Peter D. Friedmann, MD, MPH Alpert Medical School of Brown University

Medication-Assisted Treatment in Community Correctional Environments (MATICCE): An Implementation Study Peter D. Friedmann, MD, MPH Alpert Medical School of Brown University

Financial Disclosures Alkermes – medication provided for a study of parolees Pfizer – shareholder (<$1000)

Coordination Addictions Treatment Criminal Justice BEHAVIORAL CHANGE BEHAVIORAL CHANGE 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 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

CJ-DATS is funded by NIDA in collaboration with SAMHSA and BJA. 5 Background • Despite designation of many drug treatment and other interventions as “evidence-based,” such interventions are slow to be adopted, and are often poorly implementedor difficult to sustain. • One highly effective EBP that is underutilized in criminal justice settings is Medication Assisted Treatment (MAT).

Current Use of MAT in Potential Partner Agencies (N=50) Friedmann et al., Substance Abuse 2012 Low current usage = potential high CJDATS impact

Cited Barriers to Use of MAT Barriers that could be addressed in an implementation study

Willingness to Consider MAT High feasibility

CJ-DATS is funded by NIDA in collaboration with SAMHSA and BJA. 9 Goals of MATICCE Improve knowledge and perceptions of parole and probation (P/P) staff about community-based MAT. Test effect of organizational linkage intervention (OLI) on interagency coordination between probation/parole agencies and local MAT-providing treatment agencies. Increase the number of probation/parole clients linked with community-based MAT

Two-Part Implementation Strategy Pilot survey: emphasis on 2 prominent barriers to MAT: Part 1: Staff Training Addresses: 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 CJ-DATS is funded by NIDA in collaboration with SAMHSA and DOJ 10

CJ-DATS is funded by NIDA in collaboration with SAMHSA and DOJ 11 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 officers • Local treatment providers welcome to attend

MATICCE Study Design Baseline Data Collection (all sites) Knowledge, Perception, Information (KPI) Intervention (all sites) RANDOMIZATION Group 1 N=9 Linkage Intervention PEC Strategic Planning Connection Coordinator Group 2 N=9 No Linkage Intervention (KPI only ) End-of-OLI Data Collection (all sites) 6-Month Follow-up Data Collection (all sites)

CJ-DATS is funded by NIDA in collaboration with SAMHSA and DOJ 13 Part 2: Organizational Linkage Intervention (OLI) • OLI based in part on CMHS ACCESS project • Adapted 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

CJ-DATS is funded by NIDA in collaboration with SAMHSA and DOJ 14 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)

CJ-DATS is funded by NIDA in collaboration with SAMHSA and DOJ 16 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-DATS is funded by NIDA in collaboration with SAMHSA and BJA. 18 Key Measures – OAMAT and IOR • Opinions About Medication-Assisted Treatment (OAMAT) • knowledge, perceptions, and training experiences related to pharmacotherapies (e.g., methadone, buprenorphine) • Baseline and 3 mosafter 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 Includes n=347 at baseline and 3 mos. Very much Not at all

Opinions re. MAT: 3-month follow-up Very much * * * * * p<.05 * * * * * Not at all

CJ-DATS is funded by NIDA in collaboration with SAMHSA and DOJ 21 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?

Baseline IOR Very much Ratings 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 Not at all

Baseline IOR Ratings of Frequency of Communication Measures the number of times during the past six months that different types of communications were transmitted or received About every day p = 0.015 p < 0.001 Not at all

Baseline IOR Ratings of Quality of Communications Measures respondent assessment of the clarity and ease of sending and receiving messages with the partner program Very much p = 0.02 Not at all

Baseline IOR Ratings of Effectiveness of the Relationship Measures the extent to which the respondent judges the working relationship to be committed, worthwhile, productive, satisfying Very much Not at all

Baseline IOR Ratings of Quality of Communication: Detailed Differences by Setting

CJ-DATS is funded by NIDA in collaboration with SAMHSA and DOJ 27 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

CJ-DATS is funded by NIDA in collaboration with SAMHSA and DOJ 28 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 IORs • Corrections 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

Peter D. Friedmann, MD, MPH Alpert Medical School of Brown University