Addiction Treatment Starts Here (ATSH) Learning Collaborative - Application Submission Form

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Background

ATSH is a program of the Center for Care Innovations (CCI) and funded by the California Department of Health Care Services. CCI seeks up to 30 primary care health center sites in California to participate in Addiction Treatment Starts Here, an 18-month learning collaborative designed to support health centers with designing and implementing new MAT programs in primary care. Applications for the ATSH Learning Collaborative must be submitted by 5 pm PT on January 19, 2021. Please refer to the ATSH Learning Collaborative Request for Applications (RFA) for details about the program, participation requirements, and narrative questions. 


If you are interested in applying for CCI's other offering, the Addiction Treatment Starts Here Learning Network, you can access the application form here


Organizations may submit a single application or multiple applications. The following describes the two options: 

  • Option 1: Single Site: Consider submitting a single application for a $45,000 grant if: 
    • Your organization has a single site that provides patient care; OR
    • Your organization has multiple sites, but you are only applying for a single site to start a MAT program; OR
    • Your organization has multiple sites but your MAT program model will consist of a single MAT team that works across multiple sites
  • Option 2: Multi-Site: Consider submitting multiple applications for different clinic sites (up to 3), with each site eligible for a $45,000 grant, if: 
    • Your organization has multiple sites; AND
    • You intend to start a distinct MAT program at each site for which you are applying for a grant and that MAT program is designed to target that site's patient population and has goals that are specific to that site; AND
    • The site has a MAT team that is largely unique to that site (e.g., some crossover between sites is allowed but some team members, such as front-line staff, should be site-specific); AND
    • You intend to submit data on the ATSH program measure set separately for each accepted site

Organization Overview




Fiscal Sponsor Information


















Site Specific Characteristics




For Each of the Options Below, Enter the Number of Patients at Your Site With Stimulant Use

Disorder Who Receive the Following Services: If unsure, state "unsure/don't know"









Racial/Ethnic Data

The following questions are based off of the HRSA Uniform Data System report.  







Core MAT Team

Please list the contact information for each member of your anticipated team at this site. In general, we recommend teams of 4 - 6 people. Teams should include individuals who can fulfill the following roles: program lead, clinical champion, x-waivered clinician, and front-line staff person. We recognize that some roles overlap (e.g., your x-waivered prescriber may also be your clinical champion) so you may list the same person for more than one role. The individuals you list below are those that you expect will participate in all ATSH activities and will also be involved designing and implementing your MAT program. See the RFA for more information about recommended team members. 

Program Lead Contact Info

The program lead contact will serve as the point person for communication with CCI and for day-to-day management of ATSH-related program activities. This may include reminding team members about upcoming events, participating in evaluation-related interviews and discussions, and other activities.







Clinical Champion Contact Info






X-Waivered Clinician Contact Info






Other Team Member Contact Info








Senior Leader Contact Info

Applicants must have an identified senior leader who will attend the March 3, 2021 kick off call and the final program webinar on August 23, 2021. Applicants should list an individual who can champion the MAT program within the organization, including supporting protected time to participate in MAT program activities. 







Application Components



This letter should be from a senior leader that will be involved in your project (e.g., cheif medical officer) and should be no more than 1 page.