NATIONAL LEAGUE OF CITIES 1
Huntington, West Virginia: Building a Comprehensive System to Support Individuals with
Substance Use Disorder
Huntington, West Virginia:
BUILDING A COMPREHENSIVE SYSTEM TO
SUPPORT INDIVIDUALS WITH SUBSTANCE
USE DISORDER
OVERVIEW
Huntington, West Virginia is a small city in
the southeastern United States home to
approximately three percent of the state’s
population.
1,2
Thirty-four percent of individuals
in Huntington live below the federal poverty
level.
3
Meanwhile, statewide, the overdose
death rate is 57.8 per 100,000 population, the
highest in the nation.
4
In August 2016, Huntington EMS personnel
responded to 26 overdoses calls within
four hours.
5
The investigation that followed
found that of the 24 survivors, none received
referrals to substance use treatment or
harm reduction services, despite a number
of available local resources.
6
In response,
the Huntington Mayor’s Oce of Drug
Control Policy formed a partnership with
Marshall University and Marshall Health to
identify successful models for treatment and
referral during the vulnerable window after
an overdose. Using a model developed in
Colerain, Ohio, Huntington developed the
Quick Response Team (QRT): a partnership
between city agencies, emergency medical
providers, mental health specialists, law
enforcement, university researchers, and the
faith community, aimed at providing crisis
stabilization and support for people who
recently experienced an overdose.
Huntington has developed a number
of innovative programs that cut across
multiple systems and target the intersecting
challenges of substance use disorder (SUD),
homelessness, and mental health issues. This
case study will focus on the QRT and related
programs and present key takeaways for
other cities considering similar cross-systems
approaches.
PROGRAM DESCRIPTION
Quick Response Team
Created in 2017, Huntington’s QRT aims to
visit every overdose patient in Huntington
to assess each individual’s needs, develop
a personalized plan for intervention, and
connect them to local resources. The process
NATIONAL LEAGUE OF CITIES 2
Huntington, West Virginia: Building a Comprehensive System to Support Individuals with
Substance Use Disorder
begins when a person calls 911 to report an
overdose, and an EMS squad is dispatched.
Cabell County EMS (CCEMS) workers provide
emergency services to individuals who
have experienced overdoses and collect
their information for possible QRT follow-
up. Within one day, the CCEMS flags any
overdose-related calls for the QRT.
The QRT screens the call records to determine
whether these cases are appropriate for
intervention. If an overdose appears to be
related to substance use disorder upon
review, the QRT assembles a team consisting
of an EMS practitioner, a mental health
provider or a certified peer recovery coach, a
law enforcement ocer in plain clothes, and
a faith leader to follow up with the individual
within 72 hours.
The QRT prioritizes follow-up according to
three tiers. First priority is given to people
who the QRT has not yet contacted, followed
by people who the QRT could not locate
during previous eorts. Finally, the QRT
reaches out to people who were previously
contacted and chose not to engage in
treatment but expressed interest in being
contacted at a later date.
During their visits, the QRT speaks with each
individual to assess their needs and connect
individuals to the region’s numerous addiction
service providers and support services. The
QRT collects qualitative data from each
encounter, including age, gender, substance
use, overdose location, and whether the
person accepted treatment. Data are recorded
using a master spreadsheet and later entered
into Cordata, a care coordination tool.
7,8
Every QRT member is trained in Screening,
Brief Intervention, and Referral to Treatment
(SBIRT) and motivational interviewing
through Marshall University. SBIRT is an
evidence-based practice used to identify,
reduce, and prevent problematic use and
dependence on alcohol and illicit drugs.
Marshall University’s SBIRT program brings
together expertise from eight departments
across Marshall University including the
School of Medicine, School of Pharmacy, and
School of Physical Therapy. Over the course
of three years, the university trained 5,000
people in SBIRT.
9
RESULTS
While the QRT program is in its infancy, it
has realized some success. In 2017, CCEMS
responded to 1,831 suspected overdose
calls. A year later, CCEMS responded to
1,039 suspect overdose calls, a decrease
of 40 percent. County ocials note that
this decrease is likely due to a multitude
of factors, including the QRT program,
enhanced education, prevention, drug trends,
and response eorts.
10
Further, of the 650
individuals the QRT contacted between
December 2017 and June 2019, approximately
30 percent entered treatment.
11,12
While the
county would like to see this percentage
continue to increase, it is a promising and
significant improvement from the 0 percent
of cases referred to substance use treatment
or harm reduction services that provided the
impetus for the creation of the QRT.
FINANCING AND
SUSTAINABILITY
To create the QRT, Marshall University, Marshall
Health, Cabell Huntington Hospital, St. Mary’s
Hospital, and Huntington Mayor’s Oce of
Drug Control worked together to apply for
grants from the U.S. Department of Health
and Human Services (HHS) and the U.S.
Department of Justice (DOJ). In September
2017, they received $1.3 million from HHS and
$300,000 from DOJ to fund the QRT during
its first three years of operation. The American
NATIONAL LEAGUE OF CITIES 3
Huntington, West Virginia: Building a Comprehensive System to Support Individuals with
Substance Use Disorder
Red Cross donated naloxone and disposable
CPR kits for the QRT.
13
Additional local services for people coping
with substance use disorder are largely
supported through federal funding awarded
to Marshall University Research Corporation.
SBIRT trainings for the greater Huntington
community are also supported by a
Substance Abuse and Mental Health Services
Administration (SAMHSA) grant awarded to
Marshall University.
14
COLLABORATION ACROSS
SYSTEMS
The QRT works with a number of other
organizations in Huntington to coordinate
treatment and care for individuals
experiencing overdose. Below are just a few
examples of the partners that collaborate
across systems with the QRT:
PROACT
For the general population within Huntington
with substance use disorder, the QRT utilizes
the services of the Provider Response
Organization for Addiction Care and
Treatment (PROACT).
The PROACT is an outpatient substance
use disorder treatment center that brings
together behavioral, social and medical
resources from the community to provide
comprehensive care to those seeking
treatment.
15
PROACT was founded to address
a need for immediate linkage to addiction
services in Huntington, as many people who
sought help at emergency departments or
hospitals were being turned away due to
capacity or capability constraints. PROACT
is a joint eort led by Cabell Huntington
Hospital, Marshall Health and St. Mary’s
Medical Center, in partnership with Valley
Health and Thomas Health System.
16
When a person seeks care at PROACT, a
clinician conducts an assessment to inform
a diagnosis and a recommended plan of
care, and to identify social or personal
needs requiring further referral. PROACT
oers medication assisted therapy (MAT),
peer recovery supports, individual and
group therapy, career placement and career
readiness training, spiritual care, and a
pharmacy on site.
17
PROACT is also exploring
a childcare component for clients as they
attend medical or therapy services.
PROACT received initial start-up funding from
Cabell Huntington Hospital, St. Mary’s Medical
Center, and a $400,000 award from Aetna
Better Health of West Virginia.
18
Prestera Center Crisis Residential
Unit (CRU)
Individuals with substance use disorder often
suer from comorbid conditions like mental
illness. The QRT may refer such individuals to
the Presetera Center Crisis Residential Unit
which is equipped to provide both substance
use and mental health services.
Prestera Center is a non-profit health care
provider that oers comprehensive behavioral
health care and addiction recovery services
across West Virginia. They provide outpatient
services, short- and long-term residential
programs, MAT, medically monitored
detoxification, transitional living programs,
and prevention services.
19
The Prestera Center Crisis Residential Unit
(CRU) is a 16-bed voluntary residential
psychiatric stabilization and detoxification
service for adults experiencing an acute
mental health crisis. Services include daily
psychiatric medication reviews, medically
monitored detoxification, group therapy,
individual and group counseling, treatment
planning and case management. The CRU
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Huntington, West Virginia: Building a Comprehensive System to Support Individuals with
Substance Use Disorder
provides less intensive services than those
available in a psychiatric hospital and aims to
prevent psychiatric hospitalization.
20
Project Hope for Women and
Children
Expecting or recent mothers with substance
use disorder are a particularly vulnerable
population. In 2018, Marshall University
was awarded a five-year, $2.6 million
Substance Abuse and Mental Health Services
Administration (SAMHSA) grant to launch
Project Hope for Women and Children.
21
Project Hope for Women and Children is a
Huntington-based, 18-unit living complex
collaborating with the QRT to address the
unique needs of new and expecting mothers
coping with substance use.
Project Hope for Women and Children is
a facility that provides American Society
of Addiction Medicine (ASAM) level 3.5
services (i.e. clinically managed, high-intensity
residential services provided by counselors
designed to stabilize individuals to receive
outpatient treatment for four to six months).
22
The complex allows mothers to live with their
children while accessing treatment. Residents
cannot be in active withdrawal, and must
complete an intake assessment and medical
exam before moving in. The complex provides
individual and family counseling, peer
support, and life skills coaching, and residents
have access to medical and psychiatric care
through Marshall Health.
23,24,25
The QRT also works closely the legal
system and law enforcement to work to find
treatment placement for those currently
jailed. The QRT does not require an individual
to have overdosed to receive services so they
also coordinate with certified peer recovery
coaches at the Cabell Huntington Health
Department and those at our homeless
service providers such as the Huntington City
Mission and Harmony House.
ROLE OF CITY
LEADERSHIP
The Huntington Mayor’s Oce of Drug
Control Policy, established in 2014, initially
consisted of three people: a former
Huntington police ocer, the city’s fire
chief, and the city’s Director of Planning and
Development. In its brief tenure, the oce
focused on identifying community needs,
exploring innovative solutions that could be
replicated or expanded in Huntington, and
promoting collaboration. Through community
collaboration programs such as the Cabell-
Huntington Health Department, the city
expanded its harm reduction program and
its wellness eorts among the first responder
community, trained faith community leaders
who would join the QRT in dealing with
substance use disorder and the stigma
surrounding it, and expanded and/or initiated
diversion and mental health services in the legal
system through adult and juvenile drug courts.
26
LESSONS LEARNED
Responding to Challenges
The QRT identified several challenges to
reaching individuals in need, facilitating
treatment adoption.
Contact for follow-up. The QRT team noted
they often face challenges when determining
accurate residence or contact information
for individuals who have experienced an
overdose. Individuals may be experiencing
homelessness, may have overdosed at a
public location, or may not be carrying valid
identification.
Lack of infrastructure to facilitate treatment.
If the QRT is able to make contact with an
individual who has experienced an overdose
and that individual is willing to begin treatment,
they may still encounter transportation
NATIONAL LEAGUE OF CITIES 5
Huntington, West Virginia: Building a Comprehensive System to Support Individuals with
Substance Use Disorder
barriers and/or a shortage of beds at addiction
treatment facilities. Many individuals may
require withdrawal management. The necessary
coordination of this is a challenge for not only
the QRT but treatment providers.
Financing. Program sustainability remains
a challenge. Many of the initial services the
QRT oers such as street outreach are not a
billable to insurance providers. Consequently,
the QRT is largely reliant on grant funding
which may not always be renewed.
Prevention. Overall, the QRT has noted that
its model lacks a proactive component. Often
individuals are only referred to treatment
after they experience an overdose.
27
Creating
more robust interventions where high-risk
individuals can be connected to treatment
before experiencing a life-threatening
overdose can help bolster preventive eorts in
opioid use disorder.
The QRT is always exploring methods
to improve their approach and has been
working to proactively seek referrals from
sources other than EMS call logs, such as
peer networks. They also plan to enhance
data collection, segment client data into
demographic sets, tailor follow-up, and
continually refine their model based on the
impacts of these changes.
28
Key Takeaways for City Leaders
For other cities considering similar
approaches to SUD, homelessness, and
mental health issues, there are several key
lessons that can be learned from Huntington’s
QRT model:
Using data to inform program planning. City
leadership should assess gaps in services
and infrastructure before designing an
intervention. This information can then be
used to tailor programs to address areas of
greatest need. City leadership should consider
the benefits of implementing both proactive
and reactive responses to crises that involve
individuals coping with SUD, homelessness,
and/or mental health issues.
Investments in partnerships. City leadership
should invest in building strong, sustainable
community partnerships and peer networks.
Partners should be engaged early on in
program development, strategic planning
and grant applications, as well as program
implementation. City leadership should aim to
assemble a diverse coalition of stakeholders,
which may include local government oces,
hospitals, health care providers, behavioral
health providers, law enforcement, and faith
leaders, among others.
Engaging the community through
messaging. The QRT has deliberately framed
substance use disorder as a primary care
issue. Adopting this approach may help cities
engage primary care providers and reduce
stigma surrounding SUD, homelessness, and
mental health issues.
Continuous evaluation to inform program
improvements. City leadership should
continually assess and modify their approach,
using data to inform programming whenever
possible. Primary data collection is an
important tool that cities can use to tailor their
programs in response to specific, local needs.
Unless otherwise noted, all information is based on an interview with Marshall University School
of Medicine, Department of Family and Community Health, Division of Addiction Science
ENDNOTES
1 United States Census Bureau. “2013-2017 American
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6600827425|312M300US265805439460|312M300US2
69001836003|312M300US317003345140|312M300US3
79804260000|312M300US395803755000|312M300U
S396604652980|312M300US417004865000|312M300
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2 United States Census Bureau. “2013-2017 American
Community Survey 5-Year Estimates. ACS
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Colorado, Indiana, Kansas, New Hampshire, North
Carolina, Pennsylvania, South Dakota, Texas, West
Virginia.” https://factfinder.census.gov/bkmk/table/1.0/
en/ACS/17_5YR/DP05/0400000US06|0400000US0
8|0400000US18|0400000US20|0400000US33|040
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3 United States Census Bureau. “2013-2017 American
Community Survey 5-Year Estimates. Selected
Economic Characteristics: California, Colorado,
Indiana, Kansas, New Hampshire, North Carolina,
Pennsylvania, South Dakota, Texas, West Virginia.”
https://factfinder.census.gov/bkmk/table/1.0/en/
ACS/17_5YR/DP03/0500000US06097|312M300US22
6600827425|312M300US265805439460|312M300US2
69001836003|312M300US317003345140|312M300US3
79804260000|312M300US395803755000|312M300U
S396604652980|312M300US417004865000|312M300
US486202079000.
4 National Center for Health Statistics. “Drug Overdose
Mortality by State.” (2019). https://www.cdc.gov/nchs/
pressroom/sosmap/drug_poisoning_mortality/drug_
poisoning.htm.
5 Galofaro C. “4 Hours in Huntington:
how the heroin epidemic choked a city.”
Associated Press. (2016). https://apnews.
com/0c460888bdf248299915c961d872aa00.
6 Massey J, Kilkenny M, Batdorf S, et al. “Opioid
Overdose Outbreak — West Virginia, August 2016.”
MMWR Morb Mortal Wkly Rep 2017;66:975–980. DOI:
http://dx.doi.org/10.15585/mmwr.mm6637a3External.
7 Cordata Healthcare Innovations, LLC. https://www.
cordatahealth.com/.
8 Cox L. “QRT: Huntington Quick Response Team.”
Presented at the Southern WV Summit on Substance
Use Disorder. (2018). https://www.helpandhopewv.org/
sudsummit/docs/QRT%20-%20Larrecsa%20Cox.pdf.
9 Interview with Marshall University School of Medicine,
Department of Family and Community Health, Division
of Addiction Sciences.
10 Nash B. “Cabell County sees 40 percent drop in
overdoses.” The Herald-Dispatch. (2019).
https://www.herald-dispatch.com/news/cabell-county-
sees-percent-drop-in-overdoses/article_2aa435e0-
3d62-5ee7-9cf9-e3be75b202.html.
11 Id.
12 Cabell County EMS. “Cabell Co. EMS Overdose
Reports, 2015-2018.” (2019). https://www.herald-
dispatch.com/overdose-color-pdf/pdf_2b55a0ce-
0f07-11e9-8158-0f3810172d9d.html.
13 Orborne M. “QRT marks gains, lessons from first
year.” The Herald-Dispatch. (2019). https://www.
herald-dispatch.com/news/qrt-marks-gains-lessons-
from-first-year/article_5accba-4926-11e9-ab85-
07e30349224f.html.
14 Marshall University. “What is SBIRT.” https://www.
marshall.edu/wellness/sbirt/sbirt-focus/.
15 PROACT. “About Us.” PROACT. http://proactwv.com/
about-us/.
16 Nash B. “PROACT facility to open Oct. 1.” The Herald-
Dispatch. (2018). https://www.herald-dispatch.com/
news/proact-facility-to-open-oct/article_0e178f8d-
ec87-5761-9e53-84188c30a8b8.html.
17 PROACT. “About Us.” PROACT. http://proactwv.com/
about-us/.
18 The Herald-Dispatch. “PROACT receives $400K grant
from Aetna.” (2018). https://www.herald-dispatch.
com/news/proact-receives-k-grant-from-aetna/
article_272aa571-afa9-51d4-a2ab-2b10e0e18c60.html.
19 Prestera Center. “Services: Addiction Recovery.”
https://www.prestera.org/services/addictions-
recovery/.
20 Prestera Center. “Services: Crisis.”
https://www.prestera.org/services/crisis/.
21 Marshall University. “Marshall receives $2.6 million
grant for residential treatment facility.” Marshall
University. (2018). https://www.marshall.edu/
ucomm/2018/09/07/marshall-university-receives-2-6-
million-grant-for-residential-treatment-facility/.
22 Marshall University. “Project Hope for Women
and Children recognizes first graduates.” Marshall
University. (2019). https://www.marshall.edu/
ucomm/2019/07/01/marshall-healths-project-hope-
for-women-children-recognizes-first-graduates/
23 Marshall University. “Marshall Health opens residential
treatment facility for women and children.”
Marshall University. (2018). https://www.marshall.
edu/ucomm/2018/12/06/marshall-health-opens-
residential-treatment-facility-for-women-and-
children/.
24 Marshall University. “Marshall receives $2.6 million
grant for residential treatment facility.” Marshall
University. (2018). https://www.marshall.edu/
ucomm/2018/09/07/marshall-university-receives-2-6-
million-grant-for-residential-treatment-facility/.
25 Huntington City Mission. ‘Project Hope for Women
and Children.” https://www.huntingtoncitymission.org/
project-hope/.
26 Davis C. “Oce of Drug Control Policy Making a
Dierence in Huntington.” West Virginia Public
Broadcasting. (2017). https://www.wvpublic.org/
post/oce-drug-control-policy-making-dierence-
huntington#stream/0.
27 Cox L. “QRT: Huntington Quick Response Team.”
Presented at the Southern WV Summit on Substance
Use Disorder. (2018).
https://www.helpandhopewv.org/sudsummit/docs/
QRT%20-%20Larrecsa%20Cox.pdf
28 Id.