News & Updates.

As the year comes to a close, and before we usher in a new one, we at FORE wanted to express our gratitude to every person who has advised us, worked with us, and responded to our inaugural request for proposal.

Our first year as an organization has been filled with many positive and inspiring experiences as we worked to build FORE’s infrastructure and programming, and we thank each and every one of you who has helped to fulfill our objectives. We have enjoyed each and every partnership we have had the pleasure of making and look forward to many more.

The team at FORE wishes you happy holidays, and best wishes for a wonderful new year!

We are pleased to welcome Richard Schottenfeld, M.D., professor and chair of the Department of Psychiatry and Behavioral Sciences at Howard University College of Medicine, to FORE’s Board of Directors. Schottenfeld is an innovator in the field of addiction medicine and the integration of treatment for substance use and other psychiatric disorders in primary care settings.

“Dr. Schottenfeld brings a unique combination of academic rigor and hands-on experience,” says Andrea Barthwell, M.D., FORE’s board chair, the founder and CEO of Two Dreams, and medical director at Encounter Medical Group. “From his early experience as a general practitioner in rural Wyoming to his current efforts to bring treatment and recovery services into urban, community-based settings, he has consistently responded to the needs of patients and found practical ways to help. The urban primary care clinic he directed served as a model for integrating substance use treatment to primary care.”

Schottenfeld also led some of the early studies of medication-assisted treatments for opioid use disorder in primary care clinics and physicians’ offices. His studies of buprenorphine helped lead to approval in the U.S. of buprenorphine for treatment of opioid use disorder outside of specialized narcotic treatment programs.

“The thrust of my career has been to make substance use disorder treatment more readily available to more people,” says Schottenfeld. “I am thrilled to be joining FORE’s efforts to identify what’s working and spread innovative models around the nation.”

As a leading clinical researcher and educator, Schottenfeld has authored more than 125 peer-reviewed publications, directed training programs in addiction psychiatry, and led post-doctoral drug abuse clinical research. He also created an interdisciplinary faculty development program that has produced a cadre of faculty in internal medicine, obstetrics and gynecology, pediatrics, and psychiatry leading to the development of substance use disorders training, clinical services, and research in their departments.

Schottenfeld earned a B.A. from Yale College, graduating Phi Beta Kappa, magna cum laude, and with distinction in English literature. After earning an M.D. degree from Yale, he completed an internship in internal medicine at the Mt. Sinai Hospital in New York City before working for a year as a general practitioner in Hanna and Green River, Wyoming. He returned to Yale to complete psychiatry residency training and a Robert Wood Johnson Clinical Scholars Program clinical research fellowship.

In this season of giving thanks, I wanted to express my sincere appreciation to the many of you who submitted proposals during FORE’s first-ever request-for-proposal (RFP) process. We received more than 440 responses from organizations in 46 states, representing those working in academia, nonprofits, public charities, government agencies, health systems, and federally qualified health centers. As we hoped, the proposed projects further FORE’s four overarching goals:

• Educating providers about opioid use disorder (OUD) prevention and treatment
• Expanding and sustaining evidence-based treatment and payment approaches
• Informing state and federal policies
• Raising public awareness of effective strategies to curtail the opioid epidemic

The volume of proposals vastly exceeded our expectations and has made the process highly competitive. In this initial round, we invited full grant proposals from about 20 percent of the organizations that submitted letters of intent. We will announce our first grant awards by the end of January. In the meantime, I want to share a few of our observations so far.

Even with public dollars and other resources, there is still substantial room for a small foundation to help. We were heartened to hear about the incredible work taking place in communities around the country and have gained a clearer understanding of how we might help. At the same time, we realized some applicants may be unaware of the availability of state and federal funding for their efforts. It seems clear that government leaders can do more to raise awareness when there are state and federal grants for certain direct services, such as telehealth-based treatment or naloxone supplies. It may also help if we share information with other funders about unmet needs identified during the RFP process.

There is a pressing need to build the nation’s behavioral health infrastructure. The proposals laid bare the fact that behavioral health services were few and far between in many parts of the country well before the opioid epidemic increased demand. Today, psychiatrists, primary care providers, and other prescribers as well as counselors, coaches, and other professionals are struggling to deliver OUD treatment to all in need. These professionals need training opportunities and ongoing support.

Several efforts target vulnerable populations. We received proposals from people working in rural, urban, Native American, and other communities where people may be particularly vulnerable because they have low incomes, poor health, and/or limited access to care. The populations they serve are diverse, from pregnant women and mothers trying to juggle treatment with parenting to people just released from jails and prisons who are at high risk of relapse, overdose, and death. Our goal is to ensure that all those in need are served.

More clarity on FORE’s funding priorities is needed. We received nearly 200 responses to our survey asking for feedback on the RFP process. The most common suggestion was to offer more details about what we do and do not fund. Our first round of grants will do just that by enabling us to share concrete examples.

We are thankful to all those who have taken the time to submit proposals. In early 2020, we will continue to fund new opportunities and we hope you remain part of our network. The work of each and every one of you is vital to ending the opioid epidemic.

(Picture: FORE’s inaugural RFP elicited proposals from over 440 organization from 46 states.)

Earlier this month, my staff and I visited Huntington, W.V., a city that made headlines in 2016 after 26 residents overdosed in a four-hour period. Leaders of this small Appalachian city bordering Kentucky and Ohio have strived to understand the problem by working with researchers to identify the rates and types of injection drug use, the demographics of those affected, and the problems they face. Now the city is emerging as a leader in finding and implementing solutions. During our visit, we saw how city leaders and their community partners have rallied around residents suffering from opioid use disorder by promoting harm reduction and increasing access to treatment.

For example, in December 2017, the city established a Quick Response Team (QRT) through their Cabell County Emergency Medical Services. The QRT includes a paramedic, a peer recovery coach, a clergy member, and a police officer. Team members reach out within 72 hours and often sooner to residents whose opioid overdoses were reversed when paramedics administered naloxone. They encourage people to seek treatment or promote harm-reduction strategies for those who are not yet ready to do so—visiting multiple times in efforts to persuade people they care about their recovery. The approach is modeled on a program in Colerain Township, a suburb of Cincinnati, Ohio, and was launched with $1.35 million in federal grants. Team members’ persistence and resourcefulness have been remarkable. Not only will they search for available beds in treatment facilities and help people enroll in Medicaid coverage, they’ve even driven some to other states for care. Their knowledge of and presence in the local community contributes to their success: they’ve reached about half of those identified through the emergency medical response system or referrals from concerned family and friends and connected roughly a third of those with treatment.

We also visited PROACT (Provider Response Organization for Addiction Care and Treatment), a nonprofit organization offering medication-based treatment, therapy, education, job training, and other support services within the Valley Health federally qualified health center. It also includes a pharmacy and play space for children whose parents are receiving services and offers group and spiritual counseling. PROACT was developed by local health care providers who came together to fill gaps in local services and collectively finance them.

Community leaders are also thinking about the supports people need during the vulnerable period following initial treatment. Last year, Huntington City Mission, Marshall University Joan C. Edwards School of Medicine, and Marshall Health launched Project Hope for Women and Children, a transitional living facility for new and expectant mothers that provides peer and residential support, life skills training, and mental health services. It can house women and their children for up to six months, allowing them to continue in treatment and receive counseling and job training services.

Finally, we had the opportunity to meet with local foundations, including our host organization, The Pallottine Foundation, that have supported these and other efforts and are now working to spread lessons across West Virginia and beyond. They are also focusing on what Huntington needs to sustain current initiatives and build a healthier community for the future. One strategy for doing so is placing social workers in elementary schools, where they offer support to children living with parents or other adults struggling with addiction.

The visit to Huntington serves as an important reminder of why we do this work and suggests that a having a vision for a better future, collaboration, commitment, and compassion are key ingredients in efforts to curtail the opioid epidemic. We also witnessed the value of projects that are embedded in the community and reflect local values, culture, and leadership. The city has seen a 25 percent decline in overdose death rates since this work got underway.

(Picture: The Quick Response Team—which includes Larrecsa Cox, a paramedic with Cabell County Emergency Medical Services; Virgil Johnson, a faith leader; and Sue Howland, a peer recovery coach with Prestera Center—has been known to make as many as eight attempts to reach someone.)

Over the past few months, my colleagues and I have visited several states that have been hard hit by the opioid epidemic — among them Maine, North Carolina, Ohio, and Pennsylvania — so we could hear from those developing innovative solutions. We learned a lot and wanted to share some of our insights.

We can leverage the strengths of people with lived experience.

In Maine, where I attended Governor Janet Mills’ Opioid Response Summit, I saw how important it is to engage people directly affected by the opioid epidemic. Each session was launched by a person in recovery or a family member. One of the most memorable sessions was led by a young man who spoke about the obstacles he overcame to find treatment—not just for his addiction, but also for other serious health problems. His story illustrates the value of models that integrate primary care, behavioral health care, and addiction treatment. Understanding patient experiences is essential to refining our treatment approaches and tailoring services to the needs of different groups.

Those who have successfully navigated treatment for opioid use disorder (OUD) can also engage others. In Ohio, we met peer recovery coaches at Ohio State University’s (OSU) Wexner Medical Center. The coaches forge relationships with people arriving in the ED after an overdose in an attempt to engage them in treatment. This itself is a sign of progress: ED physicians told us a year ago they mostly revived people from overdoses; with the spread of naloxone, physicians are now more likely to see people who’ve already been revived and may be ready for longer-term help. Peer coaches are key to establishing trust, OSU’s physicians and nurses told us, because their lived experience demonstrates recovery is possible, even if people aren’t yet ready to accept help.

We must take a holistic approach to OUD treatment.

We also observed two programs for pregnant women coping with OUD. OSU’s medical center hosts a comprehensive program for pregnant women with OUD. In addition to taking part in group prenatal sessions, women receive medication-based treatment (MBT) and counseling from a team that includes a maternal/fetal medicine specialist, an addiction medicine fellow, and peer recovery coaches.

The Horizons program at the University of North Carolina (UNC) offers a similarly holistic package. The residential and outpatient program for pregnant women offers prenatal care, MBT, counseling, and supportive services. Some women stay for as long as a year, receiving well-child care as well as job and parenting training.

Programs that offer holistic treatment and wraparound supports help women deliver healthy babies and rebuild their lives. Horizons also provides a model for other health care programs on how to leverage diverse funding streams to support women for up to a year.

We need to support people during vulnerable transitions.

Our visits demonstrated how important it is to offer support over time — especially during moments when people may be most vulnerable. At OSU’s medical center, leaders try to connect women with other sources of treatment after the six-week postpartum period, but they worry they will struggle without having integrated medical, behavioral health, and social supports.

At the University of Pittsburgh Medical Center (UPMC) and elsewhere, teams are working to create strong guardrails to steer people from the ED to ongoing treatment. UPMC’s addiction consults team comes to the ED to assess overdose patients and recommend treatment plans.

Thank you to our hosts who so generously shared their experiences. We need to learn from organizations like these about how best to support people making transitions from one treatment setting to another, or through different stages of recovery.

In future President’s Updates, I’ll share lessons from our upcoming visits to West Virginia and other states.

(Picture: FORE president Karen A. Scott, M.D., M.P.H., meets the thriving two-month-old son of a Horizons participant, who is benefiting from the program’s array of addiction treatment and social supports.)

After receiving an overwhelming response to the RFP, we are asking for your feedback!

We had a tremendous response to FORE’s inaugural Request for Proposal (RFP) and are looking forward to developing a strong network of grantees, partners, and collaborators. Applicants who submitted a Letter of Intent by the deadline can expect a confirmation of receipt email by the end of the week.

Over the next few weeks, we will be reviewing all the submissions. In the meantime, we would love to get some feedback on your experience with the process so far. You can help us improve, whether or not you submitted an application, by completing our brief anonymous survey.

Click here to complete the survey.

We thank you for all your efforts of furthering our collective goal of bringing an end to the opioid epidemic.

Dr. Karen Scott speaks about FORE’s unique opportunity as a private foundation

On August 6th, 2019, the Foundation for Opioid Response Efforts (FORE) President Dr. Karen Scott spoke with Gary A. Enos, Editor at Addiction Professional. Dr. Scott outlined her journey since joining FORE and how she approached building the Foundation’s infrastructure. With a focus on the FORE’s first Request for Proposal (RFP), Dr. Scott expressed the Foundation’s goal of supporting organizations that can connect underserved and vulnerable populations to evidence-based opioid use treatment and recovery services.

You can find the full article at Addiction Professional.

In conjunction with the release of the inaugural RFP, FORE held an open webinar to introduce the Foundation and provide information and respond to questions regarding the inaugural ‘Access to Treatment’ RFP.

On August 1, 2019, the Foundation for Opioid Response Efforts (FORE) held a webinar to provide information regarding the Foundation and to respond to questions related to the recently released “Improving Access to Opioid Use Disorder Treatment and Recovery Services for Underserved Populations and Communities” Request for Proposal (RFP).

FORE President Dr. Karen Scott began by giving an introduction about the Foundation’s origins and vision: To inspire and accelerate action to end the opioid epidemic. Dr. Scott also discussed what FORE’s approach to developing programs, partnerships, and grantmaking will be as the Foundation continues to grow. FORE Senior Program Officer Dr. Ken Shatzkes then spent time going over how the Foundation developed the inaugural ‘Access to Treatment’ RFP. The RFP was heavily informed by expert Program Advisory meetings that FORE convened in early 2019. Dr. Shatzkes covered many topics related to the RFP, including target projects the Foundation is interested in, eligibility guidelines, as well as FORE’s grant selection process. The second part of the webinar included a 30-minute Q&A session where participants were able to ask a wide variety of questions.

There was an overwhelming response to the webinar, as registration reached maximum capacity. Of 520 registered participants, over 430 people representing 45 different States attended the webinar. The slide deck, recorded webinar, and an FAQ are now available online for viewing.

The Foundation’s first RFP is focused on improving access to appropriate opioid use disorder treatment and recovery services for underserved and vulnerable populations.

The Foundation for Opioid Response Efforts (FORE) is proud to release the Foundation’s inaugural request for proposal (RFP): “Improving Access to Opioid Use Disorder Treatment and Recovery Services for Underserved Populations and Communities.” The purpose of this RFP is to help providers and communities develop ways to treat their most vulnerable and underserved populations with OUD by creating and/or evaluating innovative programs and policy proposals that improve access to a continuum of care of appropriate addiction treatment, including wraparound and recovery supportive services, or that expand upon existing promising models.

As a national foundation, FORE is committed to funding a diverse cohort of projects across the United States. Competitive applications will demonstrate innovative and creative ways to remove barriers to OUD treatment and recovery services for underserved populations that could credibly demonstrate the potential to be scaled to a national level to reach the largest number of patients and have the greatest impact.

Applicants may request up to $300,000 annually for up to two years. All applications must be submitted by email to AccessRFP@ForeFdn.org by 11:59 PM EST on August 25, 2019.

For more information, please download the RFP documents here.

Dr. Karen Scott joined other prominent experts in the field on a panel to discuss rural lessons learned from the opioid epidemic. Dr. Scott introduced the foundation and discussed the importance of collaboration to support best practices making an impact in these communities.

On May 30, 2019, Foundation for Opioid Response Efforts (FORE) President Dr. Karen Scott participated on a panel focused on “Early Lessons Learned from the Opioid Epidemic” at the 7th annual Public-Private Collaborations in Rural Health Meeting, co-hosted by the Federal Office of Rural Health Policy at the Health Resources and Services Administration (HRSA), Grantmakers in Health (GIH), and the National Rural Health Association. Along with co-panelists from two federal agencies – HRSA and the White House Office of National Drug Control Policy (ONDCP) – and a regional foundation funding projects in West Virginia, – the Claude Worthington Benedum Foundation – Dr. Scott had the opportunity to introduce FORE, provide some background on issues of importance to the foundation, and describe the foundation’s early activities responding to challenges facing rural communities across the country.

The impact of the opioid epidemic on rural communities is well documented. Disparities in access to healthcare, along with social and economic depression, is reflected in data which show both the high mortality rates from opioid overdoses and low rates of treatment. Federal agencies are working to target funding to these much-needed areas. In addition, the panel discussed ways in which private foundations have and can contribute to addressing local challenges – through support for specific projects, as well as partnering with public agencies and other foundations. This was an important opportunity for FORE to introduce our planned Request for Proposal on ‘Access to Treatment’ and connect with many local funders and federal agency leads.

FORE Board Chair Dr. Andrea Barthwell’s webinar focused on the need to identify new approaches and enhance and expand existing policies and programs proven to reduce opioid use disorder, addiction, and overdose.

The fast-evolving nature of the U.S. prescription opioid, heroin, and illicit fentanyl epidemic can make it difficult to stay on top of timely issues and opportunities to make a greater impact. During the webinar, FORE Board Chair Dr. Andrea Barthwell, former President of the American Society of Addiction Medicine (ASAM) and Deputy Director for Demand Reduction in the White House Office of National Drug Control Policy (ONDCP) under President George W. Bush, introduced the Foundation of Opioid Response Efforts (FORE). She provided a concise overview of the opioid crisis based on her thirty years of experience in addiction medicine and shared how FORE plans to take action to address this crisis.

Dr. Barthwell shared FORE’s mission: To convene and support partners advancing patient-centered, evidence-based solutions addressing the opioid epidemic. She described FORE’s intention to inspire and advance activities to address the opioid crisis. With patients at the center, FORE’s areas of focus include provider education, payer strategies, policy Initiatives, and public awareness. Dr. Barthwell also announced that FORE will be convening advisory meeting panels with leading experts and stakeholders to advise Foundation staff on what is currently being done and where the greatest needs are. The panels will heavily inform a Request for Proposal (RFP) that FORE will be releasing later in the year.

(Picture: FORE Board of Directors Chair Andrea Barthwell, M.D., DFASAM, with U.S. Congressman Hal Rogers (R-KY, 5th District) and Michael Barnes, Esq., Managing Partner and Founder of DCBA Law & Policy.)