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.
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.
- 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|
Bolded papers indicate facility SCOUTT clinic descriptions:
Gordon AJ, Drexler K, Hawkins EJ, Burden J, Codell NK, Mhatre-Owens A, Dungan MT, Hagedorn H. Stepped Care for Opioid Use Disorder Train the Trainer (SCOUTT) initiative: Expanding access to medication treatment for opioid use disorder within Veterans Health Administration facilities. Subst Abus. 2020;41(3):275-282. doi: 10.1080/08897077.2020.1787299. PMID: 32697170; PMCID: PMC7849630.
DeRonne BM, Wong KR, Schultz E, Jones E, Krebs EE. Implementation of a pharmacist care manager model to expand availability of medications for opioid use disorder. Am J Health Syst Pharm. 2021 Feb 8;78(4):354-359. doi: 10.1093/ajhp/zxaa405. PMID: 33326564.
Lei J, Butz A, Valentino N. Management of kratom dependence with buprenorphine/naloxone in a veteran population. Subst Abus. 2021;42(4):497-502. doi: 10.1080/08897077.2021.1878086. Epub 2021 Feb 22. PMID: 33617752.
Codell N, Kelley AT, Jones AL, Dungan MT, Valentino N, Holtey AI, Knight TJ, Butz A, Gallop C, Erickson S, Patton J, Hyte-Richins LJ, Rollins BZ, Gordon AJ. Aims, development, and early results of an interdisciplinary primary care initiative to address patient vulnerabilities. Am J Drug Alcohol Abuse. 2021 Mar 4;47(2):160-169. doi: 10.1080/00952990.2020.1832507. Epub 2020 Dec 10. PMID: 33301347; PMCID: PMC8062280.
Hawkins EJ, Danner AN, Malte CA, Blanchard BE, Williams EC, Hagedorn HJ, Gordon AJ, Drexler K, Burden JL, Knoeppel J, Lott A, Sayre GG, Midboe AM, Saxon AJ. Clinical leaders and providers' perspectives on delivering medications for the treatment of opioid use disorder in Veteran Affairs' facilities. Addict Sci Clin Pract. 2021 Sep 6;16(1):55. doi: 10.1186/s13722-021-00263-5. PMID: 34488892; PMCID: PMC8419813.
Kelley AT, Dungan MT, Gordon AJ. Barriers and Facilitators to Buprenorphine Prescribing for Opioid Use Disorder in the Veterans Health Administration During COVID-19. J Addict Med. 2021 Sep-Oct 01;15(5):439-440. doi: 10.1097/ADM.0000000000000786. PMID: 33323694; PMCID: PMC8489586.
Spelman JF, Edens EL, Maya S, Moore BA, Boggs A, MacLean RR, Ackland P, Becker WC, Lynch D, Garcia-Vassallo M, Burgo AL, Rosen MI, Gordon AJ. A Facility-Wide Plan to Increase Access to Medication for Opioid Use Disorder in Primary Care and General Mental Health Settings. Fed Pract. 2021 Oct;38(10):460-464. doi: 10.12788/fp.0186. PMID: 34733066; PMCID: PMC8560103.
Hawkins EJ, Malte CA, Gordon AJ, Williams EC, Hagedorn HJ, Drexler K, Blanchard BE, Burden JL, Knoeppel J, Danner AN, Lott A, Liberto JG, Saxon AJ. Accessibility to Medication for Opioid Use Disorder After Interventions to Improve Prescribing Among Nonaddiction Clinics in the US Veterans Health Care System. JAMA Netw Open. 2021 Dec 1;4(12):e2137238. doi: 10.1001/jamanetworkopen.2021.37238. PMID: 34870679; PMCID: PMC8649831.
Gordon AJ, Kenny M, Dungan M, Gustavson AM, Kelley AT, Jones AL, Hawkins E, Frank JW, Danner A, Liberto J, Hagedorn H. Are x-waiver trainings enough? Facilitators and barriers to buprenorphine prescribing after x-waiver trainings. Am J Addict. 2022 Mar;31(2):152-158. doi: 10.1111/ajad.13260. Epub 2022 Feb 3. PMID: 35118756.
Jones AL, Kelley AT, Suo Y, Baylis JD, Codell NK, West NA, Gordon AJ. Trends in Health Service Utilization After Enrollment in an Interdisciplinary Primary Care Clinic for Veterans with Addiction, Social Determinants of Health, or Other Vulnerabilities. J Gen Intern Med. 2022 Feb 22:1–9. doi: 10.1007/s11606-022-07456-x. Epub ahead of print. PMID: 35194740; PMCID: PMC8862702.
Radmall AO, Calder S, Codell N, Kelley AT, Hawkins E, Jones AL, Hagedorn H, Reynolds MA, Gordon AJ. Roles and perceptions of nurses during implementation of a medication treatment for opioid use disorder national initiative. J Addict Nurs. 2022;33(2):70-79. PMID: 3564010
Wyse JJ, Mackeu K, Lovejoy TI, Kansagara D, Tuepker A, Gordon AJ, Korthuis TP, Herreid-O’Neill A, Williams B, Morasco BJ. Expanding access to medications for opioid use disorder through locally initiated implementation. Addict Sci Clin Pract. 2022;17(1):32. PMID: 35725648
Kelley AT, Wilcox J, Baylis JD, Crossnohere NL, Magel J, Jones AL, Gordon AJ, Bridges JFP. Increasing Access to Buprenorphine for Opioid Use Disorder in Primary Care: an Assessment of Provider Incentives. J Gen Intern Med. 2022 Dec 5. doi: 10.1007/s11606-022-07975-7. Epub ahead of print. PMID: 36471194
Lott AM, Danner AN, Malte CA, Williams EC, Gordon AJ, Halvorson MA, Saxon AJ, Hagedorn HJ, Sayre GG, Hawkins EJ. Clinician Perspectives on Delivering Medication Treatment for Opioid Use Disorder during the COVID-19 Pandemic: A Qualitative Evaluation. J Addict Med. 2023 Mar 2. doi: 10.1097/ADM.0000000000001156. Epub ahead of print. PMID: 36862502
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