JWCH will provide MAT services to patients including street outreach, monitored drug therapy (buprenorphine and naltrexone), individual counseling, group therapy, and case management services. The target population is individuals in economically disadvantaged regions of Los Angeles (including Downtown LA and East Hollywood) with high populations of homeless individuals. These are among the most heavily impacted regions of Southern California in terms of the number of individuals with opioid use disorder who are homeless or otherwise lack access to substance abuse treatment and medical care.
The program has several stages of treatment intensity: Green, Yellow, Orange, and Red. Generally, patients start in Orange, and they remain at the intensity for eight weeks, then Yellow at 16 weeks, and Green for as long as MAT is appropriate. To determine appropriate treatment intensity, clients and SAC/CM have ongoing collaborative discussions, with input from the client’s medical provider and the mental health professional. Program staff will utilize evidence-based and evidence-informed treatment interventions including Motivational Interviewing (MI), Seeking Safety, Intensive Case Management (ICM), and Prize-based contingency management. MI is an evidence-informed intervention that allows clinicians to gauge a client’s current motivation to change their behavior (i.e. addiction), and assists patient’s in overcoming their ambivalence. Whereas, Seeking Safety is a trauma-informed substance misuse intervention that facilitates cognitive, behavioral, and emotional healing through manualized group therapy. In addition, ICM has been shown to augment patient care, particularly among high need patients, by providing patients with a single point of contact to navigate health and social service systems. In this program, Prize-based contingency management will be used to incentivize program and treatment compliance, and will include rewarding clients with a raffle ticket each time they complete specific goals (i.e. pre-set number of group sessions) to potentially win a modest prize like a new backpack or shoes. Prize-based contingency management adds an element of fun which has been shown to keep individuals engaged in care, and increase program completion rates.
The proposed project will target Service Planning Area 4 “SPA 4”, including the Los Angeles Metropolitan Area with Downtown Los Angeles and Hollywood. To facilitate the delivery of services, LA County Health Agency has divided LA County into eight service planning areas. SPA 4 is 93 sq. miles and has a population of 1,190,448, with a population density of 12,786 people per square mile, the highest in LA County. JWCH’s population of focus is individuals who are economically disadvantaged including those who are homeless, at-risk of being homeless, or formerly homeless. In our current MAT program, 75% of individuals are homeless, and we will continue to focus on this population, and also provide services to non-homeless low income patients. JWCH Institute is the only community clinic that currently offers MAT, and we are committed to serving individuals regardless of ability to pay. There is a high unmet need for MAT in the SPA 4, and an estimated 6,100 individuals with OUD lack access to treatment. Through this project we will be able to expand our capacity to provide MAT services from 100 to 150 patients per year in total.