important that staffing of treatment centers reflect the community being served. When Black/African Americans make the difficult decision to enter treatment, often they will not see any staff at the treatment facility that share a similar cultural background with them. Addressing the shortage of Black/African American medical personnel who are waivered to prescribe buprenorphine may reduce the inequity in access to evidence-based medications. Additionally, recruiting and training a diverse workforce and creating billable funding structures to pay for this workforce is critically needed. One key informant shared that although there is state funding allotted for peer mentoring there are policy barriers to hiring and paying Black/African American peer mentors, “[We have] access to a peer mentor, but lack access to a supervisor. [We] can’t bill without peer supervisor. [We] have trained Black peers, but not a Black supervisor. [We] don’t have access to the other supervisors.” Adhering to the National Culturally and Linguistically Appropriate Services in Health and Health Care Standards (National CLAS Standards) can help provide a blueprint for organizations to provide quality and responsive care to diverse populations. 57 Meet people where they physically are, again and again. To persuade someone to enter treatment for SUD is not simple. It is important to consider the context in which a person with SUD is living. It is equally important to consider the challenges that may prevent an individual with SUD from entering treatment. People are often unfamiliar with or untrusting of existing resources for SUD. They do not know who to ask for help nor what to ask for, or have a strong sense of belief that no one actually cares about them. The use of mobile outreach potentially increases the likelihood of getting people with SUD into treatment. This involves physically going to where people are, connecting with them, bringing authentic care and hope, and linking them with trusted treatment and recovery providers. Leveraging the experience and expertise of those with lived experience of having an OUD such as peer recovery coaches may be critical to getting a person into treatment.
Community Snapshot: Going into the streets—Detroit Recovery Project Mobile Outreach Team. DRP collaborates with local emergency departments to provide linkage to care for people with SUD in crises. The local hospital calls DRP to help get a patient with SUD into treatment. DRP responds by deploying a mobile outreach recovery van and peer recovery coach to the local site where the patient is. They provide the support and physical transportation needed to assist the patient in accessing and entering a treatment program. The DRP mobile outreach vans are custom- wrapped with images of Black/African Americans reflective of their community and include pictures and messages of hope and recovery. The mobile outreach team includes staff with lived experience or experience working with the population, ensuring a level of trust and understanding between the person with SUD and the outreach staff. In addition, the mobile outreach team knows the geography, neighborhoods, historical and social context of Detroit in order to know where to go to engage people on the street living with a SUD. Community Snapshot: Engaging peer recovery coaches— Project RECOVER. In Boston, peer recovery coaches with ongoing supervision from a recovery coach supervisor are being used to link, engage and retain people with OUD in outpatient medication-based treatment for at least six months after completion of detoxification. Recent literature shows that the transition after completion of detoxification to be a critical touchpoint with elevated risk for opioid-related mortality. 58 Through a series of interventions including motivational interviewing, peer recovery supports, and strengths-based case management and development of recovery wellness plans, coaches work with individuals to address perceived barriers to one’s recovery. The peer recovery coaches help link individuals to SUD focused primary care services where they can get comprehensive care (screening, treatment, and referral) for mental health disorders and injection related chronic diseases such as HIV and hepatitis B and C. Most importantly the peer recovery coaches provide overdose prevention education and naloxone distribution and training to all clients and a close member of their social network. In this model, the peer recovery coaches are from the Black/African American
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THE OPIOID CRISIS AND THE BLACK/AFRICAN AMERICAN POPULATION: AN URGENT ISSUE
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