Table 3 The OUD services cascade: key actors and challenges in The services cascade.
From: America’s opioid crisis: the need for an integrated public health approach
Cascade step | Step outcome | Key actors | Challenges |
|---|---|---|---|
Screening | Need Identification | Providers in settings where people with opioid misuse and OUD present, such as Primary Care, Emergency Departments, Justice Settings, Mental Health Specialty, and School-based health centers. | • Referral is required for screening to take place • In some settings, screening for OUD may not considered a priority • Screening often must take place rapidly or in settings with competing demands |
Need Identification and referral to services | Need identified | Services referred to | • Non-diagnostic instruments are often used • Referral and tracking across systems can be difficult • Patients may have complex treatment needs, including comorbid psychiatric conditions • Few evidence-based approaches to facilitate successful transition across settings • Referrals may be both intra-organizational or inter-organizational • Referral may not always be possible due to lack of relationships or other barriers • Availability of services may be unknown |
None | N/A | ||
Preventative or low intensity services indicated | Brief interventions prevention services settings | ||
Behavioral health services needed | Outpatient specialty treatment settings | ||
Pharmacotherapy needed | OUD treatment settings (see Table 2) | ||
Intensive services needed | Inpatient treatment settings | ||
Other services | E.g., Mental health, HIV, housing | ||
Initiation of and retention in services | Type of service | Key actors | • Brief interventions for OUD may not be effective • Can be difficult to train clinicians or peers to consistently deliver brief interventions |
Brief interventions | Clinicians or peers properly trained in brief interventions | ||
Prevention services | E.g., educational settings, occupation/workplace, faith-based organizations, social services. | • Preventative services do not exist in a well-established service ecosystem • Few targeted prevention interventions exist specifically for opioids | |
Outpatient addiction treatment | See Table 2 for care settings for medications. Care may occur in a single integrated care setting, or more commonly, multiple discrete care settings (e.g., psychiatric treatment, treatment of other SUD) | • Diagnostic assessment must often be completed to determine appropriate referrals • Integrated care is desirable to address comorbid conditions including psychiatric services, but this goal is not always easily achieved • Mortality risk is elevated after inpatient care, and care is not always well coordinated • Bi-directional information sharing can be challenging | |
OUD treatment settings | |||
Inpatient addiction treatment settings | |||
Other services (e.g., HIV) |
