Empowering EMPATH Units: Training for Intergrated Mental Health and Opioid Disorder Management - PROJECT ABSTRACT Emergency departments (EDs) face significant challenges managing mental health crises, often lacking specialized resources and leading to inappropriate placements and insufficient follow-up care. Emergency Psychiatric Assessment, Treatment, and Healing (EmPATH) units are designed to specially address these issues. However, a significant proportion of individuals experiencing mental health crises also have co-occurring substance use disorders, particularly opioid use disorder (OUD). Buprenorphine has been shown to reduce all-cause mortality. Furthermore, emergency department-initiated buprenorphine (EDIB) has demonstrated a doubling of 30-day treatment retention compared to referral alone. This significant success makes integrating EDIB into the EmPATH unit model a logical and potentially transformative step toward improved patient outcomes. However, adequately addressing workforce training needs is crucial for the successful implementation and sustained improvement of patient care. This project will develop and implement a training curriculum for EmPATH personnel focused on the acute management of OUD, emphasizing initiation of medication for opioid use disorder (MOUD) with buprenorphine. A phased approach will involve stakeholder input, protocol refinement, and rigorous evaluation. Phase 1 (R-61) will focus on curriculum development, incorporating input from an external advisory board, piloting the intervention in one EmPATH unit, and gathering qualitative feedback to refine the protocol. Phase 2 (R-33) will utilize a stepped-wedge design to: 1) assess the number of individuals identified with OUD while in EmPATH units (Primary Outcome) and the number of individuals administered buprenorphine and/or given a prescription for buprenorphine (Secondary Outcome); and 2) assess EmPATH staff satisfaction, burnout, confidence, knowledge, and stigma when working with patients with opioid use disorder prior to implementation and at 3, 6, 9, and 12 months post-implementation/training. This study aims to create a replicable and scalable model for integrating state-of-the-art OUD management into psychiatric emergency settings, improving patient outcomes and workforce preparedness. The collaboration with the South Carolina Hospital Association, Department of Mental Health, and DAODAS strengthens the project's impact and sustainability.
