Integrated Substance Use Disorder Treatment (ISUDT)

What is ISUDT?

The Integrated Substance Use Disorder Treatment (ISUDT) program is a comprehensive approach to treating Substance Use Disorder (SUD) in California prisons. ISUDT requires active involvement of all business areas within the California Department of Corrections and Rehabilitation (CDCR) and California Correctional Health Care Services (CCHCS) to provide timely and effective evidence-based treatment and transitions to incarcerated individuals with SUD. The long-term goals of ISUDT are to reduce SUD-related morbidity and mortality, and recidivism.

ISUDT encompasses several areas that promote recovery, including:

  • Identifying, screening, and assessing possible participants
  • Placing participants into appropriate Cognitive Behavioral Interventions (CBI)
  • Prescribing Medication-Assisted Treatment (MAT), when appropriate
  • Creating Supportive Housing spaces for recovery-focused living while incarcerated
  • Providing robust transition planning for people preparing to leave prison
  • Forming community partnerships to assist participants after prison
  • Monitoring and supporting participants through their release

What is a Substance Use Disorder (SUD)?

SUD is a disease that affects a person’s brain chemistry and behavior and leads to an inability to control the use of alcohol or a drug. Dopamine is the brain chemical that plays a large part in motivation, mood, sleep, memory, learning, concentration, and motor control. When a drug is put into the body, it produces a pleasurable surge of dopamine, pushing past the normal amount our body produces naturally. Over time, our body adapts to the artificially produced dopamine, which causes natural dopamine levels to drop, resulting in needing more of the drug just to feel normal. This is known as tolerance. If the drug is not taken, withdrawal symptoms can result. Although alcohol and other drugs affect dopamine levels to a different degree, they all affect dopamine. When dopamine levels are too low, it significantly affects motivation and the ability to engage in treatment.

What is Medication-Assisted Treatment (MAT)?

MAT is the use of FDA-approved medications to assist in restoring dopamine levels to a normal range. By restoring dopamine levels, motivation is increased, cravings are decreased, and treatment success is increased. MAT medications are most successful when combined with other treatments and supports. Currently MAT medications are only used for Opiate Use Disorder (OUD) and Alcohol Use Disorder (AUD).

Who is eligible for ISUDT?

Statewide ISUDT screening launched on January 21, 2020. The initial screening will focus on enrolling three target populations in the ISUDT program:

  • Individuals currently receiving MAT;
  • Individuals identified as exhibiting one or more high-risk incidents (for example: overdose history, receiving Hepatitis C treatment as a result of SUD, infections); and
  • Individuals with expected release dates within the next 15 to 24 months
    • If someone is serving an indeterminate sentence and their next parole suitability hearing will be held within 15-24 months, they will be referred for assessment and will receive priority placement into CBI and receive MAT as determined by the Addiction Medical Care Team (AMCT).

Define what someone's program would look like if they were assigned to CBI and receiving MAT.

CBI for SUD is being standardized statewide across all institutions, including American Society of Addiction Medicine (ASAM) treatment methods. The new CBI model will require six hours (two-hour time blocks for three days) or 10 hours (two-hour time blocks for five days) of treatment per week for 12 months (the former SUD treatment model required 15 hours per week over five months). The classes will be provided in two-hour time blocks instead of 3.25 hours, with the overall goal of allowing participants more flexibility to attend school, hold jobs, and participate in other programs. Specific class times will vary by institution. The frequency of primary care visits regarding MAT will be determined on an individual basis.

Will ISUDT stop the problem of drugs in prisons?

Treating SUD through CBI will help stem the demand for drugs, especially when appropriately coupled with MAT services. CDCR recognizes the crisis of drug use and trafficking in California prisons. All interdiction efforts will remain in place. However, ISUDT should reduce the demand for drugs as MAT stabilizes dopamine levels, and CBI addresses the root causes and effects of substance use. Through the use of Supportive Housing, living environments will be created to allow people who are focused on their recovery to live and program together peacefully, with staff specially trained in encouraging success in treatment.

Isn’t this just exchanging one “chemical dependency” for another?

This is a common misconception. Instead, MAT medications operate to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused drug. Addiction is a chronic, relapsing disease that changes the brain. Harm reduction recognizes that medications for addiction treatment can be both beneficial and necessary for some individuals with substance use disorders.

Not everyone with SUD will require MAT, but some will need medication assistance to maintain healthy levels of dopamine. This will increase motivation in order to successfully participate in CBI and other programming. Everyone’s journey is uniquely their own. Just like with other chronic diseases, MAT works to treat some addictions, but not all. Type 2 diabetes is also a chronic illness that may or may not use medication as part of the treatment. Some individuals with Type 2 diabetes are stabilized with behavior changes such as diet and exercise (CBI) and some need medication in addition to lifestyle changes to treat their chronic condition.

Isn’t drug-free, abstinence-based treatment better?

Drug-free treatment alone is not as effective as MAT in preventing deaths. Relapses and deaths are common as patients struggle to maintain abstinence, since strong cravings persist for years after the last use. The combination of MAT, CBI, and other supports has been found to be the most effective approach.

What is supportive housing?

Creating living spaces that foster recovery success will be a vital part of ISUDT’s success. An important component to this program is ensuring supportive housing environments are identified at each institution representing all missions, levels, and programs. Supportive housing will be designed to promote peaceful communication, encourage participation in CBI and other rehabilitative programs, and provide space for individuals to relate to one another in their recovery journeys. To begin this model, each institution has identified housing unit space to cluster program participants into the same housing units to the extent possible. While it is the goal of the department to house ISUDT participants in this program together, non-participants may also reside in the same housing unit. As the program grows, additional supportive housing units will be identified.

Institutional leadership will identify locations to address diverse populations and needs, including participants identified as Enhanced Outpatient Program (EOP), to cluster them together.

Placement in supportive housing is voluntary and intended for participants who are committed to contributing to the therapeutic environment. While violence will not be tolerated, staff do recognize there will be ups and downs on the recovery journey and will evaluate substance-use rules violations individually to determine the best course of action, up to and including removal from supportive housing.

Training is currently in development to provide all staff who work in supportive housing to help support the therapeutic environments, including using effective communication and promoting positive peer interactions. This training is anticipated to be released in 2021.

Is ISUDT mandatory?

If it is determined by medical that someone is in need of CBI, they will be put on the appropriate waitlists for program placement. Effective September 20, 2021 CBI programming is mandatory for the length of the program. Staff will engage in motivational interviewing with the participant to help them understand the many benefits of CBI, including better individual quality of life, increased understanding of criminal thinking and violent behavior, and improved relationships with friends and family. Any refusal or unwillingness to actively participate or unexcused absences shall result in progressive discipline.

MAT is not mandatory, however people who agree to MAT are held to the same expectations of CBI engagement as those participants not on MAT.

What is the referral process?

In order to get individuals into treatment quickly, the process for referrals is currently streamlined, but will return to the normal process once full implementation has been achieved. At this time, all individuals who qualify for SUD treatment will be referred to Intensive Outpatient level of care. As the program continues to grow, Outpatient level of care will be added for those determined to require that level of service. All referrals to CBI, with the exception of the RVR process, will come through nursing or medical. If at any point an individual screens out for SUD, they will be a direct program placement into CBI-Life Skills.

All participants with an assessed need for CBI will be a direct program placement. In situations where participants are unwilling to attend or not actively engaged, counselors should provide motivational interviewing to help them understand the benefits of the program. Continued refusal to participate or disruptive behavior within the first 90 calendar days may result in temporary un-assignment and progressive disciplinary action. All current progressive disciplinary reviews for participants with an Enhanced Outpatient Program (EOP) level of care within the Mental Health Services Delivery Systems (MHSDS) shall remain unchanged.

All incarcerated individuals seeking treatment who are not part of the initial target populations shall submit a CDCR Form 7362, Health Care Services Request Form. Their case will be evaluated by health care professionals to determine the appropriate level of care. Additional questions or concerns shall be directed to the local Health Care Resource Registered Nurse (RN).

Providers have been trained on the appropriate referral criteria and process for ordering a consult to the Addiction Medicine Central Team (AMCT) or primary care champion if necessary.

What is CBI?

Cognitive Behavioral Interventions (CBI), formerly referred to as Cognitive Behavioral Therapies (CBT), is based on the premise that what we think determines what we feel, and that, in combination, results in how we act. CBI, provided by DRP, focuses on challenging and changing unhelpful thoughts, beliefs, attitudes (cognitive distortions) and behaviors, improving emotional regulation, and developing healthier coping skills. By learning skills to change thinking and behavior, people can get better and stay better.

After an individual is determined to have SUD, they will be referred to the appropriate level of care for CBI groups by a LCSW. The CBI-Life Skills intervention will consist of two hours per day, three days a week, for approximately seven months. The CBI-Outpatient intervention will consist of two hours per day, three days a week, and CBI-Intensive Outpatient will consist of two hours per day, five days a week for approximately 10-12 months. The curriculum used is evidence-based and will be consistent throughout all institutions, thus creating standardization and best-practice standards. All Alcohol and Other Drug (AOD) Counselors will receive training in the approved curriculum. This curriculum incorporates the most current, evidence-based strategies and covers a spectrum of topics, including SUD, trauma, criminal thinking, breaking through denial, exploring the impact crime has on victims, anger and violence emotion regulations, family dynamics/support systems, and parenting.

Will CBI interfere with job or educational opportunities?

CBI classes will be in two-hour blocks and may be held at later times in the day to allow participants the ability to attend school, hold jobs, and participate in other programs. Specific class times will vary by institution.

Will credits be awarded for ISUDT participation?

ISUDT participants will receive Milestone Completion Credits for CBI participation throughout, in addition to a completion credit for those who attended greater than 80 percent of the course component.

What if someone doesn't fit into a target category but wants to participate?

If an individual believes they are suffering from SUD and would like to be screened for treatment, they are welcome to submit a CDCR Form 7362 request for health care treatment. The CDCR Form 7362 will be triaged by the Primary Care Registered Nurse (RN). Depending on the institution, the individual would see a “Champion” provider to perform the NIDA-MA or a Resource RN. Based on the results/score on the NIDA-MA, the individual would be referred to CBI and possibly a medical provider for MAT. The same standard applies for anyone under the review authority for the Board of Parole Hearings.

Are there “holistic” treatments available, as well as pharmaceutical medication?

MAT is one small piece of SUD treatment to help stabilize a person’s dopamine levels (motivation) and such treatment does not necessarily apply to all substance abuse dependencies. Sustainability for recovery includes CBI, based on the idea that how we think (cognition), how we feel (emotion) and how we act (behavior) all interact together. Specifically, our thoughts determine our feelings and our behavior. Therefore, negative and unrealistic thoughts can cause us distress and result in problems. When a person suffers with psychological distress, the way in which they interpret situations becomes skewed, which in turn has a negative impact on the actions they take. CBI aims to help people become aware of when they make negative interpretations, and of behavioral patterns that reinforce the distorted thinking. Cognitive therapy helps people to develop alternative ways of thinking and behaving, which aims to reduce their psychological distress. Additionally, education and employment experience can assist a person in recovery for SUD.

If a participant relapses, will they be kicked out of the program?

Addiction is a chronic brain disease and unfortunately, relapse is often a part of the process of moving into recovery. Individuals will not be removed from the program, however the relapse will be addressed and ongoing recovery efforts will continue. Treatment, support groups, possibly medications, and other institutional interventions can assist the individual to stabilize and continue in the recovery process. While a person will always be offered treatment, being a participant in ISUDT does not take away accountability and infractions may be incurred for certain behaviors.

Are we expanding the requirements for current health care positions to include experience to meet ISUDT goals?

Recruitment efforts for health care staff working in the ISUDT program emphasize those with SUD experience. Training is being provided to current staff who will be providing treatment for those in the ISUDT program. Positions that are specific to ISUDT are Addiction Medicine, LCSWs and some RN positions. For these positions, there is an opportunity to supplement their expertise with appropriate ISUDT training.

Knowing each institution is different, how do you plan to standardize and adopt best practices?

ISUDT is embedded in the current Complete Care Model program, using existing processes as well as developing new processes. While the CBI curriculum is being standardized, exact implementation may vary slightly at each institution based on space availability and other local factors. Standardizing the practice of care statewide will allow for monitoring and evaluating program performance. This also provides a continuity of care for our population regardless of where they are housed in the state. As the program rolls out, subject matter experts will closely monitor institution performance. If an institution is performing exceptionally well due to a local best practice, this may be implemented statewide to improve the program overall.

What is the plan of action if interest/inclusion of ISUDT exceeds capacity, available housing, availability of medications, etc.?

Full implementation of ISUDT is a multi-year project. Capacity will continue to ramp up over the years, as CBI capacities are increased and screening/assessments are completed, but initially there will most likely be a waiting list for those wishing to participate. Those with SUD will be assessed on a risk basis; highest-risk individuals will receive priority. As CBI capacities increase, additional custody resources may be required to accommodate expansions on Third Watch or to areas where custody supervision is not currently provided. Such resources will be deployed commensurate with need through the local bargaining process and procedures. ISUDT will receive continuous monitoring and evaluation of resource needs.

Has ISUDT been implemented in other correctional settings?

While ISUDT is unique to CDCR, many prisons and jails nationwide have implemented similar models that incorporate CBI with MAT when appropriate, in rehabilitative environments that recognize SUD as a chronic, treatable disease. Rhode Island implemented MAT in 2016 and saw a marked drop in overdoses. In Sacramento County, a jail MAT program with 174 participants found that only 31 percent were rearrested for new offenses.

To address the opioid epidemic throughout the state, the California Department of Health Care Services (DHCS) is implementing the California MAT Expansion Project, which aims to increase access to MAT, reduce unmet treatment need, and reduce opioid overdose-related deaths through the provision of prevention, treatment, and recovery activities

What are the different types of MAT and how are they administered?

CCHCS offers four medications approved by the Federal Drug Administration (FDA) for MAT for OUD and AUD. The AMCT will evaluate and initiate MAT when deemed appropriate. Consent for MAT will be obtained using CDCR Form 7240. Available ISUDT MAT medications are:

BUPRENORPHINE – Buprenorphine is a partial opioid agonist and is permitted to be prescribed by physicians with an x-waiver for opioid dependency. Buprenorphine is offered as a combination product in our system (combined with naloxone, an opioid blocker) to deter diversion and misuse. Since naloxone is inactive when taken orally, if utilized properly, the naloxone component has no effect on the patient. If crushed/dissolved and injected, the naloxone will block the effects of opioids. Since buprenorphine is a controlled medication, it is administered as direct observed therapy by nursing, never dispensed as “keep on person” (KOP), which is medication patients are allowed to have in their possession at any time.

NALTREXONE – Naltrexone is an opioid antagonist, meaning it blocks the effects of opioids. This medication is typically used for patients with less severe SUD and/or who are highly motivated in their recovery. It is also effective in treating AUD, so can be the ideal choice for patients with both OUD and AUD. It is not a controlled medication and for patients who are stable on this medication, they may have the oral formulation as KOP. There is an injectable version of this medication that is long-lasting and administered every month. This injection formulation is restricted in our system to those who are leaving within three months if the patient is unstable or incapable of managing daily oral medication.

METHADONE – Methadone is a full opioid agonist and is often used in patients physiologically dependent on opioids. It reduces opioid craving and withdrawal and blunts or blocks the effects of opioids. Methadone, taken once a day, is available in various forms such as liquid, powder, tablets and diskettes. The administration of methadone for OUD is monitored and administered under the regulations of a licensed Narcotic Treatment Program (NTP). If the patient is not housed at an institution that offers an on-site NTP, transport arrangements are made to a community provider.

ACAMPROSATE – Acamprosate is a medication that is useful in the treatment of alcohol dependence when used along with counseling. It restores the natural balance of chemicals in the brain (neurotransmitters). It is not a controlled medication and for patients who are stable on this medication, they may have this agent as KOP. It is taken in pill form as directed by the primary care provider, usually three times a day.

Will MAT be readily available for all patients with SUD?

MAT medications will be available for all patients with OUD and AUD. Patients will be screened to determine individualized needs and treatment will be determined by their care team. This may or may not include MAT; treatment could just be CBI. MAT is available statewide at all 35 institutions, but is not mandatory.

What about patients already receiving MAT and/or CBI?

Patients who were receiving MAT prior to the start of ISUDT will receive priority placement into CBI. In situations where participants are unwilling to attend or not actively engaged in CBI, counselors should provide motivational interviewing to help them understand the benefits of the program. Continued refusal to participate or disruptive behavior within the first 90 calendar days may result in temporary un-assignment and progressive disciplinary action. All current progressive disciplinary reviews for participants with an EOP level of care within the MHSDS shall remain unchanged.

Can patients receive methadone in prison?

We are working to bring methadone treatment providers into several institutions so patients do not have to be transported to outside facilities for daily dosages. Currently, seven facilities have contracted with a Narcotic Treatment Provider (NTP) to administer methadone at the institution seven days per week.

Will all forms of MAT be available at all institutions?

Short answer: yes. However, we are working to bring methadone treatment providers into the institutions so patients do not have to be transported to outside facilities for daily dosages. We will most likely cluster patients receiving methadone for efficiency.

What are the short-term and long-term side effects of MAT?

Naltrexone and acamprosate are not controlled substances and since they do not create a high, they can’t be abused. Buprenorphine is a controlled substance; however, research has shown that most people who take buprenorphine take it for its intended purpose. At moderated doses, the composition of buprenorphine/naloxone, which is used in the prison system, causes euphoria initially but then stabilizes and does not increase with higher doses. When buprenorphine/naloxone is taken at high doses it can cause withdrawal symptoms. The Drug Enforcement Administration (DEA) currently rates buprenorphine/naloxone as having relatively low abuse and addiction potential. Methadone is administered in liquid form under the guidelines of a Licensed Narcotic Treatment Program (NTP). Due to the strict guidelines and method of administration, the risk of abuse within the prison system is minimal. For more information about MAT, visit California’s Choose Change website. The use of MAT for an extended period of time (several decades) is currently unknown; however, the 2008 American Journal on Addictions study did not find any serious adverse effects on the people treated. It is possible for a person to experience withdrawal symptoms if MAT is abruptly discontinued. An individual should work together with their health care professional team when stopping the use of MAT. As with most medications, not taking a prescription as prescribed can have unintended effects.

Is there treatment for other substances?

There are currently no MAT treatments for methamphetamine use; however, CBI and other behavioral interventions are available and should be utilized. If clinical symptoms are also present, levels of care may also be adjusted to ensure the individual receives adequate care for their SUD.

What efforts are being made to stop participants from improperly using or sharing MAT?

Increasing access to MAT for those who need it will reduce diversion. Policies and procedures are being developed to ensure proper medication administration. Identification and assessment of the population will help identify those with SUD engaging in high-risk behavior to get them into treatment.

For addiction that does not begin as a result of underlying trauma but as a result of an untreated/unmanaged mental health condition, do we use a different treatment approach?

ISUDT focuses on Whole Person Care individualized to the specific needs of the participant. Once a person’s addiction (cravings) are stabilized, CBI and treatment for other mental health disorders can be better received. Every journey is different. A participant may just be enrolled in CBI; others CBI and MAT; others may need MAT, CBI and additional mental health treatment.

Will 12-step programs still be offered?

Yes, 12-step programs such as Alcoholics Anonymous and Narcotics Anonymous will still be offered at all institutions. CDCR recognizes that everybody’s recovery journey is unique, and all recovery-focused programs will be encouraged. All credits associated with 12-step program participation will remain the same. However, as 12-step programs do not use specific curricula and instruction design, they will not count toward CBI program participation within ISUDT.

Will ISUDT participants be drug tested?

As part of providing SUD treatment, health care staff may perform toxicology screenings for ISUDT participants as clinically needed. Health care toxicology screens are considered personally protected health information and will be kept between the individual and their provider team. The health care provider team will work with the individual to assess if the current level of care for SUD is sufficient. Participant testing under the authority of DRP will discontinue.

All Division of Adult Institution toxicology screening policies will remain in place, including any “for cause” testing based on visual and verbal interactions. People not in ISUDT who receive two or more RVRs for substance use-related infractions will be referred to CBI and screened for ISUDT participation.

How will the implementation of the ISUDT program affect the health care grievance process statewide?

The ISUDT program should not significantly impact the health care grievance process. If a member of the population disagrees with the health care they receive for substance use disorder treatment, they may follow the grievance/appeal process. All grievances are triaged and reviewed by nursing staff to ensure proper treatment is being provided. The ISUDT program will focus on the highest risk populations as the program expands capacity, as we did while we expanded Hepatitis C treatment. There may be a wait for those not in high-risk categories and, as a result, we may have an increase in grievances filed.

Will ISUDT be available at fire camps?

Pursuant to state law, people will not be assigned to fire camp if they are prescribed Directly Observed Therapy (DOT) medications, which can impair reactions and require a physician’s presence when taking. The Department continues to review CBI opportunities at fire camps.

Will ISUDT be provided at private prisons or reentry facilities?

Current practices will be followed, meaning CBI will be provided at Modified Community Correctional Facilities (MCCFs). Reentry facilities such as Male Community Reentry Programs or Custody to Community Transitional Reentry Programs will provide CBI programming but will not follow the prescribed curricula from incarceration. Additionally, MAT may be provided at these facilities through community service providers and not through CCHCS.

Will ISUDT continue after release?

ISUDT works off the principle that transition to the community begins at reception. From the point of entry and prior to release, the health care team, utilizing the Whole-Person Care approach and in partnership with the Division of Adult Parole Operations (DAPO), and Post Release Community Supervision (PRCS) will work with each participant to establish a plan focused on success after incarceration.
People released from prison with untreated SUD are at high risk for fatal drug overdose. For this reason, ISUDT emphasizes assessment and treatment of individuals within 15-24 months of release to ensure continuity of care. The transitions team, consisting of health care professionals and DAPO staff, will work with each ISUDT participant being released to parole or probation to establish an Integrated Case Plan to inform risks and needs.
CDCR continues to enhance its community partnerships to ease transition, including establishing video conferencing with community providers prior to release, creating a data-sharing network for secure access to patient treatment plans, and creating a catalog of internal and external service providers. The transitions team works with the releasing individual to set up appointments and follow up after release.

As part of Integrated Case Planning, the transitions team will identify which services the returning participant may qualify for, including Medi-cal, Social Security and Veteran benefits, and connect them to those providers. Working with community partners, the team will work to find appropriate housing and reentry programs conducive to recovery.

What if no services are available where the participant is returning?

Each institution has a multidisciplinary transitions team consisting of health care and parole staff that work with each participant to determine where an individual will be released. CDCR/CCHCS continues to strengthen its partnerships in each community with the intent to ensure access to continuity of medical care for chronic illness, such as SUD treatment, including MAT, no matter where someone goes after prison.

What if I or someone in my family is struggling with SUD?

You are not alone. The ISUDT program is just one small piece of the governor’s statewide initiative to treat SUD in our communities. Thankfully, treatment options are more widely available and covered by most insurance companies. MAT can even be prescribed by your primary care provider. Take the first step, talk to someone, use your Employee Assistance Program (EAP) resources, talk to your doctor or reach out to our peer support teams.

What measures will be taken to ensure counselors are certified and qualified, as opposed to allowing minimum qualification waivers?

Contracts for CBI are currently being awarded. Standardized curricula and training will be provided to all counselors.

What training will clinicians receive to identify and implement treatment for patients?

An ISUDT overview In-Service Training course will be mandatory for all staff. Additional training is being provided based on a staff person’s role in ISUDT. Extensive Medical Provider, Nursing and Licensed Social Worker training have been provided and will continue as the program demands.

Are we providing training around understanding trauma?

Dr. Corey Waller, addiction medicine specialist, is working with the agency to produce a series of educational videos. One is about understanding trauma. Additionally, health care staff are working to provide trauma-informed care to clinical staff. Training about understanding trauma will also be given to those who work in an ISUDT supportive housing unit.

What are recommended resources for ISUDT Ambassadors who wish to learn more?

Each institution, regional offices, DAPO, and CDCR/CCHCS Headquarters has a team of ISUDT Ambassadors who serve as “change agents” in spreading information about ISUDT. Their role is to serve as the liaison between the ISUDT Planning & Implementation Team, sharing updates with their respective units, and to facilitate communication among the incarcerated population about the program. Ambassadors should stay engaged with the Ambassador portal for tools and resources to help them facilitate their roles and understand more about SUD. Always read emails from “CDCR CCHCS ISUDT/” There will be monthly Ambassador calls for updates, to get assignments, and to address any issues. Ambassadors work with Wardens and CEOs and participate in Quarterly Stakeholder Meetings. Visit the ISUDT intranet page for officially published documents.

How do I find out about ISUDT jobs?

All CDCR and CCHCS careers will support ISUDT in some capacity. Information about all careers can be found at For ISUDT-specific positions, visit or

How do I learn more about ISUDT?

Implementation information is being released to the field as it becomes available. An ISUDT overview IST course will be mandatory for all staff. Additional training is being provided based on a staff person’s role in ISUDT. For more information, please email