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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.

    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. 

    train the trainer

    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 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

     

    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.

    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

    • "The radical drug policy we need: Regulating alcohol" - Keith Humphreys

    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).
     

    scoutt-cwhp sites

    HAVE QUESTIONS?

    Contact us here:

    Andrea Stofko

    andrea.stofko@va.gov 

    or andrea.stofko@utah.edu

    Recent Publications

    Bolded papers indicate facility SCOUTT clinic descriptions:

    1. Percy A, Kelley AT, Valentino N, Butz A, Baylis JD, Suo Y, Gordon AJ, Jones AL. Care Practices of Mental Health Clinical Pharmacist Practitioners Within an Interdisciplinary Primary Care Model for Patients With Substance Use Disorders. Subst Abus. 2023 Oct 15:8897077231198679. doi: 10.1177/08897077231198679. Epub ahead of print. PMID: 37840212. 
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
    8. 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.
    9. 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.
    10. 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.
    11. 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.
    12. 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
    13. 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
    14. 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
    15. 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

     

     

     

    HAVE QUESTIONS?

    Contact us here:

    Spencer Calder, MPH

    spencer.calder@va.gov 

    or spencer.calder@hsc.utah.edu