Science to Systems Grant Program
Bethany A. DiPaula, PharmD, BCPP, School of Pharmacy, Principal Investigator
Catherine E. Cooke, MS, PharmD, BCPS, PAHM, School of Pharmacy, Co-Principal Investigator
Project Goal
Expand access to medications for managing opioid use disorder (OUD) by establishing strategies for the financing of a physician-pharmacist collaborative model
Problem and Significance
Opioid use disorder (OUD) is a national emergency that requires additional resources to address. Evidence-based medications have been shown to decrease morbidity and mortality and increase treatment retention but are underused. The shortage of healthcare providers trained and available to manage patients with OUD medications contributes to undertreatment.
Employing new strategies and engaging all qualified healthcare professionals are key elements to increasing access to treatment for patients with OUD. The physician-pharmacist collaborative model is an innovative solution to addressing workforce needs for patients with OUD. Utilizing pharmacists with extensive education and skills in medication management can reduce the resource gap in available care for patients with OUD. Close collaboration between prescribers and pharmacists can optimize medication selection, improve patient safety, and expand access to care. However, pharmacists do not have a traditional payment model to provide these services, which limits their ability to collaborate in non-acute care settings.
Approach
Semi-structured interviews will be used to elicit third-party payer perspectives on expanding access to OUD medications through financing of physician-pharmacist collaborative model. A white paper will be produced describing the identified barriers and proposed solutions. A survey of the third-party payers will assess the impact of the White Paper.
Bradford Schwartz, MD, School of Medicine, Principal Investigator
Zach Dezman, MD, MS, School of Medicine, Co-Investigator
Christopher J. Welsh, MD, School of Medicine, Co-Investigator
Emergency Department-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) is emerging as an effective bridge to substance abuse treatment. The implementation of SBIRT via peer recovery coaches (PRC) is a relatively new phenomenon in the emergency department. PRC’s are typically non-professional community health educators, many of who are in long-term recovery themselves, who receive training in motivational interviewing. PRCs have successfully piloted ED-based SBIRT programs in many of the large-volume ED sites in the University of Maryland Medical System (UMMS) network, boasting improved linkage to care, 30-day retention rates, and higher patient satisfaction. Smaller ED’s with lower patient volumes and tighter budgets often do not have access to SBIRT. We evaluated the impact of a telemedicine model, utilizing Peer Recovery Coaches to deliver SBIRT, in two freestanding emergency departments. We hypothesized that the intervention of telemedicine to deliver SBIRT would be non-inferior to in-person communication in regard to patient referrals to outpatient substance abuse treatment as well as 30-day retention rates in treatment. Interestingly, this study occurred during the COVID pandemic.
Sarah Kattakuzhy, M.D., School of Medicine, Principal Investigator
Maryland is among the top five states in the incidence of opioid-related deaths, with a rate of 32.2 deaths/100,000 persons, more than twice the national average. Despite the significant burden of disease attributable to opioid use disorder (OUD), and a wealth of data linking accessible treatment services to improved outcomes, implementation of evidence-based therapy remains poor. Barriers to the treatment of OUD exist at the patient, provider, and health system levels. However, stigma– both explicit and implicit- is the common driver of these barriers, reinforcing the gap between treatment need and uptake. Bias and poor education within the medical community serve to exacerbate this gap, limiting the number of patients who seek OUD care, and perpetuating the broken systems that reinforce addiction. To address the opioid epidemic, the healthcare workforce must not only expand but address stigma and bias through comprehensive, culturally-competent, interdisciplinary education in OUD.
The project Accelerating Interdisciplinary Resident Education in Opioid Use Disorder and Harm Reduction (AIROH) is an OUD education intervention to improve the knowledge and skills of residents on the front lines of the opioid epidemic and augment the physician workforce able to provide comprehensive, culturally-competent, and evidence-based care to patients with OUD. This initiative consists of two parallel interventions:
- OUD Primer: a didactic curriculum completed by every first-year (PGY-1) IM and FM resident at UMB, which includes longitudinal didactic education and buprenorphine waiver training.
- OUD Elective: an optional two-week elective that would provide an expanded didactic curriculum along with immersive clinical experience for second and third-year (PGY-2/3) IM and FM residents.
The project is led by a multidisciplinary team spanning the Departments of Medicine, Family & Community Medicine, and Psychiatry, including Drs. Sarah Kattakuzhy, Aaron Greenblatt, Dani Baek, Britt Gayle, and Elana Rosenthal.
To evaluate the success of the OUD Primer and OUD Elective interventions, all residents participating in the AIROH initiative will complete a survey entitled “Knowledge of and Attitude towards OUD” (KAO) before and after the OUD Primer or OUD Elective. The survey includes knowledge questions pertaining to diagnosis and management of OUD, as well as attitude questions, self-reflective assessments of bias and confidence in caring for individuals with OUD.
In 2020, the AIROH Program was initiated, conducting fall training sessions for PGY-1 FM and IM residents, including buprenorphine waiver training completion. Preliminary outcome data from the KAO was accepted for presentation at the American Society of Addiction Medicine 2021 conference. In 2021, we will complete didactic training, and hold the OUD Elective for PGY-2 and 3 residents. Beginning in July 2021, AIROH is poised to transition as a funded permanent training program, managed by the Maryland Addiction Consult Service, with expansion into the advanced practice provider and healthcare student populations- exemplifying the power of the CARES grant program.
Jodi Jacobson Frey, PhD, MSW, LCSW-C, CEAP, School of Social Work, Co-Principal Investigator
Marianne Cloeren, MD, MPH, FACOEM, FACP, School of Medicine, Co-Principal Investigator
Although clinical outcomes are improved in patients with opioid use disorders who hold employment, many of these individuals do not work. This study seeks to provide valuable data for the multiphase interprofessional project, “Operation PROSPER – Peer Reintegration and Other Services Promoting Employment in Recovery”, which will identify and help to systematically overcome the barriers to employment faced by individuals receiving Medication Assisted Treatment (MAT) for Opioid Use Disorder (OUD) in University of Maryland clinics. More specifically, this study will concentrate on defining the gap in critical soft skills among adults receiving MAT; therefore, a focus will be on identifying areas needing improvement and support to prepare adults for interviews, to obtain jobs, and to sustain employment. This study has four aims, the first being to provide data on strengths and gaps in vocational soft skills using the ERS and perceived work disability using the World Health Organization Disability Assessment Schedule 2.0 among working-age patients receiving MAT and meeting inclusion criteria. The second aim is to assess, through focus groups with counselors and clinic administrators, and interviews with a sample of patients, the feasibility and potential benefit of using the ERS and customized ERS Action Planning tool as a prevocational service to support treatment offered at MAT programs for patients with OUD seeking employment.The third aim is to use asset mapping techniques to describe and summarize currently existing resources and partnerships throughout Baltimore City (and State of Maryland as appropriate) to meet the needs identified in the ERS Action Planning tool. Finally, the fourth aim is to compare results from the asset map to data collected from counselors, participants, and a sample of employers and workforce development program staff to identify gaps in resources and services identified as needs by the ERS Action Planning tool. The results of this study will produce much-needed information on strengths and gaps for obtaining and sustaining employment, with specific attention to soft skills and the needs of patients with OUD who are in recovery with MAT.
Zachary Dezman, MD, MS, School of Medicine, Principal Investigator
It has been reported that fentanyl positivity may paradoxically worsen withdrawal in patients undergoing buprenorphine induction in the emergency department (ED). In this study, we will determine the overall prevalence of fentanyl use, and then stratify these patients by complaint. It is hypothesized that patients who are positive for fentanyl and are undergoing buprenorphine induction in the ED will be more likely to suffer from episodes of worsening withdrawal, or require a prolonged induction (multiple small doses spaced over 6-8 hours), than those who are fentanyl-negative. This research will add to the current dearth of information related to the impact of fentanyl use.
Kristen Rawlett, PhD, FNP-BC, School of Nursing, Co-Principal Investigator
Alexandra Wimberly, PhD, MSW, MPH, School of Social Work, Co-Principal Investigator
This study addresses the following treatment gaps: 1.) the need for women- focused services for those with opioid use disorder (OUD); 2.) the need to understand factors that impact medication assisted treatment (MAT) adherence, and 3.) the need to understand whether mindfulness interventions are a feasible and acceptable intervention to address MAT adherence. Accordingly, the aims of this study are to first adapt an existing mindfulness intervention for use with MAT adherence. Through running focus groups with women receiving methadone, this study seeks to understand the strengths and challenges of women as it relates to MAT adherence; and incorporate this learning in the mindfulness curriculum. Second, we will pilot the adapted mindfulness intervention for MAT adherence with women who are receiving methadone and test its impact on MAT adherence and substance use. Finally, this study will assess predictors of MAT adherence by controlling for the effects of demographics, self-stigma and motivation on MAT adherence and conducting qualitative interviews to better understand determinants of MAT adherence.
Victoria Selby, PhD, CRNP, UMB School of Nursing, Co-Principal Investigator
Marc Fishman, Maryland Treatment Centers (MTC) Medical Director, Co-Principal Investigator
Kevin Wenzel, PhD, MTC Research Scientist, Clinical Psychologist, Investigator
The Youth Opioid Recovery Support (YORS) model is a promising, innovative, inter-professional, behavioral approach that attempts to address barriers to opioid treatment engagement in the vulnerable young adult population, especially difficulties with medication adherence. Components of YORS include assertive outreach, home-delivered medication administration, contingency management, and family engagement. The purpose of this study is to evaluate a pilot enhancement of the YORS intervention in patients who have chosen either extended-release naltrexone or extended-release buprenorphine for treatment, use of standard reimbursement to cover clinical services, and transitioning back to clinic-based care after an intensive phase of home delivery. The first aim of this study is to evaluate feasibility and preliminary efficacy of the enhanced YORS intervention compared to recent historical data from a pilot RCT including both a YORS intervention group as a benchmark and a TAU group as a control, on the outcomes of doses of medication received, rates of opioid relapse, and total number of opioid positive urine tests. The second aim is to demonstrate the benefits of the enhanced YORS intervention in a pre-post evaluation using each participant as their own control, on the secondary outcomes of HIV risk behaviors, criminal behaviors, functional improvement, overdoses, and pattern of crisis services utilization. The third aim is to assess whether the intensive YORS intervention has the possibility of priming less intensive continuing care by measuring the rate of receipt of a clinic-based dose in the month following the last home-delivered dose. Thus, this study will glean key information that will be used to improve engagement and medication adherence for youth with OUD.
Mathangi Gopalakrishnan, MPharm, PhD, School of Pharmacy – Principle Investigator
Dina E. El-Metwally, MB, BCh, PhD, School of Medicine – Co-Investigator
Jessica Biggs, PharmD, BCPPS, UMMC – Co-Investigator
Megan Ehret, PharmD, MS, BCPP, School of Pharmacy – Co-Investigator
Vijay Ivaturi, MS, PhD, School of Pharmacy – Co-Investigator
Opioid use in pregnant mothers and its sequelae among their infants leading to neonatal abstinence syndrome (NAS) is a major public health concern in the United States (US). Current treatment recommendations are often empiric dosing of morphine or methadone and most follow intuition-based approaches that could potentially lead to increased lengths of hospital stay (LOS) and add to economic burden. The purpose of this study is to develop an adaptive-individualized dosing strategy (clinical decision support system) for morphine that can guide real-time NAS therapeutic decisions in a clinical setting. The specific aims of the research include: (i) design and conduct of a retrospective cohort study to collect data on infants with NAS admitted to the UMMC, NICU between 2013 and 2017, (ii) utilize advanced data analytical methodologies to develop and validate an adaptive-individualized morphine dosing strategy using the UMMC data and (iii) develop a prototype clinician friendly web-based application that can provide the individualized morphine dosing recommendations in real time. The proposed collaborative translational research between UMB-SOP, UMB-SOM and UMMC is envisaged to assist clinicians to make informed individualized morphine dosing decisions, that can potentially lead to better clinical outcomes (reduced LOS) in infants suffering from NAS. Efficient utilization of advancements in science and technology to improve NAS related patient care needs can inherently have a greater societal impact, serving both the baby and their mothers to lead healthier lives and reduce economic burden.
Sara B. Murthi, MD, School of Medicine – Principal Investigator
Luana Colloca, MD, PhD, School of Nursing – Principle Investigator
The purpose of this study is to validate innovative, inexpensive strategies to reduce opioid use in all aspects of trauma care. There are two main goals of this research study, the first is to establish a method of outpatient follow-up for the Relieving Traumatic Pain: A Pilot Study (RTP). The second goal is to develop a phone application with data collection and educational capabilities. Thus, the first aim of this study is to develop a phone application for data collection that can then be used to: (a.) collect long term outcome data related to pain severity, pain interference, and the use of opioids for RTP; and (b.) identify the risk factors associated with the risk of opioid dependence. The second aim is to create and assess a phone based educational tool in collaboration with clinical experts and beta test that tool with those admitted to the shock trauma center who are prescribed opioids and receive the educational tool in comparison those who do not receive the educational tool.
John Cagle, MSW, PhD, School of Social Work – Principal Investigator
Mary Lynn McPherson, MA, PharmD, School of Pharmacy – Co-Investigator
Paul Sacco, LCSW, PhD, School of Social Work – Co-Investigator
Jodi Frey, LCSW-C, PhD, School of Social Work – Co-Investigator
There is currently a dearth of knowledge related to how hospices monitor controlled medications in homes or facilities, and if, and how, these controlled medications are disposed of after an expected death. The purpose of this study is to address that gap in knowledge, and in turn help prevent substance misuse and diversion. The first aim of the study is to provide national estimates on the prevalence of: (a.) drug diversion in hospice, both suspected and confirmed; (b.) opioids being left in the home after a patient death; and (c.) screening by hospice providers for patient/family risk of substance misuse or addiction. The second aim is to use qualitative survey data to describe and summarize: (a.) promising practices and policies that hospice providers are currently employing to prevent drug diversion; (b.) strategies to detect and respond when drug diversion occurs; and (c.) how to screen, and modify practice, for patients/families who are at risk for substance misuse or addiction. The findings will be used to create a list of best practice strategies and policies for hospice agencies on: (a.) drug diversion prevention and intervention; and (b.) the screening and treatment of patients/families at risk for substance misuse or addiction. Further, these will then be disseminated to hospices nationally to improve drug diversion prevention efforts, provide indicators and risk factors for diversion and recommend response strategies for when diversion occurs. The results will also inform future intervention research to improve drug diversion prevention efforts in hospice that, importantly, do not hamper pain management efforts.
Request for Applications
Pilot Funding to Enhance Substance Use Related Systems of Care
The University of Maryland Center for Addiction Research, Education, and Service (CARES) has established a Science to Systems pilot grant program. The aim of the program is to generate new substance use related prevention, treatment and system enhancement initiatives designed to improve addiction-related systems of care.
The SSG is seeking projects that demonstrate capacity to produce measurable outcomes directly relevant to substance use disorder (SUD) service delivery within a 12-month period. The SSG anticipates funding three to four awards at $50,000 maximum per applicant.
Funding Priority
This UMB CARES Science to Systems grant (SSG) funding cycle will prioritize projects that target opioid use disorders as well as other illicit and licit (e.g., alcohol, tobacco) substance use associated with sub-optimal treatment and high rates of patient mortality. Projects targeting underserved populations who experience significant disparities in behavioral health treatment access and bio-psycho-social outcomes also are prioritized.
Proposals that demonstrate considerable potential in the following areas are most compatible with the CARES core aims: (1) potential to favorably impact substance use related systems of care, (2) feasibility for behavioral health system translation, and (3) likelihood of continued impact on SUD systems of care (e.g., further development and testing, potential for external funding generated from pilot grant findings). Interprofessional and community collaboration is considered essential for ensuring that research findings are relevant, feasible, and translatable to SUD systems of care.
Evidence of matching funds from the faculty applicant’s affiliated School will be considered in determining the best use of CARES funds.
Example SSG proposals include, but are not limited to, projects designed to:
- Increase patient access to SUD treatment, receipt of SUD treatment, or retention in SUD treatment.
- Address barriers known to impact SUD treatment outcomes (i.e., transportation, child care, family support, financial/insurance issues, treatment engagement).
- Increase patient access to and receipt of medication-assisted treatment (MAT) for opioid, alcohol, and/or nicotine use disorders.
- Identify and address factors that impede or facilitate SUD workforce participation among behavioral health practitioners in Maryland.
- Improve service delivery through interprofessional and interagency collaborations, cross-training, and care coordination across multiple systems of care.
- Integrate and synthesize existing data systems to improve prediction of substance use trends, and SUD-related service needs.
- Identify and address addiction-related specialty training opportunities for UMB students.
- Identify and address initiatives to strengthen addiction-related interprofessional education (IPE) focused among UMB schools.
- Improve patient SUD continuing care including transitions among behavioral health service providers, facilities and programs.
- Increase patient utilization of treatments or services that reduce the need for high cost service utilization (i.e., emergency room visits, inpatient psychiatric treatment, inpatient detoxification services).
- Increase the number of individuals who access and maintain insurance that includes behavioral health services within scope of coverage.
- Evaluate the impact of specific legislation on behavioral health care access, utilization, and patient outcomes.
SSG Proposal Submission Guidelines
Intent to Apply
Potential applicants are asked to inform CARES faculty of the intent to apply for funding via email to mtuten@ssw.umaryland.edu and tbrown@ssw.umaryland.edu by January 15, 2021.
Eligible Applicants
All UMB faculty at the rank of Assistant Professor or above are eligible to apply for SSG funding. All applications must include at least one UMB faculty member at the rank of Assistant Professor or above with the expertise or qualifications necessary to achieve the aims of the proposed grant. Faculty who have previously been funded may compete again but must provide clear documentation about whether and how their prior award is instrumental to their new application.
Grant Personnel
Grant personnel may include UMB students, trainees, and staff as well as non-UMB community members consistent with the qualifications of the roles specified in the application. Community providers include non-UMB behavioral health providers and community agencies that provide or have the capacity to provide direct or indirect addiction-related prevention or treatment services.
Deadline for Proposal Submission
The submission deadline for all proposals is April 1, 2021. We anticipate that funding for awarded projects will begin May 1, 2021.
Any queries regarding applicant or proposal eligibility can be directed to:
Michelle Tuten, PhD, MSW
CARES Co-Director
University of Maryland School of Social Work
Email: mtuten@ssw.umaryland.edu
Phone: 410-706-7519
Duration of Project
Projects should be completed within 12 months of grant funding (not including data analysis).
Proposal Requirements
Proposals should be formatted using 12-point font and 1-inch margins and should strictly adhere to the following page limitations and required elements:
Cover Page (1 page)
Title of Project
Name, role on project, and UMB affiliation for primary faculty member(s)
Proposed Research (maximum 5 pages)
The proposal should include a description of the problem and significance, specific aims, and project timeline and impact as described below.
Problem and Significance
Addiction-related problem to be addressed and significance of addressing the problem as it relates to one of the following CARES core areas of focus.
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Core 1: Workforce Development and Technical Assistance |
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Core 2: Development of Innovative Models and Systems of Care |
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Core 3: Translational Addiction Research, Data Surveillance, and Management |
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Core 4: Policy Analysis and Education |
Specific Aims
Proposals should describe the primary and any secondary aims of the project, and the research methodology and data analyses that will be used to accomplish the specific aims. Proposals should include a description of how the data will be collected, analyzed, and interpreted as well as any resource sharing plans as appropriate.
Project Timeline and Impact
Proposals should describe the timeline for implementing the project, including main tasks to be accomplished within the 12-month grant period, the expected outcomes for the project, and how the project will provide data sufficient for publication within 12 months following completion. Describe plans to apply for external funding following project completion and the anticipated timeframe for this application.
Budget (maximum of half a page)
A concise budget should be provided that includes the total amount of funds being requested (maximum funding of $50,000 per applicant), personnel salaries, project supplies and equipment and any patient compensation as applicable. The budget should include a brief description of how the funds will be used. The budget should clearly identify which entity will use the specified funds (i.e. CARES faculty member, community organization etc.). No indirect costs are allowed.
Additional Application Documents
Biosketches or curriculum vitae (maximum of 10 pages for CV) should be provided for all key personnel along with a brief description of each team member’s role on the project.
Additional Applicant Information
Review: Proposals will be evaluated by members of the CARES Steering Committee and/or community representatives with appropriate expertise. Reviews may be solicited from specific experts on an ad hoc basis. Applicants should not expect detailed written critiques of their proposals. Proposals will be reviewed for: 1) congruency between project and goals of the CARES SSG program; 2) potential for direct and timely impact on the problem identified and, 3) potential for future project development and impact on problem identified.
Expectations
Funded projects: Award recipients are expected to produce sufficient preliminary results so that within 12 months after expiration of the award a report on the findings in manuscript format can be prepared. Projects should include a plan for future directions and/or implementation including future grant proposals to state, federal or private funding agencies.
Contributions to center mission: Awardees will register as CARES’ faculty and are expected to contribute to the ongoing work of the center through activities such as grant application reviews, presentation at CARES-sponsored symposia and other center-related efforts.
Expenses Not Allowed: Alterations or renovations; purchase of office furniture; purchase or binding of periodicals and books; dues and memberships in scientific societies, travel not directly related to the project. No Indirect Costs will be awarded.
Other: The proposal should also identify specific goals that will enhance the success of a full proposal, as well as, provide a specific targeted timeline by which these objectives can be reasonably achieved. Finally, the proposal should provide a budget that adequately reflects the intended use of the funds with respect to the proposed objectives.
Where to Submit:
All applications should be submitted electronically by e-mail as a single PDF to:
Patricia Parkent
Director, Sponsored Projects Office
University of Maryland School of Social Work
Email: pparkent@ssw.umaryland.edu
Phone: 410-706-0505
Frequently Asked Questions
Does the 5-page limit include the reference list? ▾
The reference list is not included in the 5-page limit for the proposal.
Does SSG funding provide support for faculty salaries? ▾
Yes, faculty salaries are supported by SSG funding and should be included in the budget. Faculty requesting salary support should ensure that any salary support is approved by their respective school deans or department heads, as appropriate.
Is there a limit on the amount of salary support that can be requested? ▾
There are no specified limits on the amount of salary support that can be requested.
What is meant by the section of the RFA that states: ▾
"The proposal also should identify specific goals that will enhance the success of a full proposal as well as provide a specific targeted timeline by which these objectives can be reasonably achieved."
The SSG proposal should specify the team's plans to apply for external funding and how the SSG pilot funding will enhance the team's prospect of obtaining future funding.