SCOUTT

The Stepped Care for Opioid Use Train the Trainer (SCOUTT) operational initiative is working to implement a comprehensive plan to train interdisciplinary teams in Primary Care, General Mental Health, Pain Clinics and SUD Specialty Care clinics to deliver a stepped care model of medication treatment for opioid use disorder (M-OUD) to Veterans at his/her preferred care facility.

Background

Facilitation of the Stepped Care Model and Medication Treatment for Opioid Use Disorder is a Partnered Evaluation Initiative funded by the Quality Enhancement Research Initiative (QUERI) from the Department of Veterans Affairs.

The intent is to improve Veteran access to M-OUD treatment outside the confines of specialty addiction care and to capitalize on the Stepped Care for Opioid Use Train the Trainer (SCOUTT) operational initiative. After two national webinars during the Spring of 2018, SCOUTT was formally kicked off with a large national conference attended by nearly 300 VA staff from 18 VISNs, VACO leadership, and key stakeholders in August of 2018. At the two-day conference attended by facility non-specialty care implementation teams including 4 VISN leaders from each VISN, SCOUTT Facility Implementation Teams (SCOUTT FITs) were educated on two models to integrate SCOUTT into VA facilities, a medication management model and a case management model.

Teams developed action steps to integrate SCOUTT process in two clinic environments during the first-year post-conference (Phase 1), with the intention to spread to 18 other facilities in the subsequent year (Phase 2).

SCOUTT facilitators have engaged 18 SCOUTT Facility Implementation Teams (SCOUTT FITs) with monthly implementation meetings (at least 1 hour each) and additional mentorship and leadership calls as needed. Facilitators meet at least 1 hour weekly to compare notes and inform VACO leadership of the implementation progress. In addition, the PEC-19-001 meet at least 1 hour monthly with an ongoing planning committee meeting of national VA stakeholders regarding the progress of the initiative.

At least 2 facilitators to date also visited Lake City VA, Hampton VA, and Philadelphia VA for 2-day visits. At Lake City and Hampton VA, a buprenorphine waiver training was conducted where over 60 staff were trained on the provision of medication treatment for opioid use disorder for Veterans. In addition, in site visits the facilitators also visited with VISN leadership, Mental Health, Primary Care, Pain Clinic, Pharmacy, social work and/or conducted several training sessions with SCOUTT implementation team. The team reviewed how patients are selected for treatment, what induction day looks like at their clinic, and toured the facilities. Site reports were provided to the sites. At three sites, facility leadership was briefed regarding SCOUTT in a dedicated session, and VA facility leadership interacted with the PEC-19-001 team ad hoc at nearly all site visits. Monthly, the SCOUTT educational program provides two national webinars: one webinar monthly is geared to improve implementation and are intended for the 18 VISN teams (about 250 persons) and a second webinar monthly is geared to improve the education of all VA staff. VA EES supports this webinar and provides CME/CE credits. Webinars have included more than 300 participants at times.

SCOUTT AIMS:

AIM 1	This program focusses on implementing a comprehensive plan to train interdisciplinary teams in Primary Care, General Mental Health, Pain Clinics and SUD Specialty Care clinics to deliver a stepped care model of medication treatment for OUD in order to provide treatment services around the Veteran at his/her preferred point of care.
AIM 2	Develop, implement, deliver, produce and sustain SCOUTT strategies and products across all VISNs.
AIM 3	Facilitate, train, and mentor VISN-wide SCOUTT Pilot Team members through face-to-face meetings and community of practice webinars.

SCOUTT ACCOMPLISHMENTS:

Completed pre-implementation activities including asking VISN leaders to nominate a SCOUTT team at each VISN comprised of a pain specialist lead, a primary care lead and two clinical champions
Held two-day conference and trained teams on two models of MOUD care.
Held 7 site visits this year at VISNs to train teams implementing the train-the-trainer models.
Held routine calls with facilitators to identify barriers and brainstorm ideas to eliminate the barriers.
Held webinars where VISN SCOUTT teams provided updates on activities.
Held routine calls with the planning committee to plan for future regional conferences.
Held weekly meetings with SCOUTT External Facilitation group.
Held monthly meetings SCOUTT Planning Committee.
Liaised with the VA EES office for the monthly SCOUTT EES Webinar.
Held monthly SCOUTT Pilot Teams Facilitation Calls.
Managed listservs and responded to questions posted on the listserv.
Identified and invited leaders in the field to present on topics related to SCOUTT.
Collaborated with VA Central Office and EES
Conducted survey to understand provider perspectives
Conducted buprenorphine x-waiver trainings
Collated site reports and collected qualitative information in REDCap
Conducted provider interviews and working on evaluating the information
Collaborated with VACO leadership on VHA Notice 2019-18 buprenorphine prescribing for opioid use disorder Collaborated with VACO leadership on Emergency Dept Opioid Initiative

SCOUTT TEAM & SPONSOR:

Principal Investigator:	Adam Gordon, MD, MPH, FACP, DFASAM
Facilitators:	Hildi Hagedorn, PhD Marie Kenny, BS Amanda Midboe, PhD Princess Ackland, PhD LP, MSPH
Implementation Scientist:	Eric Hawkins, PhD
Sponsor:	Quality Enhancement Research Initiative (QUERI); Department of Veterans Affairs; PEC-19-001

HAVE QUESTIONS?

Contact us here:

Spencer Calder, MPH - Academic Program Manager

spencer.calder@va.gov or spencer.calder@hsc.utah.edu

Andrea Stofko - Research Analyst

andrea.stofko@va.gov or andrea.stofko@utah.edu

Education

SCOUTT ILEAD

These are didactic calls where clinicians and researchers share their work on caring for people with substance use disorders. These presentations primarily focus on OUD, but are expanding into alcohol use disorder, cannabis use disorder, and care for women Veterans. These calls are recorded. You must be in the VA network/firewall to attend these. They occur on Adobe Connect.

Upcoming Presentations

"Revising current assumptions to effectively manage long-term opioid therapy and its deprescribing." Presented by Ajay Manhapra, MD on October 9, 2024 at 1pm ET. Please reach out to spencer.calder@va.gov or andrea.stofko@va.gov if you would like more information.

Past Presentations

Please email Spencer.Calder@va.gov if you would like the link to any of the below presentations. These calls are primarily focused on Veterans and are accredited. They occur on the 2nd Wednesday of each month at 1pm ET.

2024

"Are Rates of Retention on Buprenorphine Improving Equitably among Veterans?"
"I'm Clean and Sober, But Not Necessarily Free: Perceptions of Buprenorphine Among Patients on Long-Term Treatment"
"The radical drug policy we need: Regulating alcohol" - Keith Humphreys
"Impact of Mandated Case Review Policy on Opioid Discontinuation and Mortality Among High-Risk Long-Term Opioid Therapy Patients: The STORM Stepped-Wedge Cluster Randomized Controlled Trial"
"Systematically Testing the Evidence on Marijuana"
"HIV prevalence and HIV screening history among Veterans with opioid and alcohol use disorders: Implications for addressing a syndemic through Integrated Health Systems"

2023

"Improving Treatment for Unhealthy Alcohol Use"
"Gender Informed Care for Women Veterans Who Use Substances" - Sara Spinella
"Developing a Primary-Care Based Buprenorphine Clinic and E-Consult: lessons from implementation science" - Jessica Wyse Katherine Mackey
"Addressing Homelessness, Serious Mental Illness, and Substance Use Disorders among Veterans" - Sonya Gabrielian Matthew McCoy
"Multi-level barriers and facilitators to treatment for alcohol use disorder" - Tessa Matson, Jessica Chen, Madeline Frost
"Buprenorphine 2023" - Thomas Hickey
"The Women's Recovery Group Curriculum Adapted for Veterans: An Overview" - Tracy Simpson, Rebekah Barton
"Qualitative Analysis of Patient Perspectives of Buprenorphine After Transitioning from Long-Term, Full Agonist Opioid Therapy Among Veterans with Chronic Pain" - Sara Edmond, Danielle Wesolowicz
"Nature vs Nurture? Positive psychosocial factors buffer genetic risk for substance use disorders and suicidal thoughts" - Peter Na
"Introduction to the “new” Extended-Release Buprenorphine Product (Cam2028 or “Brixadi”) for the treatment of opioid use disorder" - Adam Gordon, Margaret Rupprecht

2022

"MOUD-ED and/or Bridge Clinics" - Comilla Sasson
"Advancing Access to Pharmacological Treatment for Opioid Use Disorder: Results of the ADaPT-OUD Implementation Trial" - Allison Gustavson, Adam Gordon
"Systematically Testing the Evidence on Marijuana" - Devan Kansagara, Curtis Harrod
"Meeting the Veteran in Primary Care: Leveraging the clinical Pharmacist Practitioner to Improve Access" - Veldana Aliu
"Two Years of 'Ask the expert -- Substance Use Disorders': FAQs" - Ellen Edens
"Provider Incentives to Prescribe Buprenorphine for Opioid Use Disorder in Primary Care: A Preference Analysis." - Jordynn Wilcox
"Beyond state scope of practice laws for advanced practitioners – Additional supervision requirements for buprenorphine prescribing" - Basia Andraka-Cristou
"Influences of Physical Activity on Addiction and Addiction Treatment: Evidence, Methods, Mechanisms, and Future Directions" - Adam Gordon
"SCOUTT through Four Years: What We Planned, What We Accomplished, and Where We are Going" - Adam Gordon, Hildi Hagedorn, Eric Hawkins
"Pharmacotherapy for Alcohol Use Disorder" - Kyle Kampman
"Telehealth MOUD care to a CBOC: Collaborative base care model" - Alyssa Braxton

2021

"Clinical Pharmacy Specialist Provider Impact on MOUD in Primary Care" - Tera Moore
"Establishing Different Models of Level 1 Care in the SCOUTT Initiative – What is Necessary and Sufficient?" - Adam Gordon
"Using the Buprenorphine Patient Report to Improve Patient Care" - Chad Kay
"Buprenorphine Initiation: how to do it seamlessly and effectively in various settings" - Adam Gordon
"Contingency Management and the Role of Rapid UDS in supporting it" - Dominick DePhilippis
"Implementation of a pharmacist care model for MOUD." - Beth DeRonne, Erin Krebs
"Evaluating Quality of Care for Opioid Use Disorder" - Taylor Kelley
"Buprenorphine 101 for the non-Addictionologist" - Adam Gordon
"The sustainability and impact of COVID-19 on MOUD delivery during the Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) initiative." - Eric Hawkins
"A Review of Low-Dose Buprenorphine Initiation (aka “Microdosing”) – How to Accomplish in VA Settings" - Adam Gordon

2020

"The emerging role of buprenorphine in opioid dependence and pain" - William Becker
"QUERI VISN 22 Pilot to Increase Access to MAT and CIH in Primary Care" - Evelyn Chang and Rebecca Oberman
"Tele-health Approaches to Prescribing MAT" - David Moore and Marc Rosen
"Buprenorphine formulation for chronic pain management in patients with OUD or long-term opioid therapy with Physiological tolerance” - Adam Gordon
"Buprenorphine formulation for chronic pain management in patients with OUD or long-term opioid therapy with Physiological tolerance”. - Hilary Mosher
"Implementation of Medication Treatment in Rural and CBOC Settings: Progress and Opportunities." - Adam Gordon and Matthew Dungan
"Introduction and Updates on SCOUTT" - Adam Gordon and Jennifer Burden
"SCOUTT Facilitation, Implementation and Evaluation" - Hildi Hagedorn and Eric Hawkins
"Addressing the Relations between Opioid Use Disorder, Suicide Risk, and Overdose" - Elizabeth Oliva
"The Opioid Taper: The Clinical Case for Humility in Medical Decision-Making" - Stefan Kertesz
"Buprenorphine for OUD, Buprenorphine for Pain, and OEND Guidance Updates" - Mitch Nazario

2019

"Office Based Treatment of Buprenorphine: What is Necessary and Sufficient to Prescribe in VA Office" - Adam Gordon
"Introduction to Injectable Buprenorphine" - Adam Gordon
"Buprenorphine Dashboards: How to Use Data to Optimize Patient Care" - Michael A. Harvey, Pharm.D., BCPS
"So what are these VISN Partnered Implementation Initiatives?" - Adam Gordon
"Mini-Residency: Experiences and lessons learned" - Ellen Edens and team
"America’s Opioid Epidemic: Treating Opioid Addiction in Primary Care" - Ilene Robeck and Stephen Mudra
"Why should WE take care of YOUR patients?” - What Bedford VA has learned - Dongchan Park, M.D.
"Recommendations for Use: Buprenorphine Formulations for Chronic Pain Management in Patients with OUD or on Long Term Opioid Therapy with Physiologic Tolerance and Dependence." - Mitchell Nazario
"The Definition Of Addiction To Opioids And How To Code For It" - Adam Gordon, Karen Drexler, Ilene Robeck
"The Collaborative Care Model applied to Medication Assisted Treatment for SUD" - Andrew Pomerantz
"Initiative to improve drug screening in Primary Care to inform treatment." - Michael Saenger and Dominic DePhillip
"SCOUTT at a Year: Lessons Learned, Achievements, and Opportunities Going Forward" - Adam Gordon, Eric Hawkins, Karen Drexler, Jennifer Burden, Hildi Hagedorn

2018

"Treatment of Prescription Opioid Dependence and the Role of Counseling with Buprenorphine TX" - Dr. Weiss
"Multidisciplinary Management of Chronic Pain" - Dana Cervone, Sara Edmond, Ellen Edens
"Introduction to the uses of long-acting injectable naltrexone (XR-NTX)" - Maria Sullivan

SCOUTT Expansion

Phase 3

In 2022, SCOUTT began its phase 3 process by welcoming interested sites to join SCOUTT on an informal basis. These sites were given informal introductions to SCOUTT, provided with essential resources, and have been invited to share updates in monthly pilot calls.

Comprehensive Women's Health Program

The VA has been asked to improve access to evidence based treatment for substance use disorders (SUD) to women Veterans. The mission of the SCOUTT- Comprehensive Women’s Health (SCOUTT-CWH) Expansion Initiative is to improve SUD treatment for women Veterans throughout the Veterans Health Administration. Beginning in October 2022 (FY 2023), the intention of this program was to engage clinical teams from the Stepped Care for Opioid Use Disorder Train the Trainer (SCOUTT) initiative with four Comprehensive Women’s Health Programs to help facilitate care (Phase 1). The program is currently working to expand SUD treatment in Minneapolis, Portland, Puget Sound, and Salt Lake City. Over time, the SCOUTT-CWH Expansion Initiative will expand to other sites (Phase 2).