Findings from JCOIN’s New York State Psychiatric Institute (NYSPI)/Columbia University Clinical Research Center
To address the high rates of opioid use disorder (OUD) and overdose among individuals involved in the court system, New York developed the Opioid Intervention Court (OIC), a novel pre-plea court model that specifically addresses OUD by providing rapid screening and connections to community-based treatment within 24 hours of arrest. OIC diverts participants at arraignment and temporarily pauses prosecution to allow the individuals to initiate treatment. The model was designed to reduce wait times and improve referral and linkages to evidence-based treatment services (e.g., medications for OUD [MOUD], cognitive behavioral therapy [CBT]), specialized peer support, intensive case management, and other services. In addition, OICs address barriers that limit individuals' ability to engage in treatment, including logistical service delivery issues (e.g., long wait lists, limited available providers), social factors, (e.g., transportation, housing status), costs and lack of insurance, and institutional policies (e.g., policies restricting MOUD, flexible treatment program regulations).
The nation’s first OIC was launched in Buffalo in 2017 and has since been expanded by the New York State (NYS) Unified Court System throughout each of the State’s judicial districts. Outcomes from the Buffalo OIC showed that the model increased treatment outcomes and lowered overdose rates as the program can reduce treatment barriers and increase treatment linkages across the cascade of care (Carey, 2021). The OIC in Buffalo helped clients access treatment sooner and more frequently than the comparison group who were arrested before the creation of the OIC. MOUD played a critical role in the client’s success in the OIC program, with an evaluation of the program reporting that clients on MOUD were less likely to die in the twelve months after their booking and were more likely to successfully complete the OIC compared to those who were not prescribed MOUD.
Researchers from the JCOIN Clinical Research Center based at New York State Psychiatric Institute/Columbia University conducted a study to develop, evaluate, and refine implementation strategies to support the scaling up of the OIC practice guidelines across the State. In 2024, the study team published findings that examined the barriers and facilitators during the referral and the initiation and engagement stages of SUD treatment when employing the OIC model. The researchers conducted 46 semi-structured interviews in 10 New York counties with OIC stakeholders to understand how factors related to the court’s OIC implementation and to the OUD treatment providers impacted the intervention. The researchers identified the program’s barriers and facilitators using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, which identifies how structures and processes interact during program implementation. EPIS framework consists of three components that help view the referral and linkage to treatment process in a holistic context: 1) the outer context that explores the social context of the OIC (SUD treatment programs, bail reform, the community); 2) the bridging factors which considers the partnership between the treatment providers and the opioid treatment courts; and 3) the inner context of the OIC measures how the internal OIC context influence the program’s outcomes (the OIC setting, the OIC philosophy, and OIC staff/client characteristics).
To support jurisdictions in implementing or scaling up the OIC model, the researchers identified several factors and considerations within the court and treatment system that enable or inhibit its success. Key findings from the perspective of both the court and SUD treatment systems stakeholders that focus on addressing each of the EPIS domains (outer context, inner context, and bridging factors) include:
Inner context factors contributed to the implementation of the OICs:
Center policies and philosophies on treatment stabilization, reducing overdose risk, using a person-centered approach, creating non-court-mandated treatment plans, and addressing poly-substance use.
Ensure OIC staff is connected with the other parts of the courthouse and jail staff as this serves as a pathway to identifying and engaging clients.
Train court staff on how to conduct clinical assessments in a timely manner.aintain formal policy and procedures to ensure successful court operation.
Train court staff on how to conduct clinical assessments in a timely manner.
Outer context factors that influence linkage facilitation:
Focus on promoting beliefs and attitudes towards MOUD to court staff and clients that address the stigma and misconceptions around MOUD use.
Have procedures and resources for working with OIC clients to increase OIC referrals and treatment linkages.
Address community understanding of the opioid crisis as communities that view
Bridging factors that strengthen partnerships between OIC and SUD treatment providers:
Consider how staffing models and the use of peers promote program success
Create communication procedures between the treatment providers and OIC staff to ease care coordination obstacles.
Other macro-level barriers:
Work to address stigma around MOUD in correctional facilities because as the jail’s attitude towards MOUD becomes more positive, jails were more active in engaging and connecting clients with treatment.
Consider that bail reform in their jurisdiction as bail reform serves as a barrier to people participating in OIC programs.
Jurisdictions looking to implement an OIC model can incorporate the study’s findings when establishing their program. OICs can play an important role in connecting people to treatment, expanding MOUD use, and combatting stigma surrounding MOUD.
This study was published in Substance Abuse, Treatment, Prevention, and Policy and was led by Drs. Megan O’Grady, Dr. Katherine Elkington, Gail Robson, Ikenna Achebe, Arthur Robin Williams, Alwyn Cohall, Renee Cohall, Monica Christofferson, Alejandra Garcia, Kelly Ramsey, Pat Lincourt, and Susan Tross from the JCOIN Columbia University and New York State Psychiatric Institute Clinical Research Center.
This summary is based on the findings from the following publication:O'Grady, M. A., Elkington, K. S., Robson, G., Achebe, I. Y., Williams, A. R., Cohall, A. T., Cohall, R., Christofferson, M., Garcia, A., Ramsey, K. S., Lincourt, P., & Tross, S. (2024). Referral to and engagement in substance use disorder treatment within opioid intervention courts in New York: a qualitative study of implementation barriers and facilitators. Substance Abuse Treatment, Prevention, and Policy, 19(1), 12. https://doi.org/10.1186/s13011-024-00593-y