What is Thrive?

Thrive (formerly the Berkshire Post-Overdose Program, or B-POP) sends out field teams consisting of Medical and Behavioral Health Specialists to provide outreach to those who have recently experienced an overdose and/or are at higher risk of overdose and other substance use related harms. These visits will include a wellness check, connection to naloxone, and linkage to recovery, harm reduction, and/or treatment resources that the person may be interested in. 

Thrive provides outreach to those identified at high risk for overdose, including those: 

• Referred internally by the responding agency
• Referred by police or other first responders
• Referred by the health care system
• Referred by others in the community
• Living in potential “hot spots” for substance misuse

Anyone can make a referral to the team from the button below:

Services available in the field include, but are not limited to:

• Overdose prevention education and naloxone leave-behind/training
• Medical wellness check, including injection-related wound care, HIV/HCV testing, PrEP initiation, ED diversion, and potentially induction of buprenorphine
• Check-in on current use / recovery. This could include offering harm reduction supplies and a “warm hand-off” to a treatment and/or recovery provider if the person is interested
• Create an Overdose Safety Plan for the person, including connecting them to SafeSpot
• For those in treatment/ recovery, discuss challenges they may face and provide support to help overcome them, as well as additional treatment and recovery options to consider
• Linkage to address the social determinants of health, such as social workers, housing agencies, mental health services and/or domestic violence resources, along with other strategies to get them out into the community
• Linkage to support services for social networks, family members and bystanders
• Connection to grief support for loved ones of those who did not survive an overdose (expansion goal, following further protocol development and staff training)

History

In fall of 2019, as part of an intensive strategic planning process, BOAPC community partners prioritized needs that BOAPC should address going forward. After lengthy discussions, the votes strongly supported development of post-overdose engagement programs throughout Berkshire County. The collaborative focused on learning more about various post-overdose programs, such as Law Enforcement Assisted Diversion (LEAD), the Hampshire County Drug Addiction and Recovery Team (DART) and Plymouth County Outreach. It was ultimately agreed to focus on developing a model combining EMS, Harm Reduction, peer support, recovery coaches and other community navigators.

In November 2019, BOAPC was awarded a MA Department of Public Health (DPH) Bureau of Substance Addiction Services (BSAS) Overdose Data to Action (OD2A) grant to further refine, and then implement, a comprehensive post-overdose program. The project received further support from the Northampton Department of Health and Human Services.

A planned key source of real-time overdose and behavioral health crisis data involved connecting police departments with the Critical Incident Management System (CIMS).  CIMS is a web-based software that facilitates the maintenance and analysis of law enforcement data related to overdose incidents, at-risk individuals, and to share real-time information with community providers for follow-up.  CIMS is successfully assisting over 270 police departments in MA with documenting and responding to overdose events, while improving access to services for those who use substances. 

The pandemic had a disproportionate impact on the EMS and behavioral health workforce, severely delaying implementation. The planning coalition was able to continue program development, stakeholder trainings, a charter, and a logo design. This period also focused on addressing barriers impacting EMS. The program is unique since it includes ambulance agencies as part of the co-response, but (unlike law enforcement-based models) EMS is subject to HIPAA and is further regulated by the MA Office of EMS (OEMS). To conduct field outreach, OEMS requires the agency to at minimum have a Community EMS (CEMS) model in place.  The scope of CEMS services is narrow, and does not include “warm handoffs” to other agencies (such as treatment/ recovery providers, clinicians, etc.)

The state is increasingly encouraging the Mobile Integrated Health (MIH) model that utilizes mobile resources, including integrated telehealth, to deliver care and services in the field in coordination with other healthcare providers. MIH is required for the preventive outreach and “warm hand-offs” envisioned by the partners. However, MIH costs and regulations are considerable, and OEMS requires agencies to provide their own medical directors and has significant protocol development requirements. 

Despite these barriers and costs, MIH allows substantial high-value/low-risk services, ranging from low-threshold medical care to home safety checks to medication management (including psychiatric medication). MIH offers substantial further public-health benefits in rural areas, where transportation is a barrier for many and urgent care/ emergency department facilities are overburdened—rather than bringing patients to the clinic, MIH can bring the clinic to them. 

Following the designation of The Brien Center as the county’s Community Behavioral Health Center (CBHC), along with the addition of new Resource Navigators and Recovery Coaches, it was agreed that Brien would take on the Behavioral Health outreach component, co-responding with EMS or other medical providers as the regulatory process allows.

In October 2023, BOAPC was awarded a Bureau of Justice Assistance (BJA) Comprehensive Opioid, Stimulant and Substance Use Program (COSSUP) grant, focused on deflecting individuals from arrest and re-arrest. Increasingly, law enforcement and the legal system are recognizing the value of preventive outreach and post-incident wraparound care with a harm reduction lens.

Project staff continue to work with EMS agencies county-wide to develop regionally appropriate MIH programs, and are working to secure necessary permissions for Berkshire Regional Planning Commission (BRPC) public health nurses to provide medical services in the meantime. Staff are also working to bring more police departments into CIMS, while fostering increased connections among public health, the legal system, the recovery community, people who use drugs, and the community as a whole.

No matter what you or your patient, participant, colleague or loved one may be experiencing, our community is here to help you!

Click here to refer someone you may know of into the program, or if you are interested in services

Regulatory Requirements and Services Available for EMS Responders

Naloxone Leave-Behind

EMS Agencies can participate in Naloxone Leave Behind programs per Mass OEMS Protocol 6.13 (Medical Director Options) under the following conditions:

• Affiliate Hospital Medical Director (AHMD) must give approval to participate.
• The ambulance service must develop and implement a written policy to use this protocol
• The agency must provide initial training and ongoing retraining as needed
• The agency, or a partnering agency, would supply Responders naloxone leave-behind kits that are separate from the medications they use to treat patients.  These kits would, at minimum, consist of:
  • Carrying Case (a plastic freezer bag will suffice)
  • 2 doses of 4 mg nasal Narcan spray
  • CPR Mask
  • Fentanyl Test Strips
  • Palm Card or list of treatment/harm reduction resources

Community EMS (CEMS) Model

To conduct field outreach, the ambulance agency is required to at minimum have a Community EMS (CEMS) model in place.  Please note this model does not permit co-response—as such, non-paramedic level agencies are not able to jointly respond with another agency.

• There are no application or registration fees
• EMTs, AEMTs and Paramedics can participate in activities without any additional certification or licensure
• The Department of Public Health (DPH) has defined a list of approved services which Community EMS applicants may apply to provide as part of a Community EMS program.  Community EMS applicants should consider aligning proposals with the 4 current EOHHS/DPH Issue Priorities: 
  • Substance use disorders (SUDs) 
  • Housing Stability/Homelessness 
  • Mental illness and mental health 
  • Chronic disease with a focus on Cancer, Heart Disease and Diabetes
• The application needs the signature of a municipal designee (like the mayor or town administrator), the town’s Local Board of Health, and the affiliate medical control doctor
  • DPH will issue program approval within 30 days of receipt of the application. An application will be considered “complete” once all required documents have been received by DPH.
• The application can be found here and includes:
  • Completed application form, including all required attachments, descriptions, and narratives
  • Letter of support from the authorized signatory of the local jurisdiction, if signature on the application could not be completed (submission should be on official letterhead of jurisdiction)
• Agencies cannot stray from the approved services.  The scope of these services is narrow, and does not include co-response with or “warm handoffs” to other agencies (such as treatment/ recovery providers, clinicians, etc.)
  • EMS providers can provide lists of services only and are unable to make direct contact with other services
• Any training that is developed should be approved by the local health authority and medical director
  • A minimum one-hour training will be necessary, which Thrive is able to provide at no cost to the agency.
  • Additional trainings may be required, based on the identified needs of the agency in order to effectively implement services.  Thrive can likewise connect agencies to no-cost or low-cost trainings
  • The training may be eligible for EMS training credit– this would need approval from the state at least 30 days in advance of the training
• If the patient is found during outreach to be possibly having a medical emergency, the outreach workers must call for an ambulance.

Mobile Integrated Health (MIH)

This is a newer program that utilizes mobile resources, including integrated Telehealth, to deliver care and services to patients in the field in coordination with other healthcare providers.  The MIH model is available to paramedic-level ambulance agencies– MIH is a paramedic level service and EMTs are generally excluded unless they are in support roles to Community Paramedics.  The model is strongly encouraged by the state Office of EMS (OEMS), although there are significant regulatory requirements and fees.

The MIH model makes it easier for patients to stay in their homes, easing the burden on PCPs and ERs/ Urgent Care.  There are two models available, one with Emergency Department (ED) avoidance and another without.  Either model can greatly increase preventive and lower-threshold health access, such as moderate injuries or “wellness checks” for those with mobility restrictions.  This has a strong public-health advantage in areas such as the Berkshires that have significant transportation issues and an aging population.  The state requires EMS agencies to provide their own self-funded medical directors, and prefers partnership with a licensed medical facility, such as a hospital system.  Please note there may be more than one medical director responsible for different services provided by the agency.

MIH allows EMS providers to co-respond with other agencies and provide more in terms of “warm handoffs.”  Services specific to those at risk for opioid overdose that can be included in the MIH scope, subject to approval by the affiliated medical director and/or MDPH OEMS, include:

• Warm handoffs to primary care, behavioral health clinicians, and substance use disorder treatment, including transportation to said facility
• Early detection and treatment from injection related wounds, including beginning IV antibiotics and wound care
• Blood draws for PrEP initiation, HIV diagnosis and management, HepC diagnosis and management 
• Provide vaccinations, including COVID 19 and seasonal flu
• Offer in-home buprenorphine initiation using micro-dosing or macro-dosing strategies, and/or referral to a methadone provider
  • Note—this can be an involved procedure, and clinical linkage with The Brien Center and/or another experienced local buprenorphine provider is strongly encouraged

A complete MIH Application includes the following:

• Completed Application Form, including all required attachments, descriptions, and narratives
• MIH Compliance and Capacity Form with CORI Form, if applicable
  • Please note that forms must be notarized based on a government-issued photo ID and include the signature of a Notary Public with the stamp or seal on page 3
• MIH Program application fee and Application Remittance Form

As of October 2022, fees for Mobile Integrated Health without ED Avoidance include the following:

Please note: Applicants who also apply to operate an MIH with ED Avoidance Program must submit a separate MIH with ED Avoidance application fee.

Mobile Integrated Health with ED Avoidance

Please note: If applying to operate an MIH with ED Avoidance program, the applicant must either have a Certificate of Approval for an approved MIH Program OR submit a MIH application, with all required attachments, responses, and application fee, at the same time as submitting the MIH with ED Avoidance application.

A complete MIH with ED Avoidance application includes:

• Completed Application Form, including all required attachments, descriptions, and narratives
• Either (1) completed MIH Application or (2) Certificate of Approval for an approved MIH Program
• MIH with ED Avoidance Program application fee and remittance form 

A MIH with ED Avoidance program applicant is required to submit a completed MIH application or Certificate of Approval for an MIH program with their application. The applicant is responsible for program application fees ($3,000 in total) and registration fees ($70,000 in total) for each of the two programs.

Once a completed application form and the application fee are received, DPH will review the information and will contact the applicant if clarifications or additional information for the submitted application materials are needed.  Upon receiving application approval from DPH, the MIH program must submit payment for the $30,000 MIH Program Registration Fee with the MIH Program Registration Remittance Form.  Once the registration fee is received, DPH will issue a Certificate of Approval to operate an MIH Program. Certificates of Approval are valid for 2 years.

Berkshire Regional Planning Commission staff are happy to assist all Berkshire County EMS agencies (Paramedic and Basic level alike) on CEMS/MIH program development, trainings to improve first responders’ ability to respond holistically to substance-related crisis calls, and to discuss further ways we can help improve regional coordination and service delivery.