( ) Michael Razavi, MPH, CADC I, PRC, CPS Brent Labhart, MSW student-intern Eric Martin, MAC, CADC III, PRC, CPS

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1 ( ) Medicatin Assisted Treatment Oregn Behaviral Health Wrkfrce Survey (n=1,302) Michael Razavi, MPH, CADC I, PRC, CPS Brent Labhart, MSW student-intern Eric Martin, MAC, CADC III, PRC, CPS Data Analysis Cnsultants Christi Hildebran, LMSW, CADC III Anthny Jrdan, MPA, CADC II, CRM Jhn Fitzgerald, PhD, LPC, CAS Jeff Martta, Ph.D., CADC III, CGAC II David Curse, M.A., LPC, CADC III, CGAC II Sectin 1: Medicatin Assisted Treatment Summary by Andrew Mendenhall, M.D.

2 ACCBO 2018 Behaviral Health Wrkfrce Survey (1,302 respndents) Michael Razavi, MPH, CADC I, PRC, CPS Brent Labhart, MSW-intern Eric Martin, MAC, CADC III, PRC, CPS Data Analysis Cnsultants Christi Hildebran, LMSW, CADC III Anthny Jrdan, MPA, CADC II, CRM Jhn Fitzgerald, PhD, LPC, CAS Jeff Martta, Ph.D., CADC III, CGAC II David Curse, M.A., LPC, CADC III, CGAC II ACCBO 2018 Behaviral Health Survey, Razavi, Labhart & Martin 1

3 Survey Methdlgy Cllabrative Survey Develpment: This 2018 survey was develped and analyzed by 98 participants, representing statewide behaviral health rganizatins: ACCBO, AOCMHP, OPERA Prtland State University, Oregn Health Authrity, the MetrPlus Assciatin f Addictin Peer Prfessinals, HealthInsights, the NW Institut Latin, the African American Behaviral Health and Addictin Treatment Calitin, and the University f Clrad Farley Health Plicy Center. Participants wrked in cre grups and with cntributrs t design survey questins t elicit infrmatin regarding disparity, wages, benefits, cntemprary healthcare initiatives, caselads, etc. The draft survey was ed t ver 100 prgram directrs fr their review, generating feedback regarding clarity and readability f questins. Flesch-Kincaid analysis ranks this survey at grade aptitude level Implementatin: Survey was implemented thrugh Survey Mnkey. Survey was ed t 4,400 CADC s/applicants (QMHA s/p s), CRM s, CGAC s, CPS, state apprved addictin treatment prgram directrs, and state apprved mental health prgram directrs. The survey was als distributed thrugh AOCMHP, the Assciatin f Oregn Cmmunity Mental Health Prgrams, and OPERA the Oregn Preventin Educatin and Recvery Assciatin. Annuncements thrugh Cnstant Cntact bulk , and SMS text messaging encuraging participatin were disseminated statewide. Respnse: Survey data was cllected frm 1,302 respndents. 86% cmpleted the entire general survey (questins #1 thrugh #105), and 82.0% cmpleted the additinal rle related questins. Crss-Database Validatin: Of 1,302 respndents, there were 776 degreed CADCs. These 776 CADCs were assessed prprtinally by level f educatin and cmpared t prprtins f nearly 3,000 degreed CADCs frm ACCBO s database. Survey respndents cmpared t ACCBO database: prprtin f degreed CADCs Dctrate Masters Bachelrs Assciate 2% 2% 24% 29% 22% 21% 52% 48% 0% 50% 100% Assciate Bachelrs Masters Dctrate Database 22% 24% 52% 2% Survey 21% 29% 48% 2% This crss-database cmparisn suggests baccalaureate CADCs are slightly ver-represented in the survey. Overall, the prprtin f CADC respndents clsely apprximates that f Oregn s entire CADC pl. It is imprtant t nte that ACCBO updates educatinal attainment f CADCs every tw years upn recertificatin, and it is pssible sme individuals have cmpleted a bachelr s degree since their last renewal f certificatin. ACCBO 2018 Behaviral Health Survey, Razavi, Labhart & Martin 2

4 Survey Develpment Questin Writing & Cntributin: Michael Razavi, M.P.H., CADC I, PRC, CPS, Addictin Cunselr Certificatin Bard f Oregn Brent Labhart, M.S.W.-intern, Prtland State University Eric Martin, MAC, CADC III, PRC, CPS, Addictin Cunselr Certificatin Bard f Oregn Jeff Martta, Ph.D., CADC III, CGAC II, Prblem Gambling Slutins & Vices f Prblem Gambling Recvery Greta Ce, CPS, Prblem Gambling Services Manager, Oregn Health Authrity Debi Ellit, Ph.D., Prtland State University Jim Shames, M.D., Jacksn Cunty Health and Human Services Jel Rice, M.D., Grand Rnde Recvery Dana Petersn, Oregn Health Authrity Andrew Mendenhall, M.D., Central City Cncern Shale Wngm, M.D., MSPH, Farley Health Plicy Center, University f Clrad Sarah Hemeida, M.D., MSPH, Farley Health Plicy Center, University f Clrad Lina Bru, M.D., MSPH, Farley Health Plicy Center, University f Clrad Jhnnie Gage, M.S., CRM, StayClean Debra Buffal-By, CADC II, CRM, Multicultural Cnsultants & Addictin Cunselr Certificatin Bard f Oregn Jesus Navarr, CADC II, NW Institut Latin & Vlunteers f America Anthny Jrdan, M.P.A., CADC III, Multnmah Cunty Heather Jeffries, M.A., ATR, OPERA Cherryl Ramirez, M.P.H., M.P.A., AOCMHP Mark Davis, CADC II, Addictin Cunselr Certificatin Bard f Oregn & Plk Cunty Mental Health Van Burnham IV, B.A., CRM, Addictin Cunselr Certificatin Bard f Oregn & Treasurer, 4 th Dimensin Recvery Center Julia Mines, M.S.W., CADC III, Addictin Cunselr Certificatin Bard f Oregn Aja Stner, M.S., CADC III, Addictin Cunselr Certificatin Bard f Oregn & Jacksn Cunty Health and Human Services Christi Hildebran, LMSW, CADC III, HealthInsight Oregn MetrPlus Assciatin f Addictin Peer Prfessinals, review f survey questins and questin writing at membership meeting f 58 peer participants Survey Reviewers/Editrs: Andrea Quicksall, M.A., CADC II, Addictin Cunselr Certificatin Bard f Oregn & Family Care Cheryl Chen, LPC, CADC I, Healthshare, Behaviral Health Prgram Manager Jackie Fabrick, M.A., Oregn Health Authrity Reed McClintck, M.S., QMHP Cascadia Behaviral Health Care Chris Masn, CEO Addictin Recvery Center Rick Trelevan, LCSW, Executive Directr, BestCare Kim Shay, M.S., LPC, Center fr Addictin and Cunseling Services Michelle Brandsma, M.S., CADC III, MAC Jennine Smart, MSW, HealthShare Survey Analysts & Analysis Cnsultants: Michael Razavi, M.P.H., CADC I, PRC, CPS, Addictin Cunselr Certificatin Bard f Oregn Brent Labhart, M.S.W.-intern, Prtland State University & Addictin Cunselr Certificatin Bard f Oregn ACCBO 2018 Behaviral Health Survey, Razavi, Labhart & Martin 3

5 Eric Martin, MAC, CADC III, PRC, CPS, Addictin Cunselr Certificatin Bard f Oregn Christi Hildebran, LMSW, CADC III, HealthInsight Oregn Anthny Jrdan, MPA, CADC II, CRM Multnmah Cunty Jhn Fitzgerald, PhD, LPC, CAS Oregn Criminal Justice Cmmissin Jeff Martta, Ph.D., CADC III, CGAC II, Prblem Gambling Slutins & Vices f Prblem Gambling Recvery David Curse, M.A., LPC, CADC III, CGAC II, NCGC II, Prgram Manager, Lincln Cunty Health & Human Services ACCBO 2018 Behaviral Health Survey, Razavi, Labhart & Martin 4

6 Sectin I: MAT Medicatin Assisted Treatment MAT, medicatin assisted treatment, includes methadne, burprenrphine (Sublcade, Prbuphine, Subxne, Subutex), nalxne, naltrexne, and naltrexne injectable (Vivitrl). Overall, 61.76% f all behaviral health wrkers reprt they wrk with clients participating in MAT. The cmbined addictin specialty wrkfrce (addictin cunselrs, peers and addictin supervisrs) were mre likely t reprt that they wrk with clients participating in MAT (fig.1). Percent f behaviral health wrkers wh wrk with clients participating in MAT, by ccupatinal rle and regin Overall, 39.04% f behaviral health wrkers have had a clse friend, significant ther r family member wh has participated in MAT. Peers are mre likely t reprt, 60.98%, were mre likely t reprt a clse persnal experience (fig.2). Percent f behaviral health wrkers wh have had a clse friend, significant ther r family member in MAT, by ccupatinal rle and regin Addictin Peers 52.22% 60.98% Addictin Peers 72.50% Addictin Supervisrs 45.88% Addictin Supervisrs 71.93% 44.83% CADCs/Applicants MH Supervisrs 71.08% 62.86% CADCs 41.30% 60.92% MH Supervisrs 33.80% Licensed MH Prf 55.50% 24.91% 50.68% Licensed MH Prf 21.88% 50.00% Western Oregn 63.39% Western Oregn 41.00% Eastern Oregn 53.24% Eastern Oregn 25.71% 40.00% 50.00% 60.00% 70.00% 80.00% 20.00%30.00%40.00%50.00%60.00%70.00% Figure 1: Percent f wrkfrce wrking with MAT clients Figure 2: Percent f wrkfrce with a clse persnal experience invlving a friend, s.. r family participating in MAT ACCBO 2018 Behaviral Health Survey, Razavi, Labhart & Martin 5

7 Overall, 90.22% f all behaviral health wrkers reprt that they agree r strngly agree that MAT reduces piid deaths. CADC s & their supervisrs, 47.40%, are mst likely t strngly agree that MAT reduces piid deaths, while nly 1/3 rd f addictin and mental health peers strngly endrsed this belief that MAT reduces piid deaths (fig.3). Percent f behaviral health wrkers wh "strngly agree" that MAT reduces piid deaths, by ccupatinal rle and regin Addictin Supervisrs 54.87% Overall, 39.91% f all behaviral health wrkers reprt their misunderstd belief that MAT shuld nly be used fr withdrawal management. Research reveals that the shrt-term use f MAT, ften leads t relapse rates cmparable t n treatment at all. Mental Health Supervisrs, 24.10%, were the least likely t endrse this misunderstd belief, while peers were mre likely t endrse this misunderstd belief (fig.4). Percent f behaviral health wrkers wh "agree & strngly agree" that MAT shuld nly be used fr withdrawal management, by ccupatinal rle and regin CADCs/Applicants 44.60% 57.40% 44.33% Addictin Peers 57.30% Licensed MH Prf 42.70% 43.40% CADC/Applicants 38.00% 37.72% QMHP 32.10% 33.73% Addictin Supervisrs 30.90% Addictin Peers 31.00% Licensed MH Prf 29.67% MH Supervisrs 24.10% Western Oregn 42.78% Western Oregn 39.92% Eastern Oregn 36.30% Eastern Oregn 41.80% 20.00% 30.00% 40.00% 50.00% 60.00% 10.00% 30.00% 50.00% 70.00% Figure 3: Percent f wrkfrce wh strngly agree that MAT reduces piid deaths Figure 4: Percent f wrkfrce that reprting that MAT shuld nly be used fr withdrawal management ACCBO 2018 Behaviral Health Wrkfrce Survey, Razavi, Labhart & Martin 6

8 Overall, 87.59% f all behaviral health wrkers agree r strngly agree that MAT is effective and helps peple achieve lng term stabilizatin and abstinence. Addictin and mental health supervisrs were mre likely t strngly agree, while peers were the least likely t strngly agree. (fig.5). Percent f behaviral health wrkers wh "strngly agree" that MAT helps peple achieve lng term stabilizatin - abstinence, by ccupatinal rle and regin Overall, 69.16% f all behaviral health wrkers reprt their behaviral health envirnment has becme mre accepting f MAT, 28.54% reprt there has been n change, and 2.30% reprt it has becme less accepting and supprtive f MAT. The addictin specialty wrkfrce, 75.79%, were mre likely t reprt that their wrk envirnment has becme mre accepting and supprtive f MAT (fig.6). Percent f behaviral health wrkers wh reprt their wrk envirnment has becme mre accepting and supprtive f MAT, by ccupatinal rle and regin MH Supervisr 45.59% Addictin Peers 77.37% Addictin Supervisrs 44.12% MH Supervisrs 75.76% CADC/Applicant 36.74% Addictin Supervisrs 74.42% 35.40% CADC/Applicant 71.79% 33.21% 68.83% Licensed MH Prf 32.97% Licensed MH Prf 67.93% 31.20% 62.32% Addictin Peers 25.76% 58.13% Western Oregn 35.36% Western Oregn 69.71% Eastern Oregn 31.85% Eastern Oregn 66.42% 20.00% 30.00% 40.00% 50.00% 50.00% 60.00% 70.00% 80.00% Figure 5: Percent f wrkfrce wh strngly agree that MAT is effective fr lng term stabilizatin and abstinence Figure 6: Percent f wrkfrce reprting that their wrk envirnment has becme mre accepting f MAT ACCBO 2018 Behaviral Health Wrkfrce Survey, Razavi, Labhart & Martin 7

9 Overall, 59.74% f all behaviral health wrkers reprt they have received training n the different types f medicatins fr piid use disrder [methadne, burprenrphine (Sublcade, Prbuphine, Subxne, Subutex) nalxne, naltrexne, naltrexne injectable (Vivitrl)]. Overall, the cmbined mental health wrkfrce, 48.78%, were least likely t reprt having received educatin n MAT (fig.7). Percent f behaviral health wrkers wh reprt they have received training n different types f MAT, by ccupatinal rle and regin Overall, 74.73% f all behaviral health wrkers reprt they need mre infrmatin regarding the efficacy f MAT and legal prtectins affrded MAT clients. Apprximately 75% f behaviral health wrkers, supervisrs ntwithstanding, reprt a need fr mre infrmatin regarding MAT (fig.8). Percent f behaviral health wrkers wh reprt they need mre infrmatin regarding MAT efficacy and legal prtectins fr MAT clients, by ccupatinal rle and regin Addictin Supervisrs 84.88% 77.16% CADC/Applicant 68.55% 75.58% MH Supervisrs 66.18% Addictin Peers 75.12% Licensed MH Prf 59.04% CADC/Applicant 74.65% 55.17% QMHA 74.42% Addictin Peers 53.96% Addictin Supervisrs 69.41% 52.05% 47.67% MH Supervisrs 68.66% Western Oregn 59.87% Western Oregn 74.35% Eastern Oregn 56.52% Eastern Oregn 77.14% 40.00%50.00%60.00%70.00%80.00%90.00% 65.00% 70.00% 75.00% 80.00% Figure 7: Percent f wrkfrce reprting they have received educatin n MAT Figure 8: Percent f wrkfrce reprting they need mre educatin regarding MAT ACCBO 2018 Behaviral Health Wrkfrce Survey, Razavi, Labhart & Martin 8

10 Sectin I: Medicatin Assisted Treatment - Summary By Andrew Mendenhall, M.D. This sectin f the wrkfrce survey fcused n assessment f prfessinal beliefs, experience, training expsure and perceptin f recent change regarding the acceptance f Medicatin Assisted Treatment in varied behaviral health settings. MAT fr alchl use disrder was nt assessed as part f this survey. 61% f behaviral health wrkers reprted wrking with patients receiving MAT, and nearly 40% have had a family member r a clse persnal acquaintance wh has received treatment with MAT. The vast majrity, 88% agree that MAT fr piid use disrders is effective in stabilizing patients and helping them achieve abstinence and 90% believe MAT reduces verdse and saves lives. In sharp cntrast t the expsure t their direct wrk experience with patients receiving MAT and their strngly expressed beliefs regarding efficacy was the mst cncerning statistic frm this survey. Our data reveals that 40% f all behaviral health wrkers believe that MAT shuld nly be used fr withdrawal management. It appears that many behaviral health wrkers are unaware that shrt-term use f MAT fr withdrawal management is nt a best practice and is demnstrated in the literature t yield treatment results in bth relapse and verdse death rates cmparable t patients receiving n treatment at all. Mental health and addictin peer supprt mentrs were mre likely t espuse this mistaken belief. Peer supprt mentrs need mre infrmatin regarding the efficacy f maintenance fr piid use disrders. Fr example, a 2014 study reprted in JAMA, reveals that just after 3 mnths f buprenrphine, tapering was assciated with high relapse rates ver 90%. Studies have shwn that the lnger individuals participate in MAT mre benefits ccur; stabilizatin, health, emplyment, husing and reduced relapse when tapering eventually ccurs. 1 Mre educatin is clearly necessary t help the Oregn behaviral health wrkfrce gain a mre cmprehensive understanding f the evidence surrunding best practices fr the treatment f piid use disrder. Mst imprtantly there appears t be a strng desire amng the behaviral health wrkfrce and there appears t be a trend f greater desire fr knwledge within Eastern Oregn. The evidence and best-practice recmmendatins fr medicatin supprt in the management f piid use disrder cntinue t evlve based n data-sets cmprised f millins f quality-adjusted life-years. The pprtunity t prvide access t this knwledge has never been easier, and the wrkfrce appears t be receptive t learning mre abut this imprtant evidence-based clinical practice. 2 New updated infrmatin is nw available thrugh SAMHSA s TIP 63. Supervisrs in addictin and mental health are encuraged t share this infrmatin with their staff. 1. Fiellin, D. A., Schttenfeld, R. S., Cutter, C. J., Mre, B. A., Barry, D. T., & O Cnnr, P. G. (2014). Primary care-based buprenrphine taper vs maintenance therapy fr prescriptin piid dependence: A randmized clinical trial. JAMA Internal Medicine, 174(12), Substance Abuse and Mental Health Services Administratin. Medicatins fr Opiid Use Disrder. Treatment Imprvement Prtcl (TIP) Series 63, Full Dcument. HHS Publicatin N. (SMA) FULLDOC. Rckville, MD: Substance Abuse and Mental Health Services Administratin, ACCBO 2018 Behaviral Health Wrkfrce Survey, Razavi, Labhart & Martin 9