MHA Nation MAT-PDOA program. - The Three Affiliated tribes (Mandan, Hidatsa, & Arikara Nation) is located on the Fort Berthold Reservation in rural North Dakota. The Three Affiliated Tribes is a Title 1 P.L. 93-638 Program which is seeking support from the U.S. Department of Health & Human Services, Substance Abuse and Mental Health Service Administration (SAMHSA)to establish the Mandan, Hidatsa, and Arikara Medication Assisted Treatment- Prescription Drug and Opioid Addiction (MHA Nation MAT-PDOA) Model of Care Throughout the Elbowoods Memorial Health Care System. There are six segments that make up the reservation. The Three Affiliated tribes currently has 17,145 enrolled members with 5,503 tribal members living and working on the reservation. 8,274 or 48.259% of the tribal members are male and 8,871 or 51.741% are females. The tribe has 5,349 members that are under the age of 17 years old and 10,093 between the ages of 18-59. The tribe's overall average life expectancy is 51.11 years with females having 57.96 years and males coming in at 50.11 years (Tribes 2022 Enrollment Report) The main goals are to: 1. To continue making MAT accessible to members of the Three Affiliated Tribes. a. Continue training staff in Medication Assisted Treatment and training of the Behavioral health personnel in evidence-based practices in the Five A Model for Tobacco Cessation (Ask, Advise, Assess, Assist, and Arrange). b. Continue educating the EMHC staff as well as community members on protocols for the administration of Naloxone. c. Develop protocol for case management and track of clients who request or require MAT. 2. develop referral processes from primary care providers to behavioral health staff for those at high risk of substance abuse as pertains to opioid and mental health and wellness. a. Increase the knowledge and confidence in the following referral processes and workflow by annually assessing our workforce by using the referred care system and Icare EHR RPMS. 3. Improve care and outcomes for individuals who are at risk for overdose and death associated with the opioid epidemic with case managing MAT and assisting patients with support services. a. Outcomes will be tracked via case management through the development of an Opioid specific patient registry 4. Sustainability a. Enrolling clients in clients in private, state, and/or federally funded insurance programs will help in the sustainability of tribal organizational MAT Program. Elbowoods Memorial Health Center will assess our objectives at regular intervals (i.e. every 3 months) and utilize the implementation team to create continued advocacy and longevity for the project. EMHC has experience with operating a SAMHSA funded grant and are currently operating a SAMHSA MAT/TOR program which is due to expire before the start of the new proposed grant funded program. Additionally, as of January 12, 2023, the previously stringent requirement of obtaining an x-waiver to prescribe this buprenorphine has been removed. Without this requirement there should be increased ordering from more diverse sources, which will increase access to treatment and increase the need for maintenance treatment. Since 2018, when the MAT program in Elbowoods was first started, there has been an increase in facilities surrounding the Fort Berthold Reservation that also provide MAT services. As of the time of this application, with these changes mentioned above, EMHC is in the process of shifting the focus of the program to allow for more patients to have access to this treatment to decrease the financial strain on obtaining the treatment (No cost to the patient through the EMHC pharmacy).
