Facilitating MAT Acceptance & Implementation in Problem Solving & Felony Courts

National Development And Research Institutes, Inc., New York NY

Investigators

Abstract

? DESCRIPTION (provided by applicant): Facilitating MAT Acceptance & Implementation in Problem Solving & Felony Courts Despite high prevalence of opioid addiction among criminal justice clients there has been limited penetration of one of the most effective interventions; medication assisted treatment (MAT; methadone, buprenorphine, naltrexone). Our recent survey of Drug Courts identified staff concerns such as diversion, misuse and uncertainty about the efficacy of MAT as barriers to MAT implementation (Matusow et al., 2013). Despite these barriers, 59% indicated that with proper evidence MAT could be considered as a treatment option. To spur implementation of MAT in court settings, we propose a Stage I study to develop and test the feasibility of an interactive eLearning modality and an eLearning + an organizational approach (Technology Transfer [TT] model) to advance knowledge and facilitate inclusion of MAT in the criminal justice system for opioid-addicted clients. The specific aims are: Aim 1. Develop an innovative eLearning (web-based) intervention that will provide information about risks and benefits of MAT to help court staff determine whether MAT is suitable for selected drug and felony court clients. The protocol will include group discussions with both MAT-friendly and MAT-averse court personnel and inclusion of a MAT Advisory Panel (MAP), a team of experts in the implementation of MAT in criminal justice settings. Through an iterative process we will develop a consensual outline representing topics that would be addressed by our web-based intervention. Informed by diffusion of innovations theory, the eLearning modules will be enhanced by adding testimony from treatment providers and court staff about their experiences with MAT. Aim 2. Develop a TT intervention to facilitate courts' to engage in case-by-case inquiries to determine whether and under what circumstances to permit MAT. A TT change team coach will meet with court staff and treatment providers to: 1) Broker relationships between MAT providers and courts; insuring that MAT providers will accept court referred individuals; 2) Address issues of availability, access (including cost), and diversion with court personnel in order to expand policy and practice to include MAT; 3) Work with local MAT and other treatment providers to help create an environment in which MAT is accepted as part of the constellation of available treatments; 4) Help develop protocols to assure that MAT benefits are sustained such as patient-provider agreements, ongoing monitoring, and support once a client has been referred to treatment. Aim 3. Conduct a small-scale effectiveness trial of the eLearning intervention, and eLearning + change team intervention (TT). Targeting courts that do not place their opioid-dependent clients in MAT, 24 courts will be randomly assigned to 1 of 2 conditions: 1) eLearning; or 2) eLearning followed by the change team intervention (TT condition). Primary outcomes include inclusion of MAT as a treatment option, MAT referrals and MAT enrollment; as well as increased knowledge about MAT. We expect this development/pilot project will lead to a protocol to implement evidenced-based therapy (MAT) in drug and felony courts; a setting with high numbers of opioid-addicted clients.