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. Though wait times have been tracked in the past, the methodology used to record them has been inconsistent and trend information has rarely been reported. The CCOA aims to provide a forum where these numbers can be reported in a reliable fashion, using consistent methodology, moving forward. Currently, only two factors are mandated for consideration when prioritizing individuals as they wait for service at the hub, and while wait time is not one of the mandated factors, it is likely a strong determinant in the triage process.

Contemporary figures suggest there has been a steep drop in the wait times experienced by those seeking services at the Chittenden Hub, as figures as recent as October 2015 indicate active participants were waiting on average over 350 days for treatment. While it is difficult to determine what exactly may have caused the dramatic decrease in wait times, in November 2015 only 837 individuals were receiving treatment at the hub, the 5th lowest volume ever reported. This decline in service levels may have been the result of reduced staffing at the Hub. Since that time, treatment volumes have increased to the highest levels reported, reaching 972 individuals in January 2017. This rise in treatment is concurrent with trends across Vermont, and may have allowed individuals who had been waiting longest for treatment to be served. More information on statewide treatment and wait list volumes 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. 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 (ADAP), but wait times have not been reported as results were not considered reliable. Currently, wait times are calculated using a period beginning on the 18th of the previous month and ending on the 18th of the current month. Future points will be calculated from month-start to month-end. Additionally, only hub-level service providers in Vermont are required to keep a wait list and record wait times, though it may be the case that individuals initially request service from a spoke-level service provider. Therefore, it can be difficult to judge the real average time an individual will wait for treatment. As noted above, there are two factors which hub service providers are mandated to use when determining priority for individuals awaiting treatment. If the individual is pregnant, they must be offered treatment within 48 hours of initial contact. If the individual is using drugs via injection, they must be offered treatment within 14 days of initial contact, offered interim services or treatment at another service provider within 120 days. As defined in the ADAP Substance Abuse Service Guidelines from 2016, hub service providers are mandated to prioritize requests in the following order:

1. Pregnant injecting drug users
   
2. Other pregnant substance abusers
   
3. Other injecting drug users
   
4. All others

Last Updated: September 2017

By facilitating data collection and sharing efforts among Alliance partners, the CCOA aims to bolster existing efforts to better triage those waiting for services in Chittenden County. The Opiate Care Alliance of Chittenden County (OCACC), a group of service providers in Chittenden County, have been working to develop systems to more quickly find appropriate treatment for those on the wait list. Chief among their strategies is the development and implementation of the Treatment Needs Questionnaire (TNQ) as a diagnostic tool for service providers. The TNQ is modeled after the Addiction Severity Index and is designed to assess the needs of an individual upon their initial request for service, taking into account factors beyond if they are pregnant or using drugs via injection. By assessing a broad array of health, social, and economic factors, service providers can quickly assess what level of treatment may yield the best results for each individual, and triage them accordingly. Information about the Hub and Spoke model, and an example of the TNQ, was published in a Care Alliance for Opioid Dependence presentation, available for download here. The CCOA is working with the OCACC to fill in gaps in information among service partners, and to evaluate their efforts, helping them better align their resources and assess their strategies.