Intercept Initiatives Provide Needed Resources in Rural Jails, Hospitals

Within medically underserved communities, especially those in rural areas, intercept initiatives can be vital tools for meeting the needs of individuals with substance use disorders, especially those who are involved with their local justice system.

Recently at the Rx and Illicit Drug Summit, Kelley McNichols, PhD, LPC, NCC, CADC, CCDP, CCTP, an assistant professor at Waynesburg University in New Kensington, Pennsylvania, and Mike Krafick, CRS, CRSS, the CRS supervisor for the Armstrong-Indiana-Clarion Drug and Alcohol Commission in Kittanning, Pennsylvania, presented a session highlighting 3 intercept initiatives in rural parts of their state.

Ahead of their presentation, Dr McNichols and Krafick spoke with Addiction Professional about the importance of intercept initiatives, examples of such initiatives that are providing cost-effective and sustained success, and opportunities to expand treatment options for justice-involved individuals.

Editor’s note: This interview has been edited for length and clarity.

Addiction Professional: Why are intercept initiatives especially important in rural, medically underserved areas?

Kelley McNichols: [The opioid epidemic] is very challenging, it's consistent, it's pervasive. The opioid epidemic more predominantly hits rural areas, so you're faced with healthcare provider shortages for medically underserved areas and individuals. The need is outweighing the resources. I think that's the most important of our initiatives—to get in there and help address those unmet needs for marginalized groups that are being largely underserved.

Mike Krafick: I think one of the major goals is to remove barriers between people's needs and available resources, helping connect people to those resources that they need, and meeting them where they're at rather than waiting for them to come to us.

I can remember myself as a person in recovery. The model then, in the early 2000s, was: when you want it bad enough, you'll come seek the help and you'll be willing to do what we tell you to do. With these intercept models, we're really trying to do is meet people where they're at and bring the resources to them. We meet them at a starting point and build on it from there.

KM: And I would just add to that, that as much as it can be a limitation to be in these rural areas, I think it's a strength as well because the community knows its needs. Oftentimes, everybody has roots in those communities. They see the growing need, and part of this is to collaborate, work with stakeholders, the people that know the environment and have a shared mission for the community they live in.

AP: Can you share some examples of intercept initiatives that are providing cost-effective and sustainable access to substance use disorder treatment and recovery supports?

KM: Sure, I'll talk about work in rural county jails. We are providing evidence-based programming such as cognitive behavioral drug and alcohol treatment. We're also providing FDA-approved medication-assisted treatment for opioid use disorders. All 3 forms of medication are being offered, so those intercept initiatives are significant. Out of the 62 county jails in Pennsylvania, only 12 do that work, and we are one of them. We're definitely being able to reach more people to that capacity, helping to set them up for more positive outcomes upon re-entry.

We are also doing a lot of education with the jail staff at the time of onboarding. We're providing them with psychoeducation around what is happening in the jail, what evidence-based treatments are, how we know they're effective, and what is the jail offering.

We're providing Narcan to every individual who's leaving the jail. We're also providing fentanyl test strips. And with Mike's work, there are also Narcan emergency kits distributed throughout the jail itself, which is kind of unheard of.

We're making sure that people have access to these resources, these intercept initiatives, just being more attainable and tangible to individuals who most often did not have those resources. Now they do.

MK: I would say with our work in the hospitals, specifically in the emergency rooms, but that really has expanded throughout all 3 of the hospitals that we work with. We have a team of a case manager and a certified recovery specialist paired together to meet with patients as they come in. Medical staff make the referral, we engage that person and see what their needs are, get them connected to treatment, and then really follow them throughout the continuum from residential treatment to outpatient and so on.

We started that model in 2015. Historically, we’ve been a Monday through Friday, 8:00 to 4:00 organization, and we quickly learned that that was not an effective way to really engage with the healthcare system. So, we expanded and added evening and weekend hours, and then beyond that added an on-call recovery support line where either the hospital or patients themselves can call this 800 number, get connected 24 hours a day, 7 days a week to one of our recovery specialists. That has proven to be a very cost-effective way of not only getting new referrals, but keeping people engaged. Because if somebody who's in services is struggling on the verge of relapse, they can reach out and get connected with somebody, whether it's a holiday weekend or the middle of the night.

AP: Do you see other opportunities for expanding medication-assisted treatment to better serve justice-involved individuals with OUD?

KM: Yes, absolutely. I think having people become more knowledgeable about ADA Title II is significant so that we can offer non-discriminatory practices, really making sure that people have access and that it's more equitable.

That includes not only the implementation of MOUD in jails and prison systems, but also the continuation of that and looking towards induction, because I feel like that's a growing need that calls upon us to be advocates, that calls upon us to really start to look at our medical professionals and who can expand their wings into the jail system and helping to sign off on those things, oversee that.

Other than that, I think universal screening is going to be a significant place to start that we want to help ensure, again, it's equitable. We need to kind of be our own advocates in reaching out for grant opportunities, utilizing—maybe maximizing—the resources that we already have, and then building upon that home base to be able to offer more.

Something else, and maybe Mike can speak more to this, but one of the initiatives will be including a re-entry coordinator—having somebody who's in the jails, working with individuals that have lived experience, a shared experience to help do the warm handoffs, wrap them in services from institution into the community setting flawlessly.

MK: That's one of the important pieces of this program in the jail—having that person. It's a certified recovery specialist that's embedded within the jail. They work 40 hours a week there, and their one and only job is really to help people successfully transition from inside to being successful when reintegrating into the community.

I really do feel like the elimination of the X-waiver is going to be a major factor in expanding access to MOUD. I know in talking with others, especially state prisons, they had doctors who were up against their limit on the number of patients that they could treat. Eliminating that will really help. But then also, some of the other practitioners who maybe weren't going to go out and get their X-waiver, but felt comfortable enough with some training and education, would be willing to do this in other parts of the state, other parts of the country.

As Kelly had mentioned, we seem to be the exception, at least in our state as far as a county jail that's providing this medication. I'm hopeful that changes. It's not changing as quickly as I would like to see it, but it is happening.

And then I think too, just when looking at drug treatment courts, I've seen a shift over the past couple of years. I hope that that trend continues, that they're accepting and allowing people that are on medications to participate in these diversionary courts and drug courts. That was not always the case.

KM: One final thought about that: When you were talking about the X-waiver, it made me think about just licensing. Regulatory bodies are often antiquated, very burdensome. So, when you're looking to provide things such as methadone within the walls of a justice system, you have to look at OTP regulations, waivers, and acceptance. We need to continue to be advocates to revisit these laws and regulations to be able to keep up with current trends so that we can continue to expand services.

Reference

McNichols K, Krafick M. Intercept initiatives in pennsylvania rural county jails and hospitals: treatment, recovery, and warm handoffs. Presented at Rx and Illicit Drug Summit; April 10-13, 2023; Atlanta, Georgia.