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2 <br /> <br />Currently inmates are referred to the Hub and Spoke treatment as resources allow. Under the proposed <br />project, all inmates will be screened for a possible OUD (Opioid Use Disorder), or any other type of SUD <br />(Substance Use Disorder), then would be referred to the MAT partner organization as appropriate. The <br />MAT partner organization staff will begin with a general assessment for all substance use disorders <br />(SUDs) utilizing NIDA validated screening tools (NIDA quick screen, NIDA Modified ASSIST). If opioids are <br />a primary substance of abuse, both the DSM 5 Criteria for the Diagnosis of Opioid Use Disorder and the <br />Clinical Opioid Withdrawal Scale will be utilized. Assessment for other SUDs and withdrawals will also <br />occur during initial screening. For example, if alcohol is identified as a substance of abuse, the DSM 5 <br />Criteria for the Diagnosis of Alcohol Use Disorder and the Clinical Institute Withdrawal Assessment for <br />Alcohol will be used. A combination of screening/assessment instruments as well as the individual <br />characteristics of each patient will be used to identify appropriate and willing candidates for MAT. <br />Onsite Services <br />Intake: A full-time onsite Nurse Care Manager (NCM) will assist each inmate who has been pre-screened <br />using an evidence-based screening tool provided by the MAT partner organization, and identified as a <br />candidate for MAT by the jail correctional or medical staff, to complete new patient paperwork. Forms <br />include a Consent to Treat and a Consent to Release Information including a Business Associate <br />Agreement, allowing patient data to be shared between the jail and the MAT partner organization. <br />Induction: A licensed, X-DEA waivered provider and NCM will operate from inside the jail to conduct a <br />medical exam of each inmate who has completed the new patient paperwork. If the provider diagnoses <br />the inmate with substance use disorder and confirms the inmate is a candidate for MAT, the provider <br />will prescribe an appropriate dose of medication and the NCM will handle documentation, registration, <br />and induction dosing. In addition to inducting new patients, the provider will review patient charts <br />weekly and refill or adjust prescriptions as appropriate. <br />Dosing: The NCM will prepare medication doses, administer balloon dosing (3 times per week) or daily <br />dosing if medically appropriate, directly to all inmates on the MAT program, and maintain accurate <br />electronic medical record (EMR) documentation. The dosing schedule will be determined by command <br />staff in collaboration with the MAT partner organization during the implementation planning phase. <br />Counseling: An important part of this program to be successful is the inmate begins and continues to <br />receive the appropriate counseling in either a one on one, or group setting. The counselor’s <br />responsibility will be to ensure the inmate is given skills and mechanisms to utilize, in conjunction of the <br />prescribed medication to encourage rehabilitation, addiction battling, and other resources towards <br />recovery. This counselor will be responsible for monitoring the inmates and their emotional/behavioral <br />needs during incarceration while ensuring the inmate also has the resources once they are released for <br />coping with their addiction. <br />Care Coordination: The Peer Support Specialist will coordinate scheduling of ongoing care for inmates at <br />the MAT partner organization’s local clinic, starting immediately pre-release. Care coordination includes <br />appointment scheduling, documentation, financial counseling, referrals to services, and communication <br />with the patient to ensure smooth transition from onsite services to outpatient services.