Transporting to treatment: Evaluating the effectiveness of a mobile engagement unit

Stewart, Rebecca E.; Shen, Lisa; Kwon, Nayoung; Vigderman, Josh; Kramer, Susanna; Mandell, David S.; Candon, Molly; Lamb, Roland; Rothbard, Aileen B.

doi:10.1016/j.jsat.2021.108377

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…These can be combined with novel home-induction technologies that allow for patient-administered OAT dosing and adjunct online/telehealth monitoring (Gordon et al, 2019 ; MedicaSafe, 2019 ). Telehealth and mobile OAT delivery are low-barrier novel interventions that have shown promise for improving treatment access and retention, and can reduce barriers to treatment entry among remote and marginalized—including correctional—populations (Hall et al, 2014 ; Krawczyk et al, 2019 ; Krsak et al, 2020 ; O’Gurek et al, 2021 ; Stewart et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

Russell

Pang

Nafeh

et al. 2022

International Journal of Qualitative Studies on Health and Well

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Introduction Correctional populations with opioid use disorder experience increased health risks during community transition periods. Opioid Agonist Treatment (OAT) can reduce these risks, but retention is a key challenge. This study addresses a knowledge gap by describing facilitators and barriers to OAT engagement among federal correctional populations released into the community in Ontario, Canada. Methods This article describes results from a longitudinal mixed-methods study examining OAT transition experiences among thirty-five individuals released from federal incarceration in Ontario, Canada. Assessments were completed within one year of participants’ release. Data were thematically analyzed. Results The majority (77%) of participants remained engaged in OAT, however, 69% had their release suspended and 49% returned to custody. Key facilitators for OAT engagement included flexibility, positive staff rapport, and structure. Fragmented OAT transitions, financial OAT coverage, balancing reintegration requirements, logistical challenges, and inaccessibility of ‘take-home’ OAT medications were common barriers. Conclusions Post-incarceration transition periods are critical for OAT retention, yet individuals in Ontario experience barriers to OAT engagement that contribute to treatment disruptions and related risks such as relapse and/or re-incarceration. Additional measures to support community OAT transitions are required, including improved discharge planning, amendments to OAT and financial coverage policies, and an expansion of OAT options.

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Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

Russell

Pang

Nafeh

et al. 2022

International Journal of Qualitative Studies on Health and Well

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“…Previous research that examines increasing treatment access for MOUD has not focused or on addressing the unique needs and challenges faced by Black Americans [ 14 , [29] , [30] , [31] , [32] ]. Interventions and strategies that seek to address the unmet treatment needs of Black Americans diagnosed with OUD need to be culturally sensitive and responsive to the additional challenges in such as the (1) doubly stigmatized statuses of being a member of a minoritized group and their status as having a substance use disorder, (2) significant historical and present-day structural racism and indirect and direct harms within health care, social services, and the criminal justice system toward the Black American communities, (3) misperceptions and faulty explanations about addiction and opioids, and (4) lack of culturally responsive and respectful care [ 10 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Exploring the provider and organization level barriers to medication for opioid use disorder treatment for Black Americans: A study protocol

Gilbert

Starks

Gray

et al. 2022

Public Health in Practice

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“…Other cities or rural areas may face very different barriers and facilitators to mobile care. For example, recent survey studies have documented a lack of phone, Internet, and transportation access for individuals with SUD in rural areas of the United States, so MOCUs in these areas may have to rely more heavily on word-of-mouth and transport-to-treatment models to coordinate care [ 16 , 64 , 65 ]. Given the growth of mobile OUD care delivery models nationally, more broad scale evaluation of MOCUs is needed.…”

Section: Limitationsmentioning

confidence: 99%

“…Nonetheless, the small body of empirical studies suggests that MOCUs are a promising avenue for providing access to MOUD [ 36 – 38 ]. One study found that providing transportation to treatment through a MOCU led to increase treatment engagement at a brick and mortar treatment facility [ 16 ]. An ongoing study is evaluating the efficacy of using mobile care delivery models that provide MOUD to people who inject opioids in five U.S. cities [ 39 ], but has not yet published results.…”

Section: Introductionmentioning

confidence: 99%

Mobile service delivery in response to the opioid epidemic in Philadelphia

Stewart,

Christian,

Cardamone

et al. 2023

Addict Sci Clin Pract

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Background The harms of opioid use disorder (OUD) and HIV infection disproportionately impact marginalized populations, especially people experiencing homelessness and people who inject drugs (PWID). Mobile OUD service delivery models are emerging to increase access and reduce barriers to OUD care. While there is growing interest in these models, there is limited research about the services they provide, how they operate, and what barriers they face. We characterize the capacity, barriers, and sustainment of mobile OUD care services in a large city with a high incidence of OUD and HIV. Methods From May to August 2022, we conducted semi-structured interviews with leadership from all seven mobile OUD care units (MOCU) providing a medication for OUD or other substance use disorder services in Philadelphia. We surveyed leaders about their unit’s services, staffing, operating location, funding sources, and linkages to care. Leaders were asked to describe their clinical approach, treatment process, and the barriers and facilitators to their operations. Interview recordings were coded using rapid qualitative analysis. Results MOCUs are run by small, multidisciplinary teams, typically composed of a clinician, one or two case managers, and a peer recovery specialist or outreach worker. MOCUs provide a range of services, including medications for OUD, wound care, medical services, case management, and screening for infectious diseases. No units provide methadone, but all units provide naloxone, six write prescriptions for buprenorphine, and one unit dispenses buprenorphine. The most frequently reported barriers include practical challenges of working on a MOCU (e.g. lack of space, safety), lack of community support, and patients with substantial medical and psychosocial needs. Interviewees reported concerns about funding and specifically as it relates to providing their staff with adequate pay. The most frequently reported facilitators include positive relationships with the community, collaboration with other entities (e.g. local nonprofits, the police department, universities), and having non-clinical staff (e.g. outreach workers, peer recovery specialists) on the unit. Conclusions MOCUs provide life-saving services and engage marginalized individuals with OUD. These findings highlight the challenges and complexities of caring for PWID and demonstrate a need to strengthen collaborations between MOCU providers and the treatment system. Policymakers should consider programmatic funding for permanent mobile OUD care services.

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Transporting to treatment: Evaluating the effectiveness of a mobile engagement unit

Cited by 8 publications

References 29 publications

Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

Exploring the provider and organization level barriers to medication for opioid use disorder treatment for Black Americans: A study protocol

Mobile service delivery in response to the opioid epidemic in Philadelphia

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