HMA has provided ongoing technical assistance and guidance to county teams involved in learning collaboratives to expand access to MAT in jails and drug courts as part of the Criminal Justice Learning Collaborative. Teams from 29 California counties participated, and thousands of detainees received MAT throughout incarceration and upon release. This statewide approach is especially effective because the teams quickly learn from one another and regional and statewide barriers are swiftly identified and addressed, so the state prison system could simultaneously develop compatible MAT approaches. HMA project coaches facilitated in-person learning collaboratives, conducted monthly coaching calls, helped teams customize approaches to their unique jails and health care systems, and provided topic-specific webinars, podcasts, and ongoing technical assistance. This program has been replicated and expanded in multiple states and counties across the country.

A comprehensive, county-focused effort aimed at strengthening the overall addiction treatment ecosystem in 10 counties, the Opioid Ecosystems of Care project, provided process improvement work, technical assistance, and direct coaching through a multi-pronged approach. HMA convened county SUD stakeholders in two-day events for addiction treatment didactics, identification of system gaps and barriers, and consensus on a road map designed to improve the future of the treatment system. After providing technical assistance, the team continued work for one year to address the gaps and barriers and conduct direct coaching to increase the number of buprenorphine quick- start sites. Through this program’s activities, HMA built a consistent knowledge base in order to provide high-touch, evidence-based MAT and behavioral therapies for SUD patients. A website of opioid addiction treatment resources, including a robust data dashboard with county-level SUD data in the state has also been developed.

In order to prepare for, and respond to, sentinel overdose events in targeted counties in the state, HMA helped develop the CRT Development and Action Plan. HMA guided the project by recruiting key stakeholders, establishing structure and developing an action plan for each county, which was selected by using overdose activity data from first responders. Teams developed tools and templates to ensure all partners use the same materials and messages in the response. The CRTs will take collective action in specific areas including naloxone distribution, focusing on not only deployment of the drug during sentinel events, but also education in advance of an event to ensure the public is aware of its availability and ensure its rapid distribution. HMA provided hands-on training, including naloxone train-the trainer education, capacity building, overdose prevention, and stigma reducing measures for the CRT stakeholders. During the COVID-19 state of emergency, naloxone distribution was modified to include car-side distribution, and CRT teams are provided overdose education and naloxone distribution to homeless individuals temporarily housed in hotels.

Through system mapping and assessment of current readiness, HMA has tackled OUD in jails by providing technical assistance to MDOC in planning and implementing the comprehensive OUD treatment program. HMA provided training and education for MDOC leadership, facilities, and healthcare staff, including Data Waiver training for contracted physicians and prescribers. The team also provided ongoing coaching, program evaluation and technical assistance to ensure quality improvement. Working alongside designated staff, HMA provided train-the trainer education and led strategic planning and goal setting to establish goals, priorities, plans and timelines for implementation.