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Addressing the Opioid Epidemic in Rural America

Federal Office of Rural Health PolicyHealth Resources & Services Administration

Allison Hutchings, MPHPublic Health Analyst

Federal Office of Rural Health Policy

Federal Office of Rural Health PolicyU.S. Department of Health and Human Services

Quick Background• Part of HRSA & HHS• “Voice for Rural” • Policy and Research Role• Administer Grant Programs• Technical Assistance

Mission

Collaborate with rural communities and partners to support programs and shape policy that will improve health in rural America.

Office Structure

Policy & Research

Community Based Programs

Hospital State Programs

Telehealth Programs

Federal Office of Rural Health PolicyU.S. Department of Health and Human Services

Federal Office of Rural Health PolicyU.S. Department of Health and Human Services

330a of Public Health Service Act (PHS) Rural Health Outreach Services Rural Health Network Development Rural Network Development Planning Small Healthcare Provider Quality

Improvement Delta States Network Rural Network Allied Health Training Rural Health Care Coordination

Network Partnership Rural Benefits Counseling Rural Health Opioid Program

Black Lung Clinics Program & Black Lung Center of Excellence

Radiation Exposure Screening Education Rural Communities Opioid Response

initiative

Community Need

Funding

Performance Data/OutcomesSustainability

Build the Rural Evidence Base

Community Based Programs

Rural Opioid Overdose Reversal Grant Program (ROOR)

FY15 Pilot Program• Total Investment: $1.8 Million (18 awards at $100,000/year)• Support rural community partnerships comprised of local emergency responders and other entities

involved in the prevention and treatment of opioid overdoses• Increasing access to naloxone in rural communities

Objectives• Increase the availability of naloxone through purchase and strategic placement• Train individuals to recognize the signs of opioid overdose and administer naloxone• Referral to substance abuse treatment centers where care coordination can be provided by team

of providers• Demonstrate improved and measureable health outcomes, including reducing opioid overdose

morbidity and mortality in rural areas

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Addressing Opioid-Related Poisonings & Overdoses

• Counties served: 80• Devices purchased: 9,538• Total attempts to reverse an overdose: 392• Total success rate: 96%• Individuals referred to treatment: 200• Trainings: 731• First responders trained: 2,968• Laypeople trained: 1,602

FY15 - 18 awards at $100,000/year ($1.8 Million)

Rural Opioid Overdose Reversal Program

FY17-20 Pilot Program• Total Investment: $2.5 Million (10 awards up to $250,000/year)• Support rural community partnerships comprised of local health care providers, emergency

responders and other community organizations involved in the treatment and recovery of opioid use disorder

Objectives• Identify individuals at-risk of overdose and guide them towards recovery by providing

outreach and education on locally available treatment options and support services• Educate community members on opioid use disorder, treatment options and methods for

preparing and referring individuals with OUD to treatment• Implement care coordination practices to organize patient care activities• Support individuals in recovery by establishing new or enhancing existing behavioral

counselling and peer support activities

Rural Health Opioid Program (RHOP)

Healthy Acadia (Hancock & Washington Counties, ME)Project Director: Maria Donahue, MPH, MSW

Target Intervention • Increase access to opioid use disorder

treatment, with emphasis on serving individuals in jail and healthcare settings.

• Implement care coordination and systems changes through enhanced provider collaboration and expanding systems of care (Hub and Spokes).

• Support individuals to be successful in their recovery through regional recovery coach peer support system and barrier removal.

Key Outcomes• Increased referral to treatment for

individuals with OUD.• Launched “Downeast Opioid Treatment

Hub and Spokes” delivery model• Increased number of providers serving as

Spoke sites.• Implemented robust peer Recovery Coach

system to increase individuals’ success and reduce barriers to long-term recovery.

• Increased availability of alternative pain management activities to reduce use of prescription drug pain management.

Addiction Services of Eastern Ohio (Barnesville, OH)Project Director: Chanda Paczewski, LGSW

Target Intervention• Increase community’s awareness to opioid

addiction treatment options, increaseaccessible, local treatment options foropioid addiction and evaluate the need forrecovery services such as housing,transportation, employment, painmanagement etc.

Key Outcomes• Improved awareness of opioid addiction and

treatment, including among providers.• Increased patient compliance and length of Vivitrol

injections.• Decreased transportation barriers for clients.

FY18-21• Total Investment: $5 Million (25 awards up to $200,000)• Expand the delivery of health care services in rural areas

Objectives• Expand the delivery of health care services to include new and enhanced services exclusively

in rural communities• Deliver health care services through a strong consortium, in which every consortium member

organization is actively involved and engaged in the planning and delivery of services• Utilize and/or adapt an evidence-based or promising practice model(s) in the delivery of

health care services• Improve population health, and demonstrate health outcomes and sustainability

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Rural Health Care Services Outreach Program (Outreach)

Rural Health Care Services Outreach ProgramArmstrong-Indiana Clarion Drug and Alcohol Commission—Shelocta, PA

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Hospital Staff Mobile Case Manager Peer-Certified Recovery Specialist

Screen patients to determine type of SUD and refer them to ARMOT if patient gives written permission

Screens and assesses patients to determine treatment needed and discusses treatment options with patients

Meets with patients on request and can share lived experience and knowledge of SUD and recovery

Completes referral to treatment Educates families on recovery process

Connects patients to community resources Connects patients to community support groups (e.g., Alcoholics or Narcotics Anonymous meetings)

Educates hospital staff on SUD and recovery process

• $200,000/year for three years to implement Addiction Recovery Mobile Outreach Team (ARMOT) Program

• Provides case management and recovery support services to adults and adolescents with substance use disorders (SUD) and education and support to rural hospital staff, patients, and their loved ones in three hospitals

SERVICES OFFERED

Within first 18 months of grant, ARMOT made 254 referrals Source: https://www.ruralhealthinfo.org/project-examples/940 (link includes video highlighting program)

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Rural Health Network Development Planning Program“Network Planning”

2018 HRSA Clinical Priorities

Childhood Obesity

Mental Health

Substance Abuse incl.

Opioids

Increase efficiencies

Expand access to, coordinate, and improve the quality of essential health care services

Strengthen the rural health care system as a whole

Objectives: 2018 Cohort Focus Areas:

Historically, the Network Planning Program awards up to 22 awards annually.

The Fiscal Year 2020 Notice of Funding Opportunity (NOFO)HRSA 20-026 is forecasted for release on grants.gov

The projected start date for Fiscal Year 2020 Awards is July 1, 2020.

For questions, please contact the Network Planning Program Coordinator Jillian Causey at Jcausey@hrsa.gov

Rural Health Network Development Planning ProgramWhat’s next for Network Planning?

Substance Abuse Treatment Telehealth Network Grant Program (SAT-TNGP)

FY17-20 Pilot Program

• Total Investment: $750,000 (3 awards up to $250,000/year)• Demonstrate how telehealth programs and networks can improve access to health care services,

particularly substance abuse treatment services, in rural, frontier, and underserved communities.

Objectives• Provide substance use disorder treatment using telehealth technology to rural communities -

particularly small rural hospitals with high rates of poverty, unemployment, and substance use• Provide health care services using telehealth technology to address comorbid conditions (e.g.

mental health, congestive heart failure, cancer, stroke, chronic respiratory disease and/or diabetes)

• Improve and expand health care provider training related to substance use disorders• Expand and improve the quality of health information available to heath care providers as well as

patients and their families

FY18-FY23+• New appropriation of $100 million in FY18 with an additional $120 million in FY19.• Created a new multi-initiative program.• RCORP Webpage: (https://www.hrsa.gov/rural-health/rcorp)

Objectives• RCORP aims to reduce morbidity and mortality associated with SUD, to include OUD, by

improving access to and delivering prevention, treatment, and recovery support services to high-risk rural communities.

• Part of HRSA-wide initiative to combat the opioid epidemic among vulnerable and underserved populations (https://www.hrsa.gov/opioids)

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Rural Communities Opioid Response Program (RCORP)

• RCORP-Planning grants - strengthen the organizational and infrastructure capacity of multi-sector consortia (Awarded 95 grants under HRSA-18-116 and 120 under HRSA-19-081)

• RCORP-Implementation grants – fund consortia to deliver opioid and substance use disorder prevention, treatment, and recovery activities in high-need rural communities (Applications under review: HRSA-19-082 and Forecasted: HRSA-20-031)

• RCORP-Medication-Assisted Treatment Expansion grants - establish and/or expand MAT in eligible hospitals, health clinics, or tribal organizations in high-risk rural communities. (Applications under review: HRSA-19-102)

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Rural Communities Opioid Response Program (RCORP) Grants

• RCORP-Technical Assistance - provide TA support for rural communities (RCORP grantees and the general public) to enhance the organizational and infrastructural capacity of multi-sector consortiums at the community, county, state, and/or regional levels (Awarded: HRSA-18-124)

• RCORP-Evaluation - provide monitoring and evaluate impact of the Planning and Implementation grantee activities, the TA provider, and provide analysis and recommendations for improving program areas (Applications under review: HRSA-19-083)

• RCORP-Rural Centers of Excellence on Substance Use Disorders (RCORP-CoE) – establish three entities to identify and disseminate best practices regarding SUD, including OUD. (Applications under review: HRSA-19-108)

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Rural Communities Opioid Response Program (RCORP) Cooperative Agreements

FY 2018 FY 2019 FY 2020 FY 2021 FY2022

95 Planning I awards (1 year)

120 Planning II awards (1 year)

1 Technical Assistance cooperative agreement (4 years)

75 Implementation I awards (3 years)

1 Evaluation cooperative agreement (4 years)

FY18 - FY19

FY18 – FY22

FY19 - FY23

CURRENT Rural Communities Opioid Response Program Timeline

FY19 – FY21

34 Implementation II awards (3 years)FY20 – FY23

FY19 – FY21 11 MAT Expansion awards (3 years)

FY2023 FY2024

FY19 – FY21 3 Centers of Excellence cooperative agreements (3 years)

FY19 - FY20

FY20 – FY22

RCORP-Planning (FY18 Cohort)

• Consortia serving 592 counties in 40 States

• Average number of consortia partners: 10

• Average number of sectors or disciplines in each consortium: 7

RCORP-Planning

Impact to Date

• 95 FY18 awards at $200,000 for 1 year • $19 million invested in FY 2018

Project Activities Snapshot

• Providing trainings to healthcare facility staff on SBIRT

• Implementing case management services

• Utilizing telehealth for behavioral counselling and support services

• Introducing the “Hub and Spoke” model to proposed service areas

• Providing overdose education and naloxone distribution programs

• Expanding withdrawal monitoring and support services

• Educating the community on addiction, local opioid issues and methods of treatment

• Utilizing Peer Recovery Coaches to support individuals in treatment and recovery

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Upcoming Funding Opportunities (anticipated)

• FY20• Rural Health Network Development • Rural Health Network Development Planning (Network Planning)• Rural Health Care Coordination Network• Telehealth Network Grant Program• RCORP– Implementation

• FY21• Rural Health Care Services Outreach (Outreach)• Evidence-Based Tele-Behavioral Health Network Program• Rural Health Network Development Planning (Network Planning)

• FY22• Small Health Care Provider Quality Improvement Program (Quality)• Rural Health Network Development Planning (Network Planning)

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Where to Find HRSA Funding Opportunities

https://www.hrsa.gov/grants/fundingopportunities/default.aspx

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Where to Find HRSA Funding Opportunities

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FORHP Weekly Announcements

• Rural-focused Funding Opportunities• Policy and Regulatory Developments

Affecting Rural Providers and Communities• Rural Research findings• Policy updates from a Rural Perspective• Sign up:

To sign up: Email Michelle Daniels at mdaniels@hrsa.gov

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Finding HRSA-funded Projects in your State

https://data.hrsa.gov/tools/find-grants

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Connecting Stakeholders to Opioid-Related Resources

HRSA supports training dissemination and information portals that provide resources on emerging public health issues including opioids

Rural Health Information HubTARGET Center (Tools for the Ryan White Community)

MCH Navigator

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• Rural Prevention and Treatment of Substance Use Disorder Toolkit• This toolkit provides evidence-based examples, promising models, program best practices, and

resources that can be used by your organization to implement substance use disorder prevention and treatment programs.

• Cross-Walk: Integrating Behavioral Health and Primary Care• Cross-Walk, a program that integrates behavioral healthcare into primary care services, was

developed in Michigan's Marquette County (FY12-15 Outreach grantee)• Rural Response to the Opioid Crisis

• This guide will help you learn about activities underway to address the opioid crisis in rural communities at the national, state, and local levels across the country.

• Rural Services Integration Toolkit: Primary Care Behavioral Health Model• The framework describes three main categories of care between behavioral health and primary

care practitioners: coordinated care, co-located care and integrated care. • Rural Project Examples: Behavioral Health

RHIHub

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Objective Reviewers - We Need You!

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HRSA is continuously looking for health care professionals with education and experience in:

• Reviewers use their expertise to objectively evaluate and score applications against published evaluation criteria.

• Reviewers gain understanding of the grant-making process while enjoying the opportunity to work with colleagues.

o Health Professions Training o HIV/AIDS Treatmento Maternal & Child Health Services

o Organ Transplantationo Primary Care for Underserved Personso Rural Health Care

http://www.hrsa.gov/grants/reviewers/index.html

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Connect with HRSA

To learn more about our agency, visit

www.HRSA.gov

Sign up for the HRSA eNews

FOLLOW US:

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Allison Hutchings, MPH – Public Health AnalystHRSA Federal Office of Rural Health Policy

ahutchings@hrsa.gov

Contact Information