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Municipal Response to the Opioid Epidemic

MAPC | Promoting Smart Growth & Regional Planning

As communities throughout the Commonwealth grapple with the devastating effects of the opioid epidemic, municipalities have employed countless resources and implemented strategies to address the crisis.

On behalf of the 15 cities and towns of Greater Boston’s inner core that make up the Metropolitan Mayor’s Coalition (MMC), The Metropolitan Area Planning Council (MAPC) is leading an initiative to review and share municipal and regional best practices and strategies to respond to the crisis. Through a forum held in May 2017 and subsequent engagement with municipal public health and safety personnel from MMC communities, 4 key policy and project area were identified.

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

Upcoming Work & Events

MAPC continues to work on each identified issue area related to the opioid epidemic.

  • MAPC has engaged the Harvard CyberLaw Clinic to assist with the development of an information sharing toolkit that  was shared with municipal leads and health care center representatives at the Information Sharing Forum, hosted on June 6th.
  • MAPC intends to host another forum on connecting people to services in the Fall of 2018.
  • 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.

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

ProjectWorkstreams_07242018

funding reform

Grant Funding Reform

Many MMC stakeholders spoke to 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. MAPC sought to gain a more thorough understanding of the types of funding, their timings and requirements in order to identify gaps and determine improvements.

Activities Summary

To better understand the web of funding that supports MMC communities’ prevention, treatment and recovery programs we conducted interviews with the SAMHSA Regional Director and spoke to representatives from two communities, Revere and Medford, to better understand their overall funding for substance use disorder related programming. The conversations with Revere and Medford will result in a case study analysis of those two communities, specifically highlighting the gaps with current grant streams, use of municipal funds, and any need for additional resources. These case studies will serve as examples that can inform advocacy going forward. MAPC also held a Massachusetts Opioid Abuse Prevention Collaborative (MOAPC) Cluster Coordinator Meeting in the spring of 2018 to evaluate the benefits of the grant programs, consider problems or challenges, and to identify improvements that should be advocated for in advance of the expiration of this funding source.

MAPC is developing and implementing an advocacy strategy based on the recommendations identified to improve current grants.

Recovery Coach Regulation and Reimbursement Reform

Issue 1: reimbursement for municipal recover coaches

Recovery Coaches are individuals currently in recovery who have lived experience with addiction and/or co-occurring mental health disorders and have been trained to help their peers with a similar experience to gain hope, explore recovery, and achieve life goals. Recovery Coaches are actively engaged in their own personal recovery and share real-world knowledge and experience with others who are on their own recovery path. Evidence suggests that this type of peer-delivered support helps individuals achieve long-term recovery.

To date, municipalities that want to provide recovery coach services have had to rely on municipal funding. As of July 1st, approved recovery coach services are reimbursable under MassHealth, but communities remain uncertain about the requirements and processes to receive compensation for such provisions.

Issue 2: THERE IS A LACK OF CLARITY IN THE REGULATION AND CERTIFICATION OF RECOVERY COACHES

As more communities in the MMC region look to employ recovery coaches to assist individuals suffering from SUDs achieve long-term recovery, many voiced concern about the regulation and certification of recovery coaches. They cited unclear 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. Currently, recovery coach training and certification is provided from a variety of non-profit and private entities; however, no state-managed and approved certification for Recovery Coaches exists.

Improved Communication and Information Sharing

Issue: Restrictions on data sharing

A major challenge in providing care and ongoing support for people with opioid use disorders is effectively and legally sharing information. Individuals with a substance use disorder (SUD) interact with a range of organizations and individuals, from hospitals to police officers, recovery coaches, or family members.  Helping people with SUDs recover often requires that those parties work together and understand the circumstances of those in recovery in as close to real time as possible.  There are of course operational barriers to effective information sharing, but of equal importance is an understanding of the legal parameters that delineate what medical and addiction treatment information can be shared – and shared by whom, and with whom; with whose consent; in what formats; and when. MMC communities’ stakeholder identified information sharing as a key challenge in addressing the opioid epidemic for local governments.

Activities summary

In spring 2018 MAPC hosted a forum of municipal officials, state representatives, and health care providers to discuss existing barriers to effective information sharing. In advance of this convening, MAPC partnered with the Harvard Law School CyberLaw Clinic to create a resource for municipal officials improve information sharing approaches. This document was designed to address some basic questions for organizations and municipal officials about the laws that govern medical and addiction treatment related information. To achieve that goal, the document summarizes federal and state data sharing laws and their application; presents the role of consent regimes that enable information sharing; provides some scenario-based examples to inform practice; and describes data sharing models that currently exist.

MAPC is developing and implementing an advocacy strategy based on the recommendations identified at this forum. MAPC will also continue to partner with the CyberLaw Clinic as to create information sharing templates.

Connecting People to Services

Issue: PROVIDERS WANT TO BETTER CONNECT INDIVIDUALS WITH SUBSTANCE USE DISORDERS TO WRAP-AROUND SERVICES

Municipal service providers want to better connect individuals with Substance Use Disorders (SUDs) to immediate treatment options and a continuum of wrap-around services that 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 models of successful wrap-around programming from Metro Mayors communities including Boston PAATHS (Providing Access to Addictions Treatment, Hope, and Support), the Chelsea Hub, and Bay State Community Services’ Impact Quincy.

MAPC began detailing each program through interviews with the directors and program managers of each wrap-around service program. In addition, MAPC conducted a site visit of the Boston PAATHS program to understand the infrastructure and resources required for a PAATHS program to be successful. Similarly, MAPC attended a Hub training session to understand the resources required to start a Hub, the municipal resources required for sustaining the Hub, and how it is implemented.

MAPC has developed profiles of each program that will serve as a basis for a toolkit to be provided to municipal stakeholders. The toolkit will identify the key elements to success and measures or resources that cities and towns can adopt to implement the various components of the wrap-around service program. In addition, the toolkit will provide a broad overview of other state and nationwide program model that have been successful outside of the MMC region. This information will be presented at a forum in the fall of 2018.