	Federally Qualified Health Center (FQHC)	Private OB/GYN Practice	County Health Department	Hospital-Affiliated Family Practice
Do you have a DATA 2000 waiver provider?	Yes	Yes	Yes	Yes
How many providers?	4	1	2	3
How many on each license?	4 providers can prescribe for 30 patients per year	1 provider can prescribe for 100 patients per year	2 providers can prescribe for 30 patients per year	2 providers can prescribe for 30 patients per year; 1 provider can prescribe for 100 patients per year
Serve pregnant patients?	Yes	Yes	No	Yes
Can treat infants with NOWS (Neonatal Opioid Withdrawal Syndrome)?	Yes	No	No	Yes
Can see patients affected by OUD after delivery?	Yes	Yes	Yes	Yes
Identified OTP for methadone?	Yes – 2 OTPs within 30 miles	Yes – 2 OTPs within 30 miles	Yes – 2 OTPs within 30 miles	Yes – 2 OTPs within 30 miles

Table 1: Section 1 of the toolkit; an example of a community approach to using this toolkit with multiple stakeholders across the care spectrum

Section 1: Data 2000 Waiver Providers.
Abbreviations: Opioid Use Disorder (OUD), Opioid Treatment Program (OTP)

	Federally Qualified Health Center (FQHC)	Private OB/GYN Practice	County Health Department	Hospital-Affiliated Family Practice
How do you ID a patient who may be an MOUD candidate?	4 Ps and SBIRT recommended by provider or LCSW	Social history, self-report, or UDS	4 Ps	Outside referral, self-report, UDS
How do you refer a patient for SU specific BH intake (comprehensive assessment)?	In-house referral – integrated behavioral health	Referred to outside community behavioral health clinic	Referred to outside community behavioral health clinic	Referred to outside community behavioral health clinic
Have you created a patient registry for buprenorphine prescribing and who maintains it?	Yes	No	Yes	Yes
Who determines and how is it determined that a patient needs higher level of SUDs services?	Integrated behavioral health clinician at intake and as needed: ASAM criteria	Outside clinician or (if patient refuses) referral to services/multiple unexpected UDS	Clinical staff: discussion	Medical provider determined through UDS or pill counts
What services are available for ongoing BH support?	Onsite: 1 on 1 and group	Outside services: 1 on 1, group, and Intensive Outpatient	Outside services: 1 on 1, group, and Intensive Outpatient	Outside services: 1 on 1, group, and Intensive Outpatient
What are the tools your team is using to determine level of SUDs severity?	ASAM	None	ASAM-10	Provider determines tools

	Hospital-Based OB/GYN Clinic
Will providers with DATA 2000 waivers be available multiple clinics of the week or just one?	Once a week
Who will cover for buprenorphine provider during vacation/after hours?	1 provider as primary OBOT with 2 providers as back-up
How often should patients come?	Weekly – either with medical clinician or behavioral health clinician
What is your policy for missed appointments/need Rx/refills?	Case by case – warrants treatment team discussion
What is your policy for illicit use? Which substance?	Case by case – warrants treatment team discussion
Can you create dot phrases or quick charts to include: CSRS Requirements	Yes - done and already embedded in the electronic medical record
Can you create a decision tree for sending out urine drug screen for confirmatory testing?	Yes – if unexpected result, perform routinely once per trimester. If positive, do not send UDS with patient self-report
What substances does your PoC urine test for?	Tests for opiates and methadone
What does it not test for?	Buprenorphine, tramadol, fentanyl, and some opioids
Common false positives/false negatives?	Methamphetamines are the most common false positive
Do you have access to confirmatory testing? Turnaround time?	Yes – 48 hours
How frequently will you see patients postpartum?	Q2-4 weeks
For how long will your team write the buprenorphine Rx?	6-9 months post-partum
How will you assist your patients in the transition to a new provider?	LCSW support
Induction: Home	Primary induction location
Induction: Office
Induction: Hospital

Figures at a glance