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as a critical leader or contributor to the overall well- being of the community. In this sense, it is important to have an understanding of the potential variability of faith-based institutions in different communities. For Black/African American communities in which the residents are engaged with the faith-based organizations, leveraging these organizations as trusted messengers may facilitate public awareness and linkage to prevention and treatment. A common theme from the key informants was the use of faith leaders as trusted messengers to link faith communities to opioid prevention, education and treatment. In such communities, faith leaders are major influencers in large social networks. They know their community and the associated health and social issues tied to the community. They have been engaged in decades of health promotion. This includes prevention of wide-ranging conditions like diabetes, hypertension, HIV, mental health and substance use. 54-55 They are well positioned to promote awareness and education about opioid misuse and OUD. Most importantly, they know how to talk to their community, how to engage them in this issue more effectively than outsiders. Community Snapshot: Activating faith-based organizations to be bridges to health—Bridges to CareandRecovery. North St. Louis City and County have recognized that engaging faith-based organizations is a critical strategy to address behavioral health concerns for their predominantly Black/African American community. The Bridges to Care and Recovery is a community initiative with multisector partners including the faith community. It relies on the faith community to serve as extenders in identifying mental and SUDs and linking individuals to care. As of fall 2019, there were 65 churches engaged in the Bridges initiative and designated as “behavioral health- friendly churches.” To receive this designation, church congregations completed 19 hours of training on basic behavioral health topics such as Mental Health Fist Aid, trauma awareness, and others. As part of their designation, these churches provide monthly meetings and presentations on behavioral health topics to their congregations. The Bridges initiative also has trained

physical health conditions (e.g. depression, hypertension, diabetes, etc.), a history of childhood abuse, guilt and anger over their families’ anger and lack of trust, difficulty in transitioning to a non- addiction culture, low self-esteem, and major financial difficulties. The PTSCs are conducted by trained facilitators and licensed and/or certified experts in mental health, hypertension, nutrition and fitness, who are all midlife Black/African American women. They are trusted messengers who can help Black/African American women receive the tools, skills and motivation needed to appropriately address some of their recovery issues. Partnerships with community-based organizations are a core component to PTSC. The sites for the PTSC are in churches, public housing, and in health, recreation and substance abuse centers. Participants receive: a weekly ten-dollar stipend for transportation or child care costs; a blood pressure cuff, monitor and pedometer which they are taught to use; and a light meal to educate about healthy snacks. Women who participated in OUD focused PTSC shared that they valued the bonds with other Black/African American women, and made positive changes in their stress management, nutrition, fitness and blood pressure levels and increased their self-esteem. Collaborate and partner with faith-based organizations and institutions. Historically in the U.S., the Black/African American church has been a key institution for providing support and spiritual leadership in addressing unmet needs including health and social concerns in Black/African American communities. Where traditional, mainstream social services have not addressed critical needs, the Black/ African American church has stepped in. Where social justice has floundered, the church has initiated advocacy and social movements. This role continues to evolve as the Black/African American community changes over generations and the Black/African American faith-based community becomes increasingly diverse. In some communities, faith-based organizations may retain a strong leadership role and organize to address social issues and be a valuable trusted entity for the community. In other places, it may not assume such a position and may not be viewed

THE OPIOID CRISIS AND THE BLACK/AFRICAN AMERICAN POPULATION: AN URGENT ISSUE

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