Veteran Engagement Board Brings Lived Experience to OUD Treatment Implementation

HSR&D’s monthly publication Veterans’ Perspectives highlights research conducted by HSR&D and/or QUERI investigators, showcasing the importance of research for Veterans – and the importance of Veterans for research.

In the March 2021 Issue:

• Introduction: The Consortium to Disseminate and Understand Implementation of Opioid Use Disorder Treatment (CONDUIT)’s goal is to improve Veterans’ access to effective treatments for OUD.
• Creation of a Consortium: Five collaborative QUERI implementation studies related to OUD and/or chronic pain treatment make up CONDUIT.
• The Opioid Addiction and Recovery Veteran Engagement Board (OAR-VEB): OAR-VEB provides Veterans’ perspectives to CONDUIT implementation teams.
• No One Right Path to Recovery: OAR-VEB’s self-designed rules of engagement keep the focus on its goals.
• How the OAR-VEB is making a difference: Bidirectional transparent feedback ensures that board members’ experiences can and will make a difference.
• Next Steps: Members are interested in expanding dissemination roles and will play a vital role in maximizing the effectiveness of interventions.

Introduction

Opioid and other drug overdose is the leading cause of accidental death in the US. Veterans experience opioid overdose at nearly twice the rate of non-Veterans. Effective medications are available for opioid use disorder (OUD), but Veterans’ access to these medications varies. The Consortium to Disseminate and Understand Implementation of Opioid Use Disorder Treatment (CONDUIT) is a QUERI Partnered Implementation Initiative (PII) whose goal is to improve Veterans’ access to effective treatments for OUD and chronic pain across a range of VA clinical settings such as primary care, inpatient and emergency department settings and through telehealth. CONDUIT works closely with multi-level stakeholders across VA to improve quality of care in this critical clinical arena for Veteran health and safety.

Creation of a Consortium

In 2018, QUERI selected five pilot projects to begin 1-year implementation studies related to VA care for OUD and/or chronic pain. In 2019, principal investigators of these pilot projects met with QUERI leaders to propose a shared vision and shared set of implementation strategies. In this way, the QUERI funded Consortium to Disseminate and Understand Implementation of Opioid Use Disorder Treatment (CONDUIT) was born. As a consortium, the implementation teams collaborate to share lessons learned during implementation and align project goals and outcomes. CONDUIT will assess outcomes including the number and proportion of Veterans with OUD who initiate and continue medication treatment for OUD, the number of VA providers trained to prescribe medication treatment, and value of OUD care at CONDUIT sites. CONDUIT implementation teams also partner with key VA stakeholders and are supported by three Cores: an Implementation Core, a Quantitative/Economic Core, and a Veteran Engagement Core.

OAR-VEB members: Matthew Boatright, Carol Bornson, Robert Elder, Butch Hitchens, and Ryan Johnson.

The Opioid Addiction and Recovery Veteran Engagement Board

Arguably the most important stakeholder is the Opioid Addiction and Recovery Veteran Engagement Board (OAR-VEB). The OAR-VEB is a national board of thirteen Veterans from a wide variety of backgrounds and military experiences that was recruited to provide Veterans’ perspectives to CONDUIT implementation teams. During recruitment, the CONDUIT Veteran Engagement Core took pains to ensure the most diversity possible, so members represent different age, race, education, employment status, gender, branch of military, military era, time served, and time in OUD recovery. As important as their diversity is what they all have in common: they are all Veterans and identify with being in recovery from Opioid Use Disorder.

Each month, the OAR-VEB meets online via VA’s WebEx Meetings service. Following preliminary board discussion, researchers are invited to join and present their work, and a trained facilitator leads a discussion around the researchers’ pre-submitted questions. Finally, the meeting wraps up with the researchers leaving and the board debriefing on the meeting and discussing next steps. The OAR-VEB held its first meeting in May 2020. To date, the board has met with and provided feedback to six CONDUIT implementation teams on a variety of projects aimed at improving OUD care in VA.

OAR-VEB members: Karen Jones, Brian Lange, Mark Meacham, Anthony Mimms, and Darrel Morrison.

Despite the ongoing COVID-19 pandemic, all thirteen original members remain engaged with the board, and an average of 11 (85%) members attend each meeting. A vital factor for the ongoing engagement of board members is the role of the Veteran Engagement Specialist on the team, a Veteran who is in recovery himself and who worked previously as a VA Peer Support Specialist. Members have commented that including a Veteran in recovery on the OAR-VEB management team from the very beginning displays to them the high value given to Veterans’ perspectives in board management.

No One Right Path to Recovery

At the beginning of every meeting, the board reiterates and reviews the ‘Rules of Engagement’ that they developed to support collaborative, respectful communication. At each meeting, the number one rule is that there is “no one right path to recovery.” Members bring their own unique experiences with substance use and recovery to their participation with the board. Not all members came to the board with the same understanding of available OUD treatment options such as medication treatment for opioid use disorder (MOUD). A willingness to learn and be open to others’ experiences has been a focus for board members. When talking about the most effective approach to life and death matters, strong emotions sometimes present themselves. Members have varying levels of personal experience with stigma, overdose, neglectful prescribing, suicidal ideation, isolation, and hopelessness related to opioid use and chronic pain. A trained facilitator helps the board navigate this “minefield” of challenging topics. Another rule of engagement highlights the board members’ shared commitment to improving OUD care for Veterans: “trying to save lives is at the base of what we’re doing, and we are all here to help.” When debriefing after a meeting that has addressed a difficult topic, the board has successfully returned to these shared goals to re-affirm their commitment to the OAR-VEB.

“Everybody had a different way of getting there and everybody had a different way of getting out.” - OAR-VEB Member

“I think that as long as the end goal is the same, how people get there is trivial. I respect everyone’s process...“ - OAR-VEB Member

“There [are a lot of] different ways to recovery, but it is an internal decision, so it really is different for everyone. - OAR-VEB Member 

How the OAR-VEB is making a difference

A second standing agenda item at monthly OAR-VEB meetings is a discussion titled “How the OAR-VEB is making a difference.” OAR-VEB members have conveyed to the facilitation team that it is important that their suggestions are not only considered but to some degree implemented. In response to this sentiment, every month the facilitation team takes careful notes of the board members’ feedback to the researchers’ questions. Once the meeting is concluded, meeting notes are sent to the presenting CONDUIT implementation team. The presenting team is asked to respond by specifically describing their plans for incorporating the board's feedback into the ongoing CONDUIT projects. This transparency and prompt bidirectional feedback shows the board members that their voices are being heard and that their experiences can and will make a difference in the lives of other Veterans receiving OUD care in VA.

OAR-VEB members Jarvis Parker, Brian Schaaf, and Robert Welby. Veteran Engagement Specialist John Evans.

The impact of the OAR-VEB is further supported by the longitudinal nature of the consortium. CONDUIT teams present to the OAR-VEB every six months in rotation with the first follow-up presentation occurring in February 2021. These follow-up presentations allow the OAR-VEB to begin discussion with a familiarity with each project, revisiting topics discussed previously while also addressing new questions that have arisen since the prior presentation.

 “The OAR-VEB discussion really reminded me of the importance of rapport building and establishing trust for both the provider and patient.” – CONDUIT researcher

“We’re all part of the same team, and we feel accountable to the OAR-VEB. We know we’ll be meeting again in a few months, and that motivates us to put the OAR-VEB recommendations into practice.” – CONDUIT researcher

Next Steps

Looking ahead, CONDUIT is funded through 2022. The board will meet with each CONDUIT implementation team at least three more times. Several OAR-VEB members have also expressed interest in expanding their roles on the board to include disseminating CONDUIT findings in conference presentations and manuscripts as well as engaging with VA researchers on other project and grant applications. As CONDUIT continues to implement its overarching goal of increasing access to care for Veterans with OUD, the Opioid Addiction and Recovery Veteran Engagement Board will play a vital role in maximizing the effectiveness of these interventions every step of the way.

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