DOI: 10.3886/icpsr38877.v1
title: Evaluation of Using Telehealth for Opioid Use Disorders in a Correctional Setting, Massachusetts, 2020-2022
title: Version 1

description: With the third highest rates of overdose fatalities in the state and complexities with providing treatment in a rural setting, Franklin County Sheriff's Office (FCSO) in Massachusetts made a strategic decision in 2011 to shift their jail facility away from simply operating as a place to contain people, to becoming a jail that played an important role in the treatment solution to the opioid use epidemic. After more than 10 years of this transformation, FCSO has been able to offer all three federally approved Medications for Opioid Use Disorders (MOUD) (i.e., buprenorphine, methadone, and naltrexone), provide high quality individual and group counseling, and facilitate a continuum of treatment care upon reentry. In 2020, at the height of the COVID-19 pandemic, FCSO capitalized on its previously built infrastructure and system partners to continue to offer its services. FCSO also continued offering individual and group counseling via telehealth throughout the pandemic and shifted to a mix of telehealth and in-person services in 2022.
From 2020 to 2023, the research team partnered with FCSO to study how their jail approached MOUD treatment, particularly via telehealth during the COVID-19 pandemic. The mixed-methods study aimed to understand whether treatment and individual counseling as its critical component could be done remotely, what facilitated or hindered its successful application, and how clients (i.e., incarcerated people) and the professionals supporting them perceived the effects.
description: The goal of this study was to conduct a mixed-methods, implementation and outcome evaluation of Franklin County Sheriff's Office (FCSO)'s use of telehealth technology to deliver Medications for Opioid Use Disorders (MOUD) treatment and counseling. The evaluation aimed to answer the following research questions:
How has telehealth technology been implemented by FCSO to support opioid use disorder (OUD) treatment in jail and post-release, and what were the barriers and facilitators to successful telehealth implementation?
To what extent are FCSO correctional and behavioral health stakeholders committed to and able to sustain telehealth use in the long term?
How effective has telehealth technology been at providing a broader access to treatment, addressing the precursors to OUD recovery, and reducing recidivism, as measured by: (a) engaging individuals in OUD treatment; (b) achieving satisfaction among OUD treatment participants; (c) developing a positive OUD therapeutic alliance between counselors and clients; (d) facilitating a continuum of care post-release; and (e) reducing future re-arrests and/or admissions to FCSO jail?
To what extent has telehealth for OUD treatment been associated with reduced recidivism compared to in-person OUD treatment and post-release services?
description: To address the gaps in knowledge on the effectiveness of using telehealth to facilitate Medications for Opioid Use Disorders (MOUD) treatment in rural settings and answer the research questions, the research team conducted a mixed-methods evaluation, engaging in the following components:
reviewed policy and program materials, including Franklin County Sheriff's Office (FCSO) documentation regarding opioid use disorder (OUD) treatment and telehealth use, as well as findings from prior analyses of OUD services;
collected and analyzed quantitative, administrative data, including de-identified individual-level records on study participants' criminal history and OUD treatment during FCSO custody and post-release;
conducted and analyzed semi-structured interviews and surveys with 24 FCSO correctional and behavioral health staff and community providers regarding perceptions of OUD treatment and telehealth implementation success, barriers, and facilitators; the extent of OUD treatment engagement, equity, satisfaction, therapeutic alliance, and continuum of care; and
conducted and analyzed surveys of 31 participants and 4 counselors who worked with them regarding perceptions of OUD treatment engagement, equity, satisfaction, therapeutic alliance, and continuum of care.
description: The practitioner survey instrument included 14 questions covering the domains of respondent background, perceptions of telehealth, and scale to measure whether a bond between a counselor and a patient was formed known as therapeutic alliance. The participant survey instrument included 30 questions covering the domains of respondent background, opioid use disorder (OUD) diagnosis and treatment status, client satisfaction, therapeutic alliance, and drug use and arrest history.
To supplement the survey data, the research team also requested information about criminal history and behavioral health records recorded in Franklin County Sheriff's Office (FCSO)'s management information system. The administrative data included information about individuals' demographics (age, race, ethnicity, gender); number of prior arrests; number of adverse childhood experiences; mental health, addiction, and Medications for Opioid Use Disorders (MOUD) status at booking; FCSO booking date and charge(s) relevant to the incarceration of focus (between May 2020 and April 2021); sentence status; number and dates of one-on-one counseling sessions; number and dates of group therapy and support groups; first release date following booking, as of the time of this study's data collection, if relevant; and any recidivism since that release. These administrative data are split into two datasets. The first dataset covered the 62 individuals who received at least three telehealth counseling sessions between May 2020 and April 2021 ("telehealth dataset"), while the second dataset covered the 18 people who received at least three in-person counseling sessions during an overlapping timeframe (between October 2020 and March 2021; "in-person dataset").
description: Response Rates: The practitioner survey had a 100 percent response from the participating behavioral health counselors (N=4). Fifty percent of the 62 adults with opioid use disorder (OUD) on medication assisted treatment who received three sessions of telehealth counseling completed the participant survey (N=31), which included 100 percent of those who were still incarcerated and 34 percent of those who were released in the community.
description: Presence of Common Scales: The Helping Alliance Questionnaire-II (Luborsky et al. 1996)
description: The data collection was from three samples: (1) adults incarcerated in a rural U.S. county jail who had an opioid use disorder, were on medication assisted treatment, and received at least three sessions of counseling via telehealth (N=62 from administrative records, N=31 completed survey); (2) adults incarcerated in a rural U.S. county jail who had an opioid use disorder, were on medication assisted treatment, and received at least three sessions of counseling in-person (N=18); (3) people who provided behavioral health treatment via telehealth or in-person inside the jail and to people in the community upon their release from jail (N=24 interviewed, N=4 surveyed).
description: Datasets: 
DS0: Study-Level Files
DS1: Telehealth Administrative Data
DS2: In-Person Administrative Data
DS3: Telehealth Practitioner Survey
DS4: Telehealth Participant Survey
DS5: Telehealth Practitioner Therapeutic Alliance Scores for Clients
DS6: Interview Notes
description: Adults with opioid use disorders incarcerated in a rural U.S. county jail and the correctional and behavioral health professionals working with those adults in the jail and with community providers.
description: mixed mode; telephone interview; web-based surveyThe qualitative data collected for this study are not currently available. Please see the ICPSR README for Interview Notes for additional information.The collection includes a zipped package available with restricted access that contains 2 SPSS syntax files. Please see the ICPSR README for Syntax Files for additional information.