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

2. Funding and Disclaimer
Funding for this initiative was made possible (in part) by grant no. 1H79TI 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.

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

4. 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:
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

5. 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?

6. 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

7. 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)

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

9. 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

10. 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