DHCS collaborated with American Indian and Alaska Native community stakeholders to design the California Tribal Medication-Assisted Treatment (MAT) Project. Described by its lead entities as “A unified response to the opioid crisis in California Indian Country”, the Tribal MAT Project is designed to meet the specific opioid use disorder (OUD) prevention, treatment, and recovery needs of California’s Tribal and Urban Indian communities. It was a core component of the original California MAT Expansion Project and is continued through the California MAT Expansion Project 2.0. In close partnership with representatives of the communities being served, DHCS developed the Tribal MAT Project to promote opioid safety, improve the availability and provision of MAT, and facilitate wider access to naloxone with special consideration for Tribal and Urban Indian values, culture, and treatments. For a snapshot of the Tribal MAT Project, take a look at the flyer.
The Tribal MAT Project is well underway. The following organizations are implementing complementary initiatives to achieve the goals of the Tribal MAT Project:
California Consortium for Urban Indian Health
The California Consortium for Urban Indian Health (CCUIH) works with Urban Indian health organizations in support of health promotion and access for American Indians living in California cities. Under the Tribal MAT Project, CCUIH is carrying out the following activities:
- Launching a community opioid campaign. CCUIH is developing and disseminating culturally adapted education materials oriented for Urban Indian communities, including OUD prevention, treatment, and recovery materials that are specific for Urban Indian patients, providers, and other stakeholders.
- Distributing and training on naloxone. CCUIH is purchasing and distributing NARCAN Nasal Spray while facilitating training sessions for Urban Indian stakeholders on opioid overdose recognition, response, and NARCAN administration using culturally adapted training education materials.
- Serving as MAT Champions. CCUIH staff are serving as MAT Champions to facilitate Urban Indian stakeholders’ prevention, treatment, and recovery services assessment and development, including the coordination of relevant MAT-related resources available to Urban Indian providers (e.g. tele-MAT and technical assistance services offered by TeleWell [see below], Tribal Project ECHO offered by UCLA [see below], and the Hub and Spoke System).
- Supporting Opioid Safety Coalitions. CCUIH actively supports its members’ participation in the local opioid coalitions of the California Opioid Safety Network. In addition, CCUIH is collaborating with the California Rural Indian Health Board (see below) to develop and manage the California Indian Opioid Safety Coalition, a statewide coalition of Native and Native serving organizations in an organized response to the opioid epidemic in Indian Country.
California Rural Indian Health Board
The California Rural Indian Health Board (CRIHB) is a network of Tribal Health Programs, which are controlled and sanctioned by Indian people and their Tribal Governments, formed to provide a central focal point in the Indian health field in California for planning, advocacy, funding, training, technical assistance, coordination, fund raising, education, development and for the purpose of promoting unity and formulating common policy on Indian health care issues. Under the Tribal MAT Project, CRIHB is carrying out the following activities:
- Launching a community opioid campaign. CRIHB is developing and disseminating culturally adapted education materials oriented for tribal communities, including OUD prevention, treatment, and recovery materials that are specific for tribal patients, providers, and other stakeholders.
- Distributing and training on naloxone. CRIHB is purchasing and distributing NARCAN Nasal Spray to tribal stakeholders while facilitating training sessions for tribal stakeholders on opioid overdose recognition, response, and NARCAN administration using culturally adapted training education materials.
- Serving as MAT Champions. CRIHB staff are serving as MAT Champions to facilitate tribal stakeholders’ prevention, treatment, and recovery services assessment and development, including the coordination of relevant MAT-related resources available to Urban Indian providers (e.g. tele-MAT and technical assistance services offered by TeleWell [see below], Tribal Project ECHO offered by UCLA [see below], and the Hub and Spoke System).
- Supporting Opioid Safety Coalitions. CRIHB is supporting tribes and tribal organizations to create Tribal Local Opioid Coalitions, designed to function as local opioid coalitions of the California Opioid Safety Network within tribal communities. In addition, CRIHB is collaborating with CCUIH (see above) to develop and manage the California Indian Opioid Safety Coalition, a statewide coalition of Native and Native serving organizations in an organized response to the opioid epidemic in Indian Country.
TeleWell Behavioral Medicine
TeleWell Behavioral Medicine provides psychiatric and addiction medicine services using telehealth technology. Their mission is to offer high quality specialty services to rural and other underserved communities, especially tribal and urban Indian health programs. Under the Tribal MAT Project, TeleWell is carrying out the following activities:
- Delivering tele-MAT services. Through the use of telehealth technology, TeleWell offers MAT to AI/AN patients with OUD presenting at Urban Indian and tribal health providers, including clinical assessment, drug screening, induction, prescribing, evaluation and management, psychosocial, co-occurring psychiatric, and discontinuation treatment services. These services can be offered short (1-4 sessions) or long (>4 sessions) term. The goal of offering this service is to provide MAT services for programs that do not offer MAT in-house; provide a “jump-start” to programs that intend to start their own MAT program, but would like to observe the process before beginning; provide additional capacity to supplement programs that are full; and provide psychiatric services for MAT patients with complex co-occurring conditions. Co-occurring treatment is available for all AI/AN MAT patients, regardless of where they are receiving MAT services.
- Offering webinars and clinical consultation. TeleWell offers a monthly web-based educational series on OUD prevention, treatment, and recovery issues geared for tribal and urban Indian health providers, with a focus on patients with co-occurring disorders, which include didactic presentation and case discussion. In addition, TeleWell offers monthly “MAT Office Hours” calls for tribal and urban Indian health provider staff to ask questions, request clinical consultation, and participate in organic discussion regarding MAT care delivery.
- Providing MAT practice transformation support. TeleWell has subcontracted with Grace “Katie” Bell to provide site-specific startup technical assistance and ongoing coaching opportunities to tribal and urban Indian health providers interested in providing MAT. Katie Bell performs site visits to providers upon request; provides staff and leadership training; identifies the clinical, operational, administrative, and programmatic needs of the practice to begin delivering MAT; supports the development of an MAT action plan to close the identified gaps; and provides ongoing clinical consultation, coaching, staff training, and troubleshooting services.
Two Feathers – Native American Family Services
Two Feathers – Native American Family Services (Two Feathers) is a tribally chartered organization in Humboldt County providing Native American based mental health and child welfare services through a comprehensive continuum of school, community-based and family focused treatment services for children and families experiencing high levels of trauma and oppression, and who are at risk for family disruption or institutional care for the children. Under the Tribal MAT Project, Two Feathers is carrying out the following activities:
- Developing a Tribal Youth and Family Services Consortium. Two Feathers is developing a consortium consisting of tribal partners to provide OUD prevention, suicide prevention, and intensive case management services for Native American youth using the Native American Mental Health Theory of Change framework for youth and their families, OUD prevention services to parents and guardians, and community activity engagement services.
- Evaluating culturally–appropriate service modalities. Two Feathers is engaging independent evaluators to study the efficacy of the Native American Mental Health Theory of Change framework, to implement a community-engaged, elder-advised participatory evaluation to study case management programming, and to assess the performance of the Tribal Youth and Family Services Consortium.
UCLA Integrated Substance Abuse Programs
The UCLA Integrated Substance Abuse Programs (UCLA) conducts research, provides research training and clinical training, and arranges treatment for SUD in coordination with the UCLA Department of Psychiatry and Biobehavioral Sciences and in affiliation with community-based treatment providers. Under the Tribal MAT Project, UCLA ISAP is carrying out the following activities:
- Leading the Tribal MAT ECHO Project. Using the Project Extension for Community Healthcare Outcomes (ECHO) model, a distance-based learning method that links specialists at an academic medical center with primary care clinicians in local communities, UCLA is implementing the Tribal MAT ECHO Project to support health providers in Indian Country to deliver MAT. UCLA offers monthly 60-minute virtual Tribal MAT ECHO clinics, which begin with a didactic presentation on a topic relevant to MAT care delivery and predominantly feature a de-identified case presentation and facilitated discussion. The monthly Tribal MAT ECHO clinic launched on January 15th, and to date, four clinics have been conducted. In each session, a discussion of traditional healing and other cultural practices are incorporated into the didactic lecture and case presentation portion of the clinic. To inform this work, UCLA performed a targeted needs assessment to determine the specific MAT technical assistance needs of Urban Indian and tribal health providers. The top seven priority topic areas include:
- (1) cultural humility;
- (2) risk reduction/safe use and prescribing practices;
- (3) talking with patients regarding MAT;
- (4) MAT and pain;
- (5) counseling services for patients receiving medications for opioid use disorder (MOUD);
- (6) stigma; and
- (7) suicide prevention. In addition, an expert Tribal MAT Advisory Board was established with 30 members who helped determine the topics for the Tribal MAT ECHO sessions.
USC Keck School of Medicine
The USC Keck School of Medicine has been contracted by UCLA to conduct a Tribal MAT Needs Assessment and Evaluation for all Tribal MAT projects. Under the Tribal MAT Project, USC Keck School of Medicine is carrying out the following activities:
- Producing a Tribal MAT Needs Assessment. UCLA partnered with the USC Keck School of Medicine to perform a statewide community needs assessment with American Indian and Alaska Native populations in urban and rural areas of California to better understand the impact of OUD and SUD in these communities. Drawing upon 40 key informant interviews and 215 focus group participants, the Tribal MAT Needs Assessment will provide a snapshot of the current needs of the AIAN population to inform future strategic planning and implementation of funded California Tribal MAT projects.
- Evaluation of Tribal MAT Projects. USC Keck School of Medicine is to evaluate the Tribal MAT funded projects. Evaluation efforts may include coordination of patient questionnaires and interview questions, needs assessments, and other requirements to fulfill full evaluation process and outcomes for each individual program and inclusive of all programs.
For more information about the Tribal MAT Project in general, please contact firstname.lastname@example.org.