Please see attached abstract below:
In 2018, Massachusetts legislature mandated that five county jails provide all types of medications for opioid use disorders (MOUD) to incarcerated individuals with OUD. Two other jails joined voluntarily. The seven jails partnered with academic institutions and the Massachusetts Department of Public Health (see Evans et al., 2021) to implement MOUDs in jails and provide referrals to community providers for individuals upon release. We conducted focus groups and individual interviews with 61 staff from the seven jails about their experience. Using the Exploration, Preparation, Implementation, and Sustainment framework we conducted qualitative analyses and identified outer, inner, and bridging factors as being critical to program implementation. As part of the outer context, participants described the legislative mandate as driving acceptance of MOUD in jails. They also reported on the importance of engaging jail personnel in decision-making and collaboration between jails and external agencies to foster trust and manage practical limitations of correctional settings. One of the major obstacles was around managing individuals whose release dates were unknown or who could be transferred to other facilities without MOUDs. For inner context, organizational characteristics were central in implementation. All jails had to decide 1) whether they would provide methadone in the jail or transport individuals to a community-based outpatient treatment program (OTP) and 2) if their in-house medical staff or outside contractors would provide buprenorphine. All sites had in-house capacity to provide naltrexone. Decisions entailed consideration of costs, facility infrastructure, staff knowledge and availability, state and federal requirements, access to community providers, and prior relationships with contractors. Additionally, internal leadership facilitated staff buy-in and entailed shifting from traditional top-down work hierarchies towards an approach that empowered staff and incorporated their feedback. Participants attributed much of the program successes to bridging factors, including effective teamwork among disciplines in the facility and relationships with community organizations. Discussion will focus on guidelines for implementation of MOUD in correctional settings and program sustainment.
Ekaterina (Kate) Pivovarova, Ph.D.
Department of Family Medicine & Community Health
University of Massachusetts Chan Medical School
P: 508 856-7816
F: 508 856-8700
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