campbell, PhD and Karen Anderson Oliver, PhD October 17, 2018

Funding and Disclaimer Funding for this initiative was made possible (in part) by grant no. 1H79TI080816-01 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

To use the EPIS model of implementation to discuss MAT implementation Objectives To use the EPIS model of implementation to discuss MAT implementation

Implementation Stages: EPIS Model Sustainment Steps: Funding and support Ongoing training needs Ongoing fidelity monitoring Outcomes Making refinements Integrated components Exploration Steps: Form an implementation team Identify the problem Narrow the focus Conduct a needs assessment Identify potential solutions Determine program fit Create a written summary Implementation Steps: Verify buy-in Ensure priority Complete training Prepare materials Manage expectations Monitor fidelity to the EBP Collect and evaluate outcomes Explore scale-up in the service system(s) As we discussed in the last Learning Community, this figure links common implementation strategies to each stage of the EPIS model. . Additional information about the EPIS model can be found at: http://www.cebc4cw.org/files/CEBCTheEPISFrameworkOfImplementation.pdf Preparation Steps: Ensure leadership buy-in Develop an implementation support system Work with stakeholders Ensure that the chosen EBP fits with consumer concerns Identify viable funding streams Develop timetables

EPIS Exploration Stage: MAT Identify champion(s) Form an Implementation Team MAT Planning Resources: pcssnow.org; STR-TA repository Conduct Needs/Asset Assessment Assess Economic Environment Assess the Treatment Environment Assess Workforce Issues Assess Attitudes Engage stakeholders Economic Environment: Is there a process for payment and billing? Treatment Environment: Are there state regulations and policy barriers? How is care coordinated with primary care and mental health services? Assess Workforce Issues: Is there resistance to MAT from staff, leadership, providers? What provider training is needed? Assess Attitudes: How will you work with consumer groups and advocates to increase demand for MAT? Are there groups that oppose medication in treatment and recovery?

EPIS Preparation Stage: MAT Prepare an Implementation Checklist with timelines Establish workflow plan Identify patient flow (how to ID patients with OUD) Clinical guidelines Provider clinical training Clinical coach\mentor for providers as needed Monitoring and Feedback Systems Identify other implementation strategies based on the Exploration Stage Engage Stakeholders: Create a strategy to engage the list of stakeholders

EPIS Implementation Stage: MAT Verify buy-in Prepare training materials; complete training Manage expectations Finalize treatment materials/templates Perform a walk through test Begin to deliver the clinical service (start small) Collect and evaluate outcomes (discrete and process)

EPIS Sustainment Stage: MAT Establish sustainment plan with responsible staff and timelines Funding and support Ongoing training needs Monitor outcomes Make refinements

Special Issues for Criminal Justice Buy-in and stakeholders (at what levels; critical government involvement) Unique policy and service delivery considerations (e.g., payment) Stigma surrounding OUD by staff and leadership; around MAT Discharge planning (re-entry) Connection to care in community (linkages); minimizing linkage time post-release

Conclusion Don’t underestimate stakeholder engagement and buy-in; who needs to be at the table (preparation phase) Utilize stages to keep everyone on track and to organize strategies and timeline Understand goals Make use of implementation blueprints and timelines; revise as needed