In an ASPE Issue Brief in early 2015, the U.S. Department of Health and Human Services defined expansion of Medication-assisted Treatment (MAT) as one of three target priority areas to combat opioid abuse in the United States. Since 2013, Vermont has employed a system known as the Hub and Spoke Model to deliver MAT services to those suffering from opioid substance abuse disorder. The Chittenden Clinic, also known as the Northwest Hub, has had an active wait list since January 2014, the earliest that wait list information was reported statewide. Over time the wait list volume has fluctuated, reaching monthly levels as high as 302 active participants in April 2015, but had maintained a volume of 100 individuals or greater until the second quarter of 2017 when the average dropped to 90 individuals. Regarding treatment levels, it is also the case that the Chittenden Clinic provides treatment for the greatest number of recipients of any hub statewide, with treatment levels rising continuously since February 2014. This rise in treatment is concurrent with trends across Vermont, where in 2015 more individuals received treatment for opioid substance abuse than any other kind of substance abuse combined.

Even though the Chittenden Clinic has provided treatment at consistently high levels, wait list volumes did not see significant declines until mid 2016. Since then, reductions in wait list volumes have continued, with volumes decreasing to an average 90 active participants in the second quarter of 2017, the lowest volume to date. Though it can be difficult to attribute this decline to specific factors, the ability to transition patients from hub care to spoke providers has been identified as one of the main bottlenecks to providing additional treatment in Chittenden County. In this regard, the number of spoke prescribers in Chittenden County increased from 38 to 70 between March and December 2016. This increase may have helped allow for new recipients to transition off the hub wait list in this same time period. Additionally, service providers came together under the Opiate Care Alliance of Chittenden County and began triaging individuals into Spoke level care, expediting the wait list. Finally, in 2017 a new service hub was created in Franklin County, which had been covered by Chittenden County up until then. More information about hub and spoke treatment levels can be found in the Opioid Use Disorder Treatment Census And Wait List report, produced by the Vermont Department of Health.

This information was collected by the Howard Center Chittenden Clinic and is reported by Vermont Preferred Provider Reporting within the Vermont Department of Health. A census of Vermont MAT hubs is performed at regular intervals, and a report is produced by the Division of Alcohol and Drug Abuse Treatment Programs. The Opioid Use Disorder Treatment Census and Wait List report contains information from hubs across the state, with figures collected at monthly intervals, but may not always contain the most current data. Individuals are added to the Chittenden Clinic wait list upon their initial request for service, and a level of triage is applied based on the individual's needs. Individuals are removed from the wait list once they have been evaluated by a Substance Abuse Treatment professional and have been admitted for service at the Chittenden Clinic or at another Spoke location. An individual may also be removed from the wait list if their contact information can no longer be confirmed by the Clinic, they become incarcerated, they move out of state, they refuse treatment after being admitted, or they die. More details about how service providers are mandated to track individuals waiting for treatment can be found in this report on Wait List Definitions, Methodology, and Reporting from 2014.

Last Updated: August 2017

By supporting data collection efforts among Alliance partners, the CCOA aims to provide additional insight into the system of care in Chittenden County. By tracking not only the number of people waiting for treatment at the Chittenden Clinic, but their levels of need, if they've been on the wait list before, and if they leave the wait list before receiving treatment, we may be able to offer service providers insight into specific barriers which individuals experience while waiting for treatment. The goal is to assess not just how many people are waiting, but to make sure that while people wait they are receiving supports which will allow them to transition into treatment more seamlessly and stay in treatment for longer periods at a time. The Howard Center, and the CCOA Treatment & Recovery Action Team, have begun exploring the implementation of a Service Navigator position, a professional who will use the information captured as individuals enter the wait list to address their needs, for instance, if an individual needs temporary housing, or a primary care physician, in order for their treatment to be successful.