CJ-DATS is funded by NIDA in collaboration with SAMHSA and DOJ Medication-Assisted Treatment in Community Correctional Environments (MATICCE): An Implementation

CJ-DATS is funded by NIDA in collaboration with SAMHSA and DOJ

Medication-Assisted Treatment in Community Correctional Environments (MATICCE): An Implementation Study

Peter D. Friedmann, MD, MPHAlpert Medical School of Brown University


Financial Disclosures

Alkermes – medication provided for a study of parolees

Pfizer – shareholder (<$1000)


Criminal JusticeAddictions Treatment

Drug-InvolvedOffender

Services and Systems Issues

Public Safety• Supervision• Monitor illegal behavior• Monitor release conditions• Re-entry services

Health, Public Health• Drug use• Risk behaviors• Recovery• Support services

Coordination

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CJ-DATS is funded by NIDA in collaboration with SAMHSA and DOJ 3


CJDATS

Criminal Justice – Drug Abuse Treatment Studies NIDA-funded multisite research cooperative 10 research centers and CJ partner agencies Focus is on implementation research

Research to understand and improve the processes through which agencies adopt, implement, and sustain quality improvements for treating drug-involved offenders.

Larger cooperative fields multiple study protocols Assessment practices HIV continuum of care Medication-assisted treatment


Background

Despite designation of many drug treatment and other interventions as “evidence-based,” such interventions are slow to be adopted, and are often poorly implemented or difficult to sustain.

One highly effective EBP that is underutilized in criminal justice settings is Medication Assisted Treatment (MAT).

CJ-DATS is funded by NIDA in collaboration with SAMHSA and BJA. 5


Current Use of MAT in Potential Partner Agencies (N=50)

Jail(n=18)

Prison(n=12)

P/P(n=12)

Drug Court(n=8)

Mean % opiate dependent clients 30.9 25.2 16.5 49.1

Mean % alcohol dependent clients 44.1 36.9 34.8 35.1

% provide/fund Methadone 66.7 83.3 0.0 37.5

% provide/fund Buprenorphine 5.6 16.7 8.3 12.5

% provide/fund any alcohol MAT 77.8 75.0 16.7 37.5

Low current usage = potential high CJDATS impact

Friedmann et al., Substance Abuse 2012


Cited Barriers to Use of MAT

Jail(n=18)

Prison(n=12)

P/P(n=12)

Drug Court(n=8)

State/local regulations prohibiting MAT X

Security concerns X X

MAT offered by community Tx programs X X X

Agency favors drug-free Tx over MAT X X

Lack of qualified staff X X

Liability concerns X

Cost/reimbursement concerns X

Barriers that could be addressed in an implementation study


Willingness to Consider MAT

Jail(n=18)

Prison(n=12)

P/P(n=12)

Drug Court(n=8)

% open to beginning/expanding Methadone 55.6 83.3 66.7 62.5

% open to beginning/expanding Buprenorphine

55.6 58.3 83.3 75.0

% open to beginning/expanding Naltrexone 50.0 58.3 83.3 75.0

High feasibility


Goals of MATICCE

1. Improve knowledge and perceptions of parole and probation (P/P) staff about community-based MAT.

2. Test effect of organizational linkage intervention (OLI) on interagency coordination between probation/parole agencies and local MAT-providing treatment agencies.

3. Increase the number of probation/parole clients linked with community-based MAT

CJ-DATS is funded by NIDA in collaboration with SAMHSA and BJA. 9

Two-Part Implementation Strategy

Pilot survey: emphasis on 2 prominent barriers to MAT:

Part 1: Staff TrainingAddresses:

• Limited knowledge about MAT effectiveness• Inaccurate perceptions of MAT• Limited information about local MAT resources

“Implementation-as-Usual”

Part 2: Organizational Linkage Intervention identify and resolve barriers to client linkages


Part 1: Staff Training KPI = Knowledge, Perceptions and Information Developed with Pacific ATTC

Based on Blending materials, TIPs, existing ATTC resources, CJDATS workgroup input

Delivered via local ATTCs N=618 participants (18 sites)

Mainly probation & parole officersLocal treatment providers welcome to attend


MATICCE Study Design

Baseline Data Collection (all sites)

Knowledge, Perception, Information (KPI) Intervention (all sites)

RANDOMIZATION

Group 1 N=9Linkage Intervention

PECStrategic Planning

Connection Coordinator

Group 2 N=9No Linkage Intervention

(KPI only )

End-of-OLI Data Collection (all sites)

6-Month Follow-up Data Collection (all sites)

Part 2: Organizational Linkage Intervention (OLI)

OLI based in part on CMHS ACCESS projectAdapted 3 components associated with effective

organizational integration:• Working group of reps from key organizations [PEC]• Strategic planning process• Boundary spanner [Connections Coordinator]

Research Centers provide training and TA around strategic planning / SWOT analysis


Pharmacotherapy Exchange Council (PEC)

Connections Coordinator (1 per site) Person who can best engage both CJ and Tx in implementing

changes in procedure/referrals Drug Court, TASC, State/County, Treatment

Co-Chairs: CJ and Treatment (2 per site) Decision-makers for each agency/facility

• Parole/Probation Director/Supervisor/Manager• Treatment program CEO / Clinical Director

Supervisory and Line Staff (up to 8 per site) CJ, TASC, and treatment provider staff

Average = 10 team members per study site


Overview of Phases for theOrganizational Linkage Intervention (OLI)

Phase Primary Outcome(s) Duration (in weeks)

Pre-Phase Local PEC Team is formed and the MATICCE project is introduced

1-2

1. Needs Assessment

PEC completes a Needs Assessment that identifies the relative strengths & weaknesses in the inter-organizational practices associated with MAT

8

2. Strategic Planning

PEC develops and adopts a Strategic Plan that identifies goals and objectives for improvements to increase client linkages to MAT

8-12

3. Implementation PEC works in a collaborative manner to implement the objectives and attain the goals identified in their Strategic Plan

16 - 24

4. Follow-Up PEC assesses the relative sustainability of both the process improvement targets achieved and the PEC method for facilitating process improvements

4

Strategic Plan Objectives

Additional training for probation/parole staff Cross-training of probation and treatment staff Interagency communication Secure funding to support MAT services Develop shared guidelines/standards


Demographics

CJ Staff (n=309)

Tx Staff (n=210)

% Bachelor’s degree 59.9 35.1

% Master’s degree 29.1 38.5

Median Years in this field 11.0 10.0

Median Years in this unit/program 5.3 3.3

Median Years in this agency 9.7 4.0

Median Years in this position 5.0 2.8

Median Hours worked per week 40.0 40.0

% provide supervision (CJ) / counseling (Tx) 89.6 79.0

Median # client contact hours per week 20.0 22.0

Median # clients seen per week 26 20

Median # on active caseload 65 40

Key Measures – OAMAT and IOR

18CJ-DATS is funded by NIDA in collaboration with SAMHSA and BJA. 18

• Opinions About Medication-Assisted Treatment (OAMAT)• knowledge, perceptions, and training

experiences related to pharmacotherapies (e.g., methadone, buprenorphine)

• Baseline and 3 mos after KPI training• Inter-Organizational Relationships (IOR)

• Questions about how participant’s organization coordinates with other agencies

• Baseline (and after year-long intervention phase)Van de Ven & Ferry,

1980

Opinions re. MAT: Baseline

Methadone Bup Ntx - opiates Acamprosate1

1.5

2

2.5

3

3.5

4

4.5

5

FamiliarTrainedWhere to referLikely to refer

Not at all

Very much Includes n=347 at baseline and 3 mos.

Opinions re. MAT: 3-month follow-up

Methadone Bup Ntx - opiates Acamprosate1

1.5

2

2.5

3

3.5

4

4.5

5

**

*

*

*

*

FamiliarTrainedWhere to referLikely to refer

*

Not at all

Very much

* p<.05

*

**

*

**

* **

Interorg Relationships

Baseline, end of intervention (in progress) Organizational Assessment Van de Ven & Ferry, 1980

Agency and Personal Awareness (3 items) e.g. How well are you personally acquainted with the contact person in this agency?

Frequency of Communications (4 items) e.g. How frequently were personal face-to-face discussions held with people in this agency

during the past six months?

Quality of Communications (3 items) When you wanted to communicate with persons in this agency, how much difficulty have

you had getting in touch with them?

Perceived Effectiveness of Relationship (4 items) Overall, to what extent are you satisfied with the relationship between your organization

and this agency?


Director Staff POSITION

Corrections Tx SETTING

High Low CASELOAD

1

2

3

4

5

Baseline IORRatings of Agency and Personal Awareness

Measures the extent to which the respondent is familiar with the staff, goals, and clients of the partner program

p = 0.05 p < 0.001

Very much

Not at all



High Low CASELOAD

0

2

4

6

8

Baseline IOR

Ratings of Frequency of CommunicationMeasures the number of times during the past six months that different

types of communications were transmitted or received

p = 0.015 p < 0.001

Not at all

About every day

Baseline IOR

Ratings of Quality of CommunicationsMeasures respondent assessment of the clarity and

ease of sending and receiving messages with the partner program



High Low CASELOAD

1

2

3

4

5

p = 0.02

Very much

Not at all

Baseline IOR

Ratings of Effectiveness of the RelationshipMeasures the extent to which the respondent judges the working relationship

to be committed, worthwhile, productive, satisfying



High Low CASELOAD

1

2

3

4

5Very much

Not at all

Baseline IORRatings of Quality of Communication:

Detailed Differences by Setting

Item Corrections(%)

Treatment(%)

p

When you have wanted to communicate with persons in this partner agency, how much difficulty have you had?

None at all 51.0 37.1 0.02

Some 40.8 53.2

Very much 8.2 9.7

Overall, would you characterize your communications with persons in this partner agency during the past six months as high quality?

Not at all 22.6 23.1 <0.01

Some 42.6 61.2

Very much 34.8 15.7

To what extent are you satisfied overall with the relationship with this partner agency?

Not at all 15.3 20.6 0.11

Some 47.6 52.4

Very much 37.1 27.0

Conclusions

Modest training effects of KPI Perspective is important

Directors perceive stronger IORs than staff report• Directors believed staff were more aware of partners and

communicated with them more often than staff reported

CJ partners perceive stronger IORs than MAT providers• Respondents from MAT settings reported less awareness of

partner resources , less frequent and lower quality communication

• MAT providers were more likely to report problems communicating with corrections staff than vice versa


Implications

Directors perceptions of IORs misaligned with realities of front-line staff

Disconnect between corrections’ and MAT providers’ perceptions of the strengths and benefits of their IORsCorrections had more positive views of MAT than

treatment providers; they viewed the IORs to be more productive and effective

Will be interesting to see if perceptions converge after OLI

Ongoing evaluation of impact on referral


Documents

CJ-DATS is funded by NIDA in collaboration with SAMHSA and DOJ Medication-Assisted Treatment in Community Correctional Environments (MATICCE): An Implementation