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MAT Learning Collaborative

The opioid epidemic remains a pressing issue for the Staten Island community. The scourge of opioid misuse, addiction, and deaths has hit Staten Island harder than anywhere else in New York City. The borough is a hotspot in the addiction epidemic but has also been a bright spot in the initiation of innovative programs to address this challenge.

On Staten Island, there has been significant efforts to improve capacity and expand access to Medication Assisted Treatment (MAT). MAT with medications like buprenorphine is an evidence-based best practice for treating opioid use disorder (OUD). The following initiatives have increased the number of waivered clinicians on Staten Island:

  • Ancillary withdrawal management services offered by OASAS licensed treatment programs
  • Integration of buprenorphine treatment into primary care practices
  • Buprenorphine induction in emergency departments
  • Buprenorphine expansion detailing campaigns and training

The Importance of Medication Assisted Treatment (MAT) for Opioid Use Disorder (OUD) on Staten Island

To supplement these efforts, Staten Island will benefit from a Learning Collaborative on Medication Assisted Treatment that brings various stakeholders to collaborate on improving the utilization of the buprenorphine waiver to improve access and delivery of MAT.

If you are interested in taking part in the Learning Collaborative, please RSVP here.

Implementation Plan/Timeline
The Learning Collaborative kicked off in February 2019 and convenes monthly sessions through June 2019. A total of five two-hour sessions are held with stakeholders represented in each Spoke. Each session is facilitated by the Hub group including a Faculty/Content Expert, and has a Continuing Education presentation, practice case discussions, practice recommendations, and review of quality improvement measures. Community Spoke participants receive continuing education units (CEUs) as appropriate for sessions attended.

Goals
The main goal of the SI MAT Learning Collaborative is to improve the utilization of the buprenorphine waiver among clinicians to improve access and delivery of MAT. Key objectives include:

  • Increase prescriber understanding of MAT evidence-based guidelines and best practices
  • Increasing prescriber confidence and access to resources to manage complex cases
  • Increase provider engagement and education
  • Build linkages between SUD programs, ambulatory care settings, and emergency departments
  • Establish common language for all providers (physicians, nurses, social workers, counselors, etc.) to communicate to the community about MAT or shared messaging to patients
  • Engage peers/people in recovery to hear their experiences and perspectives
  • Expand peer, family and substance user engagement and education
  • Present the VBP business case for MAT services

Structure and Process
The Learning Collaborative uses a Hub and Spoke model as illustrated below to develop a network where MAT-specific knowledge and best practices are shared.

The Learning Collaborative combines continuing education, consultation, and clinical support from content experts. In addition, sample cases are reviewed to tackle several barriers and system gaps such as provider misconceptions about MAT guidelines, community awareness and acceptance of MAT, protocols, and benefits, stigma, and others.

Key deliverables and quality metrics are developed to guide the activities of the Learning Collaborative and to ensure effective results. Outputs of the Collaborative are shared widely with the providers and community members. Key deliverables and quality metrics include but not limited to:

  • Pre and post knowledge assessment
  • Increased utilization of waivered capacity in underutilizing cohort (rates to be determined)
  • Increased adoption in emergency departments
  • Improved treatment retention rates in OASAS programs from participants
  • Participation and session schedules
  • Continuing Education/Training presentations
  • Case presentations
  • Final Summary/Evaluation Report

 

 

 

Harshal Kirane, MD
Director of Addiction Services
Northwell Health –  Staten Island University Hospital

Dr. Harshal Kirane is a psychiatrist on Staten Island and is affiliated with Staten Island University Hospital. He received his medical degree from University of Texas Southwestern Medical School. He is one of 36 doctors at Staten Island University Hospital who specialize in Psychiatry. His board certifications include:

  • Psychiatry – American Board of Psychiatry/Neurology-Psychiatry
  • Addiction Psychiatry – American Board of Psychiatry/Neurology-Psychiatry

Learn more about Dr. Kirane here.

 

Amanda Wexler, LCSW, CASAC-T
Amanda Wexler is a social worker who serves individuals experiencing substance use disorders and their families. Amanda believes that we all need support at times to work towards living our best lives. Before joining the Richmond County District Attorney’s Office, Amanda worked for the YMCA Counseling Service first as a supervisor in the Little Steps Program, Teen Treatment, Medication Assisted Treatment Program, and culminating as Senior Program Director overseeing the YMCA’s prevention and treatment services in two facilities on Staten Island. Amanda has also worked as an adjunct professor at the College of Staten Island teaching in the Credentialed Alcohol and Substance Abuse Counselor (CASAC) and the Master Social Work Programs. Amanda enjoyed having a private practice from 2010-2014 working primarily with children and teens. Most recently, Amanda accepted a position as a Program Director for the HOPE (Heroin Overdose Prevention & Education) Program within the DA’s Office assisting those arrested for drug possession crimes access treatment and health care rather than going through the court system. She holds a Master of Social Work degree from New York University has achieved clinical social work licensure.

 

Below is an overview of the curriculum and schedule for the five-month MAT for OUD Learning Collaborative. A total of five, two-hour sessions will be conducted from February to June 2019. If you took part one or more sessions, please take a quick course evaluation here.

Session 1: Addiction 101, Common Myths and Pitfalls of MAT on Staten Island (Enhancing Addiction Care on Staten Island)
February 25th, 2019, 4:00 – 6:00 PM

  • Gain understanding of issues associated with opioid addiction including on a macro, micro, and clinical levels
    • Macro issues – Social, Policy, Clinical Infrastructure
    • Micro issues – biology, anatomy
    • Clinical – presentations and interventions
  • Gain understanding of common myths, misperceptions, stigma, and pitfalls of MAT from SI providers, patients, and community members
  • Gain understanding of ways to address and mitigate such myths, pitfalls, stigma, and barriers to care
  • Gain understanding of Medication Assisted Treatment options for OUD to increase provider and community education

Session 1 PresentationSession 1 Recording | Session 1 Pre/Post Test

 

Session 2: Screenings, Assessment, and Admission Requirements
March 18th, 2019, 4:00 – 6:00 PM

  • Gain understanding of tools/scales for screening and assessing OUD
  • Gain understanding of regulatory requirements for admission including toxicology screenings
  • Gain understanding of best practices for conducting screenings and assessments in various settings particularly primary care and EDs

Session 2 PresentationSession 2 Recording | Session 2 Pre/Post Test

 

Session 3: Buprenorphine Induction and Management – Advanced Topics
April 15th, 2019, 4:00 – 6:00 PM

  • Gain understanding of best practices for buprenorphine induction in various clinical settings
  • Gain understanding of best practices for buprenorphine management
  • Gain understanding of methods to improve MAT retention/adherence with engagement/counseling practices
  • Gain understanding of ways to ensure patient linkages between emergency departments, primary care practices, and SUD programs

Session 3 PresentationSession 3 Recording | Session 3 Pre/Post Test

 

Session 4: Co-occurring Disorders and Special Populations
May 20th, 2019, 4:00 – 6:00 PM

  • Gain understanding of impact of MAT on patients with co-occurring disorders
  • Gain understanding of impact of MAT on special populations (pediatric, geriatric, and pregnant women)
  • Gain understanding of best practices on how to manage patients with co-occurring disorders that need or are receiving MAT
  • Gain understanding of best practices on how to manage special populations that need or are receiving MAT

Session 4 PresentationSession 4 Recording | Session 4 Pre/Post Test

 

Session 5: VBP Business Case for MAT
June 17th, 2019, 4:00 – 6:00 PM

  • Gain understanding of the business case for providing MAT in the value-based payment world
  • Gain understanding of key VBP-related quality and outcome performance requirements tied to MAT
  • Gain understanding of the role of clinician and provider staff to improve performance on outcomes

Session 5 PresentationSession 5 Recording | Session 5 Pre/Post Test

Patient Case Presentation Form

 

Barriers to Primary Care Physicians Prescribing Buprenorphine
Eliza Hutchinson, BA; Mary Catlin, BSN, MPH; C. Holly A. Andrilla, MS; Laura-Mae Baldwin, MD, MPH; Roger A. Rosenblatt, MD, MPH, MFR
University of Washington, Department of Family Medicine, Research Section, Seattle, Washington

 

Buprenorphine prescribing practice trends and attitudes among New York providers
Andrea Kermack, M.D., Mara Flannery, Babak Tofighi, M.D., M.S.,
Jennifer McNeely, M.D., M.S., Joshua D. Lee, M.D., M.S.
NYU School of Medicine, Department of Population Health, NY, NY 10016

 

Victoria Njoku-Anokam
Director, Behavioral Health & Care Management Initiatives
Staten Island PPS
Vnjoku-anokam@statenislandpps.org

 

Jazmin Rivera
Director, Behavioral Health Initiatives
Staten Island Partnership for Community Wellness
jazmin@sipcw.org