When two or more systems work together, cross-training is key. Different systems often approach the same topic using different language, procedures and points of reference.
It is just as important for addictions workers to be familiar with the work of collaborating departments as it is for those workers to have basic training in addictions.
Here are some examples of addiction-related interagency collaborations in Massachusetts:
Interagency Workgroup on Youth and Young Adults (Youth IWG)
Centered in the Bureau of Substance Addiction Services (BSAS), the Office of Youth and Young Adult Services creates and oversees BSAS programs, policies and initiatives that address addiction among youth and young adults, building and maintaining system capacity across the continuum of care. The directive of the office is to provide effective, accessible and affordable substance abuse treatment for youth and their families. This kind of care necessarily involves coordination among systems, and the Interagency Workgroup on Youth and Young Adult Services provides a foundation for such coordination.
Opioid Overdose Prevention & Reversal Project - supporting the use of Intranasal Naloxone (Narcan)
One BSAS response to the state’s extremely high opioid overdose rates has been its Overdose Prevention & Reversal Project. Participants are trained on and can distribute intranasal naloxone (Narcan) which reverses the effects of an opiate overdose when sprayed into the nose of a person who has overdosed. BSAS SBIRT (see below) and Narcan project staff collaborated with the BNI-ART Institute to train personnel at Boston Medical Center, and incorporate this effort into Emergency Department SBIRT projects at the hospitals where they work.
Cross-Systems Training by BSAS
Staff and consultants from BSAS have developed and provided training, including training of trainers (ToT), on Addictions and the Prevention, Intervention, Treatment and Recovery Support System for a range of related systems. For example:
- Municipal Police Training Coalition
- Department of Transitional Assistance
- Department of Children and Families
- Other departments/organizations as requested
Recovery High Schools Department of Education/Local Communities/BSAS
Created under the Massachusetts General Laws, Recovery High Schools provide a four-year high school education in an environment that supports recovery. Recovery High Schools are open in Beverly, Boston, Brockton, Springfield, and Worcester.
SBIRT - Screening, Brief Intervention and Referral to Treatment
SBIRT is a public health approach to delivering early intervention to anyone who uses alchohol and/or drugs in unhealthy ways. Implemented in Emergency Rooms, Hospital main floors, Colleges and Community Health Centers in various projects, SBIRT involves physical health or behavioral health staff trained to ask short, effective screening questions; provide a brief intervention to those who screen positive; and make a successful referral where one is indicated. Information about SBIRT in Massachusetts can also be found here.
Co-Occurring Capacity Building Initiative - Department of Mental Health (DMH) Children's Behavioral Health Knowledge Center and DPH/BSAS
This initiative, which launched in September, 2016, selected four Massachusetts providers to participate in a pilot. Each provider receives an individualized onsite consultation from the Center for Innovative Practices at Case Western Reserve University who will evaluate the provider’s policies, clinical practices, and workforce related to co-occurring disorders. Following this consultation, a customized report is generated, with recommendations for how the organization can become more co-occurring capable. In addition, providers receive six months of coaching from a NIATx Process Improvement specialist.
DCF Substance Abuse Regional Coordinators in each region provide internal case consultation to DCF workers and collaborate with local substance abuse providers to improve linkages and cross-system communication efforts. This coordination was achieved through a memorandum of understanding between DCF and DPH. In addition to these Regional Coordinators, communication efforts and protocols were established at the statewide and local levels to support families, and licensing requirements were updated to require providers have family-centered training, and provide family centered treatment. To find out more, contact the DCF Substance Abuse Manager at 617-748-2000.
On a national level, many resources are available through the National Center on Substance Abuse and Child Welfare. Free tutorials are available such as “Understanding Substance Use Disorders” and “Treatment and Family Recovery: A Guide for Child Welfare Professionals”. Technical Assistance materials developed by states on shared values, inter-agency agreements and protocols are also available.
The Family Recovery Project began with a grant from the Administration of Children and Families in 2007. It is a collaboration between the Department of Public Health (Bureau of Substance Addiction Services) and the Department of Children and Families. There are two arms of FRP thanks to additional funding received from ACF in 2012, both of which are centered around regional Family Recovery Councils.
Family Recovery Councils of Hampden County and Southeastern MA
Both Councils bring together regional providers from Substance Abuse Treatment, Child Welfare, Early Intervention, Mental Health, Corrections, and Medical settings to focus on better serving all family members through communication and shared language, values, and tools.
Family Recovery Council of Hampden County's mission is:
- To remove barriers to treatment services for families struggling with substance abuse and co-occurring mental health disorders
- To improve communication and collaboration across systems, in order to provide high-quality care and coordination of support for families in recovery
- ATR - Access to Recovery is a Federally-funded program to give people with substance use disorders wider access to community services to help them start or continue on the road to recovery. MA-ATR is creating an integrated and coordinated system of care that brings together traditional treatment services with a host of non-traditional community and faith-based recovery support services. MA-ATR works in two counties: Hampden County (Springfield area) and Suffolk County (Boston area).
- NIATx Learning Collaborative for Drug Courts - Launched with support from the Substance Abuse and Mental Health Services Administration (SAMHSA) Adult Treatment Drug Courts (ATDC) grant program, the goal of this learning collaborative is to teach the grantees to use the NIATx model to improve access to and retention in substance abuse treatment offered through drug courts. The learning collaborative has also been working to spread the use of process improvement to drug courts across the nation.
Health Care Reform
The goal of integrating primary and behavioral healthcare has led to collaborative projects among:
- Individual addiction services providers and hospitals or community health centers
- Providers working together under the umbrella of a professional organization (ABH, NAADAC, The National Council)
- System level bodies, such as the Patient Centered Medical Home Initiative Behavioral Healthcare Integration Workgroup involving representatives from the Mass Department of Mental Health, Department of Public Health, academia, payers, clinicians, community health centers and hospitals.
- See suggestions for integration activities for individual organizations at Health Care Reform. For background on workforce issues related to healthcare integration, see SAMSHA-HRSA's Workforce webpage in the SAMHSA-HRSA Center for Integrated Healthcare Solutions as well as Workforce Issues Related to Physical and Behavioral Healthcare Integration Specifically Substance Use Disorders and Primary Care: A Framework.
Massachusetts Interagency Council on Substance Abuse and Prevention
This Interagency Council was formed in 2005 by Executive Order 467. Its purpose is to maximize coordination regularly across state agencies to increase collaboration on key issues relating to substance abuse, treatment and prevention.