Mobile Health Units for Opioid Use Disorder Treatment

Description

The Colorado Department of Human Services Behavioral Health Administration (BHA) received a federal State Opioid Response grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to help increase access to treatment for opioid use disorder. Colorado BHA partnered with the state's substance use disorder Managed Service Organizations (MSOs) to manage the mobile health unit project regionally. The MSOs chose three behavioral health provider agencies to operate the six mobile health units across the state.

The mobile health units (RVs converted into clinics) travel to 32 counties in Colorado and offer medication-assisted treatment (MAT). A nurse, licensed or certified addiction counselor, and peer support specialist travel in each unit. One team travels by SUV in an area with narrow mountain roads. When the grant ends, the three clinics supplying the staff members will inherit the mobile health units and costs and continue their current practice of billing Medicaid and private insurance.

Services offered

Mobile health units offer the following services:

• Counseling
• Drug testing
• Naloxone
• Referral to wraparound services
• Syringe disposal (some units)
• Telehealth session with a nurse practitioner or physician assistant who can prescribe medication to treat opioid use disorder

When a patient receives a prescription, the nurse in the mobile health unit can administer a naltrexone shot (which blocks opioid receptors) and sends the patient home with naloxone. Patients who are prescribed buprenorphine (which reduces opioid cravings) need to go to a pharmacy to fill their prescription.

Results

The mobile health units traveled more than 100,000 miles from January 2020 to January 2021 and served hundreds of Coloradans.

Challenges

• Mechanical issues: The MSOs contracted with a manufacturing company based in New York to build the mobile health units and parts of their internal hardware. The units had some mechanical issues upon arrival and have experienced ongoing, normal maintenance challenges. Unit staff work with the contractors to quickly respond to maintenance issues and have taken steps to prevent future mechanical problems.
• RV driving training: The contractors who built the units trained staff in driving, parking, and operating the 33-foot vehicles, which can be difficult for inexperienced drivers. The mobile health unit teams also follow routine startup procedures to prevent mechanical issues.
• Stigma: In its initial outreach efforts, Colorado BHA encountered stigma and resistance in certain communities. Staff used this information to design mobile health unit routes that maximize participation in and sustainability of the program. The Colorado BHA team continues to focus anti-stigma marketing and outreach efforts in all communities to expand the program footprint via the statewide Lift The Label anti-stigma campaign.

Replication

• Establish standard operating procedures: Each staff member in the mobile health unit should receive training on how to drive larger vehicles and work from checklists that outline daily startup procedures and other unit operations.
• Start with community outreach: Early stakeholder engagement efforts are a critical phase of the development process. This pre-work not only establishes key relationships for operations and referrals but also helps to reduce stigma and increase community buy-in.
• Embrace iteration: It is important to approach the project with flexibility. Staff must be willing to adjust plans to ensure that services meet the changing needs of communities.

Contact Information

Brianna Hird, Opioid Grants Administrator
Colorado Department of Human Services
brianna.hird@state.co.us