Revised January 2013
Medication-Assisted Treatment Implementation in Community Correctional Environments (MATICCE)
The MATICCE protocol focuses on implementing linkages to medication-assisted treatment in correctional settings. The US Food and Drug Administration (FDA) has approved medications for use in the treatment of alcohol and opiate dependence. Unlike much of the healthcare system, in which new medications are routinely introduced and adopted, the US addiction treatment system has been slow to adopt pharmacotherapies, lacks trained and credentialed personnel to deliver them, and evidences a longstanding philosophical preference for “drug free” treatment. These constraints and concerns are magnified in community corrections agencies, where the appropriate role of pharmacotherapy is not well understood, and the medically appropriate use of opioid agonists (e.g., methadone) may present challenges for monitoring offenders’ illicit drug use.
In the MATICCE study, community corrections staff engage in training about addiction pharmacotherapies, while leadership in the corrections and treatment facilities engage in a joint strategic planning process to identify and resolve barriers to efficient flow of clients across the two systems. Importantly, the objective is to leverage treatment services that already exist in the community. This means that the implementation strategy is not designed to promote the delivery of clinical services nor medication prescribing within or by probation and parole offices, but rather is targeted at facilitating linkages between organizations that, despite sharing the same clients, lack incentive to coordinate services, or otherwise do not view themselves as sharing a common mission.
HIV-STIC focuses on implementing interventions to address the HIV continuum of care in correctional settings. Evidence-based approaches exist for HIV risk reduction, testing, and treatment with antiretroviral therapy. However, there are significant gaps in this service continuum for offenders in the criminal justice system. Services may or may not be provided while individuals are incarcerated; transitions to the community may introduce additional service disruptions; and individual offenders face challenges navigating their prevention, testing and treatment options.
The HIV-STIC study protocol tests a modified NIATx process to facilitate site-specific improvements in the HIV services continuum. In both control sites and sites randomized to the modified NIATx process, criminal justice staff receive training on the fundamentals of HIV prevention and treatment. Sites randomized to the experimental condition form a local change team to engage in a process improvement approach with external coaching to implement a more complete HIV services continuum. Within the overall parameters of the protocol – which emphasizes HIV testing and linkage to treatment – sites assess local needs and existing services, set priorities for service improvements, and develop specific goals and strategies for achieving them. All sites participating in the HIV-STIC study target three goals: (1) improving the perceived value of HIV services among corrections staff; (2) increasing service penetration for inmates with or at risk for HIV; and (3) improving the quality of HIV service delivery.
The Assessment OPII study focuses on implementing assessment and treatment planning processes. Screening and assessment are used to identify substance abuse-related problems and to develop programming to address the problems so identified. Conducting a valid and reliable assessment is considered an essential step in providing effective treatment services and in being able to prioritize treatment and services according to type and severity of need. While research has established that a number of screening and assessment instruments (e.g., ASI, GAIN, LSI-R) have adequate validity and reliability, there is far less research on the successful implementation of these assessment tools, or on how they should be used to improve the course and effectiveness of treatment.
Like the HIV-STIC protocol, the Assessment OPII study also uses a modified NIATx approach. In contrast to the HIV-STIC protocol, which focuses on promoting the uptake of specific services, the Assessment OPII study engages corrections and treatment agencies to improve the quality of interagency communication through the effective use of assessment and case planning processes and treatment referrals. Both interagency and intra-agency change processes are targeted. A multi-phase implementation protocol is used, wherein agencies engage in team development, needs assessment, planning, implementation, and sustainability in distinct steps. Each site’s change team has a designated facilitator, and their activities are coordinated across sites through the use of a facilitator manual and ongoing fidelity measurement. Early and delayed-start sites allow the research team to control for effects of environmental changes within states. The key outcomes for this protocol reflect improvements in the use of assessment and case planning procedures for offenders. Specifically, offenders should not only receive comprehensive assessments, but the results of these assessments should inform case plans, and the information in the case plan should be conveyed to the local treatment provider agency to which the offender is referred upon release. The protocol targets critical communications channels between otherwise highly segregated correctional and treatment agencies.