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Municipal Response to the Opioid Epidemic

MAPC | Promoting Smart Growth & Regional Planning

The Metropolitan Mayors Coalition (MMC) convened a forum in May 2017 to address the opioid crisis that shared municipal and regional best practices for intervention and response. Attendees at the forum identified key policy and project recommendations, which were developed further through subsequent interviews with key municipal public health officials.

Our work to date has focused on reimbursement and funding reform; improved communication and information sharing; connecting people to needed services; and recovery coach definition and certification reform.

Resources

Questions?

For more information about MAPC's efforts to address the Opioid Epidemic, please contact:

Christine Howe | Grants Management and Procurement Specialist
Sharon Ron | Public Health Research Analyst

Community Response Efforts

A one-stop center for individuals, families and communities in the greater Boston area seeking treatment and other resources for themselves or their loved ones, the Boston Public Health Commission’s PAATHS (Providing Access to Addictions Treatment, Hope and Support) program is all about linking people to care. On-site staff are able to assess needs, plan the most appropriate treatment path, and guide individuals through the process. Although a City of Boston program, PAATHS’ open-access, walk-in location and phone hotline support individuals from across the Commonwealth.

The Chelsea Hub is a coalition of health, government, and community organizations that meet weekly to identify individuals or families at elevated levels of risk and strategize ways to intervene. Hosted by the Police Department, the Hub’s focus is linking people to support services within the community and mitigating risk. The Hub model was adapted from a successful Canadian program; already several Massachusetts cities have begun the process of adopting Hub models in their communities.

Peer-based recovery support specialist, often called recovery coaches, are a valuable community-based resource for those in recovery from a SUD. This service role has been implemented in response to the opioid crisis, to bridge the gap between treatment in an institutional setting and sustainable recovery within each individuals’ natural environment. The model is growing rapidly; peer-based services have been implemented in almost every municipality in the MMC region, whether through direct service provision or subcontracting for services, and have become a staple of successful strategies for assisting persons with a SUD.

Upcoming Work and Events

MAPC continues to work on each identified issue area related to the opioid epidemic. In particular, MAPC has engaged the Harvard CyberLaw Clinic to assist with the development of an information sharing toolkit to allow communities to successfully navigate state and federal privacy laws. This toolkit was shared with municipal leads and health care center representatives at the Information Sharing Forum, hosted on June 6th.

Building off of successful examples of community based response efforts, MAPC intends to host another forum on connecting people to services in the Fall of 2018. This meeting will provide municipalities with a tool and resource to expand service delivery and better connect individuals to short term and long term treatment options.

MAPC continues to meet with local, state, and federal officials to address the issues municipalities are facing as a result of the epidemic, including discussing opportunities for funding reform and advocacy.
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Reimbursement and funding reform

Issue 1: reimbursement for municipal recover coaches

To date, the provision of recovery coach services has relied heavily on municipal funding which may be difficult to sustain or increase. State regulations provide for Medicaid reimbursements for approved recovery coach services but communities are uncertain about the requirements and processes to receive compensation for such provision.

Issue 2: Grant Funding Reform

Many MMC stakeholders have mentioned the difficulties surrounding funding sources for their communities’ substance use disorder programs and initiatives. Communities have found that existing state and federal grant programs are inflexible and unpredictable. This has forced them to increase funding from their own operating budgets and/or obtain private donations. Because of the complexity of the epidemic which intersects public health, mental health, the criminal justice system, and a number of other intervention points, it is difficult to track what funding is available from federal and state sources for the opioid epidemic. We sought to gain a more thorough understanding of the types of funding, their timings and requirements in order to identify gaps and determine improvements.

Improved Communication and Information Sharing

Issue 1: Restrictions on data sharing

Restrictions on data sharing (as regulated by the Health Insurance Portability and Accountability Act or HIPAA) between health/social service providers and municipal officials make it hard to effectively track the medical and service interventions Substance Use Disorder patients (SUDs) are receiving and to respond accordingly. Examples of agreements or programs that enable effective data sharing between service and municipal partners exist and could provide models for MMC communities to follow.

Activities summary

MAPC spoke to a number of municipal stakeholders who detailed their information sharing barriers and identified two local examples of current information sharing contracts including a model that the city of Chelsea, social service providers, and the Whidden Hospital have used. MAPC also identified examples of electronic data sharing tools both from the U.S. and abroad. In addition, MAPC is coordinating with a professor at Harvard Law School’s Cyberlaw Clinic to look at existing models of information sharing to see how they can be applied more broadly.

Next Steps

  1. Information Sharing Forum: Spring 2018 (Details TBD) – The objective of this forum will be to invite all stakeholders and relevant municipal employees/officials to learn about successful sharing of information critical to providing effective service delivery to individuals with substance use disorder between communities and service providers such as hospitals and health alliances.
  2. Collaborate with Harvard Cyberlaw clinic to determine best practices for HIPAA Compliance
  3. Present findings and information to Metro Mayors Communities

Connecting People to Services

Issue: Providers want to better connect individuals with SUDs

Municipal service providers want to better connect individuals with SUDs to immediate treatment options and a continuum of wrap-around services to support long-term recovery. Mechanisms to address this include the expansion of existing, successful programs to enhance recovery services and the development of new tools to support these vital connections.

Activities summary

MAPC identified three programs that provide successful access to wrap around services and began a case study analysis of those programs. MAPC spoke to the directors and program managers of the Boston PAATHS, CAPIC and Chelsea’s HUB, and Impact Quincy’s Bay State Community Services to develop profiles of each program.

Next Steps

  1. Connecting People to Services Forum: Spring 2018 (Details TBD) – This meeting will present case studies of programs that successfully connect SUDs to wrap-around services to ensure long-term recovery.
  2. Initiate program partnership discussions and develop partnership proposals based on the program profile identified

Recovery Coach Regulation and Certification Reform

Issue: regulation and certification of recovery coaches by the Bureau of Substance Abuse Services (BSAS)

Multiple communities voiced concern about the regulation and certification of recovery coaches by the Bureau of Substance Abuse Services (BSAS). They cited poor definitions and criteria for certification as well as uncertainty around standards for individuals in related functions, such as program navigators or public health advocates, and the roles and responsibilities each profession possess.

Activities summary

MAPC researched and identified existing certification requirements for recovery coaches. In addition, MAPC spoke to a certified recovery coach supervisor, attended a forum on the peer-to-peer recovery support workforce, and interviewed the Recovery Support Services Coordinator at BSAS. MAPC also tracked provisions in Governor Baker’s CARE Act relating to recovery coach regulation and certification and will be submitting recommendations to legislators on that subject.

Next Steps

  1. Review MassHealth definition of “recovery coach” and approved criteria utilized for Medicaid reimbursement program
  2. Convene municipal stakeholders, BSAS, and DPH representatives to discuss identified gaps in the certification process and ways to improve the process.
  3. Monitor legislation related to certification of recovery coaches.
  4. Present findings to Metro Mayors Communities.