University of Kentucky Center on Drug and Alcohol Research

JANUARY 3, 2020

Kenton County Detention Center MAT-PDOA Evaluation Project

YEAR 1 ANNUAL REPORT

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Prepared by: The University of Kentucky

Center on Drug and Alcohol Research Lexington, KY 40508

January 3, 2020

Strong Start COR-12 Treatment and Reentry Program

KENTON COUNTY DETENTION CENTER

MEDICATION ASSISTED TREATMENT FOR PRESCRIPTION DRUG AND OPIOID ADDICTION (MAT-PDOA)

Evaluation Annual Report

GRANT YEAR 1

OCTOBER 1, 2018 – SEPTEMBER 30, 2019

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TABLE OF CONTENTS

Grant Identification Information…………………………………………………………………………………….. 3

Project Team.…………………………………………………………………………………………………………………. 4

Executive Summary………………………………………………………………………………………………………… 5

Overview of CSAT Supported Services…………………………………………………………………………….. 7

Evaluation Overview……………………………………………………………………………………………………….. 10

Kenton County MAT Evaluation Snapshot & Project Goals …………………………………………….. 11

Outcome Evaluation Findings

MAT participation…………………………………………………………………………………………………… 12 Participant characteristics………………………………………………………………………………………. 13 Housing status………………………………………………………………………………………………………… 13 Employment…………………………………………………………………………………………………………… 14 Child custody & parenting………………………………………………………………………………………. 15 Physical & mental health………………………………………………………………………………………… 15 Substance use……………………………………………………………………………………………………..…. 17 Recovery supports & services…………………………………………………………………………………. 19 Criminal justice involvement………………………………………………………………………………….. 20

Process Evaluation Findings……………………………………………………………………………………………. 21

Conclusions and Recommendations………………………………………………………………………………… 25

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GRANT IDENTIFICATION INFORMATION

Grantee Federal Identification Number:

TI 081561

Project Name:

Kenton County Detention Center MAT-PDOA

Grantee Organization:

Kenton County Detention Center

Program Director:

Jason Merrick, MSW, CDAC 3000 Decker Crane Ln. Covington, KY, 41017 Phone: (859) 363-2437 E-mail address: jason.merrick@kentoncounty.org

Evaluation Team:

Michele Staton, PhD, MSW UK College of Medicine Department of Behavioral Science Center on Drug & Alcohol Research 117 Medical Behavioral Science Building Lexington, KY 40536

Tiffany Howard, MPH

Center on Drug & Alcohol Research 643 Maxwelton Court Lexington, KY 40508

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PROJECT TEAM

Kenton County Detention Center

Jason Merrick, MSW, CDAC, Program Director/Director of Addiction Services

Bethany Ball, MSW, CSW, TCADC, Program Coordinator

Joseph Roberts, BSW, Clinical Navigator

David Wray, BS, Clinical Navigator/SAP Deputy

Rachel Pinnell, Clinical Navigator

Meghann Smith, BSW, Clinical Navigator

Michael Greenwell, Clinical Navigator

Tina Malone, BSW, Clinical Navigator

Life Learning Center

Alecia Webb-Edgington, President

Denise Govan, Managing Director & Director of Education

Robert Venable, Director of Enrollment

Mitch Haralson, MSW, LCSW, Director of Care Continuum & Volunteer Recruitment/Coordination

Ashton Van Gorden, MSW, Data & Job Placement Coordinator

University of Kentucky

Dr. Michele Staton, MSW, PhD, Principal Investigator and Evaluator

Tiffany Howard, MPH, Project Director

Martha Tillson, BSW, Administrative Research Assistant Pr.

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EXECUTIVE SUMMARY

With funding from the Center on Substance Abuse Treatment (CSAT), the Kenton County Detention Center expanded

treatment services offered through its Jail Substance Abuse Program (JSAP) for adults diagnosed with an opioid use

disorder (OUD). This expansion included implementation of Hazelden Betty Ford’s Strong Start Comprehensive

Opioid Response with the 12 Steps (COR-12) Treatment and Reentry Program, offering two “tracks” of medication-

assisted treatment (MAT) for OUD, and enhanced aftercare services provided primarily by the Life Learning Center

(LLC). Through these “tracks,” participants may choose to receive A) no medications (abstinence-only), B) extended-

release injectable naltrexone (e.g., Vivitrol®), or C) 14 days of oral buprenorphine, followed by initiation to injectable

extended-release buprenorphine.

This annual evaluation includes two primary components – a process evaluation and an outcome evaluation. The

purpose of the process evaluation was to assess project implementation using qualitative interviews with project

administrators, project staff, and project participants. Process evaluation findings included the following key themes

from project administrators and staff: (1) KCDC and the JSAP program have had to be adaptable and flexible as they

have navigated challenges related to offering an entirely new model of treatment for correctional facilities in

Kentucky; (2) implementation of treatment “tracks” (buprenorphine, naltrexone, or abstinence) has created a

valuable opportunity for open dialogue and education of staff, community partners, JSAP clients, and other inmates

concerning MAT; (3) partnerships with community organizations to provide wrap-around services have been

invaluable towards the positive outcomes observed during the first grant year; and (4) in the remaining grant years,

staff and administrators agreed that they would like to focus on sustaining positive changes, evaluating and adjusting

existing procedures, and looking for opportunities for future growth. Participants receiving services also participated

in the process evaluation and the following themes emerged from their responses: (1) clients valued the “safety net”

of MAT as an important tool to reduce the chance of relapse after they were released; (2) although access to MAT

options was one important component of treatment, clients also appreciated many other aspects of the JSAP

program; and (3) in addition to these services, clients discussed the desire and willingness to stop using as an

important aspect of successful recovery.

The outcome evaluation included a face-to-face interview at intake (baseline) and at 3-month and 6-month post-

intake (follow-up). The CSAT Government Performance and Results Act (GPRA) instrument was used for data

collection, as well as a few additional measures relevant to the grant goals. During the first year of the project

(October 1, 2018 through September 30, 2019), 101 participants received services under the CSAT Kenton County

Detention Center MAT-PDOA Evaluation grant and consented to complete a baseline evaluation interview (101% of

targeted baseline enrollment).

Participants were eligible for a 3-month follow-up interview between 2 and 5 months after their baseline intake date.

During the first year of the grant, 49 participants were eligible for a 3- month follow-up interview (i.e., had reached

3 months post-baseline) and 48 total had completed the interview for an overall follow-up rate of 98.0%. Participants

were then eligible for a 6-month follow-up interview between 5 and 8 months post-baseline. Eleven participants

were eligible for a 6-month follow-up interview during the first grant year (i.e., had reached 6 months post-baseline)

and 13 total had completed the interview for an overall follow-up rate of 118.2%.

This evaluation report highlights services provided through the CSAT-funded MAT-PDOA grant and successes

throughout the first grant year at the Kenton County Detention Center. A number of participants benefited

considerably from agency programming and services. At baseline, reflecting on their last 30 days on the street, 22.9%

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of participants reported being homeless, 62.4% were unemployed, 29.7% had experienced physical violence, and

71.3% had injected drugs. By 3-month follow-up, 83.3% of these individuals were still receiving inpatient substance

abuse treatment services through the JSAP program (87.5% were incarcerated), meaning that many outcomes post-

release (e.g., employment or housing) could not yet be validly assessed. However, 39.6% of 3-month follow-up

participants reported having participated in MAT during the last 3 months. Although 6-month follow-up findings are

preliminary given the small sample size (N=13), initial results are promising, including large reductions in many self-

reported mental health symptoms, increased attendance at recovery support meetings (such as AA/NA), more

contact with family and friends who supported their recovery, and 84.6% abstinence from drugs. Furthermore, 46.2%

of participants at 6-month follow-up reported MAT participation in the past three months, suggesting that linkages

to treatment in the community after release from JSAP have been successful.

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OVERVIEW OF CSAT-SUPPORTED SERVICES

With CSAT funding awarded by the present grant, the Kenton County Detention Center expanded treatment services

offered through its Jail Substance Abuse Program (JSAP) for adults diagnosed with an opioid use disorder (OUD). This

expansion included implementation of a Strong Start COR-12 Treatment and Reentry Program, as well as access to

expanded mediation-assisted treatments (MATs). Below is a detailed description of the JSAP program and its

expanded services, as well as services provided by key community partners.

Kenton County Detention Center (KCDC)

KCDC is recognized as a leader in Kentucky for its pioneering efforts in developing JSAP, which provides primary

treatment for substance misuse while people are incarcerated. Jailer Terry Carl identified the need for a substance

misuse program as the opioid epidemic ensued and people were being released from KCDC and immediately

overdosing. In September 2015, KCDC began offering JSAP, which grew in three years to serve 250 men and women

annually. JSAP uses an evidence-based biopsychosocial model which has proven successful at increasing employment,

reducing recidivism, and increasing access and engagement with community recovery support services. According to

University of Kentucky’s Criminal Justice Kentucky Treatment Outcome Study FY 2017, JSAP graduates have

significantly more positive outcomes than people who have been released from criminal justice facilities that do not

have a robust treatment program.

With funding awarded by the present grant, KCDC has implemented the Strong Start COR-12 Treatment and

Reentry Program, an integrated treatment approach offered through the Hazelden Betty Ford Foundation. This

model couples medications with evidence-based therapies, case management for OUD, and integration with peer-

support to provide a cohesive MAT model. It has been implemented throughout the nation in myriad settings,

including outpatient, inpatient, and federally-funded community-based behavioral health settings. One aspect of

COR-12 as implemented in KCDC JSAP is cognitive-behavioral therapy (CBT) delivered through “A New Direction”

programming, based on a modified therapeutic community model, with 15-25 hours of programming per participant

per week, focusing on changing patterns of behavior and thought related to addictive and criminal thinking and

behavior.

As mentioned, an important aspect of COR-12 is the integration of medication-assisted treatment (MAT) as

an option for clients with OUD diagnoses. Although KCDC offered clients the opportunity to initiate extended-release

naltrexone (Vivitrol®) prior to the current grant, additional CSAT funding supported expansion of these services to

include extended-release buprenorphine injections. Under the grant, eligible and consenting JSAP clients now have

the option of receiving A) no medications (abstinence-only), B) extended-release injectable naltrexone (e.g., Vivitrol®),

or C) 14 days of oral buprenorphine, followed by initiation to injectable extended-release buprenorphine. Medical

evaluations for MAT and provision of MAT services are provided by Southern Health Partners, primarily Medical

Director Dr. David Suetholtz, MD, who also offers continued services to clients in the community post-release through

his family medicine practice in Ft. Mitchell, KY.

Community Partnerships

Life Learning Center (LLC)

After release from the KCDC JSAP program, participants have the opportunity to receive 6 months of evidence-based

aftercare curriculum through LLC, including counseling, job readiness, childcare, and other reentry services. This

programming eases the transition from jail to the community by supporting clients’ efforts to maintain sobriety, to

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improve their mental and physical health, to achieve safe and stable housing, and to pursue goals such as education

or employment. In 2006, Bill Butler and other community leaders in Northern Kentucky established LLC as a 501(c)3

public charity to help “at-risk” individuals reach their highest potential. LLC provides an extensive continuum of

education and care to equip under- and unemployed individuals with the necessary resources and tools to envision,

achieve and sustain a better future for themselves and their families. LLC participants demonstrate a 100%

participation rate in employment, enlistment in U.S. Armed Forces, or enrollment in an institution of higher education

within 90 days of admission.

P.I.E.R. Recovery Community Center (Mental Health America)

Aftercare services for individuals with co-occurring OUD and mental health needs are often provided by the P.I.E.R.

Recovery Community Center. This “safe harbor,” located at Tenth & Monmouth Streets in Newport, KY, is the home

of Kentucky Certified Peer Support Specialists, who work with clients by sharing resources and building skills, leading

recovery groups, and mentoring and setting goals with clients. P.I.E.R. also offers peer support groups and classes

(including parenting, art classes, stress management, grief support, career coaching, dual diagnosis, anxiety and anger

management classes, and LGBTQIA+ groups). The Center also offers an Employment Lab (with resume, application,

and interviewing assistance), community engagement events, and pro bono counseling by licensed and insured

mental health professionals who volunteer to provide short-term counseling for unemployed, uninsured, or

underinsured clients.

Journey Recovery Center (St. Elizabeth Healthcare)

Many JSAP participants initiated to MAT pre-release choose to continue receiving MAT through Journey Recovery

Center. Journey also utilizes COR-12 programming, and offers the following services: medical and recovery support

from three board-certified doctors who specialize in substance use disorder treatment; therapists, nurses, case

managers, and peer support staff to support service provision; oral, injectable, and implant medications for detox and

withdrawal management; and intensive out-patient, individualized therapy, case management, and peer support

services.

Oxford House of Kentucky

Oxford House provides preferential review of JSAP clients and provides support with evidence-based housing for

many participants post-release to the community. Currently, there are five Oxford houses in Northern Kentucky which

follow the standards set by the Oxford House, Inc., a national 501(c)(3) organization dedicated to providing safe and

sober housing for people in recovery. Nationwide, there are nearly 2000 self-sustaining sober houses utilizing the

Oxford House model, serving more than 10,000 individuals in recovery living in houses at any one time during a year.

All Oxford Houses are democratically-run, self-supporting, and drug-free homes.

New Foundations Community Housing

New Foundations, a 501(c)(3) nonprofit transitional housing provider established in 2009, is another sober living

resource for participants transitioning to the community from JSAP. New Foundations provides fully furnished move-

in ready sober living options for those in recovery, as well as structure, accountability, and support through required

recovery meetings and sponsorship, service commitments, and mentoring relationships between junior and senior

program participants. New Foundations is also unique in offering MAT-friendly homes, which allow for individuals

prescribed oral buprenorphine to have their medications kept and dispensed securely by staff on-site (individuals

choosing to use injectable forms of medication are eligible to live in traditional non-MAT homes).

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Aetna Better Health of Kentucky

Aetna’s Start Strong Re-Entry program’s goal is to re-connect Members with their Aetna Better Health of Kentucky to

provide health and wellness resources to the justice-involved population of Kenton County Detention Center (KCDC).

Start Strong pays special attention to the medically frail population as they re-enter Kenton County and provides

members with ongoing case management and support throughout their transition. Aetna’s on-site Re-Entry Specialist

provides case management to members, as well as provides community resources and coordinated efforts to connect

members to their Aetna Better Health of Kentucky Medicaid providers. These efforts include sober living and

transportation resources, health and wellness resources as well as employment resources and justice advocacy.

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EVALUATION OVERVIEW

OUTCOME EVALUATION & METHOD

Recruitment for the evaluation begins when clients enter the JSAP program and receive a baseline biopsychosocial

assessment for OUD, based on criteria from the Diagnostic and Statistical Manual 5 (DSM-5). Two additional tools

are used in this assessment: The Criminal Justice Kentucky Treatment Outcome Study and the Level of Service/Case

Management Inventory (LSCMI) clinical assessment. Potential participants are also assessed for medical

appropriateness, past prescription use, risk of relapse, and anticipated release date when clinicians are considering

eligibility for MAT participation. During the first grant year, the total number of participants screened for study

participation, and proportions of participants screened as ineligible, or screened eligible but refused, were not

tracked; however, this information will be available in future reports.

If a participant is willing and eligible to participate in the study, a KCDC clinician performs a baseline interview using

the CSAT Government Performance and Results Act (GPRA) instrument, as well as a few additional measures. In

addition to the COR-12 enhanced JSAP services, participants are then offered the choice of A) no medications

(abstinence-only), B) extended-release injectable naltrexone (e.g., Vivitrol®), or C) 14 days of oral buprenorphine,

followed by initiation to injectable extended-release buprenorphine. From the start of the grant (October 1, 2018)

through September 30, 2019, 101 participants received services under the grant, consented to participate in the

study, and completed a baseline interview (101% of targeted baseline enrollment for year one).

Participants were eligible for a 3-month follow-up interview between 2 and 5 months after their baseline interview

date. Participants were eligible for a 6-month follow-up interview between 5 and 8 months post baseline. From the

start of the grant (October 1, 2018) through September 30, 2019, 49 clients reached 3-month GPRA eligibility and 48

completed the 3-month follow-up interview for a 3-month follow-up rate of 98.0%. 11 clients reached 6-month

GPRA eligibility and 13 completed the 6-month follow-up interview for a 6-month follow-up rate of 118.2%.

PROCESS EVALUATION

The purpose of the process evaluation was to assess grant project activities during the implementation year using

qualitative interviews with project administrators, project staff, and project participants. The process evaluation

provided descriptive information about program services, perspectives on program successes, and proposed

program recommendations. The process evaluation also addressed the extent to which the program matched the

proposed grant aims, modifications or deviations from the original plan, factors that led to modifications or changes,

and impact of changes to the program.

Process evaluation data were collected at the end of the grant year in July of 2019. The methodology included

interviews with administrators, staff, and participants. All respondents were interviewed face-to-face and reminded

that their participation was voluntary and confidential. Notes for each open-ended process evaluation interview

were written by hand during the interview and transcribed into a Microsoft Word data file for analysis. The

transcriptions were then examined to identify common themes within each respondent category.

Administrator/staff themes and participant themes were developed based on consistent discussion of constructs

across interview respondents.

YEAR ONE REPORT

The following report is organized according to the three goals of the grant (see next page): data related to MAT

utilization is presented under Goal 1; self-reported substance use, as well as other outcomes relevant to clients’

recovery and well-being, are presented under Goal 2; and results from the process evaluation, intended to inform

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continued project implementation activities, are presented under Goal 3. Due to a limited 6-month follow-up sample

size, results from both 3-month and 6-month outcome analyses are presented for the current grant year.

EVALUATION SNAPSHOT

KENTON COUNTY STRONG START COR-12 PROJECT GOALS:

100 Target number of clients to receive SAMHSA-funded services over the first year of the project

101 Number of clients served during the first grant year who consented to study participation and completed baseline interviews

101% GPRA baseline coverage rate

98% GPRA 3-month follow-up rate for participants with follow-up windows that opened prior to 8/30/2019

118% GPRA 6-month follow-up rate for participants with follow-up windows that opened prior to 8/30/2019

The overall goals of the project include:

Goal 1: To improve the capacity of clinical staff members in JSAP and at Life Learning Center, as well as those in the greater community, to provide Medication Assisted Treatment in conjunction with Evidence-Based Practices.

Goal 2: To demonstrate how expanded and enhanced access to medications

and other evidence-based therapies improves long-term recovery outcomes for high-risk individuals with OUD who are incarcerated and transition to the community.

Goal 3: To create a sustainable funding and service delivery model that will provide a robust suite of treatment and recovery support services and disseminate the results of this program so that other correctional institutions and community-based programs can replicate the evidence-based models, procedures, and policies that lead to its success.

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GOAL 1: TO IMPROVE THE CAPACITY OF CLINICAL STAFF MEMBERS IN JSAP AND AT LIFE

LEARNING CENTER, AS WELL AS THOSE IN THE GREATER COMMUNITY, TO PROVIDE

MEDICATION ASSISTED TREATMENT IN CONJUNCTION WITH EVIDENCE-BASED PRACTICES.

As shown in Table 1, at baseline, less than a quarter of all participants (23.8%) reported having participated in any

type of MAT during the 12 months before their current incarceration. Of these individuals, most (66.7%) were

prescribed oral buprenorphine (e.g., Suboxone or Subutex), while fewer participated in injectable extended-release

naltrexone (Vivitrol®; 29.2%), methadone (16.7%), or injectable extended-release buprenorphine (4.2%). The

majority of these individuals (62.5%) had discontinued treatment. Of participants who stopped, qualitative

responses indicate that 40% stopped because they became incarcerated, whereas the rest cited reasons related to

relapse, cravings, or “couldn’t stop using.”

At 3-month follow-up, MAT participation had increased to 39.6% of participants, with most using oral buprenorphine

(62.5%) or injectable extended-release buprenorphine (41.7%). Given that Kenton County MAT protocol requires

participants to engage in 14 days of oral buprenorphine before transitioning to the extended-release injection, these

increasing rates align with services offered through the JSAP program. Approximately three-fourths of participants

(73.7%) were still active in treatment at the time of the interview.

By the 6-month follow-up, when most participants were on the street, the MAT participation rate had increased

further to 46.2%. Although these results are preliminary and based on a small sample size (N=13), it is encouraging

that participants continue to engage in treatment post-release, indicating that linkages with systems of care and

support have been successful.

TABLE 1. MAT PARTICIPATION AT BASELINE AND FOLLOW-UPS

Baseline

(N=101)

3M Follow-Up

(N=48)

6M Follow-Up

(N=13)

Past 12 months

Past 3 months

Past 3 months

Participated in MAT 23.8% (n=24)

39.6% (n=19)

46.2% (n=6)

OF MAT PARTICIPANTS…

MATs prescribed:

Oral buprenorphine 66.7% 62.5% 66.7%

Injectable extended-release naltrexone 29.2% 0.0% 0.0%

Methadone 16.7% 4.2% 0.0%

Injectable extended-release buprenorphine 4.2% 41.7% 66.7%

Number of times received MAT 18.6 15.8 18.3

Treatment outcome

Completed recommended treatment 12.5% 0.0% 0.0%

Still active in treatment 25.0% 73.7% 50.0%

Discontinued treatment 62.5% 26.3% 50.0%

OF ALL PARTICIPANTS…

Sold, gave away, traded, lost, or had Suboxone stolen from them

6.9% 2.1% 7.7%

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GOAL 2: TO DEMONSTRATE HOW EXPANDED AND ENHANCED ACCESS TO MEDICATIONS AND OTHER

EVIDENCE-BASED THERAPIES IMPROVES LONG-TERM RECOVERY OUTCOMES FOR HIGH-RISK

INDIVIDUALS WITH OUD WHO ARE INCARCERATED AND TRANSITION TO THE COMMUNITY.

A. SUMMARY OF PARTICIPANT CHARACTERISTICS

Table 2 provides a sociodemographic profile of the

Kenton County COR-12 evaluation participants

who received services during the first grant year

(N=101). All information was self-reported by

participants at intake to the JSAP program and

based on the 30 days prior to participants’ current

incarceration.

On average, participants were 33.9 years old and

majority White (98.0%) and male (80.2%). The

majority of participants (66.4%) reported having

completed at least 12 years of education, with

about a quarter (24.8%) reporting some college or

technical school.

B. HOUSING STATUS

One objective of this grant goal was to increase the number of participants living in stable housing from 82% to 92%.

As shown in Table 3, at baseline, only 61.5% of participants reported staying in an apartment, room, or house (either

their own or someone else’s). Almost a quarter of participants (22.9%) were homeless, staying on the street or

outdoors, while an additional 6.3% stayed in an institution (e.g., jail or hospital) and 9.3% lived in a shelter or halfway

house. Almost half of participants (45.5%) were “dissatisfied” or “very dissatisfied” with their living arrangements.

TABLE 3. HOUSING STATUS AT BASELINE AND FOLLOW-UP

Baseline (N=101)

3M Follow-Up

(N=48)

6M Follow-Up

(N=13)

LIVING ARRANGEMENTS IN THE PAST 30 DAYS

Own/rent apartment, room, or house 29.2% 2.1% 7.7%

Someone else’s apartment, room, or house 32.3% 2.1% 23.1%

Homeless (street or outdoors) 22.9% 0.0% 0.0%

Institution 6.3% 87.5% 30.8%

Shelter or halfway house 9.3% 8.3% 30.8%

Residential treatment 0.0% 0.0% 7.7%

SATISFACTION WITH LIVING ARRANGEMENTS

Very dissatisfied 28.7% 8.3% 7.7%

Dissatisfied 16.8% 6.3% 7.7%

Neither satisfied nor dissatisfied 17.8% 22.9% 15.4%

Satisfied 20.8% 45.8% 38.5%

Very satisfied 15.8% 16.7% 30.8%

TABLE 2. PARTICIPANT CHARACTERISTICS AT BASELINE (N=101)

DEMOGRAPHICS

AGE (mean years) 33.9

GENDER (male) 80.2%

RACE

White 98.0%

Black 2.0%

MARITAL STATUS (single, never married) 60.4

EDUCATION LEVEL

Less than 12th grade 33.7%

HS Diploma or GED 41.6%

Some college or technical school 24.8%

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At 3-month follow-up, the majority of participants (87.5%) were still incarcerated,

mostly participating in the JSAP program and nearing their graduation date. However,

satisfaction with living arrangements improved, with 62.5% of participants reporting

being “satisfied” or “very satisfied” with where they lived. Satisfaction increased

further by 6-month follow-ups, with 69.3% of participants “satisfied” or “very

satisfied,” although most participants (69.2%) were not incarcerated. About a third

(30.8%) lived in their own or someone else’s house or apartment, 30.8% were in sober

living or a halfway house, and one participant (7.7%) resided at another residential

treatment program. Overall, given that no participants reported being homeless at 3- or 6-month follow-up (compared

to 22.9% at baseline), these results suggest that grant activities are on-track for the goal of improved housing stability.

C. EMPLOYMENT

A second objective of this grant goal was to increase employment rates from 67% to 92%. As shown in Table 4, at

baseline, fewer participants than anticipated – only 37.6% – reported working full-time or part-time, while 62.4% were

unemployed. Although only 6.3% of participants reported employment at the time of the 3-month follow-up, it is

important to note that 83.3% of these individuals were still receiving inpatient substance abuse treatment services

through the JSAP program (87.5% were incarcerated), meaning that concurrent employment was not possible. In

comparison, at 6-month follow-up, almost half of participants (46.2%) reported working full-time, in spite of the fact

that an additional 30.8% were incarcerated. These results suggest that, of participants who are free and unrestricted

to find employment, most are successful in seeking work.

TABLE 4. EMPLOYMENT AT BASELINE AND AT 3-MONTH FOLLOW-UP

Baseline (N=101)

3M Follow-Up

(N=48)

6M Follow-Up (N=13)

EMPLOYMENT STATUS

Unemployed 62.4% 93.8% 53.8%

Full-time 26.7% 6.3% 46.2%

Part-time or seasonal 10.9% 0.0% 0.0%

AVERAGE INCOME SOURCES IN THE LAST 30 DAYS

Wages $585 $83 $815

Non-legal income $424 $0 $0

Family/friends $243 $75 $196

Disability $73 $19 $0

Public assistance $8 $0 $0

These results are further reflected in trends of participants’ average income

sources, also reported in Table 4. Although participants reported little income

from any source at the 3-month follow-up (as expected), between baseline and 6-

month follow-up, average income from wages increased (from $585 to $815),

while decreases were observed in income from non-legal means ($424 to $0),

disability ($73 to $0), public assistance ($8 to $0), and family or friends ($243 to

$196).

22.9% of participants

were homeless at baseline, vs. none

at follow-ups.

Average wages increased by

$230 between baseline and

6-month follow-up

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D. CHILD CUSTODY AND PARENTING

A third objective of the grant was to increase the number of parents

providing financial assistance to their children from 78% to 93%; results are

shown in Table 5. At baseline, 70.3% of participants reported being parents

to at least one child, with an average of 2.6 children each. Many

participants faced custody challenges, with 43.7% reporting at least one

child living with someone else due to a child protection court order, and

33.8% having had rights terminated to at least one child. Parents who

provided financial support to children were fewer at baseline than

anticipated, with just over a third (35.2%) supporting at least one child.

By 6-month follow-up, the number of parenting participants providing financial support to children had increased to

45.5%. Although this increase may appear small, when it is considered that almost a third of participants were

incarcerated and unable to work at this time, this indicates that many parents who were free to work and gain income

were supporting their children financially. In future grant years, as the 6-month follow-up sample size increases, it

is hoped that this proportion will increase further.

TABLE 5. PARENTING AT BASELINE AND AT 3-MONTH FOLLOW-UP

Baseline (N=101)

3M Follow-Up

(N=48)

6M Follow-Up

(N=13)

Participants with 1+ children 70.3% (n=71)

72.9% (n=35)

84.6% (n=11)

Average number of children 2.6 2.4 2.4

% of parenting participants with children living with someone else due to a child protection court order

43.7% 28.6% 9.1%

% of parenting participants who reported losing parental rights of any children

33.8% 17.1% 18.2%

% of parenting participants providing financial support to 1+ child

35.2% 8.6% 45.5%

Currently pregnant 5.0%

(n=20) 0.0% (n=6)

--- (n=0)

E. PHYSICAL AND MENTAL HEALTH

Mental and physical health outcomes are another important focus of the current grant. Specifically, the grant

proposed to reduce rates of self-reported depression, anxiety, hallucinations, impaired concentration, and suicidal

thoughts and/or attempts. At baseline, as shown in Table 6, mental health symptoms were highly prevalent,

particularly for anxiety (80.2% of participants), depression (77.2%), and problems understanding, concentrating, or

remembering (66.3%). More than half of participants (61.4%) said that their health overall was “fair” or “poor,” or

reported having experienced violence or trauma during their lifetime (62.4%). Furthermore, 8.9% of participants

reported a past 30-day attempted suicide, while 29.7% had experienced physical abuse during that time period.

Although most participants were sexually active (82.2%), only three-fourths (74.3%) had ever been tested for HIV.

Finally, utilization of routine health care services was limited: while 19.8% of participants visited an emergency

department in their last 30 days on the street, far fewer used outpatient services for physical health, mental health,

or substance misuse treatment (5.0%, 8.9%, and 10.9%, respectively).

70.3% of participants at

baseline had at least one child, though only 35.2%

of parents were providing financial

support

P a g e | 16

TABLE 6. PHYSICAL AND MENTAL HEALTH STATUS

Baseline (N=101)

3M Follow-Up

(N=48)

6M Follow-Up

(N=13)

RATING OF OVERALL HEALTH

Excellent 2.0% 10.4% 7.7%

Very good 4.0% 20.8% 30.8%

Good 32.7% 43.8% 38.5%

Fair 38.6% 22.9% 7.7%

Poor 22.8% 2.1% 15.4%

Average rating 2.2 (Fair) 3.2 (Good) 3.1 (Good)

IN THE LAST 30 DAYS, EXPERIENCED...

Anxiety 80.2% 47.9% 30.8%

Depression 77.2% 33.3% 46.2%

Cognitive difficulties 66.3% 35.4% 30.8%

Violent behavior 43.6% 2.1% 7.7%

Hallucinations 23.8% 4.2% 0.0%

Suicidal thoughts/ideation 8.9% 2.1% 15.4%

Suicide attempts 8.9% 0.0% 0.0%

VIOLENCE, TRAUMA, AND PHYSICAL ABUSE

Ever experienced violence or trauma 62.4% 54.2% 53.8%

Experienced any physical abuse in the last 30 days 29.7% 4.2% 7.7%

SEXUAL ACTIVITY & RISK

Sexually active in past 30 days 82.2% 6.3% 46.2%

Ever been tested for HIV 74.3% (n=75)

66.7% (n=32)

92.3% (n=12)

Of those who have been tested, know test results 88.0% 100% 100%

HEALTH SERVICE UTILIZATION

Visited emergency department in last 30 days 19.8% 2.1% 0.0%

Received past-30-day outpatient treatment for…

Physical health 5.0% 6.3% 7.7%

Mental health 8.9% 2.1% 23.1%

Alcohol or substance misuse 10.9% 6.3% 23.1%

Prescribed medication for psychological/emotional problem 21.8% 16.7% 0.0%

By both 3- and 6-month follow-ups, participants’ health statuses had

improved notably. More participants rated their health as “excellent” or

“very good” (38.5% at 6-month follow-up, compared to 6.0% at baseline).

Furthermore, participants reported decreases across most mental health

symptoms, including anxiety (-49.4%), trouble controlling violent behavior (-

35.9%), cognitive difficulties (-35.5%), depression (-31.0%), and

hallucinations (-23.8%). It is hoped that the slight increase in suicidal

thoughts at 6-month follow-up (+6.5%) is an artifact of the small sample size

and will disappear as more interviews are conducted.

Additionally, fewer participants reported having experienced past 30-day physical abuse at 6-month follow-up

(7.7%). A lower proportion of participants reported being sexually active (46.2%), and more participants had been

tested for HIV (92.3%), all of whom knew their results. Finally, no 6-month follow-up participants reported

emergency department utilization, although more reported use of outpatient services for physical health (7.7%),

mental health (23.1%), and substance misuse treatment (23.1%).

By 6-month follow-up, anxiety, cognitive

difficulties, depression, and violent urges had decreased by at least

30 percentage points.

P a g e | 17

F. SUBSTANCE USE

A central objective of the current grant has been to increase the number of participants not using illicit opioids, other

illicit drugs, or misusing prescription opioids from 57% to 92%. As shown in Figure 1, lifetime substance use reported

at baseline indicated an extensive and diverse use profile, with almost all participants reporting having ever used

alcohol (97.0%); marijuana, non-prescription opioids, or heroin (all 93.1%); and cocaine or crack (90.1%).

As shown in Figure 2, at baseline, the primary

substance of choice reported by participants

was heroin (58.0% of participants), followed

by methamphetamine (24.0%). Fewer

participants preferred other substances,

including marijuana (7.0%), non-prescription

opioids (5.0%), or alcohol (3.0%).

97.0%

93.1%

93.1%

93.1%

90.1%

88.1%

76.2%

65.3%

60.4%

54.5%

49.5%

31.7%

29.7%

21.8%

7.9%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Alcohol

Marijuana

N-P opioids

Heroin

Cocaine/crack

Methamphetamine

Suboxone/Subutex

Benzodiazepines

N-P methadone

Hallucinogens

Synthetic drugs

Inhalants

Barbiturates

Ketamine

GHB

Figure 1. Lifetime Substance Use Reported at Baseline (N=101)

Figure 2. Substance of Choice Reported at Baseline (N=101)

Marijuana7%

N-P Opioids5%

Alcohol3%

Other3%

Methamph.24%Heroin

58%

81.2% of participants reported ever

injecting drugs.

P a g e | 18

Table 7 profiles past 30-day substance use reported at baseline, 3-, and 6-month follow-ups. At baseline, describing

their last 30 days on the street, 99.0% of participants reported having used some type of illegal drug, with 82.2%

reporting past 30-day opioid use. Of opioid drugs, participants most commonly reported using heroin (79.2%) or

fentanyl (45.5%), with fewer reporting use of non-prescribed Suboxone or

Subutex (38.6%) or other prescription opioids (also 38.6%). Other than opioids,

the most commonly-used drugs were methamphetamine (65.3%), marijuana

(59.4%), and cocaine or crack (42.6%). Almost three-fourths of participants

(71.3%) reported past 30-day intravenous drug use, while the majority of these

individuals (61.1%) reported having shared injection equipment (e.g., syringes,

cookers, or cottons).

TABLE 7. 30-DAY SUBSTANCE USE AT BASELINE AND AT FOLLOW-UPS

Baseline (N=101)

3M Follow-Up (N=48)

6M Follow-Up (N=13)

% reporting use % reporting use % reporting use

Any illegal drug use 99.0% 2.1% 15.4%

Any opioid drug use 82.2% 2.1% 0.0%

Heroin 79.2% 0.0% 0.0%

Prescription opioids 38.6% 0.0% 0.0%

Percocet 32.7% 0.0% 0.0%

OxyContin/oxycodone 22.8% 0.0% 0.0%

Morphine 17.8% 0.0% 0.0%

Codeine 11.9% 0.0% 0.0%

Dilaudid 6.9% 0.0% 0.0%

Tylenol 2/3/4 6.9% 0.0% 0.0%

Demerol 3.0% 0.0% 0.0%

Fentanyl 45.5% 0.0% 0.0%

Non-prescription Suboxone/Subutex 38.6% 2.1% 0.0%

Non-prescription methadone 11.9% 0.0% 0.0%

Other drug use:

Methamphetamine 65.3% 0.0% 7.7%

Marijuana 59.4% 0.0% 15.4%

Cocaine/Crack 42.6% 0.0% 0.0%

Alcohol 39.6% 2.1% 0.0%

Benzodiazepines 27.7% 0.0% 0.0%

Hallucinogens 11.9% 0.0% 0.0%

Synthetic drugs 8.9% 0.0% 0.0%

Barbiturates 6.9% 0.0% 0.0%

Inhalants 5.0% 0.0% 0.0%

Tranquilizers/sedatives 2.0% 0.0% 0.0%

GHB 1.0% 0.0% 0.0%

Ketamine 1.0% 0.0% 0.0%

Same day use of alcohol and illegal drugs 36.6% 0.0% 0.0%

Injected drugs in the past 30 days 71.3% (n=72)

0.0% (n=0)

7.7% (n=1)

Of injectors, shared injection equipment in past 30 days

61.1% --- 0.0%

No participants reported opioid use at 6-month follow-up, compared to 82.2% at baseline

P a g e | 19

Consistent with grant objectives to reduce substance use and misuse, at 6-month follow-up, only 15.4% of

participants (n=2) reported use of illegal drugs, which did not include use of any opioids. Although rates of substance

use reported at 3-month follow-up were even lower (2.1% for illegal drugs and 2.1% for alcohol), it should be noted

that 87.5% of those participants were incarcerated and had little to no access to intoxicants. Therefore, rates

reported at 6-month follow-up, while slightly higher, are more representative of participants’ use patterns in an

uncontrolled environment, yet still promising.

G. RECOVERY SUPPORTS AND SERVICES

Recovery supports are another vital aspect of sustaining sobriety, and as such, the current grant aimed to increase

community connections for all participants by linking them with peer recovery support specialists and increasing

engagement in support groups from 73% to 93%. As shown in Table 8, recovery meeting attendance at baseline was

lower than anticipated, with only 21.8% of participants reporting meeting attendance during their last 30 days on

the street. Furthermore, less than one in five (19.8%) reported engaging in past 30-day inpatient or outpatient

substance misuse treatment, and 68.3% reported recently interacting with

friends or family who were supportive of their recovery.

However, at 3-month follow-up, 93.7% of participants reported past 30-day

recovery meeting attendance, with 84.6% sustaining attendance at the 6-month

follow-up. All participants were engaged in some type of substance misuse

treatment at 3-month follow-up, with almost half (46.2%) reporting treatment

at 6-month follow-up. Finally, past 30-day contact with supportive friends or

family members increased to 85.4% and 100% at 3- and 6-month follow-ups,

respectively. These results suggest that KCDC is on-track for their goal to

increase contact with recovery support systems for COR-12 participants.

TABLE 8. PAST 30-DAY RECOVERY SUPPORTS AND SERVICES AT BASELINE AND 3-MONTH FOLLOW-UP Baseline

(N=101)

3M Follow-Up (N=48)

6M Follow-Up (N=13)

Any recovery meeting attendance 21.8% 93.7% 84.6%

Attended voluntary self-help group (AA/NA) 18.8% 89.6% 84.6%

Attended religious/faith-affiliated self-help group

12.9% 10.4% 7.7%

Attended any other support meetings 9.9% 6.2% 15.4%

Engaged in past 30-day substance use treatment 19.8% 100% 46.2%

Outpatient 10.9% 6.3% 23.1%

Inpatient 11.9% 83.3% 23.1%

Interacted with friends/family supportive of recovery

68.3% 85.4% 100%

Who participant turns to when they need help:

Family member 61.4% 68.8% 69.2%

Friends 14.9% 2.1% 0.0%

No one 12.0% 10.4% 7.7%

Significant other or child’s parent 5.9% 14.6% 0.0%

Clergy member/religious community 1.0% 2.1% 15.4%

Sponsor 1.0% 2.1% 7.7%

100% of participants at 6-

month follow-up reported contact

with friends or family who

supported their recovery

P a g e | 20

H. CRIMINAL JUSTICE SYSTEM INVOLVEMENT

Lastly, the current grant aimed to reduce participants’ level of criminal justice involvement by increasing the number

of people not being reincarcerated from 56% to 86%. At baseline, participants reported that they had been

incarcerated, on average, 15.9 times in their life, for a total average of 49.5 months, suggesting extensive criminal

justice involvement. As shown in Table 9, approximately two-thirds of participants reported past 30-day arrests at

baseline, though it should be acknowledged that at baseline all participants were incarcerated at KCDC and

participating in the JSAP program. By 6-month follow-up, the proportion of participants reporting recent arrests had

decreased to 15.4%, aligning closely with the grant goal. Furthermore, from baseline to 6-month follow-up,

participants awaiting charges, trial, or sentencing decreased (from 51.5% to 30.8%) while those on parole or

probation increased (from 44.6% to 84.6%). These results indicate that individuals were progressing through

resolution of pending charges and towards community supervision, suggesting a transition towards a lower level of

involvement with criminal justice.

TABLE 9. 30-DAY CRIMINAL JUSTICE INVOLVEMENT

Baseline (N=101)

3M Follow-Up

(N=48)

6M Follow-Up

(N=13)

Arrested past 30 days 66.3% (n=67)

2.1% (n=1)

15.4% (n=2)

Arrested for drug-related offense 80.6% 100% 50.0%

Crimes committed (avg.) 39.0 0.0 1.0

Incarcerated in past 30 days 28.7% 89.6% 46.2%

Currently awaiting charges, trial, or sentencing 51.5% 45.8% 30.8%

Currently on parole or probation 44.6% 70.8% 84.6%

P a g e | 21

GOAL 3: TO CREATE A SUSTAINABLE FUNDING AND SERVICE DELIVERY MODEL THAT WILL

PROVIDE A ROBUST SUITE OF TREATMENT AND RECOVERY SUPPORT SERVICES AND DISSEMINATE

THE RESULTS OF THIS PROGRAM SO THAT OTHER CORRECTIONAL INSTITUTIONS AND

COMMUNITY-BASED PROGRAMS CAN REPLICATE THE EVIDENCE-BASED MODELS, PROCEDURES, AND POLICIES THAT LEAD TO ITS SUCCESS.

The third goal of the grant was addressed through an annual process evaluation, performed in order to better

understand challenges and successes of program implementation and offer insights to inform future replications or

adaptations of the KCDC MAT-PDOA COR-12 model.

PROCESS EVALUATION A process evaluation has been described as a method of assessment that can provide descriptive information about

program services and factors that lead to desirable and undesirable outcomes towards a program’s stated goals

(Krisberg, 1980; Scarpitti, Inciardi, & Pottieger, 1993). The purpose of the process evaluation within this MAT-PDOA

evaluation is to assess project implementation and maintenance using qualitative interviews with project

administrators, staff, and clients. The process evaluation focuses on how program services were implemented,

perspectives on program successes, and proposed program recommendations. The process evaluation also

addresses the extent to which the program matches the proposed grant aims, modifications or deviations from the

original plan, factors that led to modifications or changes, and impact of changes on the program.

Method Process evaluation data were collected at the end of the grant year in July of 2019. Two survey instruments were

developed for the process evaluation—one for administrators and staff and one for clients—allowing for data

collection to capture these unique perspectives. All clients who were enrolled COR-12 services at KCDC and had

consented to study participation were eligible to be randomly selected for the process evaluation interviews. Staff

and administrators were selected based on their familiarity and involvement with COR-12 MAT services and the grant

implementation process; the final sample of administrators and staff included individuals from the areas of

supervision, jail or JSAP administration, medical staff, clinical assessment, and counseling.

In total, interviews were completed with four administrators and six staff members at KCDC (N=10) and with clients

who had received COR-12 services from KCDC’s JSAP program (N=5). The content of the interview questions for

administrators and staff focused on program successes, accomplishments, and changes and transitioned to program

maintenance, while participants were asked about the provision of services and their overall perceptions of the

program. Interviews were conducted face-to-face, at the convenience of the respondents, and lasted approximately

thirty to forty-five minutes. All respondents were reminded that their participation was voluntary and confidential.

Notes for each open-ended process evaluation interview were written by hand during the interview and transcribed

into a Microsoft Word data file for analysis. The transcriptions were then examined to identify common themes within

each respondent category. Administrator/staff themes and participant themes were developed based on consistent

discussion of constructs across interview respondents. Primary themes were identified when quotations were

consistently noted across multiple questions and interview respondents. Secondary themes were identified when

quotations were noted across multiple interview respondents but may not have resonated across multiple interview

questions.

P a g e | 22

Administrator & Staff Themes

Offering an entirely new model of treatment, Kenton County Detention Center (KCDC) and the JSAP program

have had to be adaptable and flexible in the first year of grant implementation as they navigated challenges.

Given that injectable extended-release buprenorphine is still a relatively new medication (approved for sale in 2017),

KCDC has had to establish account setup, pricing, and negotiation through a limited number of providers nationwide.

Furthermore, as buprenorphine is a partial opioid agonist, staff and administrators have been under increased scrutiny

to prevent diversion of the medication, particularly in its daily oral form, which clients were initially given for 30 days

(now two weeks) to stabilize dosage and be monitored for adverse effects before being administered the injection.

Because of administrative “red tape,” several staff also expressed frustration that they were not able to provide

buprenorphine sooner after clients were incarcerated to prevent withdrawal symptoms; rather, clients are typically

fully detoxed prior to initiating the medication. As one staff member said, “It’s a lengthy process with a lot of moving

parts; we see people in detox and can’t help them because there

are so many steps to go through.” Finally, staff and administrators

faced occasional difficulties finding community partners,

particularly sober living providers, who were willing to

accommodate clients on MAT. In spite of these challenges, KCDC

staff expressed understanding that these complications were an

inevitable part of being the “tip of the spear,” forging a path to

improve access to MAT for incarcerated individuals with OUD in

order to “set the precedent for the rest of the state.”

Implementation of treatment “tracks” (buprenorphine, naltrexone, or abstinence) has created a valuable

opportunity for open dialogue and education of staff, community partners, JSAP clients, and other inmates

concerning MAT. As one staff member said, “MAT has a bad reputation – lots of people come from an abstinence-

only frame of mind,” particularly in a correctional context, where MAT is rarely implemented, limiting familiarity and

knowledge. Another staff member agreed, stating that “stigma has been a big challenge. Even though you try to

educate staff and peers, sometimes they still have a conditioned bias.” Education has thus been an important aspect

of implementation in the first grant year, in order to establish a culture of acceptance and understanding of MAT as a

valuable clinical tool. One element of this process, according to a staff member, has been to “have very real

conversations with [clients] and be very mindful about how we talk

about MAT. The language we use is important.” Staff and

administrators agreed that how MAT is discussed, what words are

used, has the potential to reinforce or correct biases: “we do get clients

in here that ‘want to get high,’” said one staff member, “and we have

to explain the difference between a medication, given by a doctor and

taken as prescribed, and a drug.” Although another staff member

lamented that there was “lots of misinformation,” they added that “I

take this as a learning opportunity” to better inform themselves and

others.

MAT is most effective when offered in conjunction with wrap-around services, and partnerships with

community organizations have been invaluable towards the positive outcomes observed during the first grant

year. Several staff and administrators agreed that “we stress that MAT is not a cure-all” or “a magic pill,” emphasizing

the importance of engagement with other services to support recovery. While in JSAP, COR-12 programming serves

“Substance use disorders and

mental health have kind of been an

elephant in the room for criminal

justice – now, we get to really

focus on it, and get the resources

to provide the services we need.”

“This has been a monumental

change. We’ve given hope to

clients and sent the message to

staff that incarceration alone

isn’t enough: we need to give

them the tools.”

P a g e | 23

this function, but post-release to the community, KCDC has made

significant efforts during the first grant year to build relationships

with other organizations to better serve clients. These partnerships

have included the Life Learning Center for aftercare coordination;

Mental Health America (particularly the PIER Recovery Community Center) and NorthKey for mental health services;

and sober living residencies, such as Oxford House. Continuation of MAT in the community is supported by Journey

Recovery Center (St. Elizabeth Healthcare), Transitions, and private practice doctors, including Dr. Suetholtz and Dr.

Keller. Finally, expansion of MAT services has required extensive coordination with judicial entities, including the

Administrative Office of the Courts (AOC), circuit and district court judges, Commonwealth attorneys, and probation

and parole. In part, this collaboration has helped to improve the accuracy of anticipated release dates for clients who

choose to initiate MAT and has progressively minimized interruption of services. Together, these partnerships have

helped staff and administrators to “keep people from slipping through the cracks.”

In the remaining grant years, staff and administrators agreed that they would like to focus on sustaining

positive changes, evaluating and adjusting existing procedures, and looking for opportunities for future

growth. For all of the challenges faced in the first year of program

implementation, staff and administrators agreed that being a part of an

innovative system of care and paving the way for future systemic changes

has been a rewarding and gratifying experience. As one staff member said,

“Just like recovery, implementing new programs is a process. But you have

to trust the process: it works.” Staff and administrators both discussed a

desire to continue to focus on the triage and intake process to more quickly

identify clients in need and link them to services, to continue to improve connections to aftercare providers, and to

expand their own capacity to serve more individuals with OUD, including offering new programs through JSAP (such

as grief and loss counseling, family-based interventions, and recovery yoga). “There have been so many unexpected

changes with the program growing,” one staff member said; “there has been a lot of learning and waiting, taking it

one day at a time.” An administrator agreed, saying, “We’re constantly re-evaluating and adjusting our procedures as

needed.” Nonetheless, staff and administrators expressed their excitement and commitment to continuing these

efforts throughout the coming grant years.

Client Themes

Clients valued the “safety net” of MAT as an important tool to reduce the chance of relapse after they were

released. Several clients mentioned that access to MAT had made them feel more confident in their ability to resist

using opioids when they returned to the community. One client reflected that “any other time when I was in jail, I

just thought about getting high. I would get butterflies in my stomach when other people would talk about it. With

Suboxone, that doesn’t happen. I don’t get the cravings.” Some clients had previous experience with MAT that

helped to inform their current choice of treatment track: for example, one participant had previous success

abstaining from opioids with non-prescribed Suboxone; others had tried methadone, with mixed results; yet another

had a partner who was prescribed Suboxone and was in recovery. This variability, however, emphasizes the fact that

MATs are not a one-size-fits all treatment, and highlights the importance of making multiple treatment options

“This is the greatest thing that’s ever happened to this jail.”

“We’re saving people’s lives.

That’s the best thing.”

“We’re trying something

different. What we did

before wasn’t working, but

this is amazing.”

P a g e | 24

available to clients with OUD. Finally, participants discussed the

importance of increasing education and acceptance of MAT in recovery

communities. As one participant said, “Everyone used to shun MAT, like

especially in AA/NA, but science shows that it works. There’s more

acceptance of MAT now.” It is likely that awareness of this increasingly

widespread acceptance has helped to support JSAP clients’ open-

mindedness towards MAT as a valid tool to support their recovery.

Although access to MAT was one important component of treatment, clients also appreciated many other

aspects of the JSAP program. Specifically, clients mentioned AA/NA meetings and step packets, Hazelden

curriculum and homeworks, group and community meetings (including discussing weekly goals), confrontational

therapy, guest speakers, and movies. One important element of these services is committed and nonjudgmental

counselors and staff, who clients praised as “really supportive and easy to talk to.” The group environment and

fellowship, according to one client, “forces you to face your reasons and excuses” through clients holding one

another accountable. Clients also discussed that the JSAP program provided them with a better understanding of

their patterns of addictive behaviors and thinking: “the drugs aren’t the problem, they’re the solution,” said one

client; “[OUD] is a thinking disease.” Another client agreed, stating, “I would

probably still be in the same mindset if it wasn’t for the JSAP program here. I

wouldn’t be thinking at all about rehab. That’s what’s important, is the change

in thinking.” Lastly, participants valued referrals to services after release from

jail (including to AA/NA meetings, the Life Learning Center, or Journey Recovery

Center for continued MAT), indicating that “it gives us hope for when we get

out. They give us lots of supports.”

In addition to services provided through JSAP, clients discussed the desire and willingness to stop using as an

important aspect of successful recovery. Before participating in JSAP, many clients had considered or tried other

treatment programs, but found that “it’s hard to stop [using opioids].” They discussed the dichotomy of “not wanting

to [quit], but wanting to at the same time,” and stated that this ambivalence made it difficult to commit to entering

treatment. Other participants talked about the influence of others around them: as one client said, “I was always

dating people that were using and I knew they didn’t want to quit or go to treatment. I figured it was a waste of

time.” Another client stated, “I didn’t want to go to detox; I was afraid. I didn’t want to be away from my family for

six to nine months. I had to be forced.” Although other people could act

as barriers or support for treatment, clients agreed that internal

motivations, or “self-will,” were a key component of sustained abstinence.

“You have to take it seriously,” one client said. As previously stated,

although MAT was viewed as an important “safety net,” clients agreed that

their personal commitment was a pivotal aspect of recovery. “You have to

want to stay sober,” one client stated; “I could just get the shot, leave, and

not get it again – you have to want to change. It’s just a pill or a shot. It’s

really up to you.”

“I know things will be

stressful when I get out and

drugs would be my go-to…

it’s how I dealt for the

majority of my life.”

“I’m afraid that when I get

out I’ll use again. There’s a

chance that I’d come back

here without MAT, and I

don’t want to take that

chance.”

“I had tried treatment

before, but without

MAT, and I wasn’t as

successful. I think it’s

about self-will.”

P a g e | 25

CONCLUSIONS AND RECOMMENDATIONS

This Year 01 report indicates that the Kenton County Detention Center has been very successful with the

implementation of this federally funded CSAT grant targeted to enhance services for JSAP clients with OUD through

COR-12 programming, access to MAT, and improved community relationships and support systems. The program

proposed three goals, and results from the process and preliminary outcome evaluations indicate that they are on-

target for meeting those goals during the three-year project. Based on feedback from process evaluation interviews,

the following recommendations are forwarded for consideration during Year 02:

1. Continue to focus on MAT education for staff, community partners, JSAP clients, and other inmates to

support a culture of acceptance and understanding of MAT as a valuable clinical tool. This will further

increase buy-in both within and outside the facility, as well as set an expectation among clients that both

medication-assisted recovery and abstinence are valid methods for achieving and sustaining sobriety.

2. Continue to build and sustain partnerships with community organizations that support clients’ successes

post-release. Both staff and clients indicated the value of knowing that there were resources available to

assist clients with housing, health, employment, education, and medications. This awareness gave clients

hope and a positive attitude about their return to the community.

3. Continue to engage in ongoing evaluation of existing program procedures and examine areas for future

growth and change. KCDC’s successes in the first year of grant implementation have been due, in part, to

staff and administrators’ ability to adapt as new circumstances and challenges arise, and it is expected that

this flexibility will facilitate continued successes in the years to come.