How Jails Adapted Services to Treat Opioid Use Disorder During COVID-19
The findings from alumna Amelia Bailey ’22MPH appear in Substance Use & Misuse.
By Matthew Goncalves ’23
Alumna Amelia Bailey ’22MPH serves as corresponding author on a recently published paper titled “And Then COVID Hits”: A Qualitative Study of How Jails Adapted Services to Treat Opioid Use Disorder During COVID-19 appearing in the journal Substance Use & Misuse. The publication grew out of a project from Bailey’s graduate research assistantship while a student in the MPH in Community Health Education program at UMass Amherst.
“Being involved with and conducting research was central to my experience at UMass,” says Bailey, who collaborated on the project with peers Calla Harrington, Elizabeth Delorme, and Samantha Hano, as well as the paper’s senior author, Professor Elizabeth Evans. “During my second year at UMass, I completed my MPH project with data collected at a couple of partner organizations, which were local jails. I was able to explore a topic of great societal and scientific interest through the lens of these innovative jails; I received outstanding mentorship on data analysis practices and knowledge stewardship from my mentors, Dr. Liz Evans and Dr. Krishna Poudel.”
In the paper, Bailey discusses the availability and benefits of medications for opioid use disorder (MOUD) for correctional populations. Evans serves as a principle investigator on several projects that focus on how to best expand access to MOUD, what Bailey refers to as the “gold standard for opioid use disorder treatment,” in correctional settings. Two jails in Massachusetts, located in Franklin and Hampshire counties, were among the first in the nation to provide populations with MOUD during incarceration.
“This project in particular began prior to the COVID-19 pandemic, so documentation of changes that occurred during the project, aka the pandemic, was crucial to understanding the outcomes of the program,” she says. The staff and administration in these facilities had to rapidly adapt their programming, and Bailey’s study shares the impactful lessons they learned from their successes and the challenges they faced.
“I worked with a group of research assistants in Dr. Evans’ lab to qualitatively analyze focus group data collected from key staff and leaders at these Massachusetts jails,” says Bailey. “We found that these jails were incredibly innovative in their ability to meet the needs of people who were incarcerated and were able to continue to provide MOUD despite barriers. The information we learned from the jail staff and partners during these focus groups critically contributed to the field of public health research and practice.”
Medications for opioid use disorder (MOUD) support those who are dealing with opioid usage and working toward recovery. When Massachusetts began responding to the pandemic in March 2020, the state began seeing innovations and improvements made to MOUD programs, which increased accessibility and availability for released incarcerated individuals.
Bailey and her colleagues conducted interviews with staff from two jails in rural and semi-rural communities of Western Massachusetts to try to determine if the short-term changes necessitated by the pandemic might have long-term benefits. They compiled data through a rigorous process of confidentiality, consent, proper collection and transcription. The data brought to light the efforts that were put in place to maintain safety with the ongoing pandemic, while still providing sufficient and supportive care in all aspects of health and recovery.
"Jail staff created educational resources available to both residents and staff,” notes Bailey. “These included: COVID-19 educational podcasts, newsletters, and announcements; personal protective equipment and sanitizers; enhanced cleaning protocols; reminders to practice hand hygiene; and a vaccine educational campaign in preparation for vaccine roll-out." Pre-existing partnerships between the criminal justice system and community providers were a key facilitator that enabled staff to continue MOUD treatment among other things under the added strains of COVID-19.
Jail release and community re-entry difficulties arose rapidly with the unplanned rapid release of incarcerated individuals, which caused the unready system to flood with work that needed to be accomplished within limited time constraints. This caused access to support systems such as MOUD to become unavailable; in most cases, maintaining individuals in jail would have been the safer option for them. There, they would have support systems in place to help them prepare for community re-entry and not fall victim to a cycle that causes harm to them or lands them back in jail.
Although rapid release caused issues, the ability for MOUD access to rapidly expand with telehealth appointments and the pre-existing MOUD program availability being worked into the re-entry system helped a lot of folks avoid opioid use-related struggles after release. According to a response collected, "I think the fact that we were positioned where we were, in providing the support that we were, and were able to ramp up and do what we did as far as a soft handoff, for folks leaving here to make sure they had a prescription and a doctor's appointment, at least some Suboxone, or some access to methadone when they left here, probably saved a lot of catastrophes."
Now a doctoral student in Behavioral and Health Sciences at Brown University, Bailey credits her success as a student and a professional in public health to the human-centered approach to learning and practice of public health she received in the community health education program.
“The program continuously centered our focus as public health students on the mission to increase positive health outcomes of communities by working with communities and supporting their needs and assets,” she says. “I have taken the knowledge and skills from my research experiences at UMass into my current work. The data collection and analytic skills I learned with Dr. Evans and her lab are key tools that I currently use on course projects and in my current research position at Brown. For example, conducting focus groups and interviews, analyzing qualitative data, and managing quantitative data, are all skills that I began developing at UMass and have continued to develop during my first year at Brown.”
She adds, “My current program in Behavioral and Social Health Sciences blends both the fields of psychology and public health. This lens is a great asset as I grow my skills as an addiction science researcher and consider how mechanisms of addiction work.”