October 20, 2014
Aaron Williams
Director of Training and Technical Assistance for Substance Abuse
National Council for Behavioral Health
Although medications for substance use disorders have been around for many years, numerous studies have shown that people still have limited access to these medications, and they are underused as a treatment option. One thing is clear: safety-net providers can and should do more to expand access to these medications.
There is plenty of evidence that medication-assisted treatment (MAT) for substance use disorders is an effective treatment protocol.
So how do communities move forward in implementing MAT as a routine part of care?
We explored this question through a year-long project with safety-net providers by the SAMHSA-HRSA Center for Integrated Health Solutions (CIHS).
There can be a number of barriers to implementation both inside and outside of the safety-net provider setting, and so our goal was to bring together all parts of the community that are involved to create synergy to then be able to move forward with implementing MAT.
We joined single state authorities with community safety-net providers in three states (California, Maryland, and Ohio) to discuss their MAT implementation needs through meetings, site visits, regular webinars and conference calls, and peer networking opportunities.
Each of the state partnerships experienced challenges to implementing MAT in some or all of three key areas: financing and reimbursement, regulatory issues, and workforce challenges.
One common workforce challenge was the lack of behavioral health supports for medical staff considering implementing MAT. We observed that some organizations lack the infrastructure that supports physicians in prescribing MAT, such as available counselors who are knowledgeable about MAT or appropriate referral and care coordination resources. If agencies want to make a full commitment to MAT, they must ensure that appropriate continuing care and counseling services are available to accompany delivery of the medications.
Once the project ended, we asked the participants to share the challenges they faced, what they did to overcome barriers, and what should happen next with MAT. For those wanting to assess where their agency, state, or community is in terms of readiness and willingness to implement or expand MAT, we combined these lessons learned with some of the latest research into a handy checklist about what to consider when trying to move forward in implementing MAT.
The project participants identified the following key opportunities to expand implementation of MAT:
CIHS promotes the integration of primary and behavioral health care throughout the country through the sharing of information, development of resources, and through training and technical assistance to grantees in SAMHSA’s Primary and Behavioral Health Care Integration (PBHCI) Program. Learn more about CIHS at www.integration.SAMHSA.gov.
Aaron Williams leads strategic initiatives and directs training and technical assistance on substance use screening and treatment for the SAMHSA-HRSA Center for Integrated Health Solutions at the National Council for Behavioral Health. Mr. Williams' experience in the field of behavioral health services includes developing research plans, training protocols, and evaluating program effectiveness with an emphasis on substance use treatment, workforce development, and the use of evidence-based practices. Mr. Williams has written and contributed to numerous articles and reports on drugs of abuse, workforce development of substance use professionals, and implementation of evicence-based practices.
Although medications for substance use disorders have been around for many years, numerous studies have shown that people still have limited access to these medications, and they are underused as a treatment option. One thing is clear: safety-net providers can and should do more to expand access to these medications.
There is plenty of evidence that medication-assisted treatment (MAT) for substance use disorders is an effective treatment protocol.
So how do communities move forward in implementing MAT as a routine part of care?
We explored this question through a year-long project with safety-net providers by the SAMHSA-HRSA Center for Integrated Health Solutions (CIHS).
There can be a number of barriers to implementation both inside and outside of the safety-net provider setting, and so our goal was to bring together all parts of the community that are involved to create synergy to then be able to move forward with implementing MAT.
We joined single state authorities with community safety-net providers in three states (California, Maryland, and Ohio) to discuss their MAT implementation needs through meetings, site visits, regular webinars and conference calls, and peer networking opportunities.
Each of the state partnerships experienced challenges to implementing MAT in some or all of three key areas: financing and reimbursement, regulatory issues, and workforce challenges.
Workforce challenge: lack of behavioral health supports
One common workforce challenge was the lack of behavioral health supports for medical staff considering implementing MAT. We observed that some organizations lack the infrastructure that supports physicians in prescribing MAT, such as available counselors who are knowledgeable about MAT or appropriate referral and care coordination resources. If agencies want to make a full commitment to MAT, they must ensure that appropriate continuing care and counseling services are available to accompany delivery of the medications.
Once the project ended, we asked the participants to share the challenges they faced, what they did to overcome barriers, and what should happen next with MAT. For those wanting to assess where their agency, state, or community is in terms of readiness and willingness to implement or expand MAT, we combined these lessons learned with some of the latest research into a handy checklist about what to consider when trying to move forward in implementing MAT.
The project participants identified the following key opportunities to expand implementation of MAT:
- Increasing use of local pilot/demonstration projects
- Disseminating results to spread promising practices
- Fostering greater cross-collaboration between federal agencies invested in MAT
- Encouraging multiple organizations to “share” MAT providers
- Creating incentives for clinicians to adopt MAT
CIHS promotes the integration of primary and behavioral health care throughout the country through the sharing of information, development of resources, and through training and technical assistance to grantees in SAMHSA’s Primary and Behavioral Health Care Integration (PBHCI) Program. Learn more about CIHS at www.integration.SAMHSA.gov.
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