New CARF standards address variability of care in office-based opioid treatment settings

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More than 170 advisory council participants and field review respondents provided feedback to create the first national best-practice framework.

A new medication-assisted treatment (MAT) setting, called an office-based opioid treatment (OBOT) program, has arisen in recent years in response to the growing opioid epidemic. OBOT programs offer treatment solely for people with opioid use disorder (OUD) by combining the FDA-approved medications buprenorphine or naltrexone with comprehensive treatment services.

Research indicates MAT has the best outcomes when programs pair medication with a comprehensive array of psychosocial supports, such as therapy, counseling, recovery support, and case management. However, recent feedback gathered by CARF revealed a wide variability of access to and availability of these types of supports within the emerging OBOT field.

Causes of variability of care in OBOT settings:

  • Lack of a required, centralized quality framework leads to inconsistency.
  • Funding access expansion in Medicaid and Affordable Care Act caused a surge in the number of OBOT programs.
  • Recent legislation that increased the number of individuals a single OBOT program may treat put additional strain on programs’ internal quality practices.

Responding to these issues, CARF published new OBOT standards in its 2019 Behavioral Health Standards Manual. The new standards are designed to play an important role in the Department of Health and Human Services’ intended oversight model for the OBOT field, which empowers individual physicians and states in lieu of stringent federal requirements.

CARF’s third-party OBOT standards introduce an established, national mechanism for the OBOT field to share and adopt field-driven best practices to improve outcomes for people in treatment.

CARF’s OBOT standards

  • Create a standard definition of OBOT.
  • Outline the psychosocial supports services that a program must provide or arrange for.
  • Specify the qualifications and requirements of a program’s medical director.
  • Define and give examples of vital procedures that a program must have in place, especially in relation to induction, stabilization, maintenance, and monitoring.
  • Require a program to provide specific training and education for staff and persons served.
  • Address components of community relations.

“These standards are the result of CARF’s effort to define a quality framework for OBOTs,” says Michael Johnson, CARF’s managing director of behavioral health. “Providers that attain this accreditation will be able to demonstrate to persons served, regulators, and payers that they offer a comprehensive array of services and supports designed to help persons served achieve recovery.”

CARF’s process for creating new standards includes convening an International Standards Advisory Committee and conducting a public field review. Development of the OBOT standards occurred throughout 2018 and involved more than 170 service providers, therapists, counselors, social workers, government agencies, funders, and more.

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