Project Grant H79TI084771

RURAL MOBILE INTEGRATED HEALTHCARE FOR SUD/OUD AND BHS - THE NAME OF THE PROJECT IS RURAL MOBILE INTEGRATED HEALTHCARE FOR SUD/OUD AND BHS AND WILL BE IMPLEMENTED IN WASHINGTON COUNTY, MISSOURI. WASHINGTON COUNTY HAS A POPULATION OF 24,860. THE POPULATION OF FOCUS IS INDIVIDUALS UNDER 200% OF THE FEDERAL POVERTY LEVEL, WHICH COMPRISES MORE THAN 47.77% OF THE TOTAL POPULATION (COMPARED TO MO AT 32.14% AND THE US AT 30.86%).THE PROJECT WILL PROVIDE TREATMENT AND RECOVERY SUPPORTS TO 400 HIGH-RISK INDIVIDUALS WITH SUD/OUD AND WILL PROVIDE TRAINING AND EDUCATION TO A TOTAL OF 880 INDIVIDUALS INCLUDING FIRST RESPONDERS, SCHOOL PERSONNEL, HEALTHCARE PROVIDERS AND OTHER COMMUNITY SECTORS OVER THE 4-YEAR PERIOD. THE COUNTY'S DEMOGRAPHIC MAKE-UP IS PRIMARILY WHITE, WITH 51.4% OF THE POPULATION BEING MALES. THE RACIAL AND ETHNIC MAKE-UP IS FAIRLY HOMOGENOUS, WITH 95.26% OF THE POPULATION WHITE, 2.13% BLACK AND 1.85% MULTIPLE RACES. ONLY 1.39% OF THE POPULATION REPORT AS BEING HISPANIC. POVERTY AND HEALTH LITERACY ARE SIGNIFICANT CONTRIBUTORS TO SUBSTANCE USE, WITH MANY FAMILIES NOW IN THIRD- AND FOURTH-GENERATION SUBSTANCE USE. WASHINGTON COUNTY IS ECONOMICALLY CHALLENGED AND GEOGRAPHICALLY ISOLATED-THERE ARE FEW OPPORTUNITIES FOR VULNERABLE INDIVIDUALS TO CONNECT TO MEANINGFUL CARE OUTSIDE THE SERVICES PROVIDED BY NETWORK PARTNERS. ACCORDING TO COUNTY HEALTH RANKINGS, WASHINGTON COUNTY WAS AMONG THE LEAST HEALTHY FOR OUTCOME MEASURES IN 2020. ACCORDING TO THE MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES, DRUG OVERDOSE DEATHS INCREASED ABOUT 21% IN THE FIRST THREE QUARTERS OF 2020 COMPARED TO 2019. OVERDOSE DEATHS INVOLVING A COMBINATION OF OPIOIDS AND STIMULANTS INCREASED BY APPROXIMATELY 82% STATEWIDE BETWEEN 2019 AND 2020. STATEWIDE, 2020 INCREASES IN OPIOID-INVOLVED AND STIMULANT-INVOLVED DRUG OVERDOSE DEATHS WERE SIMILAR, BOTH ABOUT 30% HIGHER THAN 2019. OPIOID-INVOLVED DRUG OVERDOSE DEATHS REPRESENT THE MAJORITY OF TOTAL DRUG OVERDOSE DEATHS IN MISSOURI (ABOUT 75% OF DEATHS INVOLVE OPIOIDS). RATES ARE HIGHEST IN THE SOUTHEAST REGION WHICH ENCOMPASSES WASHINGTON COUNTY. THE SOUTHEAST REGION HAD THE 2ND HIGHEST RATE PERCENT CHANGE IN OPIOID AND STIMULANT-INVOLVED DEATHS FROM 2019 TO 2020 IN MISSOURI. FOR THE PERIOD JANUARY 2017-JUNE 2018, STATEWIDE, MANY WHO FATALLY OVERDOSED HAD SOME HISTORY OF SUBSTANCE ABUSE (74%) AND 14% HAD OVERDOSED PREVIOUSLY. FATAL OVERDOSES FREQUENTLY HAPPEN ALONE WITH NO BYSTANDER PRESENT (38%), THOUGH EMERGENCY MEDICAL SERVICES (EMS) IS NEARLY ALWAYS PRESENT POST-EVENT (92%). MANY OVERDOSES INDICATE POLYSUBSTANCE ABUSE, INCLUDING USE OF BENZODIAZEPINES (31%). UNFORTUNATELY, SUBSTANCE USE TREATMENT IS INDICATED IN LESS THAN 2 PEOPLE OUT OF 10 WHO FATALLY OVERDOSE. THE GOALS OF THE PROJECT ARE TO IMPROVE REFERRALS TO APPROPRIATE TREATMENT AND RECOVERY SUPPORTS FOR 400 HIGH-RISK INDIVIDUALS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL, INCREASE LOCAL WORKFORCE CAPACITY TO ENGAGE, TREAT AND SUPPORT RECOVERY OF INDIVIDUALS WITH SUD/OUD AND/OR BEHAVIORAL HEALTH NEEDS, DEVELOP A REPLICABLE AND SUSTAINABLE MIH PAYMENT MODEL SUPPORTED BY MEDICAID AND OTHER PAYERS, AND MEET ALL FR-CARA GRANT DELIVERABLES ON TIME AND ON BUDGET. THE PRIMARY INTERVENTION IS PROVISION OF MOBILE INTEGRATED HEALTH CARE (AKA COMMUNITY PARAMEDICINE) THROUGH A TEAM-BASED MODEL THAT INVOLVES HOSPITAL EMERGENCY DEPARTMENT PROVIDERS AND PERSONNEL FOR INPATIENT SERVICES AND ACCESS TO MAT TREATMENT THROUGH PROVIDERS AT THE FEDERALLY QUALIFIED HEALTH CENTER. MIH CLINICIANS TRAINED AND EMPLOYED BY WASHINGTON COUNTY AMBULANCE DISTRICT WILL BE DISPATCHED TO THE LOCATION FOR FIELD INITIATION OF LOW-THRESHOLD BUPRENORPHINE AND/OR SUBOXONE. COMMUNITY HEALTH WORKER AND PEER SUPPORT WILL ALSO BE LEVERAGED AND PROVIDED TO INDIVIDUALS ENROLLED IN THE PROGRAM. THE PROGRAM WILL UTILIZE THE GUIDING PRINCIPLES TO A TRAUMA-INFORMED APPROACH AND WILL STANDARDIZE TREATMENT PROTOCOLS CROSS-ORGANIZATIONALLY THROUGH THE MIH ADVISORY COMMITTEE, COMPRISED OF EX