Addiction Treatment Starts Here: Equity-Centered Community Learning Collaborative | Invitation to Apply


Made possible by the California Department of Health Care Services

Introduction

The Center for Care Innovations (CCI) is pleased to announce the 2023-2024 Addiction Treatment Starts Here Equity-Centered Community Learning Collaborative (aka “ATSH Equity Collaborative”), our fourth wave of programming to support community health centers’ identification and treatment of substance use disorders. The goal of the ATSH Equity-Centered Community Learning Collaborative is to address, and ultimately eliminate, substance use disorder (SUD) inequities

 

Drivers of systemic inequities that include the criminalization of substance use, racism, and structural barriers to health services drive a tremendous treatment gap: only 5% of people with substance use disorders get treatment for these conditions any given year. Closing this treatment gap will require a health equity approach to community health center-based substance use disorder treatment.

 

This ATSH Equity Collaborative will support up to 20 primary care health centers in California with existing MAT programs to expand the reach of these MAT program through improving health equity by 1) identifying and addressing inequities in outcomes and treatment for patients with SUDs, 2) developing effective partnerships with other clinics and nonmedical community based organizations (including, but not limited to, addiction treatment programs, street outreach programs, syringe service and other harm reduction programs), and 3) extending the focus to include multiple substances including opioid, stimulant, alcohol, and/or tobacco use disorders.

 

Health centers accepted into the program will be eligible for up to $75,000 in funding. The 16-month learning collaborative will launch in February 2023 and conclude in June 2024. In addition to funding, the ATSH Equity Collaborative will offer learning sessions and webinars led by experts in the field, site visits to organizations with exemplar MAT programs that center equity and racial justice, 1:1 coaching, and other technical assistance to support each organization to expand the reach of the existing MAT programs and identify and address inequities in SUD treatment and outcomes. The ATSH Equity Collaborative is funded through the State Opioid Response Grant as part of the MAT Expansion Project from the California Department of Health Care Services.

Background:

Over the last six years, CCI designed and led three programs focused on improving treatment for people with opioid use disorder (OUD). Combined, these programs supported more than 100 primary care health centers in California with designing new or expanding existing MAT programs. MAT includes FDA-approved medications for OUD: ­methadone, buprenorphine, and naltrexone.

 

The programs increased the number of active MAT prescribers by 191 providers -equivalent to more than two active prescribers per participating clinic. In addition, there was a combined increase of more than 2,199 patients receiving MAT. Many participants doubled or tripled the number of patients accessing MAT for OUD. Central to these successes was the creation of learning communities which offered a structured forum to develop new capabilities, share best practices, and discuss lessons learned.

 

Despite gains made in these areas, California saw dramatic increases in opioid related deaths through the COVID-19 pandemic (a 63% increase in opioid related deaths through 2020 and another 10% increase through 2021),[1]and we are now more aware than ever of the stark inequities in SUD outcomes and treatment access for Native American/Alaska Native  and Black and African American people (in 2021, Black/African American opioid related overdose deaths were 26% higher than Whites, and Native American/Alaska Native deaths were 45% higher than Whites). [2]

 

CCI’s 2023-2024 ATSH programming includes 1) the new Equity-Centered Community Learning Collaborative, focused on assessing and responding to SUD inequities and expansion of MAT access through community partnerships and 2) the Learning Network, geared towards the general improvement and sustainability of MAT programs within community health centers through a less intensive, completely virtual program. This RFA is for the Equity-Centered Community Learning Collaborative. To view the RFA for the Learning Network, click here.


Learning Collaborative

The ATSH Equity Collaborative builds on federal, state, and local commitment to address the overdose crisis. We know that medications for OUD are incredibly effective at preventing opioid overdose. Evidence demonstrates that patients with OUD who use MAT can reduce their risk of all-cause mortality by 50%[1] For overdose survivors, that percentage can climb to 60%[2] Despite this impact, nearly 80% of Americans with OUD do not receive MAT.[3] This 80% of the population is not evenly distributed: American Indian/Native Alaskan and Black and African American people access MAT at lower rates than population averages, highlighting the importance of equity approaches for MAT expansion.[4]


Addiction Treatment Starts Here is funded through a generous grant from the California Department of Health Care Services as part of its portfolio of projects addressing the opioid crisis. Combined, these projects are known as the California MAT Expansion Project and are administered under the umbrella of California’s State Opioid Response grant. The MAT Expansion Project aims to address the opioid and stimulant use disorder crisis by improving access to treatment, reducing unmet treatment need, and reducing opioid and stimulant-related overdose deaths through the provision of prevention, treatment, harm reduction and recovery service activities. More information on California MAT Expansion Projects is available here.


Program Components:

Curriculum Topics:

The curriculum has been designed by state and national experts and is based on lessons learned from CCI’s previous MAT collaboratives. Content will address clinical and operational issues associated with MAT equity, including but not limited to:

 

   Health equity foundations, strategies for identifying health inequities, and implementing a health equity program

    Expanding primary care MAT program models, including community partnerships with community-based organizations and/or involving peer support workers, to reduce SUD treatment, access, and health outcome disparities

    Patient identification, selection, and outreach

 Staff training and education for MAT, especially addressing equity and relationships with community partners

  Assessing levels of care and building strong referral pathways to specialty care when appropriate

   Strategies to reduce barriers to care – specifically racism, discrimination, stigma, and trauma – by actively embracing health equity practices

      Harm reduction

    Trauma-informed care

    Tools and approaches to address stimulant use disorder and manage co-occurring SUDs, such as alcohol, methamphetamine, cocaine, tobacco, and/or benzodiazepine use

   Systems practice tools to support building partnerships and collaborations across care transition points, such as with acute care hospitals with emergency departments, sobering centers, behavioral health programs, schools, and the justice system


The Equity-Centered Community Learning Collaborative Provides a $75,000 Grant for Up To 20 Community Health Centers. 

ATSH Equity Collaborative Activities

CCI designed a mix of program activities that have proven effective in enabling teams to expand access to MAT. Program activities include:

 

    3 Learning Sessions: A mix of virtual and in-person learning sessions to share and learn from peers and experts

  2 Webinars: To orient teams on the program requirements, evaluation, and data collection

      Site Visits: (Optional) Learn from sites with mature MAT programs, that center equity and racial justice. Site visits are likely to include virtual and in-person options

      Half-day training addressing a specific topic (e.g., equity, harm reduction)

  1:1 coaching to support your team. Coaches’ expertise include MAT clinics, health equity, systems practices/community partnerships, and quality improvement

   Virtual role-based peer forums, e.g., one group for nurses, another for prescribers, or SUD counselors, etc.

     Online community to share resources and communicate

   Grants of $75,000 to help offset the costs of participating in program activities, support community linkages and community partnerships, regularly submit data, and/or expand and sustain a MAT program

Grant Installment Details

Installments are typically released to participants within two months of deliverable due dates.

1.    $30,000 for meeting Deliverable No. 1: Participation by your team, including a senior leader, in the February 28, 2023, kick-off webinar and submission of baseline data on the measure set and the capability assessment (both due April 30, 2023).

2.    $20,000 for meeting Deliverable No. 2: Submitting three quarters of data, the midpoint capability assessment, a progress update, and participating in learning sessions 1 and 2.

3.  $25,000 for meeting Deliverable No. 3: Submitting two quarters of data, the final capability assessment, a final progress update, and attending learning session 3.


Requirements to Apply and Participate:

Eligibility

Organizations in California that provide comprehensive primary care services to underserved populations are eligible to apply. Organizations must be non-profit and tax exempt under 501(c)(3) of the Internal Revenue Service Code or a governmental, tribal, or public entity. This includes: 

 

      Federally Qualified Health Centers (FQHCs) and FQHC look-alikes.

      Community clinics, rural health clinics, and free clinics.

  Ambulatory care clinics owned and operated by local jurisdictions such as public hospitals.

      Indian Health Services clinics.

 

Applicants should not be ‘new’ to MAT, in other words they should have an established MAT program that has been in operation for not less than one year, with multiple active prescribers working within an established multidisciplinary team (e.g., nurse, SUD counselor, peer support worker, other behavioral health practitioner) that meets regularly to maintain and improve the MAT program.

 

We encourage applicants to apply who already have, or have begun to, develop partnerships with key stakeholders in their community (e.g., health department, schools, needle exchange, justice, etc.). It’s suggested, if applicable, to involve the partner(s) in the application stage, in particular what the clinic and their community partner hope to achieve together and set as aims for the collaborative. We are also welcoming applicants who are just starting out with community linkages to propose other entities/organizations within their community with whom they aim to develop strategic partnerships.

 

CCI will accept applications from multiple clinic sites within the same organization. Up to three clinic sites per organization can apply. Project team members may overlap, but each site must define the team responsible for its MAT program and their site-specific goals. Each site selected will be eligible for a grant of up to $75,000. 

 

 If you have questions about whether you qualify, please email Angela Sherwin, program manager, at angela.sherwin@careinnovations.org.

 

Timeline

The Addiction Treatment Starts Here Equity Collaborative runs from February 2023 to June 2024. Key dates include: 


      Request for Applications Released: November 9, 2022

      Informational Webinar: November 15, 2022

      Application Deadline: December 12, 2022

      Cohort Announced: February 15, 2023

      Program Start: February 28, 2023

      Kick-Off Webinar: February 28, 2023

      Measure Set & Capability Assessment Office Hours: March 2023

      Learning Session 1: 2-day in-person session: May 2023

      Learning Session 2: Virtual session: September 13, 2023

      Learning Session 3: 2-day in-person session: March 2024

      Program End: June 30, 2024

 

Participant Expectations

Based on CCI’s previous MAT collaboratives, we identified factors that contribute to an organization’s success in implementing and expanding MAT programs. We designed participation requirements with this in mind. By applying to join ATSH Equity Collaborative, applicants agree they will:

 

1.    Establish Leadership Sponsorship and Develop a Core MAT Team

·       Leadership: Commit to at least one member of your executive or senior leadership actively sponsoring and championing this project, as demonstrated through a letter of leadership support committing to engage in the program in at least 3 ways:

o   Attend the February 28, 2023, kick-off webinar where the CCI team will describe program goals, expectations, and requirements.

o   Hold periodic (monthly or bi-monthly) leadership conversations to review progress and identify barriers.

o   Align team/staff resources and time to dedicate to this project.

 

·       Core MAT Team: In general, we recommend teams of 4-6 people. We recognize that some roles overlap (e.g., your X-waivered clinician may also be your clinical champion) so you may list the same person for more than one role. You will list your core team members in the ATSH Equity Collaborative application. Core teams should include the following roles:

o   Program lead: Responsible for day-to-day activities of the program and serves as the point person for communications with CCI.

o   X-waivered clinician: Prescriber with DATA 2000 X-waiver providing services at your site.

o   Clinical champion: A clinical leader, such as a Behavioral Health Director, Medical Director, or Chief Medical Officer.

o   Other staff: At least one non-prescribing clinician involved in MAT.  Examples of other staff include nurses, SUD counselors, care coordinators/navigators, medical assistants, social workers, etc.

o   Data lead: The point person for submitting data on the measure set.

o   Senior leader: Chief executive officer, executive director, or chief operating officer.

o   Behavioral health staff: Drug and alcohol counselors, licensed clinical social workers, etc. 

 

·       Extended Team: A Community partner lead or liaison (can be internal or external to your clinic organization) that your Core MAT team is partnering with to address substance use disorder in your community.

 

2.    Actively Participate in the Following Events and Activities:

      Learning Sessions and webinars: Participation by at least three core team members in all three learning sessions and webinars.

      Measurement:

      Capability assessments: Evaluate your current state, using a tool that assesses capabilities important to MAT. This will be completed three times (baseline, midpoint, endpoint).

      Measure set: Submit data on a quarterly basis on the program measure set, that is disaggregated by race/ethnicity, gender in order to identify and understand inequities.

      Data lead: Assign a data lead who will take responsibility for submitting numerator and denominator information on the measures and be a liaison to ATSH’s evaluation team.

      Establish MAT Program Goals: Submit aim statements, driver diagram, and work plan for your MAT program that addresses SUD inequities in your community. Templates will be provided along with guidance and support.

      Progress Reporting: Update CCI on your progress via conversations that the CCI team will set up at mid-point and end-point of the program.

 

We also ask that your team actively share challenges, opportunities, bright spots, and questions with your fellow program participants. This sharing can be done via participation in learning events, using the online community, and conducting regular calls with your coach.

 

3.    Work with Your ATSH Equity Collaborative Coaches


Each team will have access to a rotating group of coaches with expertise in MAT clinics, health equity, systems practice/community partnerships, and quality improvement. In our experience, teams that make the most progress set aside dedicated time for multiple team members to meet regularly with their assigned coaches. Each team will establish regularly scheduled and protected time to meet with their coaches monthly. 

 

What Makes a Strong Application

CCI is looking for applicants with the following characteristics: 

   Organizations with established MAT programs in at least one site and spreading to another site. This commitment is demonstrated by having:

      A clinician champion who advocates for and provides clinical support to the MAT team.

      A commitment to protect the time of core team members needed for their participation in ATSH Equity Collaborative activities.

      An administrative champion who supports your team, including enabling protected time to participate in ATSH Equity Collaborative activities and improvement work at your site.

      A core team that actively participates in ATSH Equity Collaborative activities and in work to expand their MAT program and address SUD equity and community partnerships.

  Leadership is fully engaged, and sites can share at least 3 concrete ways that leadership is engaged.

 Organizations that are led by, and serve, people of color or those who are most affected by inequities. We’re also interested in hearing how your organization is working towards this.

Demonstrated commitment to equity and racial justice. Site can provide concrete examples of engaging the voices of lived experience and centering equity in areas of strategy, policies, planning, hiring, training, and/or populations served.

 Basic partnership established between the site and a community partner with stated common goals.

    Readiness to actively share approaches and lessons learned with other teams.

Ability to submit quarterly data on the program measure set, disaggregated by race/ethnicity, and to submit a baseline, midpoint, and endpoint capability assessment.

 

To apply for one or more of your clinic sites, please read through the instructions on the next page. Each site interested in participation must complete its own application, including describing site-specific goals.


How to Apply

 

Step 1: Attend Informational Webinar (Optional)

Interested organizations are encouraged to participate in an informational webinar on November 15, 2022 (12 pm - 1 pm) to hear a program overview and ask questions. Register here

 

Step 2: Apply Online

Applications must be submitted online by December 12, 2022, at 5 pm PT. The program cohort will be announced by February 15, 2023.

 

Applications should include the following:

  1. Application Form
  2. 501(c)3 tax status documentation
  3. Narrative response – see the narrative questions below
  4. Budget proposal, using CCI’s budget template (download)
  5. Letter of support from leadership: This letter should be from a senior leader who will be involved in your project and should be no more than 1 page.
  6. Organization logo image file (300x300px minimum, png format).

Application Narrative Questions

Please respond to the following questions in a Word or PDF document and upload it to the Application Form.

  1. Please provide demographic data on your organization’s leadership and population served using the table below.

 

 

% patients served by organization

% people on executive leadership team

% people on staff

% people on board of directors

Racial/Ethnic

American Indian or Alaska Native

 

 

 

 

Asian (Asian Indian, Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or Other Asian)

 

 

 

 

Black or African American

 

 

 

 

Hispanic, Latino, or Spanish Origin

 

 

 

 

Pacific Islander (Native Hawaiian, Guamanian or Chamorro, Samoan, or Other Pacific Islanders)

 

 

 

 

White

 

 

 

 

More than one race

 

 

 

 

Other race not listed

 

 

 

 

Unknown

 

 

 

 

TOTAL

 

 

 

 

Gender

Female

 

 

 

 

Male

 

 

 

 

Gender diverse or transgender

 

 

 

 

Other

 

 

 

 

TOTAL

 

 

 

 

Sexual Orientation

Straight or Heterosexual

 

 

 

 

Lesbian or Gay

 

 

 

 

Bisexual

 

 

 

 

Something else (including queer, pansexual, and/or questioning)

 

 

 

 

Don’t know (person’s response)

 

 

 

 

Decline to Answer

 

 

 

 

Unknown

 

 

 

 

TOTAL

 

 

 

 

 

  1. What does equity mean to your organization? (Up to ~100 words) 
  2. How has your thinking about equity and racial justice informed how you develop and implement programs in your organization? Please share one or more concrete examples. (Up to ~250 words)
  3. How will equity inform your MAT program goals? Please consider why addressing equity is important for your patient population and community. What do you know about SUD outcomes and treatment in your community? (Up to ~250 words)
  4. Have you developed and nurtured community partnerships? Please share at least 1 concrete example. (Up to ~250 words)
  5. Please name at least 1 community partner with whom you aim to partner. How would you describe the current state of your partnership right now? What do you and your community partner hope to achieve in the ATSH Equity Collaborative? (Up to ~250 words)
  6. Describe the current state of MAT care within your organization generally and within your site specifically. If your organization only has a single site, please note this in your response. In your response, please address:
    1. The infrastructure you have in place to identify and treat patients with SUD in primary care, including the number of providers actively prescribing MAT, support staff dedicated to the MAT program. (Up to ~100 words)
    2. Behavioral health services you have in place for patients with SUD (e.g., counseling, support groups). (Up to ~100 words)
    3. Any barriers to care, challenges, or improvement opportunities your clinic faces. (Up to ~100 words)
    4. Anything else you’d like to add about your MAT program, including the number of patients in the program. (Up to ~100 words)
  7. What specific and measurable aim statement do you hope to achieve with your community partner(s) as a result of participating in the ATSH Equity Collaborative? At a minimum, your response should include the following: 
    1. The specific SUD inequities your program would address, in other words which population(s) do you plan to focus on in the ATSH Equity Collaborative? Participants should identify one or more populations such as: Black and African American, Latinx, Asian American, Pacific Islander, American Indian or Alaska Native, etc.
    2. A SMARTIE format for the aim statement so that it includes the elements of being Specific (what are you improving, which population/location), Measurable (by how much are you improving, from baseline to what target?), Ambitious (how is the goal going beyond incremental change), Relevant (e.g., addressing inequities in SUD outcomes), Time-bound (by when will you reach the goal), Inclusive (the right stakeholders are involved, including those traditionally marginalized), Equitable (addressing disparities, injustice, or oppression)

You may have intermediate aims that describe measurable changes for the following:

a.    Number and demographic breakdown(race/ethnicity) of active prescribers of medications for OUD.

b.    Provider and staff training, education, and engagement in addressing equity.

c.     Community partnerships and linkages.



Upload and submit all application materials via this form by December 12th, 2022 by 5pm PST.


Upon reviewing applications, CCI may request follow-up information or schedule a phone call with your team. We intend to select 20 teams for the program. CCI will contact you by February 15, 2023, to let you know whether you have been accepted into the program. In the meantime, please hold February 28, 2023 (12 pm - 1:30 pm) for the Addiction Treatment Starts Here kick-off webinar. You should invite your MAT core team and a senior leader from your organization. Once you have been accepted into the program, we will send webinar registration information, along with the URL to join the meeting.



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