NIATx in New Places: Implementing MOUD Programming in Criminal Justice Settings

By: Jessica Vechinski, MSW, Client-Based Researcher & Project Manager, Justice Community Opioid Innovation Network (JCOIN),Center for Health Enhancement Systems Studies, UW–Madison, and Kristina Spannbauer, MA, Communications Specialist, Great Lakes ATTC, MHTTC, PTTC Center for Health Enhancement Systems Studies, UW–Madison

Coaching is a favored strategy for the implementation of medications for opioid use disorder (MOUD), yet research has not adequately tested or assessed coaching dosages and mediums for overall effectiveness, nor has coaching been widely used or studied within criminal justice settings (CJS).

The University of Wisconsin’s Center for Health Enhancement and Systems Studies (CHESS) in partnership with the Justice Community Opioid Innovation Network (JCOIN) funded by the National Institute on Drug Abuse (NIDA) was provided the opportunity to implement a pilot program and research study using the NIATx learning collaborative model within jails and community treatment provider sites around the country where recent policy mandates for the provision of MOUD have been handed down to jails. 

Over the last three years, 50 sites in 14 states have participated in the study and utilized NIATx coaching in their jail systems. As of July 2023, 32 sites have completed the two-year study and the remaining 18 sites will be completing the study by January 2024.

In the initial steps of the pilot, a NIATx coach worked with each site to identify one or more process improvement aims to focus on during the 12-month intervention phase by flow-charting and conducting a walk-through of their MOUD processes. These steps not only provided NIATx coaches with a greater understanding of the operational environment of CJS, but a few reoccurring themes related to the existing barriers of offering MOUD treatment presented themselves. One theme was the stigmatization of providing MOUD to incarcerated individuals. This was a monumental barrier that needed to be addressed before any changes could effectively be made. Another predominant theme was that each correctional setting is a complex system with processes that are structured around standard operational procedures as well as guidance from multiple different key stakeholders—and there is often little direct correlation or communication between the two!

The Role of Stigma

The stigmatization of MOUD in CJS is the greatest barrier preventing many of the sites from implementing a successful MOUD program. For some sites, leadership was in support of MOUD; however, the staff was not, and protocols would be skipped. On the flip side, other sites would have medical teams pushing for change and the leadership would be resistant. These examples highlight the importance following the NIATx principles, because if staff and leadership are not on board with the MOUD programming, change cannot occur. This unique dynamic created the ultimate barrier for NIATx coaches and was ultimately addressed by dedicating multiple coaching sessions to educating staff and leadership about the benefits of MOUD and how MOUD programs improve CJS conditions and outcomes.

Interprofessional Communication Gaps

Conducting the CJS walkthroughs were “eye-opening” experiences for everyone involved. Sites asked a variety of different staff and stakeholders to describe their current processes—from intake, to screening, to the administration of medication, and the warm-community handoff. For many of the sites, it was the first time their staff had sat down together and created a process flowchart based on input from a diverse cross-section of site staff and leadership, and they discovered that often the processes were not occurring as described by their team. The NIATx coaches used team coaching calls to help the participating sites improve gaps in communication that may be affecting the follow-through of their processes. As the study progressed, many of the sites commented on the helpfulness of the NIATx coaching calls in keeping them on track, bringing key players to the table, facilitating fruitful discussions, and maintaining accountability. There was also the added bonus of having a coach to guide them through MOUD process improvement! 

NIATx Keeps Evolving

This pilot program and study is not only testing the efficacy of the NIATx model in CJS, but also assessing the optimal amount of coaching needed to successfully implement or increase MOUD programming. Although the jails enjoyed the coaching calls, most of them stated that they wish they would have had more one-on-one coaching time. Some sites received four hours of coaching while others received twelve hours of coaching of the course of a year. Based on preliminary findings, there was a need for more communication between the sites and the coach. A small pilot is underway to develop and test a web based NIATx Coaching Extender Platform (CEP) that will allow asynchronous communication between the coach and jail staff. The platform will include a running agenda, all rapid-cycle PDSAs, MOUD data, a message board, and an "ask the expert" feature. All these features will include email and/or phone notifications so that communication can happen in a quick, timely matter.

We've learned so much from this unique and intensive pilot. Although the study has concluded for many of the participating sites, several of those facilities have continued their monthly team meetings and remain committed to maintaining MOUD programming in their facilities.

Want to learn more?

Read Jessica's 2021 blog post, The Treatment Challenge in Jail Settings: Detox and Withdrawal or Continuing Medication? for additional insight on JCOIN's research and the aims of this pilot program during the early stages of the study.

Discover additional evidence-based information about medications for OUD by downloading SAMHSA's TIP 63: Medications for Opioid Use Disorder.

Stay tuned for updates on the NIATx CEP next year!

Jessica Vechinski is a member of Center for Health Enhancement System Studies (CHESS) at the University of Wisconsin. She serves as a client-based researcher and project manager for a five-year study with the Justice Community Opioid Innovation Network (JCOIN), an initiative funded by NIDA/NIH. The study is testing the combination and dosages of two evidence-based strategies to implement or improve medications for opioid use disorder (MOUD) programming within justice settings around the country. You can reach Jessica at jvechinski@wisc.edu.