Apr 10, 2019
Project Overview
This project, MAT in Jails and Drug Courts, is funded by the California Department of Health Care Services (DHCS) through the California FY 2022/23 budget, which included an allocation of State General Funds for ongoing support to the Medication Assisted Treatment (MAT) Expansion Project. The goal of this project is to increase access to MAT in county jails and drug courts while also building county capacity to effectively respond to individuals with justice system involvement with opioid use disorder (OUD), stimulant use disorder, and other substance use disorders (SUD). The ultimate goal of the Learning Collaborative is for Jail MAT county teams to commit to increasing access to at least two forms of the three FDA-approved medications for treatment of OUD in their jails and drug courts. The technical assistance model works from the basis that each county starts at a different point in access to MAT and will progress in accordance with their resources and priorities. The project brings together county teams in a learning collaborative with the objective to improve coordination among all county agencies and providers who serve justice-involved county residents and to develop bridges to further build system capacity to ensure access to effective treatment and recovery supports.
Counties participating in the MAT in Jails and Drug Courts Learning Collaborative receive technical assistance through individualized monthly coaching, topic-specific webinars, quarterly learning collaboratives, office hours, and ad hoc training. The Learning Collaborative is available to teams from all California counties interested in developing or expanding access to MAT for OUD in their jails and through their drug court systems. This project will also provide technical assistance to child welfare/juvenile justice county teams. Grant funds and participation stipends are available to participating county teams receiving technical assistance to enhance county efforts and pilot innovative solutions that demonstrate outcomes to lead to sustainable funding. Outreach and communication regarding the project and participation requirements to counties and applicable associations will be sent in November 2022 with the county team participation finalized in January 2023.
This project receives State General Funds from the State of California.
State Opioid Response I and II Project History
Throughout State Opioid Response (SOR) I and SOR II, Health Management Associates (HMA) led two projects:
- Expanding Access to MAT in County Criminal Justice Settings “Jail MAT”
- County Touchpoints for Access to MAT for Justice-Involved Individuals “County Touchpoints”
Jail MAT Background
In 2018, Health Management Associates (HMA) launched the first cohort of Expanding Access to MAT in County Criminal Justice Settings learning collaborative in 23 California counties under contract with California’s Department of Health Care Services (DHCS) with State Opioid Response (SOR) I funding. In spring 2020, additional counties joined, bringing the total to 32 counties which covered more than 80% of the state’s population. In September 2020, county teams who participated under SOR I as were invited to apply to continue in the learning collaborative under SOR II. New counties were also encouraged and invited to participate. Throughout 2021-2022, 32 CA counties participated under SOR II and 27 of these counties received an implementation grant. Implementation grants were used to supplement staffing costs, purchase medications, increase behavioral health services, provide harm reduction, develop reentry resources and support, and more. All project artifacts and resources have been archived on this website page. Throughout the State Opioid Response (SOR) I and SOR II funding and contracting periods, 37 different California counties have participated in the Learning Collaborative. As of August 2022, 31,968 individuals have received MAT while incarcerated in county jails participating in this Learning Collaborative across the 36 counties who have submitted data during SOR I and SOR II. The project engaged advisors from state associations of counties, sheriffs, narcotic treatment providers, the state prison system, and others to help break down barriers and to spread project information.
County Touchpoints Background
In August 2018, Health Management Associates (HMA) recognized the need to educate and engage other justice system stakeholders to support jail MAT implementation among key county partners and stakeholders. HMA established an in-person learning collaborative model across the state with six targeted stakeholder groups: probation, adult collaborative courts, youth/dependency courts, public defenders, district attorneys, and human services/child welfare. More than 1,500 persons from these stakeholder groups were trained under State Opioid Response (SOR) I. Under SOR II, the project operated two learning collaboratives that addressed MAT access issues identified in SOR I justice-related projects and built on the successful strategies engaged in the Jail MAT project: county child welfare systems, including dependency courts and juvenile probation, and special populations focusing on persons with co-occurring substance use disorder (SUD) and serious mental illness (SMI) outside of incarceration. There were 13 Child Welfare teams and 5 Special Populations teams representing 14 county teams at the intersection of SUD, justice, and child welfare systems. County teams received targeted education and training about opioid addiction and treatment in county criminal justice and child welfare systems and worked on system collaborations, resource alignment, system mapping and gap analysis. Additional optional workgroups (Plans of Safe Care and Child Welfare Data) were convened with the aim of enhancing processes, sharing best practices, and leveraging multi-county input to inform state and county decisions.
Project Leads
Other Resources
Apr 10, 2019
The DUI MAT Integration/Outreach Project provides the framework to optimize select DUI Programs to become new and effective access points for medication-assisted and other treatment modalities for OUD and PolySUD.
DUI MAT Providers receive support, training, tools, and resources to deliver DUI MAT services through integration into their DUI Programs. Project data defines the population of OUD and PolySUD persons who are reached through interaction with the DUI Treatment System.
The DUI MAT Project integrated into DUI Programs helps to reduce DUI recidivism, increases public safety on the roadways, and assists more people in accessing treatment for OUD and PolySUD.
CADTP is currently engaged with 58 licensed DUI Programs to participate in the DUI MAT Project, SOR IV.
For additional information, please visit the project website at: https://caduimat.com or email the project manager, Janice Forbes at janice@cadtp.org.
This project receives funding from the State Opioid Response (SOR) grant through the Substance Abuse and Mental Health Services Administration (SAMHSA).
CADTP DUI MAT Project Team
Apr 10, 2019
The California Hub and Spoke System aims to increase access to MAT services throughout the state, particularly in counties with the highest overdose rates. This program was modeled after the Vermont Hub and Spoke system, which successfully increased access to MAT in a rural state with little treatment infrastructure. The Hub & Spoke System has increased the availability of MAT for patients with opioid use disorder by increasing the total number of physicians, physician assistants and nurse practitioners prescribing buprenorphine. The Hub & Spoke System consists of narcotic treatment programs which are referred to as “Hubs” and serve as experts in treating opioid use disorder, as well as office-based treatment settings which are referred to as “Spokes” and provide ongoing care and maintenance treatment.
Hub & Spoke System participants also participate in Learning Collaboratives and have access to other training opportunities. The purpose of the Learning Collaboratives is to engage CA Hub & Spoke System provider and physician participants in the process of shared learning to facilitate implementation of services and provide opportunities for interactive problem solving. To learn more about the Learning Collaboratives and other technical assistance efforts, visit the CA Hub and Spoke System page managed by managed by UCLA’s Integrated Substance Abuse Programs (UCLA ISAP)..
Please contact sor3ae@ahp.net with any questions about this project.
This project receives funding from the State Opioid Response (SOR) grant through the Substance Abuse and Mental Health Services Administration (SAMHSA).
Project Leads
Other Resources:
Apr 10, 2019
CA Bridge is disrupting the addiction treatment landscape by ensuring that every hospital in California provides 24/7 access to evidence-based care, treating substance use disorder (SUD) like any other life-threatening condition. CA Bridge is working with hospital emergency departments (EDs) to provide immediate access to medication for addiction treatment (MAT) to anyone seeking help. CA Bridge is a program of the Public Health Institute.
Low Barrier MAT in the ED
Hospital EDs are an underutilized resource in the fight against the overdose crisis, as no other setting can provide 24/7/365 access to care combined with the high-level medical wrap-around services available in an ED. Key elements of the CA Bridge model include:
- Low-barrier, immediate access to MAT
- Navigation to ongoing care and community
- A culture of harm reduction
CA Bridge has conducted rigorous research on its program. Studies have shown that it is feasible to implement low-barrier MAT in all types of EDs, that it successfully reaches low-income patients, and that low-barrier MAT is effective even with the increasing presence of fentanyl in the drug supply.
Navigators are a critical component of the program. Guided by the principles of harm reduction, they work with hospital staff to change organizational culture to reduce stigma and put patients’ goals first. A study at Highland Hospital in Oakland demonstrated that patients seen by a navigator were three times more likely to be in follow-up treatment 30 days after their ED visit.
Statewide Implementation
CA Bridge launched at 52 hospitals in 2018 with a grant from the MAT Expansion Project. In 2020, a state appropriation of $20 million extended funding to 206 hospitals as part of the Behavioral Health Pilot Project. In the spring of 2022, a new appropriation of $40 million launched the CalBridge Behavioral Health Navigator Program which has supported 276 hospital EDs to provide MAT and behavioral health navigation to 65,000 people each year. Funding was awarded on a rolling basis between July 2022 and February 2023 with hospitals having 12-15 months for implementation.
Innovations for Better Care
Treating opioid use disorder with MAT in the ED is the foundation of CA Bridge. However, the negative consequences associated with substance use are deep and complex. To further expand opportunities to improve care for people who use drugs, CA Bridge is pursuing innovation at multiple levels:
- Low-Barrier MAT Clinics. Recognizing the challenge of transitioning patients from the ED to ongoing MAT, a growing number of CA Bridge hospitals have developed their own low-barrier MAT clinics. Sometimes known as “Bridge Clinics,” these facilities have proven highly successful in increasing follow-up rates.
- Harm Reduction in the ED—CA Bridge is introducing ED staff to harm reduction practices, such as distributing naloxone for overdose reversal, safe injection supplies, fentanyl test strips, and patient education on using drugs more safely.
- Youth—CA Bridge is making treatment in the ED more accessible to young patients to prevent youth from developing devastating use disorders.
- Mental Health—Many patients with SUDs also suffer from mental health conditions. Navigators will connect patients with community mental health providers to better leverage ED resources to provide integrated care to patients.
- Racial Equity—CA Bridge is committed to addressing the structural racism, which has led to drug policy and healthcare practices that create harmful disparities associated with drug use for people of color. CA Bridge supports decriminalizing drug use, develops equity and inclusion tools and trainings, and commits to increasing the representation of communities of color on the CA Bridge team.
- Alcohol and Stimulants—Alcohol accounts for more non-fatal ED visits than all other drugs combined, and CA Bridge is working with navigators and clinicians to make treatment for alcohol use disorder available in the ED. CA Bridge also offers training on managing stimulant use and helping patients use more safely.
Project Lead
Other Resources
CA Bridge has a searchable library of resources on many aspects of SUD care and navigation. Anyone is welcome to participate in the program’s regular trainings for clinicians, navigators, and program staff. Reach out to info@cabridge.org with any questions. Other resources include:
This project receives funding from the State Opioid Response (SOR) grant through the Substance Abuse and Mental Health Services Administration (SAMHSA).
