SAFE Solutions - User contributions [en]

Understand Funding and Identify Your Resources

2025-03-24T20:01:28Z

BasilSavitsky: /* Available Tools and Resources */

= Introductory Paragraph =

This article focuses on ways that coalitions can increase their funding base. It also addresses various components of sustaining funding, because communities and funders need assurance that the coalition is working toward long-term outcomes that are built on a reliable foundation that will continue independently of single-source financing.

One key strategy is to diversify approaches to funding, so this article covers public, private, and philanthropic sources. In addition, within the public, or governmental funding stream, a key strategy is to balance state and local sources with federal, and if appropriate, tribal funding sources.

= Key Information =

'''The Funding Landscape'''

There are a variety of funding streams that can be blended and braided, including:

* Public funding or grants, which includes federal, state, and local funding streams,
* Private sources include contributions from corporate resources and in-kind support or fee-for-service options. Traditional approaches to fundraising can be supplemented with social impact bonds also known as pay-for-success financing
* Philanthropic agencies — at both national and local levels,
* Other one-time payments, such as opioid settlement dollars.

Understanding the funding landscape of the substance use crisis is essential, but complex. Taking the long view, on the positive side, major impacts have been achieved as a result of focused funding initiatives. For example, prevention efforts generated by the tobacco settlement dollars resulted in dramatic decreases in adolescent smoking over a ten-year span. However, public health gains in this domain dissolved rapidly after the advent of e-cigarettes. There is a great deal of optimism about the potential use of opioid settlement funds to have a similar degree of impact, but optimal allocation of funding requires an awareness of sustainability strategies. It takes a committed intention to offset the flux in the history of funding which has been directed at substance use prevention, harm reduction, treatment, and recovery. For example, there is long-term oscillation associated with particular substances, shifting priorities from one substance to another, rather than addressing all forms of substance use. Likewise, there is variability in focus between reducing supply, which typically falls to law enforcement, and reducing demand, which involves public health and social services. Prevention funding has witnessed a dynamic which started with reaching individuals (“just say no”) to changing social norms (nicotine free-free public spaces). Taking recent advances in harm reduction strategies within such a broad perspective ensures that optimal strategies are deployed across changing political climates at national and local scales.

'''Sustainability'''

While human capital is the lifeblood of the coalition, financial capital is vital to initiate and sustain long-term collaborative efforts. Unfortunately, both human and financial capital are too frequently overlooked in the week-to-week stream of coalition activities. The energy and wisdom of coalition members and agency relationships are often only recognized when they are gone. Likewise, focus on financial resources is typically considered as a grant cycle approaches closure. A sustainability strategy brings home that creating significant community change is a long-term process. Despite short-term successes, long-term results can take years. Persistent collaboration and working toward a common vision are essential to sustain long-term community efforts.

Crafting a sustainability plan with specific objectives brings ongoing support to the coalition vision by its members, funders, and the community at large. It is useful to build a vision as part of a grant or a project, but more useful to plan from the start how that vision will be sustained after the grant is over. Sustainability planning should happen as soon as the vision, mission, and objectives are established. Since sustainability is a process and not just a one-time venture, each phase of every project should have sustainability considerations. This will help the coalition to:

* Make time to recognize problems and to allocate funding, staffing, and resources for best solutions.
* Structure approaches and objectives that will continue to grow and achieve the desired impact in the community.
* Have more efficient and effective efforts to maintain support.
* Avoid interruptions in progress if funding is declined.

'''Coalition Actions'''

Effective strategies to increase and sustain funding are closely tied to building robust partnerships (See “Mobilize Community Champions” wiki). One example can be seen in developing ties with experts in local universities, who may be adept in obtaining grant funding. Likewise, other agencies working on distinct but related issues, such as suicide prevention and gun violence or domestic violence prevention. While agencies working in these areas have different risk factor reduction strategies, their methods to enhance protective factors are similar (See SAFE Solution article titled, “Address Risk & Protective Factors for Individuals, Families, and Communities.) This both fosters increased collaboration and provides opportunities to share funding streams. (See “Apply a Multi-Sectoral Approach.”)

Each sustainability tactic the coalition chooses will require members, staff, or other volunteers with skills or interests related to the identified need. Some examples include activity implementation, grant writing, marketing, event planning, and establishing a donor or membership base. Asking the kinds of questions listed below will help clarify what is needed to build a sustainability strategy:

* Is sustainability being considered “up front” and integrated with tracking performance over time? Data demonstrating success and a trend of success justify the sustainability of the funding for that program. See SAFE Solutions article, titled “Plan, Implement, and Evaluate.” <ref>https://www.yoursafesolutions.us/wiki/Plan,_Implement,_and_Evaluate</ref>
* What goals have been successfully achieved?
* What new goals are emerging?
* Do we have a broad range of support across all partner systems (health, legal, social, etc.)
* Can we connect our local initiatives back to state-level efforts and link to broader activities?
* Does our initiative have enough staffing or volunteer support to consistently drive its efforts?
* Can our budget cover existing costs? Can we pursue new funding opportunities? Have we explored innovative solutions?
* Have we communicated our successes to our partners and the public?
* Do we incorporate the voice of people most impacted by our decisions?
* Do we focus on the specific needs of individuals and families in our community?

'''“Small and Fast” Funding Wins'''

While large grants get a lot of attention, there are a number of ways that coalitions can gain traction in the funding arena by taking on quick and easy projects that work from small-dollar expenditures:

* Supplement local health department funding for use on addressing overdose. This could include basic education, marketing, and printing costs, or it could enhance overdose data collection to understand the local severity of the crisis in real time.
* Purchase low-cost Naloxone. Remedy Alliance is a nonprofit with the cheapest price for intramuscular Naloxone, which is much more affordable than intranasal. <ref>https://remedyallianceftp.org/</ref>
* Purchase test strips. Fentanyl test strips are particularly useful for stimulant users who might not have a tolerance for opioids. Xylazine test strips can help people avoid this contaminant, which can cause extreme sedation and skin wounds.
* Purchase wound care supplies for people who use drugs. Supplies to treat Xylazine wounds include soap and sterile water, petroleum jelly, gauze pads, and gauze wrap.
* Campaign to combat increasing overdose rates amongst stimulant users. Provide educational materials and training specifically for stimulant users about the risks of opioids and how to access Naloxone.
* Provide transportation vouchers so people can get to treatment, job interviews, and other appointments.
* Flexible funds for care navigators, especially for reentry, peer, recovery programs. These could include bus passes, cellphones, etc.
* Wifi for those who don't have access to it so they can take advantage of tele-health appointments.
* A more ambitious project might support or create a local syringe service program, to offer an “on-ramp to care” for people who don't currently interface with the medical system.
* Similar in scope, fundraising could be directed to help people stay on medication-assisted treatment, as they transition out of local jails.

= Relevant Research =

* '''The O’Neill Institute for National and Global Health Law''' at the Georgetown University Law Center has published a research report on methods to transform government budgets to incentivize investment in a coordinated, targeted, and outcomes-driven approach to SUD. One chapter in this report is titled “Aligning Funding for SUD Across the Government Agencies to Meet a Cohesive Set of Outcomes.” <ref>https://oneill.law.georgetown.edu/wp-content/uploads/2023/06/ONL_Whole_Person_Government_P6r1.pdf</ref>

* '''The Center for Health Care Strategies''' offers an online “Principles-in-Action” series funded by the Pew Charitable Trusts with support from Bloomberg Philanthropies. It addresses financing strategies for state investments in SUD along three evidence-based SUD interventions: peer supports, medications for opioid use treatment, and harm reduction services. <ref>https://www.chcs.org/resource/principles-in-action-financing-strategies-for-substance-use-disorder-treatment/</ref>

= Impactful Federal, State, and Local Policies =

A variety of federal agencies have legislative mandates to provide services associated with prevention and treatment of substance use. Although SUD funding is typically prioritized on a bi-partisan basis, these funds can be impacted by presidential and congressional priorities and decisions. Election cycles in both the executive and legislative branches can influence funding streams. In addition to political variability, one source of confusion in developing funding strategies at the state and local level is the number of federal departments in which funds are housed. The major focus on policy and associated SUD grant funding can be found in three agencies. The Department of Health and Human Services (HHS) includes the Centers for Medicare and Medicaid Services, CDC, FDA, HRSA, NIH, and SAMHSA. Medicaid expansion which has been adopted in 39 states and Washington DC provides access to additional services for low-income populations, and this has a positive impact on SUD services. The Department of Justice and the Department of Housing and Urban Development are also key agencies in implementing policy and grants linked to the various HHS missions.

Block grants are issued in areas of general need like public health, housing, and other social services. Each state is awarded the federal grant and is given flexibility to decide on specific implementation strategies. States determine eligibility for the grants they manage, setting their own guidelines on their service expectations. State offices determine how to distribute these funds between various statewide initiatives and how much funding is allocated to specific counties. Below are some examples of block grants:

* The Community Development Block Grant (CDBG) is administered by the Department of Housing and Urban Development (HUD) and awards funds for community development projects.
* The Community Mental Health Block Grant (MHBG) is administered by the Substance Abuse and Mental Health Services Administration to improve mental health services.
* The Social Services Block Grant (SSBG) is administered by the Office of Community Services and provides funding for programs and services that increase self-sufficiency, decrease dependency, and protect people from abuse and neglect.
* The Substance Abuse Prevention and Treatment Block Grant (SAPTBG) is administered in partnership between HHS and SAMHSA and awards funding to update, improve, and expand SUD services. States are required to set aside 20% of their SAPTBG funding for prevention services. There is an effort underway to allocate a comparable 10% exclusively for recovery services.
* Temporary Assistance for Needy Families (TANF) is administered through the Department of Health and Human Services and provides assistance to families with children in financial need.
* The Indian Housing Block Grant is administered by HUD and helps low-income Native Americans living in a tribe or on a reservation find and maintain suitable housing.

To support a local level understanding of policy concerns, the National Association of Counties (NACo) has published “The Principles Quick Guide to Removing Policy Barriers.” <ref>https://www.naco.org/resource/principles-quick-guide-removing-policy-barriers</ref> It summarizes the role of policy barriers in implementing best practices and provides steps to perform a policy review to overcome barriers. The information on the NACo website is based upon “The Principles for the Use of Funds from the Opioid Litigation” developed by the Johns Hopkins Bloomberg School of Public Health. <ref>https://opioidprinciples.jhsph.edu/</ref>

= Available Tools and Resources =

'''Grants.gov''' is a one-stop shop on federal funding opportunities for organizations which support the development and management of government-funded programs and projects. The website includes a useful search engine.

'''The National Academy for State Health Policy''' has generated a report and infographic which summarizes the major sources of SUD funding for states. <ref>https://nashp.org/funding-options-for-states/?utm_source=Nashp+Enews&utm_campaign=f0947b17c3-EMAIL_CAMPAIGN_MAY_14_2024_COPY_01&utm_medium=email&utm_term=0_afe3b8a6e2-f0947b17c3-604326169</ref>

There are numerous resources associated with the opioid settlement:

* '''The Opioid Settlement Tracker''' provides a status report on settlements reached between U.S. state and local governments and the major pharmaceutical opioid manufacturers, marketers, distributors, and retailers. <ref>https://www.opioidsettlementtracker.com</ref>
* '''The National Tracker''' also includes a searchable index on non-opioid remediation use reports. <ref>https://www.nationalopioidofficialsettlement.com/Home/StateTerritory</ref>
* '''The Tribal Opioid Settlement''' website provides information and a tracker on suits brought by American Indian Tribal Nations against companies involved in manufacturing and selling opioids in the United States. <ref>https://www.tribalopioidsettlements.com</ref>
* '''The Appalachia Opioid Remediation (AOR)''' database catalogues information about how the 13 states of Appalachia are managing and spending funds received from litigation settlements with opioid manufacturers, distributors, and retailers. <ref>https://appalachiaopioidremediation.org</ref>
* '''The National Association of Counties (NACo)''' offers the Opioid Solutions Center to help counties maximize the impact of the opioid settlement funding stream. It provides custom planning, implementation and peer learning resources. <ref>https://www.naco.org/program/opioid-solutions-center</ref>
* '''Vital Strategies''' provides opioid settlement guides to demystify how each state will receive and allocate opioid settlement funds. Their goal is to empower on-the-ground community advocates to effectively understand and engage with their states and localities on the opioid settlement planning and spending processes. <ref>https://www.opioidsettlementguides.com/</ref>
* '''National Association of County and City Health Officials (NACCHO)''' partnered with Community Education Group (CEG) in a 3-part webinar series on opioid settlements. <ref>https://www.naccho.org/blog/articles/opioid-settlements-webinar-resources-and-a-quick-how-to-guide-for-understanding-opioid-settlements-state-to-state</ref> The webinars provide information on how to leverage funds to support evidence-based strategies to reduce harms associated with opioid use and are summarized in a “How-To” Guidebook. <ref>https://www.naccho.org/uploads/downloadable-resources/OpioidSettlementsPDFFinal.pdf</ref>
* '''The Legal Action Center,''' with funding from NACCHO, has published “Equity Considerations for Local Health Departments on Opioid Settlement Funds.” <ref>https://www.naccho.org/uploads/card-images/custom/Equity-Considerations-for-LDH-Opioid-Settlement-Funds_pdf-1.pdf</ref>
* '''The Margolis Institute for Health Policy''' at Duke University has published "Pathways to Progress on sustainability.” This resource includes numerous links to related resources to support and supplement use of opioid settlement funds. <ref>https://healthpolicy.duke.edu/sites/default/files/2024-03/Opioid%20Settlement%20Community%20Guide_0.pdf</ref>

= Promising Practices =

* '''Colorado and North Carolina.''' A webinar titled, “Promising Practices for Collaboration on State and Local Opioid Settlement Spending, was sponsored by the National Academy for State Health Policy and the National Association of Counties. It highlights how state and county officials are working together to maximize the impact of settlement resources and includes best practices for settlement administration, coordinating spending at the state and local levels, and promoting transparency of settlement spending. <ref>https://nashp.org/promising-practices-for-collaboration-on-state-and-local-opioid-settlement-spending/</ref>

* '''New York.''' Allegany County has published their strategic plan to align with potential state and federal funding opportunities with evidence-based and best-practice prevention, intervention and treatment programs and services. <ref>https://alleganyco.gov/wp-content/uploads/allegany_county_heroin_and_opioid_report-2016.pdf</ref>

* '''North Carolina.''' The Campus & Community Coalition (CCC) was launched through a collaborative funding agreement between the University of NC, the Town of Chapel Hill, the Orange County Health Department, and the Orange County Board of the Alcohol Beverage Commission. <ref>https://downtownchapelhill.com/coalition/</ref>

* '''Wisconsin.''' Milwaukee County collaborated with the Wisconsin state legislature to decriminalize fentanyl test strips which enabled ti to begin distribution of testing strips through its Division of Behavioral Health Services. <ref>https://county.milwaukee.gov/EN/County-Executive/News/Press-Releases/Milwaukee-County-Behavioral-Health-Services-to-Distribute-1600-Fentanyl-Testing-Strips-to-Help-Pr-</ref>

= Sources =

Understand Funding and Identify Your Resources

2025-03-24T19:58:46Z

BasilSavitsky: /* Available Tools and Resources */

Understand Funding and Identify Your Resources

2025-03-24T19:56:36Z

BasilSavitsky: /* Available Tools and Resources */

= Introductory Paragraph =

This article focuses on ways that coalitions can increase their funding base. It also addresses various components of sustaining funding, because communities and funders need assurance that the coalition is working toward long-term outcomes that are built on a reliable foundation that will continue independently of single-source financing.

One key strategy is to diversify approaches to funding, so this article covers public, private, and philanthropic sources. In addition, within the public, or governmental funding stream, a key strategy is to balance state and local sources with federal, and if appropriate, tribal funding sources.

= Key Information =

'''The Funding Landscape'''

There are a variety of funding streams that can be blended and braided, including:

* Public funding or grants, which includes federal, state, and local funding streams,
* Private sources include contributions from corporate resources and in-kind support or fee-for-service options. Traditional approaches to fundraising can be supplemented with social impact bonds also known as pay-for-success financing
* Philanthropic agencies — at both national and local levels,
* Other one-time payments, such as opioid settlement dollars.

Understanding the funding landscape of the substance use crisis is essential, but complex. Taking the long view, on the positive side, major impacts have been achieved as a result of focused funding initiatives. For example, prevention efforts generated by the tobacco settlement dollars resulted in dramatic decreases in adolescent smoking over a ten-year span. However, public health gains in this domain dissolved rapidly after the advent of e-cigarettes. There is a great deal of optimism about the potential use of opioid settlement funds to have a similar degree of impact, but optimal allocation of funding requires an awareness of sustainability strategies. It takes a committed intention to offset the flux in the history of funding which has been directed at substance use prevention, harm reduction, treatment, and recovery. For example, there is long-term oscillation associated with particular substances, shifting priorities from one substance to another, rather than addressing all forms of substance use. Likewise, there is variability in focus between reducing supply, which typically falls to law enforcement, and reducing demand, which involves public health and social services. Prevention funding has witnessed a dynamic which started with reaching individuals (“just say no”) to changing social norms (nicotine free-free public spaces). Taking recent advances in harm reduction strategies within such a broad perspective ensures that optimal strategies are deployed across changing political climates at national and local scales.

'''Sustainability'''

While human capital is the lifeblood of the coalition, financial capital is vital to initiate and sustain long-term collaborative efforts. Unfortunately, both human and financial capital are too frequently overlooked in the week-to-week stream of coalition activities. The energy and wisdom of coalition members and agency relationships are often only recognized when they are gone. Likewise, focus on financial resources is typically considered as a grant cycle approaches closure. A sustainability strategy brings home that creating significant community change is a long-term process. Despite short-term successes, long-term results can take years. Persistent collaboration and working toward a common vision are essential to sustain long-term community efforts.

Crafting a sustainability plan with specific objectives brings ongoing support to the coalition vision by its members, funders, and the community at large. It is useful to build a vision as part of a grant or a project, but more useful to plan from the start how that vision will be sustained after the grant is over. Sustainability planning should happen as soon as the vision, mission, and objectives are established. Since sustainability is a process and not just a one-time venture, each phase of every project should have sustainability considerations. This will help the coalition to:

* Make time to recognize problems and to allocate funding, staffing, and resources for best solutions.
* Structure approaches and objectives that will continue to grow and achieve the desired impact in the community.
* Have more efficient and effective efforts to maintain support.
* Avoid interruptions in progress if funding is declined.

'''Coalition Actions'''

Effective strategies to increase and sustain funding are closely tied to building robust partnerships (See “Mobilize Community Champions” wiki). One example can be seen in developing ties with experts in local universities, who may be adept in obtaining grant funding. Likewise, other agencies working on distinct but related issues, such as suicide prevention and gun violence or domestic violence prevention. While agencies working in these areas have different risk factor reduction strategies, their methods to enhance protective factors are similar (See SAFE Solution article titled, “Address Risk & Protective Factors for Individuals, Families, and Communities.) This both fosters increased collaboration and provides opportunities to share funding streams. (See “Apply a Multi-Sectoral Approach.”)

Each sustainability tactic the coalition chooses will require members, staff, or other volunteers with skills or interests related to the identified need. Some examples include activity implementation, grant writing, marketing, event planning, and establishing a donor or membership base. Asking the kinds of questions listed below will help clarify what is needed to build a sustainability strategy:

* Is sustainability being considered “up front” and integrated with tracking performance over time? Data demonstrating success and a trend of success justify the sustainability of the funding for that program. See SAFE Solutions article, titled “Plan, Implement, and Evaluate.” <ref>https://www.yoursafesolutions.us/wiki/Plan,_Implement,_and_Evaluate</ref>
* What goals have been successfully achieved?
* What new goals are emerging?
* Do we have a broad range of support across all partner systems (health, legal, social, etc.)
* Can we connect our local initiatives back to state-level efforts and link to broader activities?
* Does our initiative have enough staffing or volunteer support to consistently drive its efforts?
* Can our budget cover existing costs? Can we pursue new funding opportunities? Have we explored innovative solutions?
* Have we communicated our successes to our partners and the public?
* Do we incorporate the voice of people most impacted by our decisions?
* Do we focus on the specific needs of individuals and families in our community?

'''“Small and Fast” Funding Wins'''

While large grants get a lot of attention, there are a number of ways that coalitions can gain traction in the funding arena by taking on quick and easy projects that work from small-dollar expenditures:

* Supplement local health department funding for use on addressing overdose. This could include basic education, marketing, and printing costs, or it could enhance overdose data collection to understand the local severity of the crisis in real time.
* Purchase low-cost Naloxone. Remedy Alliance is a nonprofit with the cheapest price for intramuscular Naloxone, which is much more affordable than intranasal. <ref>https://remedyallianceftp.org/</ref>
* Purchase test strips. Fentanyl test strips are particularly useful for stimulant users who might not have a tolerance for opioids. Xylazine test strips can help people avoid this contaminant, which can cause extreme sedation and skin wounds.
* Purchase wound care supplies for people who use drugs. Supplies to treat Xylazine wounds include soap and sterile water, petroleum jelly, gauze pads, and gauze wrap.
* Campaign to combat increasing overdose rates amongst stimulant users. Provide educational materials and training specifically for stimulant users about the risks of opioids and how to access Naloxone.
* Provide transportation vouchers so people can get to treatment, job interviews, and other appointments.
* Flexible funds for care navigators, especially for reentry, peer, recovery programs. These could include bus passes, cellphones, etc.
* Wifi for those who don't have access to it so they can take advantage of tele-health appointments.
* A more ambitious project might support or create a local syringe service program, to offer an “on-ramp to care” for people who don't currently interface with the medical system.
* Similar in scope, fundraising could be directed to help people stay on medication-assisted treatment, as they transition out of local jails.

= Relevant Research =

* '''The O’Neill Institute for National and Global Health Law''' at the Georgetown University Law Center has published a research report on methods to transform government budgets to incentivize investment in a coordinated, targeted, and outcomes-driven approach to SUD. One chapter in this report is titled “Aligning Funding for SUD Across the Government Agencies to Meet a Cohesive Set of Outcomes.” <ref>https://oneill.law.georgetown.edu/wp-content/uploads/2023/06/ONL_Whole_Person_Government_P6r1.pdf</ref>

* '''The Center for Health Care Strategies''' offers an online “Principles-in-Action” series funded by the Pew Charitable Trusts with support from Bloomberg Philanthropies. It addresses financing strategies for state investments in SUD along three evidence-based SUD interventions: peer supports, medications for opioid use treatment, and harm reduction services. <ref>https://www.chcs.org/resource/principles-in-action-financing-strategies-for-substance-use-disorder-treatment/</ref>

= Impactful Federal, State, and Local Policies =

A variety of federal agencies have legislative mandates to provide services associated with prevention and treatment of substance use. Although SUD funding is typically prioritized on a bi-partisan basis, these funds can be impacted by presidential and congressional priorities and decisions. Election cycles in both the executive and legislative branches can influence funding streams. In addition to political variability, one source of confusion in developing funding strategies at the state and local level is the number of federal departments in which funds are housed. The major focus on policy and associated SUD grant funding can be found in three agencies. The Department of Health and Human Services (HHS) includes the Centers for Medicare and Medicaid Services, CDC, FDA, HRSA, NIH, and SAMHSA. Medicaid expansion which has been adopted in 39 states and Washington DC provides access to additional services for low-income populations, and this has a positive impact on SUD services. The Department of Justice and the Department of Housing and Urban Development are also key agencies in implementing policy and grants linked to the various HHS missions.

Block grants are issued in areas of general need like public health, housing, and other social services. Each state is awarded the federal grant and is given flexibility to decide on specific implementation strategies. States determine eligibility for the grants they manage, setting their own guidelines on their service expectations. State offices determine how to distribute these funds between various statewide initiatives and how much funding is allocated to specific counties. Below are some examples of block grants:

* The Community Development Block Grant (CDBG) is administered by the Department of Housing and Urban Development (HUD) and awards funds for community development projects.
* The Community Mental Health Block Grant (MHBG) is administered by the Substance Abuse and Mental Health Services Administration to improve mental health services.
* The Social Services Block Grant (SSBG) is administered by the Office of Community Services and provides funding for programs and services that increase self-sufficiency, decrease dependency, and protect people from abuse and neglect.
* The Substance Abuse Prevention and Treatment Block Grant (SAPTBG) is administered in partnership between HHS and SAMHSA and awards funding to update, improve, and expand SUD services. States are required to set aside 20% of their SAPTBG funding for prevention services. There is an effort underway to allocate a comparable 10% exclusively for recovery services.
* Temporary Assistance for Needy Families (TANF) is administered through the Department of Health and Human Services and provides assistance to families with children in financial need.
* The Indian Housing Block Grant is administered by HUD and helps low-income Native Americans living in a tribe or on a reservation find and maintain suitable housing.

To support a local level understanding of policy concerns, the National Association of Counties (NACo) has published “The Principles Quick Guide to Removing Policy Barriers.” <ref>https://www.naco.org/resource/principles-quick-guide-removing-policy-barriers</ref> It summarizes the role of policy barriers in implementing best practices and provides steps to perform a policy review to overcome barriers. The information on the NACo website is based upon “The Principles for the Use of Funds from the Opioid Litigation” developed by the Johns Hopkins Bloomberg School of Public Health. <ref>https://opioidprinciples.jhsph.edu/</ref>

= Available Tools and Resources =

'''Grants.gov''' is a one-stop shop on federal funding opportunities for organizations which support the development and management of government-funded programs and projects. The website includes a useful search engine.

'''The National Academy for State Health Policy''' has generated a report and infographic which summarizes the major sources of SUD funding for states. <ref>https://nashp.org/funding-options-for-states/?utm_source=Nashp+Enews&utm_campaign=f0947b17c3-EMAIL_CAMPAIGN_MAY_14_2024_COPY_01&utm_medium=email&utm_term=0_afe3b8a6e2-f0947b17c3-604326169</ref>

There are numerous resources associated with the opioid settlement:

* This website provides a status report on settlements reached between U.S. state and local governments and the major pharmaceutical opioid manufacturers, marketers, distributors, and retailers. <ref>https://www.opioidsettlementtracker.com</ref>
* The National Tracker also includes a searchable index on non-opioid remediation use reports. <ref>https://www.nationalopioidofficialsettlement.com/Home/StateTerritory</ref>
* The Tribal Opioid Settlement website provides information and a tracker on suits brought by American Indian Tribal Nations against companies involved in manufacturing and selling opioids in the United States. <ref>https://www.tribalopioidsettlements.com</ref>
* The Appalachia Opioid Remediation (AOR) database catalogues information about how the 13 states of Appalachia are managing and spending funds received from litigation settlements with opioid manufacturers, distributors, and retailers. <ref>https://appalachiaopioidremediation.org</ref>
* The National Association of Counties (NACo) offers the Opioid Solutions Center to help counties maximize the impact of the opioid settlement funding stream. It provides custom planning, implementation and peer learning resources. <ref>https://www.naco.org/program/opioid-solutions-center</ref>
* Vital Strategies provides opioid settlement guides to demystify how each state will receive and allocate opioid settlement funds. Their goal is to empower on-the-ground community advocates to effectively understand and engage with their states and localities on the opioid settlement planning and spending processes. <ref>https://www.opioidsettlementguides.com/</ref>
* National Association of County and City Health Officials (NACCHO) partnered with Community Education Group (CEG) in a 3-part webinar series on opioid settlements. <ref>https://www.naccho.org/blog/articles/opioid-settlements-webinar-resources-and-a-quick-how-to-guide-for-understanding-opioid-settlements-state-to-state</ref> The webinars provide information on how to leverage funds to support evidence-based strategies to reduce harms associated with opioid use and are summarized in a “How-To” Guidebook. <ref>https://www.naccho.org/uploads/downloadable-resources/OpioidSettlementsPDFFinal.pdf</ref>
* The Legal Action Center, with funding from NACCHO, has published “Equity Considerations for Local Health Departments on Opioid Settlement Funds.” <ref>https://www.naccho.org/uploads/card-images/custom/Equity-Considerations-for-LDH-Opioid-Settlement-Funds_pdf-1.pdf</ref>
* The Margolis Institute for Health Policy at Duke University has published "Pathways to Progress on sustainability.” This resource includes numerous links to related resources to support and supplement use of opioid settlement funds. <ref>https://healthpolicy.duke.edu/sites/default/files/2024-03/Opioid%20Settlement%20Community%20Guide_0.pdf</ref>

Understand Funding and Identify Your Resources

2025-03-24T19:54:36Z

BasilSavitsky: /* Impactful Federal, State, and Local Policies */

= Introductory Paragraph =

This article focuses on ways that coalitions can increase their funding base. It also addresses various components of sustaining funding, because communities and funders need assurance that the coalition is working toward long-term outcomes that are built on a reliable foundation that will continue independently of single-source financing.

One key strategy is to diversify approaches to funding, so this article covers public, private, and philanthropic sources. In addition, within the public, or governmental funding stream, a key strategy is to balance state and local sources with federal, and if appropriate, tribal funding sources.

= Key Information =

'''The Funding Landscape'''

There are a variety of funding streams that can be blended and braided, including:

* Public funding or grants, which includes federal, state, and local funding streams,
* Private sources include contributions from corporate resources and in-kind support or fee-for-service options. Traditional approaches to fundraising can be supplemented with social impact bonds also known as pay-for-success financing
* Philanthropic agencies — at both national and local levels,
* Other one-time payments, such as opioid settlement dollars.

Understanding the funding landscape of the substance use crisis is essential, but complex. Taking the long view, on the positive side, major impacts have been achieved as a result of focused funding initiatives. For example, prevention efforts generated by the tobacco settlement dollars resulted in dramatic decreases in adolescent smoking over a ten-year span. However, public health gains in this domain dissolved rapidly after the advent of e-cigarettes. There is a great deal of optimism about the potential use of opioid settlement funds to have a similar degree of impact, but optimal allocation of funding requires an awareness of sustainability strategies. It takes a committed intention to offset the flux in the history of funding which has been directed at substance use prevention, harm reduction, treatment, and recovery. For example, there is long-term oscillation associated with particular substances, shifting priorities from one substance to another, rather than addressing all forms of substance use. Likewise, there is variability in focus between reducing supply, which typically falls to law enforcement, and reducing demand, which involves public health and social services. Prevention funding has witnessed a dynamic which started with reaching individuals (“just say no”) to changing social norms (nicotine free-free public spaces). Taking recent advances in harm reduction strategies within such a broad perspective ensures that optimal strategies are deployed across changing political climates at national and local scales.

'''Sustainability'''

While human capital is the lifeblood of the coalition, financial capital is vital to initiate and sustain long-term collaborative efforts. Unfortunately, both human and financial capital are too frequently overlooked in the week-to-week stream of coalition activities. The energy and wisdom of coalition members and agency relationships are often only recognized when they are gone. Likewise, focus on financial resources is typically considered as a grant cycle approaches closure. A sustainability strategy brings home that creating significant community change is a long-term process. Despite short-term successes, long-term results can take years. Persistent collaboration and working toward a common vision are essential to sustain long-term community efforts.

Crafting a sustainability plan with specific objectives brings ongoing support to the coalition vision by its members, funders, and the community at large. It is useful to build a vision as part of a grant or a project, but more useful to plan from the start how that vision will be sustained after the grant is over. Sustainability planning should happen as soon as the vision, mission, and objectives are established. Since sustainability is a process and not just a one-time venture, each phase of every project should have sustainability considerations. This will help the coalition to:

* Make time to recognize problems and to allocate funding, staffing, and resources for best solutions.
* Structure approaches and objectives that will continue to grow and achieve the desired impact in the community.
* Have more efficient and effective efforts to maintain support.
* Avoid interruptions in progress if funding is declined.

'''Coalition Actions'''

Effective strategies to increase and sustain funding are closely tied to building robust partnerships (See “Mobilize Community Champions” wiki). One example can be seen in developing ties with experts in local universities, who may be adept in obtaining grant funding. Likewise, other agencies working on distinct but related issues, such as suicide prevention and gun violence or domestic violence prevention. While agencies working in these areas have different risk factor reduction strategies, their methods to enhance protective factors are similar (See SAFE Solution article titled, “Address Risk & Protective Factors for Individuals, Families, and Communities.) This both fosters increased collaboration and provides opportunities to share funding streams. (See “Apply a Multi-Sectoral Approach.”)

Each sustainability tactic the coalition chooses will require members, staff, or other volunteers with skills or interests related to the identified need. Some examples include activity implementation, grant writing, marketing, event planning, and establishing a donor or membership base. Asking the kinds of questions listed below will help clarify what is needed to build a sustainability strategy:

* Is sustainability being considered “up front” and integrated with tracking performance over time? Data demonstrating success and a trend of success justify the sustainability of the funding for that program. See SAFE Solutions article, titled “Plan, Implement, and Evaluate.” <ref>https://www.yoursafesolutions.us/wiki/Plan,_Implement,_and_Evaluate</ref>
* What goals have been successfully achieved?
* What new goals are emerging?
* Do we have a broad range of support across all partner systems (health, legal, social, etc.)
* Can we connect our local initiatives back to state-level efforts and link to broader activities?
* Does our initiative have enough staffing or volunteer support to consistently drive its efforts?
* Can our budget cover existing costs? Can we pursue new funding opportunities? Have we explored innovative solutions?
* Have we communicated our successes to our partners and the public?
* Do we incorporate the voice of people most impacted by our decisions?
* Do we focus on the specific needs of individuals and families in our community?

'''“Small and Fast” Funding Wins'''

While large grants get a lot of attention, there are a number of ways that coalitions can gain traction in the funding arena by taking on quick and easy projects that work from small-dollar expenditures:

* Supplement local health department funding for use on addressing overdose. This could include basic education, marketing, and printing costs, or it could enhance overdose data collection to understand the local severity of the crisis in real time.
* Purchase low-cost Naloxone. Remedy Alliance is a nonprofit with the cheapest price for intramuscular Naloxone, which is much more affordable than intranasal. <ref>https://remedyallianceftp.org/</ref>
* Purchase test strips. Fentanyl test strips are particularly useful for stimulant users who might not have a tolerance for opioids. Xylazine test strips can help people avoid this contaminant, which can cause extreme sedation and skin wounds.
* Purchase wound care supplies for people who use drugs. Supplies to treat Xylazine wounds include soap and sterile water, petroleum jelly, gauze pads, and gauze wrap.
* Campaign to combat increasing overdose rates amongst stimulant users. Provide educational materials and training specifically for stimulant users about the risks of opioids and how to access Naloxone.
* Provide transportation vouchers so people can get to treatment, job interviews, and other appointments.
* Flexible funds for care navigators, especially for reentry, peer, recovery programs. These could include bus passes, cellphones, etc.
* Wifi for those who don't have access to it so they can take advantage of tele-health appointments.
* A more ambitious project might support or create a local syringe service program, to offer an “on-ramp to care” for people who don't currently interface with the medical system.
* Similar in scope, fundraising could be directed to help people stay on medication-assisted treatment, as they transition out of local jails.

= Relevant Research =

* '''The O’Neill Institute for National and Global Health Law''' at the Georgetown University Law Center has published a research report on methods to transform government budgets to incentivize investment in a coordinated, targeted, and outcomes-driven approach to SUD. One chapter in this report is titled “Aligning Funding for SUD Across the Government Agencies to Meet a Cohesive Set of Outcomes.” <ref>https://oneill.law.georgetown.edu/wp-content/uploads/2023/06/ONL_Whole_Person_Government_P6r1.pdf</ref>

* '''The Center for Health Care Strategies''' offers an online “Principles-in-Action” series funded by the Pew Charitable Trusts with support from Bloomberg Philanthropies. It addresses financing strategies for state investments in SUD along three evidence-based SUD interventions: peer supports, medications for opioid use treatment, and harm reduction services. <ref>https://www.chcs.org/resource/principles-in-action-financing-strategies-for-substance-use-disorder-treatment/</ref>

= Impactful Federal, State, and Local Policies =

A variety of federal agencies have legislative mandates to provide services associated with prevention and treatment of substance use. Although SUD funding is typically prioritized on a bi-partisan basis, these funds can be impacted by presidential and congressional priorities and decisions. Election cycles in both the executive and legislative branches can influence funding streams. In addition to political variability, one source of confusion in developing funding strategies at the state and local level is the number of federal departments in which funds are housed. The major focus on policy and associated SUD grant funding can be found in three agencies. The Department of Health and Human Services (HHS) includes the Centers for Medicare and Medicaid Services, CDC, FDA, HRSA, NIH, and SAMHSA. Medicaid expansion which has been adopted in 39 states and Washington DC provides access to additional services for low-income populations, and this has a positive impact on SUD services. The Department of Justice and the Department of Housing and Urban Development are also key agencies in implementing policy and grants linked to the various HHS missions.

Block grants are issued in areas of general need like public health, housing, and other social services. Each state is awarded the federal grant and is given flexibility to decide on specific implementation strategies. States determine eligibility for the grants they manage, setting their own guidelines on their service expectations. State offices determine how to distribute these funds between various statewide initiatives and how much funding is allocated to specific counties. Below are some examples of block grants:

* The Community Development Block Grant (CDBG) is administered by the Department of Housing and Urban Development (HUD) and awards funds for community development projects.
* The Community Mental Health Block Grant (MHBG) is administered by the Substance Abuse and Mental Health Services Administration to improve mental health services.
* The Social Services Block Grant (SSBG) is administered by the Office of Community Services and provides funding for programs and services that increase self-sufficiency, decrease dependency, and protect people from abuse and neglect.
* The Substance Abuse Prevention and Treatment Block Grant (SAPTBG) is administered in partnership between HHS and SAMHSA and awards funding to update, improve, and expand SUD services. States are required to set aside 20% of their SAPTBG funding for prevention services. There is an effort underway to allocate a comparable 10% exclusively for recovery services.
* Temporary Assistance for Needy Families (TANF) is administered through the Department of Health and Human Services and provides assistance to families with children in financial need.
* The Indian Housing Block Grant is administered by HUD and helps low-income Native Americans living in a tribe or on a reservation find and maintain suitable housing.

To support a local level understanding of policy concerns, the National Association of Counties (NACo) has published “The Principles Quick Guide to Removing Policy Barriers.” <ref>https://www.naco.org/resource/principles-quick-guide-removing-policy-barriers</ref> It summarizes the role of policy barriers in implementing best practices and provides steps to perform a policy review to overcome barriers. The information on the NACo website is based upon “The Principles for the Use of Funds from the Opioid Litigation” developed by the Johns Hopkins Bloomberg School of Public Health. <ref>https://opioidprinciples.jhsph.edu/</ref>

= Available Tools and Resources =

'''Grants.gov''' is a one-stop shop on federal funding opportunities for organizations which support the development and management of government-funded programs and projects. The website includes a useful search engine.

'''The National Academy for State Health Policy''' has generated a report and infographic which summarizes the major sources of SUD funding for states. <ref>https://nashp.org/funding-options-for-states/?utm_source=Nashp+Enews&utm_campaign=f0947b17c3-EMAIL_CAMPAIGN_MAY_14_2024_COPY_01&utm_medium=email&utm_term=0_afe3b8a6e2-f0947b17c3-604326169</ref>

There are numerous resources associated with the opioid settlement:

* This website provides a status report on settlements reached between U.S. state and local governments and the major pharmaceutical opioid manufacturers, marketers, distributors, and retailers. <ref>https://www.opioidsettlementtracker.com</ref>
* The National Tracker also includes a searchable index on non-opioid remediation use reports. <ref>https://www.nationalopioidofficialsettlement.com/Home/StateTerritory</ref>
* The Tribal Opioid Settlement website provides information and a tracker on suits brought by American Indian Tribal Nations against companies involved in manufacturing and selling opioids in the United States. <ref>https://www.tribalopioidsettlements.com</ref>
* The Appalachia Opioid Remediation (AOR) database catalogues information about how the 13 states of Appalachia are managing and spending funds received from litigation settlements with opioid manufacturers, distributors, and retailers. <ref>https://appalachiaopioidremediation.org</ref>
* The National Association of Counties (NACo) offers the Opioid Solutions Center to help counties maximize the impact of the opioid settlement funding stream. It provides custom planning, implementation and peer learning resources. <ref>https://www.naco.org/program/opioid-solutions-center<ref>
* Vital Strategies provides opioid settlement guides to demystify how each state will receive and allocate opioid settlement funds. Their goal is to empower on-the-ground community advocates to effectively understand and engage with their states and localities on the opioid settlement planning and spending processes. <ref>https://www.opioidsettlementguides.com/</ref>
* National Association of County and City Health Officials (NACCHO) partnered with Community Education Group (CEG) in a 3-part webinar series on opioid settlements. <ref>https://www.naccho.org/blog/articles/opioid-settlements-webinar-resources-and-a-quick-how-to-guide-for-understanding-opioid-settlements-state-to-state</ref> The webinars provide information on how to leverage funds to support evidence-based strategies to reduce harms associated with opioid use and are summarized in a “How-To” Guidebook. <ref>https://www.naccho.org/uploads/downloadable-resources/OpioidSettlementsPDFFinal.pdf</ref>
* The Legal Action Center, with funding from NACCHO, has published “Equity Considerations for Local Health Departments on Opioid Settlement Funds.” <ref>https://www.naccho.org/uploads/card-images/custom/Equity-Considerations-for-LDH-Opioid-Settlement-Funds_pdf-1.pdf</ref>
* The Margolis Institute for Health Policy at Duke University has published "Pathways to Progress on sustainability.” This resource includes numerous links to related resources to support and supplement use of opioid settlement funds. <ref>https://healthpolicy.duke.edu/sites/default/files/2024-03/Opioid%20Settlement%20Community%20Guide_0.pdf</ref>

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BasilSavitsky: Created page with "= Introductory Paragraph = This article focuses on ways that coalitions can increase their funding base. It also addresses various components of sustaining funding, because communities and funders need assurance that the coalition is working toward long-term outcomes that are built on a reliable foundation that will continue independently of single-source financing. One key strategy is to diversify approaches to funding, so this article covers public, private, and phil..."

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Understand Funding and Identify Your Resources

Intersectionality and Addressing Disparities

2025-03-24T19:12:48Z

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= Introductory Paragraph =

This is the second in a pair of related articles on health equity centered around disparities and disproportionality. The first article titled, “Apply a Health Equity Lens,” focused on resources associated with building health equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref> This requires an active commitment to remove obstacles for groups that are more impacted by inequity. The material below centers on strategies in the field of substance use which are associated with populations impacted by various systemic inequities.

= Key Information =

Addressing disparities begins by acknowledging that we are all unique and hold multiple identity lenses. Likewise, as members of different groups within our communities, we experience thesse differences in navigating screening, diagnosis, treatment, and recovery supports. This is particularly relevant in the historical context of substance use because some groups have been more marginalized or historically underrepresented and impacted by systemtic inequities over others. For example, recent overall statistics demonostrate a 14.5% decline in national overdose deaths for the 12-month period ending June 2024. <ref>https://www.safestates.org/news/687677/CDC-Data-Shows-a-Decline-in-Overdose-Deaths.htm</ref> However, upon further examination, it becomes apparent that the recent decrease in the overdose rate is not uniformly distributed. Positive trends predominantly benefit White people.

Increased awareness of disparities and disproportionalities impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with lower socio-economic status, and pregnant people. The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this recent crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:

* While studies show that Black people use cocaine at similar rates to other racial and ethnic groups, the overdose rates related to cocaine for Black individuals, disproportionately higher compared to White individuals. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment/recovery (MAT/MAR). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>
* The overdose rate for Native Americans, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions are associated with methamphetamines, versus opioids. In 2022, the national Native American overdose fatality rate associated with methamphetamines was more than double the rate for Whites. Tribal lands often have limited infrastructure impacting service delivery. Oftentimes, resources off reservations can be a transportation barrier and lack cultural competency to effectively serve Native Americans. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
* Latinx communities have experienced significant challenges with rising overdose rates (doubling between 2018 and 2022), especially as the prevalence of Fentanyl has increased. This is compounded by barriers to care, such as language access and documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
* Linguistic disparities affect a large portion of the approximately 26 million people who have limited English proficiency (LEP). One survey found that adults with LEP report worse health status and increased barriers in accessing health care compared to English-proficient adults. One out of three say they have faced language barriers when seeking health care. Twice as many LEP adults than English-proficient adults report not having a usual source of healthcare and almost twice as many report having fair or poor health. <ref>https://www.kff.org/racial-equity-and-health-policy/poll-finding/language-barriers-in-health-care-findings-from-the-kff-survey-on-racism-discrimination-and-health/</ref>

Inequitable impacts are also well documented across the following identities:

* Socioeconomic Status (SES). In a summary of research within NIH funded by the National Institute on Minority Health and Health Disparities (NIMHD), two “pillars of health disparity science” were identified. The first encompasses the racial and ethnic disparities described above. The second pillar relates to SES which “contributes to health disparities through limited resources and opportunities to engage in health-promoting activities relative to high educational attainment and income.” <ref>https://jamanetwork.com/journals/jama-health-forum/fullarticle/2812750</ref> Lower SES was found to be strongly linked with health outcomes, including mortality. <ref>https://www.pnas.org/doi/full/10.1073/pnas.2024777118</ref> More specifically related to SUD disparities, SAMHSA data indicates that in 2019 the uninsured populations had a 7.3% rate of alcohol use disorder compared to a 5.0% rate for the insured. <ref>https://www.samhsa.gov/data/sites/default/files/reports/rpt35328/2021NSDUHBHEReport.pdf</ref>

* Geographic Disparities. The Rural Health Information Hub documents higher rates of binge drinking in rural areas as well as use of tobacco, methamphetamines, and opioids. Challenges faced in rural communities include lower number of behavioral health and detoxification services and a decreased range of services in centers which can be accessed. Greater distance to substance use disorder treatment often results in lower completion rates of substance use treatment programs. <ref>https://www.ruralhealthinfo.org/topics/substance-use</ref> This is compounded by a differential among rural health providers in a negative perception of treatment for substance use disorder. <ref>https://www.tandfonline.com/doi/full/10.1080/00952990.2019.1694536</ref>

* A majority of pregnant people who use substances who do receive appropriate prenatal care and intervention are typically older and White with private health insurance. These people are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear of criminalization and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are disproportionately impacted by social and health disparites, and do seek treatment, often face significant barriers, as their honesty around their circumstances often leads to criminal reporting or an inability to find available and affordable treatment programs that meet their specific needs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>

* Older Adults. An evaluation by the Office of Disease Prevention and Health Promotion within US-HHS on the social determinants of health lists several factors which amplify health disparities for older adults. These include increased isolation for singles aged 65+ as well as decreased ease of access to services and increased need for services, particularly associated with a higher rate of chronic health conditions. <ref>https://odphp.health.gov/our-work/national-health-initiatives/healthy-aging/social-determinants-health-and-older-adults#health</ref> In 2020, consumers aged 65 and older averaged out-of-pocket health care expenditures of $6,668, and older Americans spent 14% of their total expenditures on health, compared to 8.4% among all consumers. <ref>https://acl.gov/sites/default/files/Profile%20of%20OA/2021%20Profile%20of%20OA/2021ProfileOlderAmericans_508.pdf</ref> This forces difficult choices in prioritizing health needs within families which might delay or eliminate pursuit of SUD services.

* Youth. Risk factors for youth(18-25) having higher substance use rates than adults over 25 years old are commonly recognized. For example 2023 data indicate that 18% of youth had a drug use disorder in the past year, compared to 8.6% for adults 26 or older — more than twice the rate. <ref>https://www.samhsa.gov/data/report/2023-nsduh-detailed-tables</ref> The disparities that youth face in protective factors is less understood. For example, access to alternatives to substance-free activities is based on a variety of social determinants, such as transportation to extracurricular activities and family or community funding to foster equitable access to athletic, artistic, or social functions that promote protective factors such as self-esteem and pro-social bonding. <ref>https://pmc.ncbi.nlm.nih.gov/articles/PMC6601618/</ref>

* Veterans. One in five veterans experience behavioral health problems and veterans are twice as likely to die from overdose than non-veterans. <ref>https://www.safeproject.us/veterans/</ref> In terms of social determinants of health, one research meta-analysis concluded that “veterans enrolled in VHA services are more medically complex, have lower physical and mental health functioning, and have lower socioeconomic resources, as compared with either non-Veterans or Veterans not engaged in VHA care.” <ref>https://pmc.ncbi.nlm.nih.gov/articles/PMC6153229/</ref>

* Persons with disabilities are 2-4 times more likely to experience alcohol and substance use disorder. <ref>https://americanaddictioncenters.org/rehab-guide/addiction-disability</ref>

'''Intersectionality'''

Intersectionality is a complex topic that warrants a full understanding by anyone engaged in social change work. Intersectionality runs deeper than, and should not be confused with, the type of inter-sectoral work found in promoting environmental justice by both environmentalists and social justice activists. Intersectionality describes a method for defining the mix of social identities with more accuracy than single identity formulations allow. For example, everyone is a blend of gender, race, class, and ability categories as opposed to being a type of member in different categories. Intersectionality has become associated with social and political correlations with privilege and marginalization. The term, intersectionality, was coined by Kimberlé Williams Crenshaw in three legal cases in 1989. Although each of the cases were lost, her position has been adopted widely in the social justice community and is often linked with its formative roots in Critical Race Theory. Crenshaw made a case in law suits for black women that this newly defined form of discrimination transcended racial and gender discrimination because black women were being judged in the legal system separately both as women and as members of a minority rather than as black women. In the decades since, the term has become politically controversial, because it has moved outside of the generally agreed upon ''descriptive'' nature of discriminatory patterns to a ''prescriptive'' call to action to address sources of structural power differentials. It has been critiqued both for the scope of change for which intersectional advocates calls and for the difficulty in measuring success in conditions which are inherently multi-variable. <ref>https://www.vox.com/the-highlight/2019/5/20/18542843/intersectionality-conservatism-law-race-gender-discrimination</ref>

'''Coalition Responsibilities When Addressing Disparities'''

Coalitions have a responsibility to work towards the well-being and protection of all individuals in our communities, ensuring equity and inclusion in all efforts. The first step in implementing this responsibility is to recognize that history points to long-term patterns of inequity. The next step is to realize the scope and diversity within health inequity. This includes incorporating people with lived experience in the decision making process and implementing trauma-informed approaches. Specific recommendations for practicing cultural competence and humility and for applying a health equity lens in strategy planning are detailed in the section titled “Building Capacity for Health Equity” within the SAFE Solution article on Health Equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref>

In addition to the statistics on racial and ethnic disparities detailed above, there are several constituencies within communities for which substance use statistics are less documented. For example, collection of data on the transgender and people questioning their gender identity have been more difficult to collect, particularly for youth, as compared to their heterosexual peers. However, limited data have been collected by SAMHSA in its annual surveys on people who identify as lesbian, gay, or bisexual. Factors around discrimination, trauma, stigma, and lack of services available to meet their needs often double or triple use rates by LGB respondents, for all substances. <ref>https://clearbrook.banyantreatmentcenter.com/news/lgbtq-substance-abuse-facts-and-tatistics/</ref> When a coalition examines the membership of its community, it should look at not only the specific needs of racial, ethnic, and LGBTQ+ communities, but also evaluate the concerns of military-connected people, individuals with disabilities, and those with lower socio-economic status.

One example might help to humanize what may seem to be abstract demographic characteristics. This points to the complexity of systems which are faced in one specific case. Someone named Chris has just been released from prison and is returning home. Chris is fortunate enough to have been supported in developing a recovery plan which includes medication-assisted treatment/recovery (MAT/MAR). However, Chris’s parole officer maintains that Chris cannot use any substances, MAT/MAR, or otherwise. Instead Chris is required to do x, y, and z, none of which are in the recovery plan. A lack of re-entry services and laws in Chris’s state precluded applying for Medicaid in advance. Chris left jail with three days of medication, but cannot see a doctor for a week. Chris is unable to find recovery housing with nearby transportation who will accept someone with a criminal background, so has not yet found employment. Without a job and without prescription coverage, Chris cannot afford to get more medication. The doctor wants to prescribe medications which the parole officer will not allow. If coalition members understand how their local systems are not working together and are working against people, then they can begin to see how difficult daily life might be for undocumented people or LGBTQ+ youth who are ready but uncertain as to how to access substance use services.

= Relevant Research =

*'''This article''' addresses disparities in treatment and access to treatment, regarding economic status and race/ethnicity. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087681/</ref>

*'''The Boston University Center for Antiracist Research''' is a collaborative research and education effort which includes Racial Data Lab, a national online database of racial inequality, and a qualitative (narrative) archive. <ref>https://www.bu.edu/antiracism-center/antiracism-research/</ref>

*'''O'Neill Institute for National and Global Health Law''' published "The Context: Racial and other Disparities in the Opioid Crisis." <ref>https://oneill.law.georgetown.edu/wp-content/uploads/2024/03/240308-APP-Policy-Scholar-Lauren-N-WEB.pdf</ref>

= Available Tools and Resources =

*'''SAMHSA.''' This text includes a chapter allocated to behavioral health treatment for major racial and ethnic groups. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4849.pdf</ref> SAMHSA also manages the Prevention Technology Transfer Center Network (PTTC) and this presentation covers by the Southwest PTTC covers unique challenges faced by marginalized communities in accessing substance use prevention resources and effective strategies for engaging and empowering all communities. <ref> https://pttcnetwork.org/wp-content/uploads/2024/05/Mobilizing-vulnerable-populations-PPT.pdf</ref>

*'''SAFE Project''' has published “Resources for Diverse Populations” which provides links to a suite of resources for a variety of populations. Typically, it will take a combination of several strategies to reduce disparity. Therefore, it is important that there be as much input as possible when considering what needs to be done in a given community. <ref>https://www.safeproject.us/resource/resources-for-diverse-populations/</ref>

*'''United Nations.''' The UN Partnership on the Rights of Persons with Disabilities and UN Women have published “Intersectionality Resource Guide and Toolkit: An Intersectional Approach to Leave No One Behind." It was developed to help both organizations and individual practitioners address intersectionality in policies and in programs. It aims to contribute to an understanding of intersectionality that bridges the gap between theory and practice. <ref>https://wrd.unwomen.org/practice/resources/intersectionality-resource-guide-and-toolkit</ref>

*'''JUSTICE SQUARED (Just Leaders for a Just Health System)''' is a collective which is supported by the Robert Wood Johnson Foundation. It aims to create practical, impactful, structural change to advance health equity and racial justice. <ref>https://justicesquared.org/</ref>

*'''The Hawai’i Department of Health''' manages the ‘Ohana Center of Excellence, which provides training and technical assistance for those working in substance use, behavioral, and mental health to better serve the needs of the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) communities through culturally responsive care. Their website provides access to a variety of workshops and research articles. <ref>https://aanhpi-ohana.org/</ref>

*'''"How to Be an AntiRacist"''' is a best-selling book by Ibram X. Kendi. Since racism is often what is being left unsaid in addressing disproportionality, this book, while not directly about health inequity, provides a broad understanding of racism and other “-ism’s” and includes recommendations for building a more just society.

*'''The Drug Policy Alliance''' has published three facts sheets on the impact of the overdose crisis on Black, Native American, and Latinx communities. <ref>https://drugpolicy.org/resource/fact-sheet-the-impact-of-the-overdose-crisis-on-black-communities-in-the-united-states/</ref>

= Promising Practices =

*'''Arkansas.''' This project aims to reduce alcohol use among black men by providing screening and brief interventions in a barbershop. <ref>https://health-equity-action.org/project/crhs-3</ref>

= Sources =

Intersectionality and Addressing Disparities

2025-03-24T19:12:00Z

BasilSavitsky: /* Key Information */

= Introductory Paragraph =

This is the second in a pair of related articles on health equity centered around disparities and disproportionality. The first article titled, “Apply a Health Equity Lens,” focused on resources associated with building health equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref> This requires an active commitment to remove obstacles for groups that are more impacted by inequity. The material below centers on strategies in the field of substance use which are associated with populations impacted by various systemic inequities.

= Key Information =

Addressing disparities begins by acknowledging that we are all unique and hold multiple identity lenses. Likewise, as members of different groups within our communities, we experience thesse differences in navigating screening, diagnosis, treatment, and recovery supports. This is particularly relevant in the historical context of substance use because some groups have been more marginalized or historically underrepresented and impacted by systemtic inequities over others. For example, recent overall statistics demonostrate a 14.5% decline in national overdose deaths for the 12-month period ending June 2024. <ref>https://www.safestates.org/news/687677/CDC-Data-Shows-a-Decline-in-Overdose-Deaths.htm</ref> However, upon further examination, it becomes apparent that the recent decrease in the overdose rate is not uniformly distributed. Positive trends predominantly benefit White people.

Increased awareness of disparities and disproportionalities impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with lower socio-economic status, and pregnant people. The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this recent crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:

* While studies show that Black people use cocaine at similar rates to other racial and ethnic groups, the overdose rates related to cocaine for Black individuals, disproportionately higher compared to White individuals. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment/recovery (MAT/MAR). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>
* The overdose rate for Native Americans, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions are associated with methamphetamines, versus opioids. In 2022, the national Native American overdose fatality rate associated with methamphetamines was more than double the rate for Whites. Tribal lands often have limited infrastructure impacting service delivery. Oftentimes, resources off reservations can be a transportation barrier and lack cultural competency to effectively serve Native Americans. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
* Latinx communities have experienced significant challenges with rising overdose rates (doubling between 2018 and 2022), especially as the prevalence of Fentanyl has increased. This is compounded by barriers to care, such as language access and documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
* Linguistic disparities affect a large portion of the approximately 26 million people who have limited English proficiency (LEP). One survey found that adults with LEP report worse health status and increased barriers in accessing health care compared to English-proficient adults. One out of three say they have faced language barriers when seeking health care. Twice as many LEP adults than English-proficient adults report not having a usual source of healthcare and almost twice as many report having fair or poor health.
<ref>https://www.kff.org/racial-equity-and-health-policy/poll-finding/language-barriers-in-health-care-findings-from-the-kff-survey-on-racism-discrimination-and-health/</ref>

Inequitable impacts are also well documented across the following identities:

* Socioeconomic Status (SES). In a summary of research within NIH funded by the National Institute on Minority Health and Health Disparities (NIMHD), two “pillars of health disparity science” were identified. The first encompasses the racial and ethnic disparities described above. The second pillar relates to SES which “contributes to health disparities through limited resources and opportunities to engage in health-promoting activities relative to high educational attainment and income.” <ref>https://jamanetwork.com/journals/jama-health-forum/fullarticle/2812750</ref> Lower SES was found to be strongly linked with health outcomes, including mortality. <ref>https://www.pnas.org/doi/full/10.1073/pnas.2024777118</ref> More specifically related to SUD disparities, SAMHSA data indicates that in 2019 the uninsured populations had a 7.3% rate of alcohol use disorder compared to a 5.0% rate for the insured. <ref>https://www.samhsa.gov/data/sites/default/files/reports/rpt35328/2021NSDUHBHEReport.pdf</ref>

* Geographic Disparities. The Rural Health Information Hub documents higher rates of binge drinking in rural areas as well as use of tobacco, methamphetamines, and opioids. Challenges faced in rural communities include lower number of behavioral health and detoxification services and a decreased range of services in centers which can be accessed. Greater distance to substance use disorder treatment often results in lower completion rates of substance use treatment programs. <ref>https://www.ruralhealthinfo.org/topics/substance-use</ref> This is compounded by a differential among rural health providers in a negative perception of treatment for substance use disorder. <ref>https://www.tandfonline.com/doi/full/10.1080/00952990.2019.1694536</ref>

* A majority of pregnant people who use substances who do receive appropriate prenatal care and intervention are typically older and White with private health insurance. These people are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear of criminalization and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are disproportionately impacted by social and health disparites, and do seek treatment, often face significant barriers, as their honesty around their circumstances often leads to criminal reporting or an inability to find available and affordable treatment programs that meet their specific needs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>

* Older Adults. An evaluation by the Office of Disease Prevention and Health Promotion within US-HHS on the social determinants of health lists several factors which amplify health disparities for older adults. These include increased isolation for singles aged 65+ as well as decreased ease of access to services and increased need for services, particularly associated with a higher rate of chronic health conditions. <ref>https://odphp.health.gov/our-work/national-health-initiatives/healthy-aging/social-determinants-health-and-older-adults#health</ref> In 2020, consumers aged 65 and older averaged out-of-pocket health care expenditures of $6,668, and older Americans spent 14% of their total expenditures on health, compared to 8.4% among all consumers. <ref>https://acl.gov/sites/default/files/Profile%20of%20OA/2021%20Profile%20of%20OA/2021ProfileOlderAmericans_508.pdf</ref> This forces difficult choices in prioritizing health needs within families which might delay or eliminate pursuit of SUD services.

* Youth. Risk factors for youth(18-25) having higher substance use rates than adults over 25 years old are commonly recognized. For example 2023 data indicate that 18% of youth had a drug use disorder in the past year, compared to 8.6% for adults 26 or older — more than twice the rate. <ref>https://www.samhsa.gov/data/report/2023-nsduh-detailed-tables</ref> The disparities that youth face in protective factors is less understood. For example, access to alternatives to substance-free activities is based on a variety of social determinants, such as transportation to extracurricular activities and family or community funding to foster equitable access to athletic, artistic, or social functions that promote protective factors such as self-esteem and pro-social bonding. <ref>https://pmc.ncbi.nlm.nih.gov/articles/PMC6601618/</ref>

* Veterans. One in five veterans experience behavioral health problems and veterans are twice as likely to die from overdose than non-veterans. <ref>https://www.safeproject.us/veterans/</ref> In terms of social determinants of health, one research meta-analysis concluded that “veterans enrolled in VHA services are more medically complex, have lower physical and mental health functioning, and have lower socioeconomic resources, as compared with either non-Veterans or Veterans not engaged in VHA care.” <ref>https://pmc.ncbi.nlm.nih.gov/articles/PMC6153229/</ref>

* Persons with disabilities are 2-4 times more likely to experience alcohol and substance use disorder. <ref>https://americanaddictioncenters.org/rehab-guide/addiction-disability</ref>

'''Intersectionality'''

Intersectionality is a complex topic that warrants a full understanding by anyone engaged in social change work. Intersectionality runs deeper than, and should not be confused with, the type of inter-sectoral work found in promoting environmental justice by both environmentalists and social justice activists. Intersectionality describes a method for defining the mix of social identities with more accuracy than single identity formulations allow. For example, everyone is a blend of gender, race, class, and ability categories as opposed to being a type of member in different categories. Intersectionality has become associated with social and political correlations with privilege and marginalization. The term, intersectionality, was coined by Kimberlé Williams Crenshaw in three legal cases in 1989. Although each of the cases were lost, her position has been adopted widely in the social justice community and is often linked with its formative roots in Critical Race Theory. Crenshaw made a case in law suits for black women that this newly defined form of discrimination transcended racial and gender discrimination because black women were being judged in the legal system separately both as women and as members of a minority rather than as black women. In the decades since, the term has become politically controversial, because it has moved outside of the generally agreed upon ''descriptive'' nature of discriminatory patterns to a ''prescriptive'' call to action to address sources of structural power differentials. It has been critiqued both for the scope of change for which intersectional advocates calls and for the difficulty in measuring success in conditions which are inherently multi-variable. <ref>https://www.vox.com/the-highlight/2019/5/20/18542843/intersectionality-conservatism-law-race-gender-discrimination</ref>

'''Coalition Responsibilities When Addressing Disparities'''

Coalitions have a responsibility to work towards the well-being and protection of all individuals in our communities, ensuring equity and inclusion in all efforts. The first step in implementing this responsibility is to recognize that history points to long-term patterns of inequity. The next step is to realize the scope and diversity within health inequity. This includes incorporating people with lived experience in the decision making process and implementing trauma-informed approaches. Specific recommendations for practicing cultural competence and humility and for applying a health equity lens in strategy planning are detailed in the section titled “Building Capacity for Health Equity” within the SAFE Solution article on Health Equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref>

In addition to the statistics on racial and ethnic disparities detailed above, there are several constituencies within communities for which substance use statistics are less documented. For example, collection of data on the transgender and people questioning their gender identity have been more difficult to collect, particularly for youth, as compared to their heterosexual peers. However, limited data have been collected by SAMHSA in its annual surveys on people who identify as lesbian, gay, or bisexual. Factors around discrimination, trauma, stigma, and lack of services available to meet their needs often double or triple use rates by LGB respondents, for all substances. <ref>https://clearbrook.banyantreatmentcenter.com/news/lgbtq-substance-abuse-facts-and-tatistics/</ref> When a coalition examines the membership of its community, it should look at not only the specific needs of racial, ethnic, and LGBTQ+ communities, but also evaluate the concerns of military-connected people, individuals with disabilities, and those with lower socio-economic status.

One example might help to humanize what may seem to be abstract demographic characteristics. This points to the complexity of systems which are faced in one specific case. Someone named Chris has just been released from prison and is returning home. Chris is fortunate enough to have been supported in developing a recovery plan which includes medication-assisted treatment/recovery (MAT/MAR). However, Chris’s parole officer maintains that Chris cannot use any substances, MAT/MAR, or otherwise. Instead Chris is required to do x, y, and z, none of which are in the recovery plan. A lack of re-entry services and laws in Chris’s state precluded applying for Medicaid in advance. Chris left jail with three days of medication, but cannot see a doctor for a week. Chris is unable to find recovery housing with nearby transportation who will accept someone with a criminal background, so has not yet found employment. Without a job and without prescription coverage, Chris cannot afford to get more medication. The doctor wants to prescribe medications which the parole officer will not allow. If coalition members understand how their local systems are not working together and are working against people, then they can begin to see how difficult daily life might be for undocumented people or LGBTQ+ youth who are ready but uncertain as to how to access substance use services.

= Relevant Research =

*'''This article''' addresses disparities in treatment and access to treatment, regarding economic status and race/ethnicity. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087681/</ref>

*'''The Boston University Center for Antiracist Research''' is a collaborative research and education effort which includes Racial Data Lab, a national online database of racial inequality, and a qualitative (narrative) archive. <ref>https://www.bu.edu/antiracism-center/antiracism-research/</ref>

*'''O'Neill Institute for National and Global Health Law''' published "The Context: Racial and other Disparities in the Opioid Crisis." <ref>https://oneill.law.georgetown.edu/wp-content/uploads/2024/03/240308-APP-Policy-Scholar-Lauren-N-WEB.pdf</ref>

= Available Tools and Resources =

*'''SAMHSA.''' This text includes a chapter allocated to behavioral health treatment for major racial and ethnic groups. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4849.pdf</ref> SAMHSA also manages the Prevention Technology Transfer Center Network (PTTC) and this presentation covers by the Southwest PTTC covers unique challenges faced by marginalized communities in accessing substance use prevention resources and effective strategies for engaging and empowering all communities. <ref> https://pttcnetwork.org/wp-content/uploads/2024/05/Mobilizing-vulnerable-populations-PPT.pdf</ref>

*'''SAFE Project''' has published “Resources for Diverse Populations” which provides links to a suite of resources for a variety of populations. Typically, it will take a combination of several strategies to reduce disparity. Therefore, it is important that there be as much input as possible when considering what needs to be done in a given community. <ref>https://www.safeproject.us/resource/resources-for-diverse-populations/</ref>

*'''United Nations.''' The UN Partnership on the Rights of Persons with Disabilities and UN Women have published “Intersectionality Resource Guide and Toolkit: An Intersectional Approach to Leave No One Behind." It was developed to help both organizations and individual practitioners address intersectionality in policies and in programs. It aims to contribute to an understanding of intersectionality that bridges the gap between theory and practice. <ref>https://wrd.unwomen.org/practice/resources/intersectionality-resource-guide-and-toolkit</ref>

*'''JUSTICE SQUARED (Just Leaders for a Just Health System)''' is a collective which is supported by the Robert Wood Johnson Foundation. It aims to create practical, impactful, structural change to advance health equity and racial justice. <ref>https://justicesquared.org/</ref>

*'''The Hawai’i Department of Health''' manages the ‘Ohana Center of Excellence, which provides training and technical assistance for those working in substance use, behavioral, and mental health to better serve the needs of the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) communities through culturally responsive care. Their website provides access to a variety of workshops and research articles. <ref>https://aanhpi-ohana.org/</ref>

*'''"How to Be an AntiRacist"''' is a best-selling book by Ibram X. Kendi. Since racism is often what is being left unsaid in addressing disproportionality, this book, while not directly about health inequity, provides a broad understanding of racism and other “-ism’s” and includes recommendations for building a more just society.

*'''The Drug Policy Alliance''' has published three facts sheets on the impact of the overdose crisis on Black, Native American, and Latinx communities. <ref>https://drugpolicy.org/resource/fact-sheet-the-impact-of-the-overdose-crisis-on-black-communities-in-the-united-states/</ref>

= Promising Practices =

*'''Arkansas.''' This project aims to reduce alcohol use among black men by providing screening and brief interventions in a barbershop. <ref>https://health-equity-action.org/project/crhs-3</ref>

= Sources =

Integrate Substance Use Prevention & Mental Health Services

2025-03-10T21:01:24Z

BasilSavitsky: /* Available Tools and Resources */

= Introductory Paragraph =

A national study shows that one in five Americans has a mental health issue. <ref>https://www.nimh.nih.gov/health/statistics/mental-illness#:~:text=Mental%20illnesses%20are%20common%20in,(57.8%20million%20in%202021).</ref> In this study, young adults between the ages of 18 and 24, indicated that more than 61 percent of respondents who had used opioids not prescribed to them had done so primarily to relieve anxiety and stress. <ref>https://marychristieinstitute.org/announcements/survey-finds-risky-opioid-use-among-college-age-youth-with-limited-knowledge-of-the-danger-or-where-to-get-help/</ref> Early identification, screening, accurate diagnosis, and effective treatment of mental health and substance use conditions can alleviate suffering for individuals and their families dealing with behavioral health challenges. Early access and detection of mental health conditions can expedite recovery, enhance educational and employment opportunities, positively impact relationships, and ultimately improve quality of life.<ref>https://www.mhanational.org/issues/position-statement-41-early-identification-mental-health-issues-young-people</ref>

Mandated screenings for physical health concerns are in place for issues such as vision and hearing. Similarly, early detection of mental health and substance use should occur for young people who may be vulnerable to these issues. These screenings should occur as they do for early detection of physical conditions in venues such as schools, primary health care providers, and other community areas. Communities should be given the tools and support necessary to identify signs of mental health or substance use issues at the earliest possible time. This position is endorsed by the United States Preventive Services Task Force <ref>https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-depression-suicide-risk-children-adolescents</ref> and the American Academy of Pediatrics, specifically for depression in youth over age 12. <ref>https://www.additudemag.com/mental-health-screening-aap-anxiety-depression-youth/</ref> Early detection and screening will reduce the likelihood and consequences of delaying care.

Resources such as access to comprehensive mental health and substance use evaluations should be available to parents and guardians whenever warning signs are observed. <ref>https://mhanational.org/MentalHealthInfo</ref> Access to adequate care can reduce barriers to learning and improve educational, behavioral, and health outcomes for our youth. The most effective services promote collaboration among all of the people available to help. Pertinent individuals include families, educators, child welfare caseworkers, health insurers, community mental health providers, and substance use treatment providers. Reducing barriers and creating incentives can improve collaboration across systems and funding sources.

In order to improve mental health detection and treatment outcomes, some barriers need to be addressed. Health disparities such as lack of health insurance, cultural factors that discourage mental health treatment, and socioeconomic status need to be addressed to ensure adequate care to all individuals. Disparities in communities may be a factor in the early diagnosis and treatment of mental health conditions and can increase mental illness challenges in already vulnerable and underserved individuals, families, and communities.<ref>https://www.nimh.nih.gov/about/director/messages/2020/addressing-disparities-advancing-mental-health-care-for-all-americans</ref>

= Key Information =

'''Mental Health and Drug Addiction'''

Mental health and drug addiction are undeniably linked. According to the National Institute on Drug Abuse “Many individuals who develop substance use disorders (SUD) are also diagnosed with mental disorders, and vice versa. Multiple national population surveys have found that about half of those who experience a mental illness during their lives will also experience a substance use disorder and vice versa.” <ref>https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness
</ref> Studies have shown that around 1 in 4 individuals that have a serious mental illness also have an SUD. <ref>https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness</ref> Many people attempt to use drugs to self-medicate their mental illness or escape their situation, so understanding mental health is essential to any prevention or recovery effort. The National Alliance of Mental Illness (NAMI) has distilled the following statistics from SAMHSA and CDC: <ref>https://www.nami.org/mhstats</ref>

* 1 out of 5 U.S. adults experience mental illness each year <ref>https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf</ref>
* 1 out of 20 U.S. adults experience serious mental illness each year <ref>https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf</ref>
* 1 out of 6 U.S. youth, aged 6-17, experience a mental health disorder each year <ref>https://jamanetwork.com/journals/jamapediatrics/fullarticle/2724377?guestAccessKey=f689aa19-31f1-481d-878a-6bf83844536a</ref>
* 50% of all lifetime mental illness begins by age 14, and 75% by age 24 <ref>https://www.ncbi.nlm.nih.gov/pubmed/15939837</ref>
* Suicide is the 2nd leading cause of death among people aged 10-14 <ref>https://www.nimh.nih.gov/health/statistics/suicide.shtml</ref>

'''Youth Are Struggling with Mental Health Issues'''

A nationwide U.S. survey of over 1,300 youth conducted in 2018 shows evidence of a growing mental health crisis affecting 14 to 22-year-olds. The survey, sponsored by Hopelab and Well Being Trust (WBT), found that many teens and young adults who were experiencing moderate to severe symptoms of depression utilized online resources for help. Common uses of the Internet included researching mental health issues online (90 percent), accessing other people’s health stories through blogs, podcasts, and videos (75 percent), using mobile apps related to well-being (38 percent), and connecting with health providers through digital tools such as texting and video chat (32 percent).<ref>https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/</ref>

'''Co-Occurring Disorders'''

Co-occurring disorders, or dual diagnosis, refers to simultaneous having a mental health disorder and an SUD. It is common for people with addictions to also suffer from depression, anxiety, or more severe mental illnesses such as schizophrenia or bipolar disorder. Research shows that people who use alcohol or other drugs early in life are more likely to have mental or emotional problems. It’s also true that many people with mental illnesses “self-medicate” with alcohol or other drugs to numb emotional pain, relieve anxiety, or quiet their thoughts. In the past, the medical profession treated one disorder first, typically the substance use disorder, before addressing the other. It is now understood that treating both simultaneously leads to better outcomes. Any successful addiction treatment program will include a mental health assessment and treat co-occurring disorders at the same time.

'''Depression'''

Stigmatization of depression can reduce the likelihood of people reaching out to get the mental care they need. Instead, depressed people may ask for prescriptions to treat physical ailments, and use these prescription drugs to treat their emotional pain. Other factors to consider are listed below:

* Because depression is under-diagnosed and under-treated, depression and opioid abuse are strongly concurrent.<ref>https://doi.org/10.1097/j.pain.0000000000000658</ref>
* People with depression show abnormalities in the body’s release of its own opioid. chemicals<ref>https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/</ref>
* Depression tends to exacerbate pain—it makes chronic pain last longer and impacts the recovery process after surgery.
* Depression nearly doubles the risk that someone already using opioids will continue to use them long-term.
* Depressed people are about twice as likely to misuse their painkillers for non-pain symptoms.
* Depressed individuals are between two and three times more likely to ramp up their own doses of painkillers.
* Adolescents with depression are also more likely to use prescription painkillers for non-medical reasons and to become addicted.
* Depressed people are likely to keep using opioids, even when their pain has subsided.

'''Rural Areas'''

Shortages of mental-health providers are prominent in rural areas where the opioid epidemic hit the hardest. Some have suggested that providing mental health care to those suffering from chronic pain may help detangle the relationship between pain and depression.<ref>https://vrphobia.com/about-us-old/</ref> Overall, improving detection and treatment of mental health conditions includes improved early screening, assessment, and access to treatment as well as outreach and education in communities.

'''Homelessness'''

The unhoused population poses a unique opportunity to address the challenges of integrating substance use and mental health services, as well as in advancing work on health disparities and social determinants of health. Efforts made in harm reduction have highlighted the need for increasing awareness of the intersection of three primary issues facing unhoused people within their social contexts -- economic hardship, mental illness, and/or substance use disorder. The complex intersection of these three distinct but related issues amplify the stigma associated with each issue by itself. While awareness of co-occurring disorders has increased, public perceptions of safety versus the delivery of essential social and behavioral health services has generated confusion on effective solutions to a rapidly growing problem. This often polarizes support for increased law enforcement and support for increased social services. Medication-Assisted Treatment (MAT) is one domain with the substance use field which is successfully navigating this apparent conflict. Various policy recommendations to control the prescription of opiates and the treatment of opioid addiction have been made by the National Healthcare For Homeless Council and are detailed in the SAFE Solutions article titled "Expand Access to Medicated Assisted Treatment/Recovery (MAT/MAR) <ref>https://www.yoursafesolutions.us/wiki/Expand_Access_to_Medicated_Assisted_Treatment/Recovery_(MAT/MAR)</ref> Two of these policy recommendations are listed below: <ref>https://nhchc.org/wp-content/uploads/2019/08/addressing-the-opioid-crisis-priorities-for-the-hch-community.pdf</ref>
*Reduce stigma and treat addiction as a disease. The main barrier to any type of treatment for persons experiencing homelessness is a lack of stable housing. In addition, drug screens are often required when accessing housing, and employers often require drug screens for employment. Landlords and employers need to accept Buprenorphine prescribed as part of a MAT plan as a medical treatment process, and not have it count negatively against a person by including it as a prohibited substance. Addiction needs to be seen as a disease and not a moral failing, and engagement in MATs as a health care intervention should not be a liability to accessing housing or employment.
*Train all health care disciplines on addiction. Expanding awareness of addiction and providing substance abuse education for medical students, residents, practicing physicians, and all other health care providers is essential. Curricula which treat substance use conditions similarly to other chronic disorders and provide more adequate basic preparation need to be implemented. In addition, continuing education opportunities to learn about evidence-based practices for the treatment of SUDs need to be provided, and programs to support the adoption of MAT, screening, brief intervention, and referral to treatment need to be identified and implemented.

'''Recovery-Oriented Systems of Care (ROSC)'''

ROSC reflects a systems approach which has been successful in improving the quality of SUD service provision. <ref>The Surgeon General’s Report on Alcohol, Drugs, and Health. (2016), Drug-Free Communities, Retrieved from: https://obamawhitehouse.archives.gov/sites/default/files/ondcp/dfc/AdministratorEnomotoMeetDFCTeamPresentation.pdf</ref> It is an approach which requires collaboration between agencies -- with a person-centric posture. ROSC has utility for adoption within the prevention community, perhaps as PROSC (Prevention AND Recovery-Oriented Systems of Care). ROSC is described in the SAFE Solutions article titled, "Create Recovery-Ready Communities." <ref>https://www.yoursafesolutions.us/wiki/Create_Recovery-Ready_Communities#Available_Tools_and_Resources</ref>

= Relevant Research =

'''Prevention and Early Intervention in Youth Mental Health.''' This research article addresses the need to move the provision of mental health services from a secondary prevention approach (early intervention) to a series of primary prevention strategies -- reducing the onset of mental illness by promoting mental health for all youth. "Evidence suggests that it would be unrealistic to consider promotion and prevention in mental health responsibility of mental health professionals alone. Integrated and multidisciplinary services are needed." This calls for broader community engagement that is guided by mental health professionals. <ref>https://ijmhs.biomedcentral.com/articles/10.1186/s13033-020-00356-9</ref>

'''Findings of the Early Detection and Intervention Center Dresden.''' This article summarizes research on adolescents and young adults who sought help for bipolar disorders. The intervention and treatment recommendations provide insight into the complexity of prevention and intervention in one specific mental illness context, thus, facilitating an understanding of the challenges associated with prevention of co-occurring disorders. <ref>https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-021-00227-3</ref>

= Impactful Federal, State, and Local Policies =

'''SAMSHA Infant & Early Childhood Mental Health Grants''' are authorized under the 21st Century Cures Act. <ref>https://www.samhsa.gov/early-childhood-mental-health-programs/iecmh-grant-program</ref> The purpose of this program is to improve outcomes for children, from birth up to 12 years of age, by developing, maintaining, or enhancing infant and early childhood mental health promotion, intervention, and treatment services.

'''Project AWARE (Advancing Wellness and Resiliency in Education).''' SAMHSA also provides State Education Agency grants to develop sustainable infrastructure for school-based mental health programs and services and to ensure that school-aged youth have access to and are connected with appropriate and effective behavioral health services. With Project AWARE, SAMHSA aims to promote the healthy social and emotional development of school-aged youth and prevent youth violence in school settings. Through this program, schools are implementing evidence-based, culturally appropriate prevention programs that support youth at the universal, selective, and indicated levels. <ref>https://www.samhsa.gov/grants/2021/project-aware</ref>

'''Medicaid -- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)''' is designed to ensure that Medicaid benefits meet the needs of youth with SUD. States must comply with their obligations under Medicaid’s EPSDT requirements which enable youth to address their substance use disorders, to receive treatment and continuing care, and to participate in recovery services and supports. <ref>https://www.medicaid.gov/federal-policy-guidance/downloads/cib-01-26-2015.pdf</ref> NAMI provides guidance on advocacy for mental health screening associated with the EPSDT program. <ref>https://www.nami.org/Advocacy/Policy-Priorities/Improving-Health/Mental-Health-Screening</ref>

'''HRSA Pediatric Mental Health Access''' The purpose of this program is to promote behavioral health integration into pediatric primary care by supporting pediatric mental health care tele-health access programs. <ref>https://mchb.hrsa.gov/training/projects.asp?program=34</ref>

= Available Tools and Resources =

'''SAMHSA:'''
*'''SAMHSA 988 website.''' An easier-to-use 988 Partner Toolkit is now searchable and designed to help you better navigate the bank of the materials available for promoting 988 in your community. The toolkit has all the same video PSAs, social media promotions, print materials, logo and branding, radio, FAQs, messaging, and other 988 marketing materials. You can now easily search and filter all 988 materials by target audience, population, language, and resource type, allowing you to find the right materials that resonate with your audiences. <ref>https://www.samhsa.gov/resource-search/988?utm_source=SAMHSA&utm_campaign=a70075912e-EMAIL_CAMPAIGN_2024_01_16_06_24&utm_medium=email&utm_term=0_-a70075912e-%5BLIST_EMAIL_ID%5D</ref>
*'''Resources for Suicide and Substance Use Prevention in Youth.''' This webinar includes best practices for suicide prevention and intervention. <ref>https://store.samhsa.gov/product/Preventing-Suicide-A-Toolkit-for-High-Schools/SMA12-4669</ref>
*'''Comprehensive Case Management for Substance Abuse Treatment.''' This publication is in the SAMHSA Treatment Improvement Protocol Series. <ref>https://www.ncbi.nlm.nih.gov/books/NBK64863/pdf/Bookshelf_NBK64863.pdf</ref>

'''SAFE Project:'''
*'''Bridging Prevention and Recovery (BPR): A Community Approach to Systems Change.''' This SAFE Project program, offered in-person and virtually, guides community leaders through an action-oriented model to systemically integrate prevention and recovery systems to strengthen programs and improve outcomes. BPR is a 3.5 day training program that culminates with 6 technical assistance sessions tailored to each community’s unique set of needs to support implementation and sustainability of joint prevention and recovery community projects.<ref>https://www.safeproject.us/bridging-prevention-recovery/</ref>
*See the wiki titled "Become a Trauma-Informed Community" for more detailed information on the relationship between SUD and trauma-related mental health concerns. <ref>https://www.yoursafesolutions.us/wiki/Become_a_Trauma-Informed_Community</ref>

'''The National Institute of Mental Health''' provides resources on how to find immediate help, health care providers, how to decide if a provider is right for you, how to join a study, and resources to learn more about mental disorders. <ref>https://www.nimh.nih.gov/about/director/messages/2020/addressing-disparities-advancing-mental-health-care-for-all-americans</ref>

'''The American Academy of Child and Adolescent Psychiatry''' provides a service that helps find child and adolescent psychiatrists throughout America. <ref>https://www.aacap.org/</ref>

'''Mental Health America.''' MHA's work is driven by its commitment to promote mental health as a critical part of overall wellness, including prevention services for all; early identification and intervention for those at risk; integrated care, services, and supports for those who need them; with recovery as the goal. <ref>https://www.mhanational.org/issues/position-statement-41-early-identification-mental-health-issues-young-people</ref>

'''National Alliance on Mental Illness (NAMI)''' provides advocacy and education to support all individuals and families affected by mental illness build better lives. <ref>https://www.nami.org/Advocacy/Policy-Priorities/Improving-Health/Mental-Health-Screening</ref> NAMI provides a website, "Mental Health by the Numbers" which provides statistics that can be used to promote mental health awareness. <ref>https://www.nami.org/mhstats</ref>

'''The Homeless and Housing Resource Center (HHRC)''' provides an online library of webinars and self-paced training courses. HHRC works to foster housing stability and recovery, with an aim to end homelessness for people with serious mental illness, serious emotional disturbance, or co-occurring disorders. <ref>https://hhrctraining.org</ref>

'''Communities that Care''' promotes a range of youth mental and behavioral health outcomes, including survey tools, a parenting program, and a variety of prevention education programs. <ref>https://www.communitiesthatcare.net/</ref>

'''Early Mental Health Screening and Intervention.''' This clinical practice brief by the American Mental Health Counselors Association (AMHCA) provides information on intervention and screening across the lifespan. <ref>https://www.amhca.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=2ca60afe-8be0-af27-2ad9-7100b61ad636&forceDialog=0</ref>

'''Identifying Mental Health and Substance Use Problems of Children and Adolescents: A Guide for Child-Serving Organizations.''' This manual offers guidance and tools for identifying mental illness or substance use issues early in children and adolescents in various setting, such as in schools, the juvenile justice and child welfare systems, and when receiving primary care. <ref>https://store.samhsa.gov/product/Identifying-Mental-Health-and-Substance-Use-Problems-of-Children-and-Adolescents-A-Guide-for-Child-Serving-Organizations/SMA12-4700</ref>

'''Mental Health During Global Conflict.''' People across the world may find they struggle with their mental health during times of global conflict. This does not affect only those in active combat. These are humanitarian crises, impacting an entire community or region and beyond. This page addresses how mental health might be affected by major conflict events like war, terrorism, geopolitical tension, territorial disputes, and political instability. <ref>https://mhanational.org/crisis/global-conflict?eType=EmailBlastContent&eId=5fab664b-5726-42b6-a0da-0c1fcf0fba92</ref>

= Promising Practices =

'''Centers for Medicare & Medicaid Services''' has launched its Innovation in Behavioral Health (IBH) Model in collaboration with state Medicaid agencies in Michigan, New York, Oklahoma, and South Carolina. IBH is designed to deliver person-centered, integrated care to Medicaid and Medicare populations, including those who are dually eligible, with moderate to severe mental health conditions or substance use disorder (SUD), or both. <ref>https://www.cms.gov/priorities/innovation/innovation-models/innovation-behavioral-health-ibh-model</ref>

'''Virtual Reality Medical Center (VRMC)''' has been working since the 1990s to use virtual reality to treat mental illness. An early clinical trial of their software found that after an average of seven sessions, 45 percent of those treated no longer screened positive for PTSD and 62 percent had reliably improved. VRMC uses simulation technologies for: <ref>https://vrphobia.com/about-us-old/</ref>

*Treating patients with anxiety disorders
*Training for both military and civilian populations
*Enhancing various educational programs
*Desensitization
*Sessions at home
*Reduction of the number of sessions people need

'''M3 Information ''' provides a mental health screening tool that measures outcomes based on a 27-question diagnostic checklist targeted for adults aged 18 and older. The M3 Checklist accurately measures outcomes based on question responses for major depression, bipolar disorder, anxiety disorder and post-traumatic stress disorder (PTSD). <ref>https://www.m3information.com/</ref>

'''MyStrength''' is a digital platform that integrates state-of-the-art technologies to support people in addressing mental and behavioral health issues. It can be integrated with a professional practice to allow them to see more patients more efficiently and better meet the needs of their patients between in-person visits. <ref>https://mystrength.com/</ref>

= Sources =

Collect and Share Data

2025-03-10T20:08:42Z

BasilSavitsky: /* Available Tools and Resources */

= Introductory Paragraph =

Data collection, analysis, and reporting are critical components to strengthening a community’s response to drug misuse and substance use disorder (SUD). By sharing and regularly monitoring data, communities can build credibility, raise awareness and political will, share knowledge, identify more effective interventions and strategies, guide decision making, and allow for better budgeting and allocation of funds. For a community coalition to be successful, it needs to understand how the community perceives a number of elements of substance use, as well as what resources are already at work across the many stakeholders in the community.

Systems-building is a complex process. The role of data in this process can be understood using a chemistry metaphor. Data are the atoms, and in proper combination, they form molecules of information. In complex systems, these molecules interact in a variety of ways. So, having the right amount of data and converting that data into information is essential for the optimal functioning of a balanced system. When the system is out of balance, as we see in the SUD crisis, then it is essential to identify the right data and to convert that data to information for use within the community.

= Key Information =

Assessment is the first of five phases in SAMHSA's Strategic Prevention Framework (SPF). The collection of data from multiple sectors is vital to inform the ''assessment, planning, implementation, and evaluation'' steps in the SPF approach. The first step of assessment is based upon up-to-date and accurate data to support the diagnosis of what is currently happening at the most local scale of community. The planning phase uses the information derived from that assessment data to prioritize optimal implementation strategies. Planning data also fosters coalition capacity-building by using a data-driven approach to reaching agreement about the most effective strategies to implement. The evaluation phase not only uses data to measure outcomes, it also provides a method for communicating success, backed by data, to the community. This creates a new baseline for the coalition to revise its strategies and begin the SPF cycle again -- more effectively.

Assessment of community resources links to the assessment of community needs. The gap between needs and resources creates a clear foundation for next action steps. The collection, distribution, and rapid analysis of data is critically important to developing a strategy to address areas within a community which are being severely impacted by SUD. This typically goes far beyond just tracking overdose deaths and non-fatal overdoses. It is important to know precisely where they are occurring in order to know where more resources need to be deployed. Data are commonly simplified or ''aggregated'' into broad geographic regions such as the city or by population characteristics such as race and ethnicity. Using more specific census data requires going to a ''disaggregated level'' which can help to identify disparities and to inform policies and practices for specific populations at the zip code, census tract, or even neighborhood level. Such data collection efforts foster healthy equity and can help to more effectively direct appropriate services to targeted areas within the community where they are most needed. This will also help community partners in better addressing the crisis in their specific neighborhoods.

Some examples of disaggregate data include: age, sex, average household income, veteran status, marital status, education, citizenship, disability status, primary language spoken at home, and employment status.

'''Where to Start and Key Questions to Consider'''

Drug misuse and SUD are complex problems requiring a comprehensive set of solutions. Building a sufficient data set to support real solutions can often be challenging, so communities should expect to be met with some level of resistance. Many agencies who hold important sources of data are often not accustomed to working with others and sharing their data. Although questions of confidentiality may pose a barrier to data-sharing, many communities have successfully worked to establish trusting relationships between agencies. One key to this success has been having clearly identified leadership to coordinate and gather needed data and to regularly summarize and report on findings. These leaders are often individuals in the public health sector, who have the experience and expertise necessary to collect, analyze, and present data in a way that is clear and easy to understand. Once leadership of the data effort is determined, discussions can take place between agencies to determine data sources, willingness and ability to share data, and any restrictions which may exist. In most cases, all parties want to help save lives and improve their community, and any issues can be worked out with little difficulty.

In some cases, there may not already be a community-wide data collaboration effort in place. The following questions may serve to guide the coalition in launching commitment to such a process:

*What data sources are currently available?
*How are they being used?
*Does the coalition have the partners to provide the necessary data?
*How can the coalition expand the data set to help focus resources where they are most needed, and when they are most needed?
*What can be done in a short amount of time, at reasonable expense, to better collect, analyze, and make use of data related to the SUD epidemic in the region?
*How can the coalition better serve areas of the community that have been underserved?
*What partnerships can help make this happen effectively?
*What drugs are residents using? What are the trends? What are youth substance use rates?
*How many who need medication-assisted treatment (MAT) are receiving it? Does this include the criminal justice system?
*Are recovery support services - including housing, job training, coaching, and education available, and do they meet the needs of the community?
*For those involved in the criminal justice system, is there a history or presence of substance use problems?

It also may help to start with the exploration of data on the most severe harms - including fatal and non-fatal overdoses. Knowing the numbers is important to understand the scope of the problem, but to guide response, more detailed data is usually required. For example:

*Where are the geographic regions of where overdoses are occurring?
*What are the demographics of those areas?
*What type of substance, or combination, is involved?
*How often are such data collecting and analyzed?
*For non-fatal overdoses, how many go to a hospital or community health center?
*How many non-fatal overdoses are revived with naloxone? Who administers Naloxone - first responders or others?
*Are there clusters of overdoses occurring in specific areas and neighborhoods?
*What is currently being done? Are overdose prevention services being offered in areas with high overdose rates?
*What are the local opioid prescribing practices?
*Are people experiencing overdose being connected to services? How is this being done, and by whom?
*Are area treatment and other support services at capacity? Are there wait times or wait lists to get in?

'''Other Potential Data Sources'''

Asking any combination of all of the questions above typically leads to new questions which require additional data in order to identify gaps in services and the implementation of strategies to fill such gaps. Before collecting any new data, it is useful to scan existing sources, such as public records or a needs assessment which may have already been conducted that includes some SUD considerations. Common '''local data sources''' include:

*Local and State Health Departments (number of overdoses, locations, demographics)
*Fire/EMS Services (portion of overdoses, connection to services, Naloxone administration)
*Police and Public Safety Departments (number of overdoses, drug seizures, drug-related crime, diversion, and MAT in correctional facilities)
*Medical Examiner/Coroner's Reports (cause of death from overdose, type of substance(s) involved)
*911 Calls (calls related to suspected overdose)
*Local Hospitals and Community Health Organizations (number of non-fatal overdoses, connection to services, naloxone administration)
*Local Harm Reduction Service Providers (Naloxone and needle distribution, connection to services)
*Treatment Providers (treatment capacity and availability, wait times, MAT providers)
*Pharmacies (records on Naloxone distribution to indicate awareness and/or increased use)
*Prescription Drug Monitoring Program (PDMP) (identify high risk prescribers)
*Recovery Support Services (amount and adequacy of peers, availability of housing, access to job training, tracking data on clients remaining in recovery)

To help put community data into a bigger context, it helps to compare local data to other communities with a similar makeup at the state and even national levels. Some '''national data sources''' include:

*Centers for Disease Control (CDC) <ref>https://www.cdc.gov/</ref>
*Substance Abuse and Mental Health Services Administration (SAMSHA) <ref>https://www.samhsa.gov/</ref>
*National Survey on Drug Use and Health <ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>
*Robert Wood Johnson County Rankings and Roadmaps <ref>https://www.countyhealthrankings.org/</ref>
*U.S. Census Bureau American Community Survey (ACS)<ref>https://www.census.gov/programs-surveys/acs</ref>

'''Telling the Story Behind the Data'''

In addition to measurable, or quantitative data, a community coalition can use ''qualitative data'' to make the issues more personal and relatable. Capturing qualitative data to describe the story behind the numbers can be done through community surveys, listening sessions, public forums, interviews, observations, case studies, or focus groups. Such a deeper examination may identify trends in drug use, types of drugs, and community perception of the problem. This may lead to a better understanding of the root causes of the problem which might not be as immediately apparent using only quantitative data ''about the problem.'' This targeted examination can include questions about accessibility, affordability, availability, and the cultural relevance of programs and policies. Honoring the perspectives and voices of those most impacted by the coalition’s decisions helps to increase the engagement of individuals directly being served. Understanding their challenges and barriers creates a foundation for including some of them in the formal decision-making of the coalition. If possible, these community members should be provided compensation for their time.

Another benefit to using qualitative data, is that the process can be used to balance how much coalition time is dedicated to data and to know when they have collected enough quantitative data. The qualitative data help to have a true understanding of what i occurring in their communities and to be able to tell that story in a way that is compelling. quantitive data back up the story. While data should be at the forefront of the coalition’s decision-making, it is important to move from assessment to the action phase of implementation.

= Impactful Federal, State, and Local Policies =

'''Federal.''' SAMHSA promotes a data-driven approach in order to ensure that evidence-based practices are deployed and the optimal outcomes can be known to be achieved. It is important for communities to understand the federal and state legal framework since some data might contain protected health information -- because they are measured. The US Bureau of Justice Assistance has worked with the Justice Center of the Council of State Governments to create a guide about best practices for sharing data across behavioral health and criminal justice systems. <ref>https://bja.ojp.gov/sites/g/files/xyckuh186/files/Publications/CSG_CJMH_Info_Sharing.pdf</ref>

'''Communities''' often have to break down existing data silos so that various public, private, and community partners can engage and collaborate effectively. When agencies are ready to share data, some type of data sharing agreement is usually required. Parties will need to know that confidential or other sensitive data will not be disclosed publicly or beyond a limited number of participants. While the creation of such documents is often done by legal counsel in order to address privacy issues and compliance with laws and regulations, there are many existing examples which can be modified to meet the requirements of most agencies.

= Available Tools and Resources =

* '''SAMHSA''' provides online access to national substance use and mental health data and a variety of tools for performing analysis and presentation for communities to utilize. It has also has compiled extensive information on SPF. Two starting points for accessing decades of experience on the role of data processes within SPF can be found in "A guide to SAMHSA’s Strategic Prevention Framework" <ref> https://www.samhsa.gov/sites/default/files/20190620-samhsa-strategic-prevention-framework-guide.pdf </ref> and "Selecting Best-fit Programs and Practices: Guidance for Substance Misuse Prevention Practitioners." <ref>https://www.samhsa.gov/sites/default/files/ebp_prevention_guidance_document_241.pdf</ref>

* '''SAFE Project''' provides the "Community Playbook" which is a framework for communities to organize, evaluate, and create the level of change needed to impact the substance use epidemic. <ref>https://www.safeproject.us/safe-community-playbook-and-safe-solutions/</ref> It includes tools such as the SAFE Community Pulse Survey and SAFE Community Resources Exercise which are designed specifically to provide the insight a coalition needs to focus and prioritize its work. The Pulse Survey examines community perceptions of the opioid and substance use crisis through a short survey. It is not meant to be a scientific analysis of attitudes and perceptions, but rather to provide a snapshot of how the community as a whole perceives the issues a coalition will be tackling. This is also a tool to let the broader community know about the coalition’s focus and to engage with other community members. Not everyone will agree on the best approaches; the climate survey allows the community to “speak for itself.” The SAFE Community Resources Exercise helps coalition members understand the resources that their fellow members bring to the table as well as to educate the coalition about the depth and breadth of other services that are offered in the community.

* '''The National Association of County and City Health Officials (NACCHO)''' has published "Specifying Monitoring and Evaluation Measures for Local Overdose Prevention and Response Strategies: A Toolkit." <ref>https://www.naccho.org/uploads/card-images/community-health/SpecifyingOPRSMonitoringEvaluationMeasures_Toolkit2024.pdf</ref> This resource explicitly addresses common data sources and data sharing, but also focuses on the need to develop an effective data strategy to employ in the SPF Evaluation phase (See SAFE Solutions article titled "Plan, Implement, and Evaluate." <ref>https://www.yoursafesolutions.us/wiki/Plan,_Implement,_and_Evaluate</ref>

*'''Johns Hopkins Bloomberg School of Public Health''' has created a database of suggested indicators for monitoring opioid settlement funds. This tool is especially useful for linking the assessment process within SPF to the evaluation phase following Implementation. Opioid Settlement Principles Resource and Indicators (OSPRI) aims to help local government leaders find tangible impact indicators to evaluate community objectives funded by opioid settlement dollars. <ref> https://opioidprinciples.jhsph.edu/ospri/#using-the-indicators%22</ref>

* '''Harvard Institute for Excellence in Government''' – Includes case studies on data-driven approaches.<ref>https://scholar.harvard.edu/files/janewiseman/files/data_driven_approaches_to_fighting_the_opioid_crisis_jane_wiseman_april_2019.pdf</ref>

* '''The Margolis Institute for Health Policy''' at Duke University has published "Opioid Measurement Toolkit: Leveraging Aligned Data and Measures to Sustain Opioid Settlement Fund Investments." It provides context on the relationship between new funding streeams, existing health system infrastructure, and the need for data sharing and common measures. <ref>https://healthpolicy.duke.edu/sites/default/files/2024-06/Margolis%20Opioid%20Measurement%20Toolkit.pdf</ref>

* '''The Monitoring the Future Study''' <ref>http://monitoringthefuture.org/</ref> from the University of Michigan is an ongoing study that provides communities with data necessary to frame the issue related to the behaviors, attitudes, and values of American secondary school students, college students, and young adults. Each year, a total of approximately 50,000 8th, 10th, and 12th grade students are surveyed (12th graders since 1975, and 8th and 10th graders since 1991).

= Promising Practices =

Most coalitions choose to make public at least some of the data they collect. A data report raises awareness about the problem, the impacts it is having within the community, and often comparing the community to state or national conditions. This can be done through a dashboard or other regularly updated reports made available by the local government or a local task force. Dashboards often include information about opioid overdoses and other substance use concerns. These dashboards not only helps build public awareness and transparency, but also helps coalitions to support their identified strategies and to report back to their communities on progress over time. Most states and localities who have developed dashboards have greatly expanded available information to include information on other programs and efforts which provide additional opportunities for community members to take action. Three examples of dashboard follow:

* Cincinnati Overdose Response <ref>https://insights.cincinnati-oh.gov/stories/s/Heroin-Overdose-Responses/dm3s-ep3u/</ref>

* New Hampshire Drug Monitoring Initiative <ref>https://www.dhhs.nh.gov/programs-services/health-care/substance-misuse-data-page</ref>

* New Jersey Overdose Data Dashboard <ref>https://www.state.nj.us/health/populationhealth/opioid/</ref>

= Sources =

Intersectionality and Addressing Disparities

2025-03-01T01:24:30Z

BasilSavitsky: /* Key Information */

= Introductory Paragraph =

This is the second in a pair of related articles on health equity and disproportionality. The first article titled, “Apply a Health Equity Lens,” focused on resources associated with building health equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref> This requires an active commitment to remove obstacles for groups that are more impacted by inequity, and the material below centers on strategies in the field of substance use which are associated with marginalized populations.

= Key Information =

Addressing disparities begins by acknowledging that we are all unique and that a community look through multiple identity lenses. Likewise, as members of different groups within our communities, we experience differences in the screening, diagnosis, treatment, and recovery supports. This is particularly relevant in the historical context of substance use, because some groups have been more marginalized than others. For example, in looking at recent overall statistics, there is positive news — a 14.5% decline in national overdose deaths for the 12-month period ending June 2024. <ref>https://www.safestates.org/news/687677/CDC-Data-Shows-a-Decline-in-Overdose-Deaths.htm</ref> However, examining these gains through a disparities lens, it becomes apparent that the recent decrease in the opioid overdose rate is not uniformly distributed. Positive trends predominantly benefit White people.

Increased awareness of disproportionality impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with low socio-economic status, and pregnant people. For example, the majority of pregnant substance-using people who do receive appropriate care and intervention are older and white with private health insurance. They are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are marginalized and do seek treatment have little success, as their honesty often leads to criminal reporting or they are unable to find available and affordable treatment programs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>

The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:

* Black people do not use cocaine at higher rates than other groups, yet the cocaine-related overdose for Blacks is triple that of Whites. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment (MAT). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>
* Native Americans overdose death rates, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions associated with methamphetamines, versus opioids. In 2022, the national Native American overdose death rate associated with methamphetamines was more than double the rate for Whites. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
* Latinx overdose rates doubled between 2018 and 2022, in large part to the proliferation of Fentanyl. Linguistic barriers which reduce access to prevention and harm reduction programs and compounded by disparities associated with documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>

'''Intersectionality'''

Intersectionality is a complex topic that warrants a full understanding by anyone engaged in social change work. Intersectionality runs deeper than and should not be confused with the type of inter-sectoral work found in promoting environmental justice by both environmentalists and social justice activists. Intersectionality describes a method for defining the mix of social identities with more accuracy than single identity formulations allow. For example, everyone is a blend of gender, race, class, and ability categories as opposed to being a type of member in different categories. Intersectionality has become associated with social and political correlations with privilege and marginalization. The term, intersectionality, was coined by Kimberlé Williams Crenshaw in three legal cases in 1989. Although each of the cases were lost, her position has been adopted widely in the social justice community and is often linked with its formative roots in Critical Race Theory. Crenshaw made a case in law suits for black women that this newly defined form of discrimination transcended racial and gender discrimination, because black women were being judged in the legal system separately both as women and as members of a minority rather than as black women. In the decades since then, the term has become politically controversial, because it has moved outside of the generally agreed upon ''descriptive'' nature of discriminatory patterns to a ''prescriptive'' call to action to address sources of structural power differentials. It has been critiqued both for the scope of change for which intersectional advocates calls and for the difficulty in measuring success in conditions which are inherently multi-variable. <ref>https://www.vox.com/the-highlight/2019/5/20/18542843/intersectionality-conservatism-law-race-gender-discrimination</ref>

'''Coalition Responsibilities'''

Coalitions have a responsibility to work to protect everyone in our communities. The first step in implementing this responsibility is to recognize that history points to long-term patterns of inequity. The next step is to realize the scope and diversity within health inequity. This includes incorporating people with lived experience in the decision making process and implementing trauma-informed approaches. Specific recommendations for practicing cultural competence and humility and for applying a health equity lens in strategy planning are detailed in the section titled “Building Capacity for Health Equity” within the SAFE Solution article on Health Equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref>

In addition to the statistics on racial and ethnic disparities detailed above, there are several constituencies within communities for which substance use statistics are less documented. For example, collection of data on the transgender and questioning members of the LGBTQ+ has been more difficult to collect, particularly for youth. However, limited data have been collected by SAMHSA in its annual surveys on people who identify as lesbian, gay, or bisexual. These data point to double or triple use rates by LGB respondents, for all substances. <ref>https://clearbrook.banyantreatmentcenter.com/news/lgbtq-substance-abuse-facts-and-tatistics/</ref> When a coalition examines the membership of its community, it should look at not only the specific needs of racial, ethnic, and LGBTQ+ communities, but also evaluate the concerns of military-connected people, individuals with disabilities, and those with low socio-economic status.

One example might help to humanize what may seem to be abstract demographic characteristics. This points to the complexity of systems which are faced in one specific case. Someone named Chris has just been released from prison and is returning home. Chris is fortunate enough to have been supported in developing a recovery plan which includes medication-assisted treatment. However, Chris’s parole officer maintains that Chris cannot use any substances, MAT or otherwise. Instead Chris is required to do x, y, and z, none of which are in the recovery plan. A lack of re-entry services and laws in Chris’s state precluded applying for Medicaid in advance. Chris left jail with three days of medication but cannot see a doctor for a week. Chris is unable to find recovery housing with nearby transportation who will accept someone with a criminal background, so has not yet found employment. Without a job and without prescription coverage, Chris cannot afford to get more medication. The doctor wants to prescribe medications which the parole officer will not allow. If coalition members understand how their local systems are not working together and are working against people, then they can begin to see how difficult daily life might be for undocumented people or LGBTQ+ youth who are ready but uncertain as to how to access substance use services.

= Relevant Research =

*'''This article''' addresses disparities in treatment and access to treatment, regarding economic status and race/ethnicity. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087681/</ref>

*'''The Boston University Center for Antiracist Research''' is a collaborative research and education effort which includes Racial Data Lab, a national online database of racial inequality, and a qualitative (narrative) archive. <ref>https://www.bu.edu/antiracism-center/antiracism-research/</ref>

*'''O'Neill Institute for National and Global Health Law''' published "The Context: Racial and other Disparities in the Opioid Crisis." <ref>https://oneill.law.georgetown.edu/wp-content/uploads/2024/03/240308-APP-Policy-Scholar-Lauren-N-WEB.pdf</ref>

= Available Tools and Resources =

*'''SAMHSA.''' This text includes a chapter allocated to behavioral health treatment for major racial and ethnic groups. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4849.pdf</ref> SAMHSA also manages the Prevention Technology Transfer Center Network (PTTC) and this presentation covers by the Southwest PTTC covers unique challenges faced by marginalized communities in accessing substance use prevention resources and effective strategies for engaging and empowering all communities. <ref> https://pttcnetwork.org/wp-content/uploads/2024/05/Mobilizing-vulnerable-populations-PPT.pdf</ref>

*'''SAFE Project''' has published “Resources for Diverse Populations” which provides links to a suite of resources for a variety of populations. Typically, it will take a combination of several strategies to reduce disparity. Therefore, it is important that there be as much input as possible when considering what needs to be done in a given community. <ref>https://www.safeproject.us/resource/resources-for-diverse-populations/</ref>

*'''United Nations.''' The UN Partnership on the Rights of Persons with Disabilities and UN Women have published “Intersectionality Resource Guide and Toolkit: An Intersectional Approach to Leave No One Behind." It was developed to help both organizations and individual practitioners address intersectionality in policies and in programs. It aims to contribute to an understanding of intersectionality that bridges the gap between theory and practice. <ref>https://wrd.unwomen.org/practice/resources/intersectionality-resource-guide-and-toolkit</ref>

*'''JUSTICE SQUARED (Just Leaders for a Just Health System)''' is a collective which is supported by the Robert Wood Johnson Foundation. It aims to create practical, impactful, structural change to advance health equity and racial justice. <ref>https://justicesquared.org/</ref>

*'''The Hawai’i Department of Health''' manages the ‘Ohana Center of Excellence, which provides training and technical assistance for those working in substance use, behavioral, and mental health to better serve the needs of the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) communities through culturally responsive care. Their website provides access to a variety of workshops and research articles. <ref>https://aanhpi-ohana.org/</ref>

*'''"How to Be an AntiRacist"''' is a best-selling book by Ibram X. Kendi. Since racism is often what is being left unsaid in addressing disproportionality, this book, while not directly about health inequity, provides a broad understanding of racism and other “-ism’s” and includes recommendations for building a more just society.

*'''The Drug Policy Alliance''' has published three facts sheets on the impact of the overdose crisis on Black, Native American, and Latinx communities. <ref>https://drugpolicy.org/resource/fact-sheet-the-impact-of-the-overdose-crisis-on-black-communities-in-the-united-states/</ref>

= Promising Practices =

*'''Arkansas.''' This project aims to reduce alcohol use among black men by providing screening and brief interventions in a barbershop. <ref>https://health-equity-action.org/project/crhs-3</ref>

= Sources =

Intersectionality and Addressing Disparities

2025-03-01T01:23:18Z

BasilSavitsky: /* Available Tools and Resources */

= Introductory Paragraph =

This is the second in a pair of related articles on health equity and disproportionality. The first article titled, “Apply a Health Equity Lens,” focused on resources associated with building health equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref> This requires an active commitment to remove obstacles for groups that are more impacted by inequity, and the material below centers on strategies in the field of substance use which are associated with marginalized populations.

= Key Information =

Addressing disparities begins by acknowledging that we are all unique and that a community look through multiple identity lenses. Likewise, as members of different groups within our communities, we experience differences in the screening, diagnosis, treatment, and recovery supports. This is particularly relevant in the historical context of substance use, because some groups have been more marginalized than others. For example, in looking at recent overall statistics, there is positive news — a 14.5% decline in national overdose deaths for the 12-month period ending June 2024. <ref>https://www.safestates.org/news/687677/CDC-Data-Shows-a-Decline-in-Overdose-Deaths.htm</ref> However, examining these gains through a disparities lens, it becomes apparent that the recent decrease in the opioid overdose rate is not uniformly distributed. Positive trends predominantly benefit White people.

Increased awareness of disproportionality impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with low socio-economic status, and pregnant people. For example, the majority of pregnant substance-using people who do receive appropriate care and intervention are older and white with private health insurance. They are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are marginalized and do seek treatment have little success, as their honesty often leads to criminal reporting or they are unable to find available and affordable treatment programs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>

The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:

* Black people do not use cocaine at higher rates than other groups, yet the cocaine-related overdose for Blacks is triple that of Whites. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment (MAT). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>
* Native Americans overdose death rates, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions associated with methamphetamines, versus opioids. In 2022, the national Native American overdose death rate associated with methamphetamines was more than double the rate for Whites. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
* Latinx overdose rates doubled between 2018 and 2022, in large part to the proliferation of Fentanyl. Linguistic barriers which reduce access to prevention and harm reduction programs and compounded by disparities associated with documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>

'''Intersectionality'''

Intersectionality is a complex topic that warrants a full understanding by anyone engaged in social change work. Intersectionality runs deeper than and should not be confused with the type of inter-sectoral work found in promoting environmental justice by both environmentalists and social justice activists. Intersectionality describes a method for defining the mix of social identities with more accuracy than single identity formulations allow. For example, everyone is a blend of gender, race, class, and ability categories as opposed to being a type of member in different categories. It has become associated with social and political correlations with privilege and marginalization. The term, intersectionality, was coined by Kimberlé Williams Crenshaw in three legal cases in 1989. Although each of the cases were lost, her position has been adopted widely in the social justice community and is often linked with its formative roots in Critical Race Theory. Crenshaw made a case in law suits for black women that this newly defined form of discrimination transcended racial and gender discrimination, because black women were being judged in the legal system separately both as women and as members of a minority rather than as black women. In the decades since then, the term has become politically controversial, because it has moved outside of the generally agreed upon ''descriptive'' nature of discriminatory patterns to a ''prescriptive'' call to action to address sources of structural power differentials. It has been critiqued both for the scope of change for which intersectional advocates calls and for the difficulty in measuring success in conditions which are inherently multi-variable. <ref>https://www.vox.com/the-highlight/2019/5/20/18542843/intersectionality-conservatism-law-race-gender-discrimination</ref>

'''Coalition Responsibilities'''

Coalitions have a responsibility to work to protect everyone in our communities. The first step in implementing this responsibility is to recognize that history points to long-term patterns of inequity. The next step is to realize the scope and diversity within health inequity. This includes incorporating people with lived experience in the decision making process and implementing trauma-informed approaches. Specific recommendations for practicing cultural competence and humility and for applying a health equity lens in strategy planning are detailed in the section titled “Building Capacity for Health Equity” within the SAFE Solution article on Health Equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref>

In addition to the statistics on racial and ethnic disparities detailed above, there are several constituencies within communities for which substance use statistics are less documented. For example, collection of data on the transgender and questioning members of the LGBTQ+ has been more difficult to collect, particularly for youth. However, limited data have been collected by SAMHSA in its annual surveys on people who identify as lesbian, gay, or bisexual. These data point to double or triple use rates by LGB respondents, for all substances. <ref>https://clearbrook.banyantreatmentcenter.com/news/lgbtq-substance-abuse-facts-and-tatistics/</ref> When a coalition examines the membership of its community, it should look at not only the specific needs of racial, ethnic, and LGBTQ+ communities, but also evaluate the concerns of military-connected people, individuals with disabilities, and those with low socio-economic status.

One example might help to humanize what may seem to be abstract demographic characteristics. This points to the complexity of systems which are faced in one specific case. Someone named Chris has just been released from prison and is returning home. Chris is fortunate enough to have been supported in developing a recovery plan which includes medication-assisted treatment. However, Chris’s parole officer maintains that Chris cannot use any substances, MAT or otherwise. Instead Chris is required to do x, y, and z, none of which are in the recovery plan. A lack of re-entry services and laws in Chris’s state precluded applying for Medicaid in advance. Chris left jail with three days of medication but cannot see a doctor for a week. Chris is unable to find recovery housing with nearby transportation who will accept someone with a criminal background, so has not yet found employment. Without a job and without prescription coverage, Chris cannot afford to get more medication. The doctor wants to prescribe medications which the parole officer will not allow. If coalition members understand how their local systems are not working together and are working against people, then they can begin to see how difficult daily life might be for undocumented people or LGBTQ+ youth who are ready but uncertain as to how to access substance use services.

= Relevant Research =

*'''This article''' addresses disparities in treatment and access to treatment, regarding economic status and race/ethnicity. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087681/</ref>

*'''The Boston University Center for Antiracist Research''' is a collaborative research and education effort which includes Racial Data Lab, a national online database of racial inequality, and a qualitative (narrative) archive. <ref>https://www.bu.edu/antiracism-center/antiracism-research/</ref>

*'''O'Neill Institute for National and Global Health Law''' published "The Context: Racial and other Disparities in the Opioid Crisis." <ref>https://oneill.law.georgetown.edu/wp-content/uploads/2024/03/240308-APP-Policy-Scholar-Lauren-N-WEB.pdf</ref>

= Available Tools and Resources =

*'''SAMHSA.''' This text includes a chapter allocated to behavioral health treatment for major racial and ethnic groups. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4849.pdf</ref> SAMHSA also manages the Prevention Technology Transfer Center Network (PTTC) and this presentation covers by the Southwest PTTC covers unique challenges faced by marginalized communities in accessing substance use prevention resources and effective strategies for engaging and empowering all communities. <ref> https://pttcnetwork.org/wp-content/uploads/2024/05/Mobilizing-vulnerable-populations-PPT.pdf</ref>

*'''SAFE Project''' has published “Resources for Diverse Populations” which provides links to a suite of resources for a variety of populations. Typically, it will take a combination of several strategies to reduce disparity. Therefore, it is important that there be as much input as possible when considering what needs to be done in a given community. <ref>https://www.safeproject.us/resource/resources-for-diverse-populations/</ref>

*'''United Nations.''' The UN Partnership on the Rights of Persons with Disabilities and UN Women have published “Intersectionality Resource Guide and Toolkit: An Intersectional Approach to Leave No One Behind." It was developed to help both organizations and individual practitioners address intersectionality in policies and in programs. It aims to contribute to an understanding of intersectionality that bridges the gap between theory and practice. <ref>https://wrd.unwomen.org/practice/resources/intersectionality-resource-guide-and-toolkit</ref>

*'''JUSTICE SQUARED (Just Leaders for a Just Health System)''' is a collective which is supported by the Robert Wood Johnson Foundation. It aims to create practical, impactful, structural change to advance health equity and racial justice. <ref>https://justicesquared.org/</ref>

*'''The Hawai’i Department of Health''' manages the ‘Ohana Center of Excellence, which provides training and technical assistance for those working in substance use, behavioral, and mental health to better serve the needs of the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) communities through culturally responsive care. Their website provides access to a variety of workshops and research articles. <ref>https://aanhpi-ohana.org/</ref>

*'''"How to Be an AntiRacist"''' is a best-selling book by Ibram X. Kendi. Since racism is often what is being left unsaid in addressing disproportionality, this book, while not directly about health inequity, provides a broad understanding of racism and other “-ism’s” and includes recommendations for building a more just society.

*'''The Drug Policy Alliance''' has published three facts sheets on the impact of the overdose crisis on Black, Native American, and Latinx communities. <ref>https://drugpolicy.org/resource/fact-sheet-the-impact-of-the-overdose-crisis-on-black-communities-in-the-united-states/</ref>

= Promising Practices =

*'''Arkansas.''' This project aims to reduce alcohol use among black men by providing screening and brief interventions in a barbershop. <ref>https://health-equity-action.org/project/crhs-3</ref>

= Sources =

Intersectionality and Addressing Disparities

2025-03-01T01:22:27Z

BasilSavitsky: /* Available Tools and Resources */

= Introductory Paragraph =

This is the second in a pair of related articles on health equity and disproportionality. The first article titled, “Apply a Health Equity Lens,” focused on resources associated with building health equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref> This requires an active commitment to remove obstacles for groups that are more impacted by inequity, and the material below centers on strategies in the field of substance use which are associated with marginalized populations.

= Key Information =

Addressing disparities begins by acknowledging that we are all unique and that a community look through multiple identity lenses. Likewise, as members of different groups within our communities, we experience differences in the screening, diagnosis, treatment, and recovery supports. This is particularly relevant in the historical context of substance use, because some groups have been more marginalized than others. For example, in looking at recent overall statistics, there is positive news — a 14.5% decline in national overdose deaths for the 12-month period ending June 2024. <ref>https://www.safestates.org/news/687677/CDC-Data-Shows-a-Decline-in-Overdose-Deaths.htm</ref> However, examining these gains through a disparities lens, it becomes apparent that the recent decrease in the opioid overdose rate is not uniformly distributed. Positive trends predominantly benefit White people.

Increased awareness of disproportionality impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with low socio-economic status, and pregnant people. For example, the majority of pregnant substance-using people who do receive appropriate care and intervention are older and white with private health insurance. They are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are marginalized and do seek treatment have little success, as their honesty often leads to criminal reporting or they are unable to find available and affordable treatment programs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>

The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:

* Black people do not use cocaine at higher rates than other groups, yet the cocaine-related overdose for Blacks is triple that of Whites. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment (MAT). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>
* Native Americans overdose death rates, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions associated with methamphetamines, versus opioids. In 2022, the national Native American overdose death rate associated with methamphetamines was more than double the rate for Whites. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
* Latinx overdose rates doubled between 2018 and 2022, in large part to the proliferation of Fentanyl. Linguistic barriers which reduce access to prevention and harm reduction programs and compounded by disparities associated with documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>

'''Intersectionality'''

Intersectionality is a complex topic that warrants a full understanding by anyone engaged in social change work. Intersectionality runs deeper than and should not be confused with the type of inter-sectoral work found in promoting environmental justice by both environmentalists and social justice activists. Intersectionality describes a method for defining the mix of social identities with more accuracy than single identity formulations allow. For example, everyone is a blend of gender, race, class, and ability categories as opposed to being a type of member in different categories. It has become associated with social and political correlations with privilege and marginalization. The term, intersectionality, was coined by Kimberlé Williams Crenshaw in three legal cases in 1989. Although each of the cases were lost, her position has been adopted widely in the social justice community and is often linked with its formative roots in Critical Race Theory. Crenshaw made a case in law suits for black women that this newly defined form of discrimination transcended racial and gender discrimination, because black women were being judged in the legal system separately both as women and as members of a minority rather than as black women. In the decades since then, the term has become politically controversial, because it has moved outside of the generally agreed upon ''descriptive'' nature of discriminatory patterns to a ''prescriptive'' call to action to address sources of structural power differentials. It has been critiqued both for the scope of change for which intersectional advocates calls and for the difficulty in measuring success in conditions which are inherently multi-variable. <ref>https://www.vox.com/the-highlight/2019/5/20/18542843/intersectionality-conservatism-law-race-gender-discrimination</ref>

'''Coalition Responsibilities'''

Coalitions have a responsibility to work to protect everyone in our communities. The first step in implementing this responsibility is to recognize that history points to long-term patterns of inequity. The next step is to realize the scope and diversity within health inequity. This includes incorporating people with lived experience in the decision making process and implementing trauma-informed approaches. Specific recommendations for practicing cultural competence and humility and for applying a health equity lens in strategy planning are detailed in the section titled “Building Capacity for Health Equity” within the SAFE Solution article on Health Equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref>

In addition to the statistics on racial and ethnic disparities detailed above, there are several constituencies within communities for which substance use statistics are less documented. For example, collection of data on the transgender and questioning members of the LGBTQ+ has been more difficult to collect, particularly for youth. However, limited data have been collected by SAMHSA in its annual surveys on people who identify as lesbian, gay, or bisexual. These data point to double or triple use rates by LGB respondents, for all substances. <ref>https://clearbrook.banyantreatmentcenter.com/news/lgbtq-substance-abuse-facts-and-tatistics/</ref> When a coalition examines the membership of its community, it should look at not only the specific needs of racial, ethnic, and LGBTQ+ communities, but also evaluate the concerns of military-connected people, individuals with disabilities, and those with low socio-economic status.

One example might help to humanize what may seem to be abstract demographic characteristics. This points to the complexity of systems which are faced in one specific case. Someone named Chris has just been released from prison and is returning home. Chris is fortunate enough to have been supported in developing a recovery plan which includes medication-assisted treatment. However, Chris’s parole officer maintains that Chris cannot use any substances, MAT or otherwise. Instead Chris is required to do x, y, and z, none of which are in the recovery plan. A lack of re-entry services and laws in Chris’s state precluded applying for Medicaid in advance. Chris left jail with three days of medication but cannot see a doctor for a week. Chris is unable to find recovery housing with nearby transportation who will accept someone with a criminal background, so has not yet found employment. Without a job and without prescription coverage, Chris cannot afford to get more medication. The doctor wants to prescribe medications which the parole officer will not allow. If coalition members understand how their local systems are not working together and are working against people, then they can begin to see how difficult daily life might be for undocumented people or LGBTQ+ youth who are ready but uncertain as to how to access substance use services.

= Relevant Research =

*'''This article''' addresses disparities in treatment and access to treatment, regarding economic status and race/ethnicity. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087681/</ref>

*'''The Boston University Center for Antiracist Research''' is a collaborative research and education effort which includes Racial Data Lab, a national online database of racial inequality, and a qualitative (narrative) archive. <ref>https://www.bu.edu/antiracism-center/antiracism-research/</ref>

*'''O'Neill Institute for National and Global Health Law''' published "The Context: Racial and other Disparities in the Opioid Crisis." <ref>https://oneill.law.georgetown.edu/wp-content/uploads/2024/03/240308-APP-Policy-Scholar-Lauren-N-WEB.pdf</ref>

= Available Tools and Resources =

*'''SAMHSA.''' This text includes a chapter allocated to behavioral health treatment for major racial and ethnic groups. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4849.pdf</ref> SAMHSA also manages the Prevention Technology Transfer Center Network (PTTC) and this presentation covers by the Southwest PTTC covers unique challenges faced by marginalized communities in accessing substance use prevention resources and effective strategies for engaging and empowering all communities. <ref> https://pttcnetwork.org/wp-content/uploads/2024/05/Mobilizing-vulnerable-populations-PPT.pdf</ref>

*'''SAFE Project''' has published “Resources for Diverse Populations” which provides links to a suite of resources for a variety of populations. Typically, it will take a combination of several strategies to reduce disparity. Therefore, it is important that there be as much input as possible when considering what needs to be done in a given community. <ref>https://www.safeproject.us/resource/resources-for-diverse-populations/</ref>

*'''United Nations.''' The UN Partnership on the Rights of Persons with Disabilities and UN Women have published “Intersectionality Resource Guide and Toolkit: An Intersectional Approach to Leave No One Behind." It was developed to help both organizations and individual practitioners address intersectionality in policies and in programs. It aims to contribute to an understanding of intersectionality that bridges the gap between theory and practice. <ref>https://wrd.unwomen.org/practice/resources/intersectionality-resource-guide-and-toolkit</ref>

*'''JUSTICE SQUARED (Just Leaders for a Just Health System)''' is a collective which is supported by the Robert Wood Johnson Foundation. It aims to create practical, impactful, structural change to advance health equity and racial justice. <ref>https://justicesquared.org/</ref>

*'''The Hawai’i Department of Health''' manages the ‘Ohana Center of Excellence, which provides training and technical assistance for those working in substance use, behavioral, and mental health to better serve the needs of the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) communities through culturally responsive care. Their website provides access to a variety of workshops and research articles. <ref>https://aanhpi-ohana.org/</ref>

*'''"How to Be an AntiRacist"''' is a best-selling book by Ibram X. Kendi. Since racism is often what is being left unsaid in addressing disproportionality, this book, while not directly about health inequity, provides a broad understanding of racism and other “-ism’s” and includes recommendations for building a more just society.

*'''The Drug Policy Alliance''' has published three facts sheets on the impact of the overdose crisis on Black, Native American, and Latinx communities. <ref>https://drugpolicy.org/resource/fact-

= Promising Practices =

*'''Arkansas.''' This project aims to reduce alcohol use among black men by providing screening and brief interventions in a barbershop. <ref>https://health-equity-action.org/project/crhs-3</ref>

= Sources =

Intersectionality and Addressing Disparities

2025-03-01T01:17:41Z

BasilSavitsky: /* Key Information */

= Introductory Paragraph =

This is the second in a pair of related articles on health equity and disproportionality. The first article titled, “Apply a Health Equity Lens,” focused on resources associated with building health equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref> This requires an active commitment to remove obstacles for groups that are more impacted by inequity, and the material below centers on strategies in the field of substance use which are associated with marginalized populations.

= Key Information =

Addressing disparities begins by acknowledging that we are all unique and that a community look through multiple identity lenses. Likewise, as members of different groups within our communities, we experience differences in the screening, diagnosis, treatment, and recovery supports. This is particularly relevant in the historical context of substance use, because some groups have been more marginalized than others. For example, in looking at recent overall statistics, there is positive news — a 14.5% decline in national overdose deaths for the 12-month period ending June 2024. <ref>https://www.safestates.org/news/687677/CDC-Data-Shows-a-Decline-in-Overdose-Deaths.htm</ref> However, examining these gains through a disparities lens, it becomes apparent that the recent decrease in the opioid overdose rate is not uniformly distributed. Positive trends predominantly benefit White people.

Increased awareness of disproportionality impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with low socio-economic status, and pregnant people. For example, the majority of pregnant substance-using people who do receive appropriate care and intervention are older and white with private health insurance. They are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are marginalized and do seek treatment have little success, as their honesty often leads to criminal reporting or they are unable to find available and affordable treatment programs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>

The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:

* Black people do not use cocaine at higher rates than other groups, yet the cocaine-related overdose for Blacks is triple that of Whites. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment (MAT). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>
* Native Americans overdose death rates, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions associated with methamphetamines, versus opioids. In 2022, the national Native American overdose death rate associated with methamphetamines was more than double the rate for Whites. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
* Latinx overdose rates doubled between 2018 and 2022, in large part to the proliferation of Fentanyl. Linguistic barriers which reduce access to prevention and harm reduction programs and compounded by disparities associated with documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>

'''Intersectionality'''

Intersectionality is a complex topic that warrants a full understanding by anyone engaged in social change work. Intersectionality runs deeper than and should not be confused with the type of inter-sectoral work found in promoting environmental justice by both environmentalists and social justice activists. Intersectionality describes a method for defining the mix of social identities with more accuracy than single identity formulations allow. For example, everyone is a blend of gender, race, class, and ability categories as opposed to being a type of member in different categories. It has become associated with social and political correlations with privilege and marginalization. The term, intersectionality, was coined by Kimberlé Williams Crenshaw in three legal cases in 1989. Although each of the cases were lost, her position has been adopted widely in the social justice community and is often linked with its formative roots in Critical Race Theory. Crenshaw made a case in law suits for black women that this newly defined form of discrimination transcended racial and gender discrimination, because black women were being judged in the legal system separately both as women and as members of a minority rather than as black women. In the decades since then, the term has become politically controversial, because it has moved outside of the generally agreed upon ''descriptive'' nature of discriminatory patterns to a ''prescriptive'' call to action to address sources of structural power differentials. It has been critiqued both for the scope of change for which intersectional advocates calls and for the difficulty in measuring success in conditions which are inherently multi-variable. <ref>https://www.vox.com/the-highlight/2019/5/20/18542843/intersectionality-conservatism-law-race-gender-discrimination</ref>

'''Coalition Responsibilities'''

Coalitions have a responsibility to work to protect everyone in our communities. The first step in implementing this responsibility is to recognize that history points to long-term patterns of inequity. The next step is to realize the scope and diversity within health inequity. This includes incorporating people with lived experience in the decision making process and implementing trauma-informed approaches. Specific recommendations for practicing cultural competence and humility and for applying a health equity lens in strategy planning are detailed in the section titled “Building Capacity for Health Equity” within the SAFE Solution article on Health Equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref>

In addition to the statistics on racial and ethnic disparities detailed above, there are several constituencies within communities for which substance use statistics are less documented. For example, collection of data on the transgender and questioning members of the LGBTQ+ has been more difficult to collect, particularly for youth. However, limited data have been collected by SAMHSA in its annual surveys on people who identify as lesbian, gay, or bisexual. These data point to double or triple use rates by LGB respondents, for all substances. <ref>https://clearbrook.banyantreatmentcenter.com/news/lgbtq-substance-abuse-facts-and-tatistics/</ref> When a coalition examines the membership of its community, it should look at not only the specific needs of racial, ethnic, and LGBTQ+ communities, but also evaluate the concerns of military-connected people, individuals with disabilities, and those with low socio-economic status.

One example might help to humanize what may seem to be abstract demographic characteristics. This points to the complexity of systems which are faced in one specific case. Someone named Chris has just been released from prison and is returning home. Chris is fortunate enough to have been supported in developing a recovery plan which includes medication-assisted treatment. However, Chris’s parole officer maintains that Chris cannot use any substances, MAT or otherwise. Instead Chris is required to do x, y, and z, none of which are in the recovery plan. A lack of re-entry services and laws in Chris’s state precluded applying for Medicaid in advance. Chris left jail with three days of medication but cannot see a doctor for a week. Chris is unable to find recovery housing with nearby transportation who will accept someone with a criminal background, so has not yet found employment. Without a job and without prescription coverage, Chris cannot afford to get more medication. The doctor wants to prescribe medications which the parole officer will not allow. If coalition members understand how their local systems are not working together and are working against people, then they can begin to see how difficult daily life might be for undocumented people or LGBTQ+ youth who are ready but uncertain as to how to access substance use services.

= Relevant Research =

*'''This article''' addresses disparities in treatment and access to treatment, regarding economic status and race/ethnicity. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087681/</ref>

*'''The Boston University Center for Antiracist Research''' is a collaborative research and education effort which includes Racial Data Lab, a national online database of racial inequality, and a qualitative (narrative) archive. <ref>https://www.bu.edu/antiracism-center/antiracism-research/</ref>

*'''O'Neill Institute for National and Global Health Law''' published "The Context: Racial and other Disparities in the Opioid Crisis." <ref>https://oneill.law.georgetown.edu/wp-content/uploads/2024/03/240308-APP-Policy-Scholar-Lauren-N-WEB.pdf</ref>

= Available Tools and Resources =

*'''SAMHSA.''' This text includes a chapter allocated to behavioral health treatment for major racial and ethnic groups. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4849.pdf</ref> SAMHSA also manages the Prevention Technology Transfer Center Network (PTTC) and this presentation covers by the Southwest PTTC covers unique challenges faced by marginalized communities in accessing substance use prevention resources and effective strategies for engaging and empowering all communities. <ref> https://pttcnetwork.org/wp-content/uploads/2024/05/Mobilizing-vulnerable-populations-PPT.pdf</ref>

*'''SAFE Project''' has published “Resources for Diverse Populations” which provides links to a suite of resources for a variety of populations. Typically, it will take a combination of several strategies to reduce disparity. Therefore, it is important that there be as much input as possible when considering what needs to be done in a given community. <ref>https://www.safeproject.us/resource/resources-for-diverse-populations/</ref>

*'''United Nations.''' The UN Partnership on the Rights of Persons with Disabilities and UN Women have published “Intersectionality Resource Guide and Toolkit: An Intersectional Approach to Leave No One Behind." It was developed to help both organizations and individual practitioners address intersectionality in policies and in programs. It aims to contribute to an understanding of intersectionality that bridges the gap between theory and practice. <ref>https://wrd.unwomen.org/practice/resources/intersectionality-resource-guide-and-toolkit</ref>

*'''JUSTICE SQUARED (Just Leaders for a Just Health System)''' is a collective which is supported by the Robert Wood Johnson Foundation. It aims to create practical, impactful, structural change to advance health equity and racial justice. <ref>https://justicesquared.org/</ref>

*'''The Hawai’i Department of Health''' manages the ‘Ohana Center of Excellence, which provides training and technical assistance for those working in substance use, behavioral, and mental health to better serve the needs of the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) communities through culturally responsive care. Their website provides access to a variety of workshops and research articles. <ref>https://aanhpi-ohana.org/</ref>

*'''"How to Be an AntiRacist"''' is a best-selling book by Ibram X. Kendi. Since racism is often what is being left unsaid in addressing disproportionality, this book, while not directly about health inequity, provides a broad understanding of racism and other “-ism’s” and includes recommendations for building a more just society.

= Promising Practices =

*'''Arkansas.''' This project aims to reduce alcohol use among black men by providing screening and brief interventions in a barbershop. <ref>https://health-equity-action.org/project/crhs-3</ref>

= Sources =

Intersectionality and Addressing Disparities

2025-03-01T01:16:15Z

BasilSavitsky: /* Key Information */

= Introductory Paragraph =

This is the second in a pair of related articles on health equity and disproportionality. The first article titled, “Apply a Health Equity Lens,” focused on resources associated with building health equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref> This requires an active commitment to remove obstacles for groups that are more impacted by inequity, and the material below centers on strategies in the field of substance use which are associated with marginalized populations.

= Key Information =

Addressing disparities begins by acknowledging that we are all unique and that a community look through multiple identity lenses. Likewise, as members of different groups within our communities, we experience differences in the screening, diagnosis, treatment, and recovery supports. This is particularly relevant in the historical context of substance use, because some groups have been more marginalized than others. For example, in looking at recent overall statistics, there is positive news — a 14.5% decline in national overdose deaths for the 12-month period ending June 2024. <ref>https://www.safestates.org/news/687677/CDC-Data-Shows-a-Decline-in-Overdose-Deaths.htm</ref> However, examining these gains through a disparities lens, it becomes apparent that the recent decrease in the opioid overdose rate is not uniformly distributed. Positive trends predominantly benefit White people.

Increased awareness of disproportionality impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with low socio-economic status, and pregnant people. For example, the majority of pregnant substance-using people who do receive appropriate care and intervention are older and white with private health insurance. They are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are marginalized and do seek treatment have little success, as their honesty often leads to criminal reporting or they are unable to find available and affordable treatment programs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>

The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:

Black people do not use cocaine at higher rates than other groups, yet the cocaine-related overdose for Blacks is triple that of Whites. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment (MAT). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>
Native Americans overdose death rates, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions associated with methamphetamines, versus opioids. In 2022, the national Native American overdose death rate associated with methamphetamines was more than double the rate for Whites. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
Latinx overdose rates doubled between 2018 and 2022, in large part to the proliferation of Fentanyl. Linguistic barriers which reduce access to prevention and harm reduction programs and compounded by disparities associated with documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>

'''Intersectionality'''

Intersectionality is a complex topic that warrants a full understanding by anyone engaged in social change work. Intersectionality runs deeper than and should not be confused with the type of inter-sectoral work found in promoting environmental justice by both environmentalists and social justice activists. Intersectionality describes a method for defining the mix of social identities with more accuracy than single identity formulations allow. For example, everyone is a blend of gender, race, class, and ability categories as opposed to being a type of member in different categories. It has become associated with social and political correlations with privilege and marginalization. The term, intersectionality, was coined by Kimberlé Williams Crenshaw in three legal cases in 1989. Although each of the cases were lost, her position has been adopted widely in the social justice community and is often linked with its formative roots in Critical Race Theory. Crenshaw made a case in law suits for black women that this newly defined form of discrimination transcended racial and gender discrimination, because black women were being judged in the legal system separately both as women and as members of a minority rather than as black women. In the decades since then, the term has become politically controversial, because it has moved outside of the generally agreed upon ''descriptive'' nature of discriminatory patterns to a ''prescriptive'' call to action to address sources of structural power differentials. It has been critiqued both for the scope of change for which intersectional advocates calls and for the difficulty in measuring success in conditions which are inherently multi-variable. <ref>https://www.vox.com/the-highlight/2019/5/20/18542843/intersectionality-conservatism-law-race-gender-discrimination</ref>

'''Coalition Responsibilities'''

It is useful to keep in mind a common phrase in the recovery community: “Nothing about us, without us.” This speaks to the fact that there are unique needs for various populations and that the people being served should have a voice in the planning and delivery of a coalition’s initiatives. It is likely that inequitable representation exists within the coalition membership list, as in a lack of participation by all of the specific communities within the broader community. Thus, there will probably be a need for a focused intention to cultivate new partnerships with people from different backgrounds and racial and ethnic groups.

A challenging task within the health equity domain is understanding the level of ''readiness'' of the coalition members to recognize the systemic nature of health inequity within the substance use crisis. A parallel objective is to increase the ''ability'' of the coalition to generate systemic community change to address the social determinants of health. There is usually a readiness to close disparity gaps, but the ability may not be there yet.

= Relevant Research =

*'''This article''' addresses disparities in treatment and access to treatment, regarding economic status and race/ethnicity. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087681/</ref>

*'''The Boston University Center for Antiracist Research''' is a collaborative research and education effort which includes Racial Data Lab, a national online database of racial inequality, and a qualitative (narrative) archive. <ref>https://www.bu.edu/antiracism-center/antiracism-research/</ref>

*'''O'Neill Institute for National and Global Health Law''' published "The Context: Racial and other Disparities in the Opioid Crisis." <ref>https://oneill.law.georgetown.edu/wp-content/uploads/2024/03/240308-APP-Policy-Scholar-Lauren-N-WEB.pdf</ref>

= Available Tools and Resources =

*'''SAMHSA.''' This text includes a chapter allocated to behavioral health treatment for major racial and ethnic groups. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4849.pdf</ref> SAMHSA also manages the Prevention Technology Transfer Center Network (PTTC) and this presentation covers by the Southwest PTTC covers unique challenges faced by marginalized communities in accessing substance use prevention resources and effective strategies for engaging and empowering all communities. <ref> https://pttcnetwork.org/wp-content/uploads/2024/05/Mobilizing-vulnerable-populations-PPT.pdf</ref>

*'''SAFE Project''' has published “Resources for Diverse Populations” which provides links to a suite of resources for a variety of populations. Typically, it will take a combination of several strategies to reduce disparity. Therefore, it is important that there be as much input as possible when considering what needs to be done in a given community. <ref>https://www.safeproject.us/resource/resources-for-diverse-populations/</ref>

*'''United Nations.''' The UN Partnership on the Rights of Persons with Disabilities and UN Women have published “Intersectionality Resource Guide and Toolkit: An Intersectional Approach to Leave No One Behind." It was developed to help both organizations and individual practitioners address intersectionality in policies and in programs. It aims to contribute to an understanding of intersectionality that bridges the gap between theory and practice. <ref>https://wrd.unwomen.org/practice/resources/intersectionality-resource-guide-and-toolkit</ref>

*'''JUSTICE SQUARED (Just Leaders for a Just Health System)''' is a collective which is supported by the Robert Wood Johnson Foundation. It aims to create practical, impactful, structural change to advance health equity and racial justice. <ref>https://justicesquared.org/</ref>

*'''The Hawai’i Department of Health''' manages the ‘Ohana Center of Excellence, which provides training and technical assistance for those working in substance use, behavioral, and mental health to better serve the needs of the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) communities through culturally responsive care. Their website provides access to a variety of workshops and research articles. <ref>https://aanhpi-ohana.org/</ref>

*'''"How to Be an AntiRacist"''' is a best-selling book by Ibram X. Kendi. Since racism is often what is being left unsaid in addressing disproportionality, this book, while not directly about health inequity, provides a broad understanding of racism and other “-ism’s” and includes recommendations for building a more just society.

= Promising Practices =

*'''Arkansas.''' This project aims to reduce alcohol use among black men by providing screening and brief interventions in a barbershop. <ref>https://health-equity-action.org/project/crhs-3</ref>

= Sources =

Intersectionality and Addressing Disparities

2025-02-28T22:23:17Z

BasilSavitsky: /* Introductory Paragraph */

Become a Trauma-Informed Community

2025-02-21T21:34:49Z

BasilSavitsky: /* Promising Practices */

= Introductory Paragraph =

Trauma is widespread and is an important component of understanding service delivery in behavioral health and substance use disorder.<ref>https://store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884.html</ref> To become “Trauma Informed,” it’s necessary to first understand the root causes of trauma, such as Adverse Childhood Experiences, or ACEs. Then, it is possible to understand that trauma has no boundaries with regard to age, gender, socioeconomic status, race, ethnicity, geography or sexual orientation. This is the beginning of becoming a trauma-informed community. The next challenge is for a community to provide a trauma-informed service system.

= Key Information =

'''Root Causes of Trauma'''

Trauma is especially common in the lives of people with behavioral and/or substance use disorders. For this reason, the need to address trauma is increasingly viewed as a critical component of behavioral health care and part of the healing and recovery process. The American Psychological Association defines trauma “as an emotional response to a terrible event like an accident, rape or natural disaster. Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and has adverse effects on the individuals functioning and well-being. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea. While these feelings are normal, some people have difficulty moving on with their lives."<ref>https://acestoohigh.com/got-your-ace-score/</ref>

ACEs are potentially traumatic events that occur in childhood (0-17 years).<ref> https://www.preventioninstitute.org/publications/adverse-community-experiences-and-resilience-framework-addressing-and-preventing</ref> The ACEs survey measures 10 types of childhood trauma; five are personal: physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect; five are related to other family members: a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. Each type of trauma in the ACES survey counts as one. The higher the ACES score, the higher the risk of social and health issues -- including substance use disorder. Using the ACES survey as a foundation, communities can see how trauma can result from racism and discrimination, intergenerational poverty, lack of job opportunities, exposure to violence, substandard housing and education, and lack of access to key services. <ref>http://sparqtools.org/mobility-measure/philadelphia-adverse-childhood-experiences-phl-ace/</ref> Some communities have developed expanded versions of the ACES survey to address issues specific to their region or city. For example, the city of Philadelphia’s Expanded ACE sub-scale has respondents answer six questions specific to experiences in their communities: witnessing violence, experiencing discrimination or food insecurity or racism, living in an unsafe neighborhood, being bullied, or living in foster care. <ref>http://wilsonfdn.org/wp/wp-content/uploads/2015/03/TIC-position-paper.pdf
</ref>

'''What Is a Trauma Informed Community?'''
The Wilson Foundation of Rochester, NY describes the concept of trauma informed community as “...a strategic approach linking all community sectors together around the effects of trauma, while preventing gaps in services for clients. It is coordinated and collaborative; recognizes that the diversity of the population requires individual responses; uses a common language, measurements and accountability.”<ref>http://wilsonfdn.org/wp/wp-content/uploads/2015/03/TIC-position-paper.pdf
</ref> If a community works to identify the specific drivers of trauma in its own backyard, it can also identify the factors that influence substance use disorder, allowing them to create the appropriate community supports for behavioral health care, plus healing and recovery.<ref>https://www.nctsn.org/trauma-informed-care/creating-trauma-informed-systems
</ref>

'''Trauma-Informed Systems.'''
The National Child Traumatic Stress Network describes a trauma-informed service system as one where all agencies, programs, and service providers have a trauma-informed perspective, including the following: <ref>https://nashp.org/wp-content/uploads/2018/09/Children-and-Opioid-Epidemic-1.pdf</ref>
* Routinely screen for trauma exposure and related symptoms.
* Use evidence-based, culturally responsive assessment and treatment for traumatic stress and associated mental health symptoms.
* Make resources available to children, families, and providers on trauma exposure, its impact, and treatment.
* Engage in efforts to strengthen the resilience and protective factors of children and families impacted by and vulnerable to trauma.
* Address parent and caregiver trauma and its impact on the family system.
* Emphasize continuity of care and collaboration across child-service systems.
* Maintain an environment of care for staff that addresses, minimizes, and treats secondary traumatic stress, and that increases staff wellness.

'''Child Welfare.'''
Substance use disorders can affect parents’ ability to effectively care for their children, and is sometimes linked to rises in foster care placement and mistreatment cases. These parents are also a particularly vulnerable population. They benefit from a family-based approach to care which ensures that community services are tailored to children’s needs and are provided in tandem with those delivered to the whole family. <ref>http://socialwork.buffalo.edu/social-research/institutes-centers/institute-on-trauma-and-trauma-informed-care/what-is-trauma-informed-care.html</ref>

'''School Systems.'''
For any community, schools may be the first resource for students coping with traumatic events. And it’s not just teachers in the classroom - it includes administrators, staff, and parents. The environment in a trauma-informed school supports all children to feel safe physically, socially, emotionally, and academically. When interviewed for a Washington State resource guide for creating trauma informed school settings, one teacher described the issue succinctly: a student who tries to focus on academics while struggling with trauma is like “trying to play chess in a hurricane." <ref>https://www.k12.wa.us/sites/default/files/public/compassionateschools/pubdocs/theheartoflearningandteaching.pdf</ref>

'''Healthcare.'''
Individuals who have experienced trauma are at an elevated risk for substance use disorders. A trauma-informed healthcare system understands and considers the pervasive nature of trauma and promotes environments of healing and recovery rather than practices and services that may inadvertently re-traumatize those seeking help. <ref>https://www.nctsn.org/trauma-informed-care/creating-trauma-informed-systems</ref>

'''Justice.'''
In a law enforcement setting, a trauma-informed approach starts with the same premise: to understand the physical, social, and emotional impact of trauma on the individual involved in that system. It also requires the understanding that both police officers and other professionals may also be traumatized by a particular event or long-term history of or exposure to violence. <ref>https://www.vera.org/blog/police-perspectives/building-trust-through-trauma-informed-policing</ref>

'''Ensuring Diversity in Trauma Informed Settings.'''
It is vital that communities are inclusive in terms of both the populations affected by trauma and the functions of agencies that provides services, such as education, law enforcement, and the faith-based community.

= Relevant Research =

*'''Emerging research''' has documented the relationship among exposure to traumatic events, impaired neuro-development and immune system responses, and subsequent health risks resulting in chronic physical or behavioral health disorders. Research has also indicated that with appropriate supports and interventions, people can overcome traumatic experiences. <ref>https://www.apa.org/topics/trauma/</ref>

*'''A book''' by Gabor Maté, "In the Realm of Hungry Ghosts: Close Encounters with Addiction" and one co-written by Gabor Maté and his son, Daniel Maté, "The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture," blend research and personal history to reframe the relationships between trauma, addiction, and effective healthcare.

= Impactful Federal, State, and Local Policies =

* The SUPPORT for Patients and Communities Act (or Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act) in its Subtitle-N on Trauma-Informed Care gives the CDC authority to collect and report data using specified surveys regarding adverse childhood experiences, particularly with respect to rural and tribal areas (Sec. 7131). It also mandates HHS to provide resources to early childhood care and education providers and other professionals working with young children on ways to recognize and respond to children who may be affected by a family member's or other adult's substance abuse. <ref>https://www.congress.gov/bill/115th-congress/house-bill/6</ref>

* The Center for Health Care Strategies operates an online "Trauma-Informed Care Implementation Resource Center." This site includes a menu on policy considerations which contains various case studies and resources for state and local policy. <ref>https://www.traumainformedcare.chcs.org/policy-considerations/</ref>

= Available Tools and Resources =

'''SAFE Project:'''
*'''SAFE Veterans''' provides services to connect veterans, active-duty service members, and their families — all military-connected individuals — to the resources they need to address mental health challenges and substance use disorders. <ref>https://www.safeproject.us/veterans/</ref>
*'''Bridging Prevention and Recovery (BPR): A Community Approach to Systems Change.''' This SAFE Project program, offered in-person and virtually, guides community leaders through an action-oriented model to systemically integrate prevention and recovery systems to strengthen programs and improve outcomes. BPR is a 3.5 day training program that culminates with 6 technical assistance sessions tailored to each community’s unique set of needs to support implementation and sustainability of joint prevention and recovery community projects.<ref>https://www.safeproject.us/bridging-prevention-recovery/</ref>
*'''"Lessons Learned: What are Adverse Childhood Experiences?"''' This SAFE Project article an overview on what ACEs are and how to use this knowledge to better care for someone who is experiencing or has experienced ACEs in their lifetime. <ref>https://www.safeproject.us/resource/aces/</ref>
*See the wiki titled "Expand School-Based Prevention Programs" for more detailed information on how the school setting for children/adolescents can be used as protective factor from the adverse effects of substance use, misuse, and abuse. <ref>https://www.yoursafesolutions.us/wiki/Expand_School-Based_Prevention_Programs</ref>

'''This ACEs Infographic''' provides a succinct method for communicating an overview of ACEs. <ref>https://vetoviolence.cdc.gov/apps/aces-infographic/home</ref>

'''Adverse Community Experiences and Resilience: A Framework for Addressing and Preventing Community Trauma.''' This report was published by the Prevention Institute and focuses on linking personal and community resiliency. <ref>[https://www.preventioninstitute.org/publications/adverse-community-experiences-and-resilience-framework-addressing-and-preventing https://www.preventioninstitute.org/publications/adverse-community-experiences-and-resilience-framework-addressing-and-preventing]</ref>

'''Futures Without Violence''' has published "Changing Minds: Preventing and Healing Childhood Trauma State Policy Guide." <ref>https://www.pacesconnection.com/g/sonoma-county-aces-connection/fileSendAction/fcType/5/fcOid/473910123815383730/fodoid/473910123815383729/Changing-Minds-State-Policy-Framework.pdf</ref>

'''The Heart of Learning and Teaching: Compassion, Resiliency, and Academic Success.''' This report spans the needs of students and school staff and the responsibility of the community in fostering compassionate schools. It is a collaborative effort between staff in a public school, Western Washington University, and the Washington State Office of Superintendent of Public Instruction (OSPI) -- .<ref>https://www.k12.wa.us/sites/default/files/public/compassionateschools/pubdocs/theheartoflearningandteaching.pdf</ref>

'''National Child Traumatic Stress Network Learning Center:''' Registering for this free online learning center provides access to several archived sessions of interest to education professionals. The Schools and Trauma Speaker Series has five archived sessions: (1) Trauma-informed IEPs (2) Evidence-based practices (3) Sudden death on a school campus (4) Trauma-informed understanding of bullying (5) School/mental health partnerships. More resources are also available. <ref>http://learn.nctsn.org/</ref>

'''PACEs Connection''' is a major resource for information exchange for local, state, and national ACEs initiatives.<ref>https://www.acesconnection.com/</ref> It also provides a Diversity, Equity & Inclusion Tool that helps communities organize their stakeholders and other contacts to make sure that every part of the community is included. <ref>https://www.pacesconnection.com/g/fairfax-county-va-trauma-informed-community-network/blog/aces-connection-s-inclusion-tool-makes-sure-nobody-s-left-out</ref>

'''Trauma-Informed Care in Behavioral Health Services''' is a SAMHSA publication within its series of Treatment Improvement Protocols. <ref>https://www.ncbi.nlm.nih.gov/books/NBK207201/</ref>

'''Trauma Informed Schools Resource Guide.''' This publication by the Wilson Foundation provides insight on how to relate increasing awareness of ACES to the film, "Paper Tigers, which documents the life of some students in one school year at a trauma-informed high school. <ref> http://wilsonfdn.org/wp/wp-content/uploads/2015/03/Trauma-Informed-Schools-Resource-Guide.pdf</ref>

'''This documentary,''' "The Wisdom of Trauma," provides a video summary of many of the points brought forth in the work of Gabor Maté, discussed in the Relevant Research section of this article. <ref>https://www.youtube.com/watch?v=70HNmSsJvVU#:~:text=Gabor%20Mat%C3%A9%20to%20explore%20why,:%20https://thewisdomoftra...</ref>

= Promising Practices =

'''Peace4Tarpon.''' Tarpon City, Florida, was the first city in the US to declare itself a trauma-informed community. Trauma-informed practices have been implemented in small and large ways in a variety of organizations, including an elementary school, an ex-offender re-entry program, and the local housing authority. <ref>https://acestoohigh.com/2014/09/17/tarponsprings/</ref>

'''Compassionate Schools Program.''' This program in Washington State is an initiative that helps teachers to understand fundamental brain development and function and to correctly interpret behaviors, while engaging students, families, and the community. It simultaneously uses strategies that touch students daily -- through mindfulness activities in everyday teaching and learning, creating contracts with students for conflict resolution, and creating a culture that supports learning. The program resulted in dropping absenteeism rates, a decrease in disciplinary referrals, and improved engagement and achievement scores. <ref>https://www.schoolmentalhealth.org/media/SOM/Microsites/NCSMH/Documents/Archives/Compassionate-Schools-Start-Up-Guide.pdf</ref>

'''The National Pediatric Practice Community on ACEs''' is working with pediatricians to incorporate screening for ACEs and to adopt a trauma-informed approach to care. <ref>https://www.acesaware.org/wp-content/uploads/2019/12/National-Pediatric-Practice-Community-Communicating-about-ACEs-with-Patients-and-Families.pdf</ref>

= Sources =

Become a Trauma-Informed Community

2025-02-21T21:32:29Z

BasilSavitsky: /* Impactful Federal, State, and Local Policies */

Become a Trauma-Informed Community

2025-02-21T21:01:25Z

BasilSavitsky: /* Available Tools and Resources */

= Introductory Paragraph =

Trauma is widespread and is an important component of understanding service delivery in behavioral health and substance use disorder.<ref>https://store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884.html</ref> To become “Trauma Informed,” it’s necessary to first understand the root causes of trauma, such as Adverse Childhood Experiences, or ACEs. Then, it is possible to understand that trauma has no boundaries with regard to age, gender, socioeconomic status, race, ethnicity, geography or sexual orientation. This is the beginning of becoming a trauma-informed community. The next challenge is for a community to provide a trauma-informed service system.

= Key Information =

'''Root Causes of Trauma'''

Trauma is especially common in the lives of people with behavioral and/or substance use disorders. For this reason, the need to address trauma is increasingly viewed as a critical component of behavioral health care and part of the healing and recovery process. The American Psychological Association defines trauma “as an emotional response to a terrible event like an accident, rape or natural disaster. Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and has adverse effects on the individuals functioning and well-being. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea. While these feelings are normal, some people have difficulty moving on with their lives."<ref>https://acestoohigh.com/got-your-ace-score/</ref>

ACEs are potentially traumatic events that occur in childhood (0-17 years).<ref> https://www.preventioninstitute.org/publications/adverse-community-experiences-and-resilience-framework-addressing-and-preventing</ref> The ACEs survey measures 10 types of childhood trauma; five are personal: physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect; five are related to other family members: a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. Each type of trauma in the ACES survey counts as one. The higher the ACES score, the higher the risk of social and health issues -- including substance use disorder. Using the ACES survey as a foundation, communities can see how trauma can result from racism and discrimination, intergenerational poverty, lack of job opportunities, exposure to violence, substandard housing and education, and lack of access to key services. <ref>http://sparqtools.org/mobility-measure/philadelphia-adverse-childhood-experiences-phl-ace/</ref> Some communities have developed expanded versions of the ACES survey to address issues specific to their region or city. For example, the city of Philadelphia’s Expanded ACE sub-scale has respondents answer six questions specific to experiences in their communities: witnessing violence, experiencing discrimination or food insecurity or racism, living in an unsafe neighborhood, being bullied, or living in foster care. <ref>http://wilsonfdn.org/wp/wp-content/uploads/2015/03/TIC-position-paper.pdf
</ref>

'''What Is a Trauma Informed Community?'''
The Wilson Foundation of Rochester, NY describes the concept of trauma informed community as “...a strategic approach linking all community sectors together around the effects of trauma, while preventing gaps in services for clients. It is coordinated and collaborative; recognizes that the diversity of the population requires individual responses; uses a common language, measurements and accountability.”<ref>http://wilsonfdn.org/wp/wp-content/uploads/2015/03/TIC-position-paper.pdf
</ref> If a community works to identify the specific drivers of trauma in its own backyard, it can also identify the factors that influence substance use disorder, allowing them to create the appropriate community supports for behavioral health care, plus healing and recovery.<ref>https://www.nctsn.org/trauma-informed-care/creating-trauma-informed-systems
</ref>

'''Trauma-Informed Systems.'''
The National Child Traumatic Stress Network describes a trauma-informed service system as one where all agencies, programs, and service providers have a trauma-informed perspective, including the following: <ref>https://nashp.org/wp-content/uploads/2018/09/Children-and-Opioid-Epidemic-1.pdf</ref>
* Routinely screen for trauma exposure and related symptoms.
* Use evidence-based, culturally responsive assessment and treatment for traumatic stress and associated mental health symptoms.
* Make resources available to children, families, and providers on trauma exposure, its impact, and treatment.
* Engage in efforts to strengthen the resilience and protective factors of children and families impacted by and vulnerable to trauma.
* Address parent and caregiver trauma and its impact on the family system.
* Emphasize continuity of care and collaboration across child-service systems.
* Maintain an environment of care for staff that addresses, minimizes, and treats secondary traumatic stress, and that increases staff wellness.

'''Child Welfare.'''
Substance use disorders can affect parents’ ability to effectively care for their children, and is sometimes linked to rises in foster care placement and mistreatment cases. These parents are also a particularly vulnerable population. They benefit from a family-based approach to care which ensures that community services are tailored to children’s needs and are provided in tandem with those delivered to the whole family. <ref>http://socialwork.buffalo.edu/social-research/institutes-centers/institute-on-trauma-and-trauma-informed-care/what-is-trauma-informed-care.html</ref>

'''School Systems.'''
For any community, schools may be the first resource for students coping with traumatic events. And it’s not just teachers in the classroom - it includes administrators, staff, and parents. The environment in a trauma-informed school supports all children to feel safe physically, socially, emotionally, and academically. When interviewed for a Washington State resource guide for creating trauma informed school settings, one teacher described the issue succinctly: a student who tries to focus on academics while struggling with trauma is like “trying to play chess in a hurricane." <ref>https://www.k12.wa.us/sites/default/files/public/compassionateschools/pubdocs/theheartoflearningandteaching.pdf</ref>

'''Healthcare.'''
Individuals who have experienced trauma are at an elevated risk for substance use disorders. A trauma-informed healthcare system understands and considers the pervasive nature of trauma and promotes environments of healing and recovery rather than practices and services that may inadvertently re-traumatize those seeking help. <ref>https://www.nctsn.org/trauma-informed-care/creating-trauma-informed-systems</ref>

'''Justice.'''
In a law enforcement setting, a trauma-informed approach starts with the same premise: to understand the physical, social, and emotional impact of trauma on the individual involved in that system. It also requires the understanding that both police officers and other professionals may also be traumatized by a particular event or long-term history of or exposure to violence. <ref>https://www.vera.org/blog/police-perspectives/building-trust-through-trauma-informed-policing</ref>

'''Ensuring Diversity in Trauma Informed Settings.'''
It is vital that communities are inclusive in terms of both the populations affected by trauma and the functions of agencies that provides services, such as education, law enforcement, and the faith-based community.

= Relevant Research =

*'''Emerging research''' has documented the relationship among exposure to traumatic events, impaired neuro-development and immune system responses, and subsequent health risks resulting in chronic physical or behavioral health disorders. Research has also indicated that with appropriate supports and interventions, people can overcome traumatic experiences. <ref>https://www.apa.org/topics/trauma/</ref>

*'''A book''' by Gabor Maté, "In the Realm of Hungry Ghosts: Close Encounters with Addiction" and one co-written by Gabor Maté and his son, Daniel Maté, "The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture," blend research and personal history to reframe the relationships between trauma, addiction, and effective healthcare.

= Impactful Federal, State, and Local Policies =

SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

= Available Tools and Resources =

'''SAFE Project:'''
*'''SAFE Veterans''' provides services to connect veterans, active-duty service members, and their families — all military-connected individuals — to the resources they need to address mental health challenges and substance use disorders. <ref>https://www.safeproject.us/veterans/</ref>
*'''Bridging Prevention and Recovery (BPR): A Community Approach to Systems Change.''' This SAFE Project program, offered in-person and virtually, guides community leaders through an action-oriented model to systemically integrate prevention and recovery systems to strengthen programs and improve outcomes. BPR is a 3.5 day training program that culminates with 6 technical assistance sessions tailored to each community’s unique set of needs to support implementation and sustainability of joint prevention and recovery community projects.<ref>https://www.safeproject.us/bridging-prevention-recovery/</ref>
*'''"Lessons Learned: What are Adverse Childhood Experiences?"''' This SAFE Project article an overview on what ACEs are and how to use this knowledge to better care for someone who is experiencing or has experienced ACEs in their lifetime. <ref>https://www.safeproject.us/resource/aces/</ref>
*See the wiki titled "Expand School-Based Prevention Programs" for more detailed information on how the school setting for children/adolescents can be used as protective factor from the adverse effects of substance use, misuse, and abuse. <ref>https://www.yoursafesolutions.us/wiki/Expand_School-Based_Prevention_Programs</ref>

'''This ACEs Infographic''' provides a succinct method for communicating an overview of ACEs. <ref>https://vetoviolence.cdc.gov/apps/aces-infographic/home</ref>

'''Adverse Community Experiences and Resilience: A Framework for Addressing and Preventing Community Trauma.''' This report was published by the Prevention Institute and focuses on linking personal and community resiliency. <ref>[https://www.preventioninstitute.org/publications/adverse-community-experiences-and-resilience-framework-addressing-and-preventing https://www.preventioninstitute.org/publications/adverse-community-experiences-and-resilience-framework-addressing-and-preventing]</ref>

'''Futures Without Violence''' has published "Changing Minds: Preventing and Healing Childhood Trauma State Policy Guide." <ref>https://www.pacesconnection.com/g/sonoma-county-aces-connection/fileSendAction/fcType/5/fcOid/473910123815383730/fodoid/473910123815383729/Changing-Minds-State-Policy-Framework.pdf</ref>

'''The Heart of Learning and Teaching: Compassion, Resiliency, and Academic Success.''' This report spans the needs of students and school staff and the responsibility of the community in fostering compassionate schools. It is a collaborative effort between staff in a public school, Western Washington University, and the Washington State Office of Superintendent of Public Instruction (OSPI) -- .<ref>https://www.k12.wa.us/sites/default/files/public/compassionateschools/pubdocs/theheartoflearningandteaching.pdf</ref>

'''National Child Traumatic Stress Network Learning Center:''' Registering for this free online learning center provides access to several archived sessions of interest to education professionals. The Schools and Trauma Speaker Series has five archived sessions: (1) Trauma-informed IEPs (2) Evidence-based practices (3) Sudden death on a school campus (4) Trauma-informed understanding of bullying (5) School/mental health partnerships. More resources are also available. <ref>http://learn.nctsn.org/</ref>

'''PACEs Connection''' is a major resource for information exchange for local, state, and national ACEs initiatives.<ref>https://www.acesconnection.com/</ref> It also provides a Diversity, Equity & Inclusion Tool that helps communities organize their stakeholders and other contacts to make sure that every part of the community is included. <ref>https://www.pacesconnection.com/g/fairfax-county-va-trauma-informed-community-network/blog/aces-connection-s-inclusion-tool-makes-sure-nobody-s-left-out</ref>

'''Trauma-Informed Care in Behavioral Health Services''' is a SAMHSA publication within its series of Treatment Improvement Protocols. <ref>https://www.ncbi.nlm.nih.gov/books/NBK207201/</ref>

'''Trauma Informed Schools Resource Guide.''' This publication by the Wilson Foundation provides insight on how to relate increasing awareness of ACES to the film, "Paper Tigers, which documents the life of some students in one school year at a trauma-informed high school. <ref> http://wilsonfdn.org/wp/wp-content/uploads/2015/03/Trauma-Informed-Schools-Resource-Guide.pdf</ref>

'''This documentary,''' "The Wisdom of Trauma," provides a video summary of many of the points brought forth in the work of Gabor Maté, discussed in the Relevant Research section of this article. <ref>https://www.youtube.com/watch?v=70HNmSsJvVU#:~:text=Gabor%20Mat%C3%A9%20to%20explore%20why,:%20https://thewisdomoftra...</ref>

= Promising Practices =

'''Peace4Tarpon.''' Tarpon City, Florida, was the first city in the US to declare itself a trauma-informed community. Trauma-informed practices have been implemented in small and large ways in a variety of organizations, including an elementary school, an ex-offender re-entry program, and the local housing authority. <ref>https://acestoohigh.com/2014/09/17/tarponsprings/</ref>

'''Compassionate Schools Program.''' This program in Washington State is an initiative that helps teachers to understand fundamental brain development and function and to correctly interpret behaviors, while engaging students, families, and the community. It simultaneously uses strategies that touch students daily -- through mindfulness activities in everyday teaching and learning, creating contracts with students for conflict resolution, and creating a culture that supports learning. The program resulted in dropping absenteeism rates, a decrease in disciplinary referrals, and improved engagement and achievement scores. <ref>https://www.schoolmentalhealth.org/media/SOM/Microsites/NCSMH/Documents/Archives/Compassionate-Schools-Start-Up-Guide.pdf</ref>

= Sources =

Become a Trauma-Informed Community

2025-02-21T20:49:23Z

BasilSavitsky: /* Available Tools and Resources */

= Introductory Paragraph =

Trauma is widespread and is an important component of understanding service delivery in behavioral health and substance use disorder.<ref>https://store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884.html</ref> To become “Trauma Informed,” it’s necessary to first understand the root causes of trauma, such as Adverse Childhood Experiences, or ACEs. Then, it is possible to understand that trauma has no boundaries with regard to age, gender, socioeconomic status, race, ethnicity, geography or sexual orientation. This is the beginning of becoming a trauma-informed community. The next challenge is for a community to provide a trauma-informed service system.

= Key Information =

'''Root Causes of Trauma'''

Trauma is especially common in the lives of people with behavioral and/or substance use disorders. For this reason, the need to address trauma is increasingly viewed as a critical component of behavioral health care and part of the healing and recovery process. The American Psychological Association defines trauma “as an emotional response to a terrible event like an accident, rape or natural disaster. Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and has adverse effects on the individuals functioning and well-being. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea. While these feelings are normal, some people have difficulty moving on with their lives."<ref>https://acestoohigh.com/got-your-ace-score/</ref>

ACEs are potentially traumatic events that occur in childhood (0-17 years).<ref> https://www.preventioninstitute.org/publications/adverse-community-experiences-and-resilience-framework-addressing-and-preventing</ref> The ACEs survey measures 10 types of childhood trauma; five are personal: physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect; five are related to other family members: a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. Each type of trauma in the ACES survey counts as one. The higher the ACES score, the higher the risk of social and health issues -- including substance use disorder. Using the ACES survey as a foundation, communities can see how trauma can result from racism and discrimination, intergenerational poverty, lack of job opportunities, exposure to violence, substandard housing and education, and lack of access to key services. <ref>http://sparqtools.org/mobility-measure/philadelphia-adverse-childhood-experiences-phl-ace/</ref> Some communities have developed expanded versions of the ACES survey to address issues specific to their region or city. For example, the city of Philadelphia’s Expanded ACE sub-scale has respondents answer six questions specific to experiences in their communities: witnessing violence, experiencing discrimination or food insecurity or racism, living in an unsafe neighborhood, being bullied, or living in foster care. <ref>http://wilsonfdn.org/wp/wp-content/uploads/2015/03/TIC-position-paper.pdf
</ref>

'''What Is a Trauma Informed Community?'''
The Wilson Foundation of Rochester, NY describes the concept of trauma informed community as “...a strategic approach linking all community sectors together around the effects of trauma, while preventing gaps in services for clients. It is coordinated and collaborative; recognizes that the diversity of the population requires individual responses; uses a common language, measurements and accountability.”<ref>http://wilsonfdn.org/wp/wp-content/uploads/2015/03/TIC-position-paper.pdf
</ref> If a community works to identify the specific drivers of trauma in its own backyard, it can also identify the factors that influence substance use disorder, allowing them to create the appropriate community supports for behavioral health care, plus healing and recovery.<ref>https://www.nctsn.org/trauma-informed-care/creating-trauma-informed-systems
</ref>

'''Trauma-Informed Systems.'''
The National Child Traumatic Stress Network describes a trauma-informed service system as one where all agencies, programs, and service providers have a trauma-informed perspective, including the following: <ref>https://nashp.org/wp-content/uploads/2018/09/Children-and-Opioid-Epidemic-1.pdf</ref>
* Routinely screen for trauma exposure and related symptoms.
* Use evidence-based, culturally responsive assessment and treatment for traumatic stress and associated mental health symptoms.
* Make resources available to children, families, and providers on trauma exposure, its impact, and treatment.
* Engage in efforts to strengthen the resilience and protective factors of children and families impacted by and vulnerable to trauma.
* Address parent and caregiver trauma and its impact on the family system.
* Emphasize continuity of care and collaboration across child-service systems.
* Maintain an environment of care for staff that addresses, minimizes, and treats secondary traumatic stress, and that increases staff wellness.

'''Child Welfare.'''
Substance use disorders can affect parents’ ability to effectively care for their children, and is sometimes linked to rises in foster care placement and mistreatment cases. These parents are also a particularly vulnerable population. They benefit from a family-based approach to care which ensures that community services are tailored to children’s needs and are provided in tandem with those delivered to the whole family. <ref>http://socialwork.buffalo.edu/social-research/institutes-centers/institute-on-trauma-and-trauma-informed-care/what-is-trauma-informed-care.html</ref>

'''School Systems.'''
For any community, schools may be the first resource for students coping with traumatic events. And it’s not just teachers in the classroom - it includes administrators, staff, and parents. The environment in a trauma-informed school supports all children to feel safe physically, socially, emotionally, and academically. When interviewed for a Washington State resource guide for creating trauma informed school settings, one teacher described the issue succinctly: a student who tries to focus on academics while struggling with trauma is like “trying to play chess in a hurricane." <ref>https://www.k12.wa.us/sites/default/files/public/compassionateschools/pubdocs/theheartoflearningandteaching.pdf</ref>

'''Healthcare.'''
Individuals who have experienced trauma are at an elevated risk for substance use disorders. A trauma-informed healthcare system understands and considers the pervasive nature of trauma and promotes environments of healing and recovery rather than practices and services that may inadvertently re-traumatize those seeking help. <ref>https://www.nctsn.org/trauma-informed-care/creating-trauma-informed-systems</ref>

'''Justice.'''
In a law enforcement setting, a trauma-informed approach starts with the same premise: to understand the physical, social, and emotional impact of trauma on the individual involved in that system. It also requires the understanding that both police officers and other professionals may also be traumatized by a particular event or long-term history of or exposure to violence. <ref>https://www.vera.org/blog/police-perspectives/building-trust-through-trauma-informed-policing</ref>

'''Ensuring Diversity in Trauma Informed Settings.'''
It is vital that communities are inclusive in terms of both the populations affected by trauma and the functions of agencies that provides services, such as education, law enforcement, and the faith-based community.

= Relevant Research =

*'''Emerging research''' has documented the relationship among exposure to traumatic events, impaired neuro-development and immune system responses, and subsequent health risks resulting in chronic physical or behavioral health disorders. Research has also indicated that with appropriate supports and interventions, people can overcome traumatic experiences. <ref>https://www.apa.org/topics/trauma/</ref>

*'''A book''' by Gabor Maté, "In the Realm of Hungry Ghosts: Close Encounters with Addiction" and one co-written by Gabor Maté and his son, Daniel Maté, "The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture," blend research and personal history to reframe the relationships between trauma, addiction, and effective healthcare.

= Impactful Federal, State, and Local Policies =

SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

= Available Tools and Resources =

'''SAFE Project:'''
*'''SAFE Veterans''' provides services to connect veterans, active-duty service members, and their families — all military-connected individuals — to the resources they need to address mental health challenges and substance use disorders. <ref>https://www.safeproject.us/veterans/</ref>
*'''Bridging Prevention and Recovery (BPR): A Community Approach to Systems Change.''' This SAFE Project program, offered in-person and virtually, guides community leaders through an action-oriented model to systemically integrate prevention and recovery systems to strengthen programs and improve outcomes. BPR is a 3.5 day training program that culminates with 6 technical assistance sessions tailored to each community’s unique set of needs to support implementation and sustainability of joint prevention and recovery community projects.<ref>https://www.safeproject.us/bridging-prevention-recovery/</ref>
*'''"Lessons Learned: What are Adverse Childhood Experiences?"''' This SAFE Project article an overview on what ACEs are and how to use this knowledge to better care for someone who is experiencing or has experienced ACEs in their lifetime. <ref>https://www.safeproject.us/resource/aces/</ref>
*See the wiki titled "Expand School-Based Prevention Programs" for more detailed information on how the school setting for children/adolescents can be used as protective factor from the adverse effects of substance use, misuse, and abuse. <ref>https://www.yoursafesolutions.us/wiki/Expand_School-Based_Prevention_Programs</ref>

'''This ACEs Infographic''' provides a succinct method for communicating an overview of ACEs. <ref>https://vetoviolence.cdc.gov/apps/aces-infographic/home</ref>

'''Adverse Community Experiences and Resilience: A Framework for Addressing and Preventing Community Trauma.''' This report was published by the Prevention Institute and focuses on linking personal and community resiliency. <ref>[https://www.preventioninstitute.org/publications/adverse-community-experiences-and-resilience-framework-addressing-and-preventing https://www.preventioninstitute.org/publications/adverse-community-experiences-and-resilience-framework-addressing-and-preventing]</ref>

'''Futures Without Violence''' has published " Changing Minds: Preventing and Healing Childhood Trauma State Policy Guide." <ref>https://www.pacesconnection.com/g/sonoma-county-aces-connection/fileSendAction/fcType/5/fcOid/473910123815383730/fodoid/473910123815383729/Changing-Minds-State-Policy-Framework.pdf</ref>

'''The Heart of Learning and Teaching: Compassion, Resiliency, and Academic Success.''' This report spans the needs of students and school staff and the responsibility of the community in fostering compassionate schools. It is a collaborative effort between staff in a public school, Western Washington University, and the Washington State Office of Superintendent of Public Instruction (OSPI) -- .<ref>https://www.k12.wa.us/sites/default/files/public/compassionateschools/pubdocs/theheartoflearningandteaching.pdf</ref>

'''National Child Traumatic Stress Network Learning Center:''' Registering for this free online learning center provides access to several archived sessions of interest to education professionals. The Schools and Trauma Speaker Series has five archived sessions: (1) Trauma-informed IEPs (2) Evidence-based practices (3) Sudden death on a school campus (4) Trauma-informed understanding of bullying (5) School/mental health partnerships. More resources are also available. <ref>http://learn.nctsn.org/</ref>

'''PACEs Connection''' is a major resource for information exchange for local, state, and national ACEs initiatives.<ref>https://www.acesconnection.com/</ref> It also provides a Diversity, Equity & Inclusion Tool that helps communities organize their stakeholders and other contacts to make sure that every part of the community is included. <ref>https://www.pacesconnection.com/g/fairfax-county-va-trauma-informed-community-network/blog/aces-connection-s-inclusion-tool-makes-sure-nobody-s-left-out</ref>

'''Trauma-Informed Care in Behavioral Health Services''' is a SAMHSA publication within its series of Treatment Improvement Protocols. <ref>https://www.ncbi.nlm.nih.gov/books/NBK207201/</ref>

'''Trauma Informed Schools Resource Guide.''' This publication by the Wilson Foundation provides insight on how to relate increasing awareness of ACES to the film, "Paper Tigers, which documents the life of some students in one school year at a trauma-informed high school. <ref> http://wilsonfdn.org/wp/wp-content/uploads/2015/03/Trauma-Informed-Schools-Resource-Guide.pdf</ref>

'''This documentary,''' "The Wisdom of Trauma," provides a video summary of many of the points brought forth in the work of Gabor Maté, discussed in the Relevant Research section of this article. <ref>https://www.youtube.com/watch?v=70HNmSsJvVU#:~:text=Gabor%20Mat%C3%A9%20to%20explore%20why,:%20https://thewisdomoftra...</ref>

= Promising Practices =

'''Peace4Tarpon.''' Tarpon City, Florida, was the first city in the US to declare itself a trauma-informed community. Trauma-informed practices have been implemented in small and large ways in a variety of organizations, including an elementary school, an ex-offender re-entry program, and the local housing authority. <ref>https://acestoohigh.com/2014/09/17/tarponsprings/</ref>

'''Compassionate Schools Program.''' This program in Washington State is an initiative that helps teachers to understand fundamental brain development and function and to correctly interpret behaviors, while engaging students, families, and the community. It simultaneously uses strategies that touch students daily -- through mindfulness activities in everyday teaching and learning, creating contracts with students for conflict resolution, and creating a culture that supports learning. The program resulted in dropping absenteeism rates, a decrease in disciplinary referrals, and improved engagement and achievement scores. <ref>https://www.schoolmentalhealth.org/media/SOM/Microsites/NCSMH/Documents/Archives/Compassionate-Schools-Start-Up-Guide.pdf</ref>

= Sources =

Apply a Health Equity Lens

2025-02-20T22:32:02Z

BasilSavitsky: /* Key Information */

= Introductory Paragraph =

This is the first in a pair of related articles on health equity and disparities as it pertains to the field of substance use. This particular article focuses on defining health equity and introduces general resources associated with building health equity. The second article, “Addressing SUD Disparities,” focuses on various populations who more frequently encounter health inequity and avenues to increase health outcomes across these disparate populations. <ref>https://www.yoursafesolutions.us/wiki/Intersectionality_and_Addressing_Disparities</ref>

Health equity is a broad term that describes the ability of everyone to have a fair and just opportunity to attain their highest level of health. The first step in understanding health equity is to recognize that the opportunity to be healthy is not equally available everywhere or for everyone in the community. This leads to a more personal understanding of the importance of increasing health equity and paves the way to addressing the root causes of health inequity. Many factors impact our ability to achieve health equity, such as our race, ethnicity, sex, gender identity, sexual orientation, disability/disease type, language, religious, socioeconomic status, health care coverage, access to healthy food, transportation, and geographic location among others. Since all of these factors are different for each of us as individuals, we all have a different opportunity to obtain health. When we are impacted by health inequity, it contributes to our quality of life, disease type, disability status, and even death.

It has been well-documented that there are differences in health outcomes for different groups of people. Populations that are more likely to experience health inequity include people of color, Native Americans, LGBTQI+ individuals, individuals with disabilities, and those with low socio-economic status. The lack of health equity and inequity has become amplified in social issues involving substance use disorder. Recently, the term has become more highly politicized; however, there is exhaustive historical research and data demonstrating clear disparities in health. It is typical for this work to become politicized because policy and funding decisions are usually intermixed with issues that impact health equity, like access to housing, environment, education for example.

= Key Information =

Health equity requires an active commitment to identify groups in your community that are more negatively impacted by substance use and remove obstacles that keep them from being able to achieve their greatest potential for health. This includes increasing opportunities to access care, reducing active, problematic substance use, and increasing outcomes across disparate populations.

There are two strategies embedded within health equity work. One approach is to increase access to substance use services and to increase positive health outcomes. The complementary approach is to remove barriers that cause health disparities. This requires going deeper into the root causes of intergenerational patterns and understanding the differences in values that underlie cultural behaviors. Likewise, reversing disparities that exist as a result of policy decisions that systematically disadvantage some populations over others will create new avenues for advocacy.

'''Key Terms'''

One way to understand the objectives for advancing health equity is to look at the language of this work. We can decouple the term health equity from related, but distinctly different terms, such as cultural competency, cultural humility, and the social determinants of health. ''Cultural competency'' can be understood as the foundational level. It typically involves methods for decreasing cultural offense. In communities, an example of this would be increasing the offering of materials and services in multiple languages. In contrast, ''cultural humility'' requires a higher order of understanding. It moves from an awareness of what the differences are to why the differences have caused inequity. Addressing the ''social determinants of health'' is a systems approach that provides a complex set of solutions.

Working across the continuum of care takes a systems approach. This positions our communities to take on more complex systems work, such as that associated with social determinants of health. It is difficult to work for long in the behavioral health field without bumping into multiple interrelated systems, creating a foundation to advance in the territory of social determinants of health. It is useful to realize the potential difficulties and to adjust expectations of outcome accordingly. This creates the foundation for advancing cultural competency and cultural humility in the territory of social determinants of health.

*'''Cultural Competence''' is central to each of the five phases of the Strategic Prevention Framework (SPF). See three SAFE Solutions articles titled “Collect and Share Data,” <ref>https://www.yoursafesolutions.us/wiki/Collect_and_Share_Data</ref> “Build Capacity,” <ref>https://www.yoursafesolutions.us/wiki/Build_Capacity</ref> and “Plan, Implement, and Evaluate.” <ref>https://www.yoursafesolutions.us/wiki/Plan,_Implement,_and_Evaluate</ref> Cultural Competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients. A culturally competent healthcare organization seeks to understand the culture of the population served, recognizes the impact of cultural differences, fosters internal learning opportunities to improve cultural knowledge among care teams, and modifies patient care to meet the patient’s unique needs. There continues to be an increase in training in cultural competency. However, since addressing the substance use disorder epidemic is a complex problem requiring a complex and coordinated set of solutions, much of the implementation of learned skills remains superficial.

*'''Cultural Humility.''' Health equity requires more than being culturally competent. It requires an examination of our personal biases. While cultural competence can be seen as operational at the community scale, cultural humility is grounded in personal relationships. It transcends one-way communication by moving into a two-way communication, which involves suspension of judgment and active listening. For example, the commonly used term, “target population,” carries a subtle message that leads to talking at people, rather than working with them. Cultural humility shifts the focus of communication from content to engagement. An example from youth engagement can be drawn from the work of Roger Hart (1992). <ref>Hart, R. A. (1992). Children’s participation: From tokenism to citizenship. Florence, Italy: United Nations Children’s Fund International Child Development Centre. </ref> His “youth participation ladder” has five phases which move beyond the non-participation of tokenism:
**Assigned, but informed
**Consulted and informed
**Adult-initiated with shared decision-making
**Youth initiated and directed
**Youth-initiated with shared adult decision-making
Building cultural humility is a very layered process and is never finished. The main point is to be aware of the different values, behaviors, and institutions of various populations and to address those respectfully and purposefully.

*'''Social Determinants of Health (SDOH).''' The CDC defines SDOH as “the nonmedical factors that influence health outcomes — the conditions in which people are born, grow, work, live, worship, and age.” Five key areas in which this work is advanced include:
**healthcare access and quality
**education access and quality
**social and community context,
**economic stability, and
**neighborhood and built environment

'''Building Capacity for Health Equity'''

It is useful to keep in mind a common phrase in the recovery community: “Nothing about us, without us.” This speaks to the fact that there are unique needs for various populations and that the people being served should have a central voice in the planning and delivery of your coalition’s initiatives. Such a systems-change intention taps our leadership and communication skills because it requires coalitions to build meaningful partnerships, establish trust with each other and within the community, and allow for the time and space to identify shared priorities and evaluate outcomes for continuous improvement. Overall, health equity requires a focused intention to cultivate new partnerships with people from different backgrounds. A challenging task within the health equity domain is understanding the readiness of the coalition members to recognize the systemic nature of health inequity within the substance use crisis and increasing the ability of the coalition to generate the level of systemic community change that is required to address the social determinants of health. There is usually a readiness to close disparity gaps, but the ability may not be there yet. Coalitions should work towards building a plan that focuses specifically on achieving greater health equity in their community as it relates to behavioral health. A culturally competent organization seeks to understand the culture of the population served, recognizes the impact of cultural differences, fosters internal learning opportunities to improve cultural knowledge among care teams, and modifies patient care to meet the patient’s unique needs.

A few guideposts follow for community groups looking to improve their response to substance use and to make health equity a priority:
*Collect demographic data including race, ethnicity, language preference, and other indicators that track trends over a period of time and allow for comparison across different populations,
*Identify and report on disparities regularly in order to maintain accountability,
*Work in partnership with other sectors (like housing, criminal justice, education, etc.) to incorporate unique perspectives and allowing for better integration of services,
*Offer culturally and linguistically competent care (i.e. interpretation services, respecting and offering diverse dietary options),
*Situate services in geographical areas that are easily accessible to people across the entire community,
*Develop culturally competent management programs,
*Increase diversity and minority participation including those with lived experienced,
*Involve the community in the decision-making process,
*Train staff on sociocultural factors and recognition of personal biases, and
*Make health equity a priority and educate others, including policymakers.

= Relevant Research =

*'''World Health Organization.''' A landmark work titled “Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health,” is the final report of WHO’s Commission on Social Determinants of Health. This research set the stage for the work being done on social determinants since then. <ref>CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization, retrieved from https://iris.who.int/bitstream/handle/10665/43943/9789241563703_eng.pdf;jsessionid=D2EB5F0D0BC71039E0E64D1450E8E5AD?sequence=1</ref>

*'''This article''' delineates a more recent assessment of research directions for SDOH. <ref>Palmer, R.C., Ismond, D., Rodriguez, E.J., & Kaufman, J.S. (January 2019). Social Determinants of Health: Future Directions for Health Disparities Research. American Journal of Public Health, 109, S-70-S71. DOI: 10.2105/AJPH.2019.304964 retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC6356128/</ref>

*'''JUSTICE SQUARED''' (Just Leaders for a Just Health System) provides a library of over 5000 resources including leading research on health equity. <ref>https://www.racialequitytools.org/resources/fundamentals</ref>

= Impactful Federal, State, and Local Policies =

*In 2023, the White House published “The U.S. Playbook to to Address Social Determinants of Health.” <ref>https://www.whitehouse.gov/wp-content/uploads/2023/11/SDOH-Playbook-4.pdf</ref>

*The US Department of Health and Human Services hosts the Social Determinants of Health Workgroup which includes six lead federal agencies. Its work is focused upon eight “Healthy 2030” objectives, such as reducing poverty and increasing employment and housing opportunities. This is paralleled by the Healthy 2030 Substance Use Workgroup which has and 25 measurable objectives. <ref>https://odphp.health.gov/healthypeople/about/workgroups/substance-use-workgroup</ref>

*SAMHSA has examined health equity in great detail. It provides many resources that discuss how to improve cultural competence in the areas of substance use and mental health. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4849.pdf</ref>

* The National Institute for Minority Health and Health Disparities (NIMHD) provides funding for the Health Equity Action Network (HEAN), a national consortium of health researchers and community partners. <ref>https://health-equity-action.org/</ref>

* CDC sponsors "Health Equity in Action" which highlights the work of CDC and CDC-funded projects that work to reduce health disparities and advance health equity. <ref>https://www.cdc.gov/health-equity/in-action/index.html</ref>

*The National Academy for State Health Policy (NASHP) focused its 2024 annual conference on health equity, promoting “whole-of-government” strategies to encourage cross-agency and system-wide collaboration in establishing policies to address health disparities <ref>https://nashp.org/nashps-annual-conference-highlights-state-strategies-to-advance-health-equity/</ref> Their publication, “Data Strategies to Understand and Address Health Disparities” indicates that there remains variability between states regarding data collection and analysis procedures on health equity. The NASHP report highlights examples of states which are leading in implementing data strategies. <ref> https://nashp.org/data-strategies-to-understand-and-address-health-disparities/</ref>

= Available Tools and Resources =

*'''The School of Medicine at the University of California, Davis.''' This 2-minute video provides a quick introduction to health equity by differentiating it from the term “equality.”

*'''Pfizer Multicultural Health Equity Collective''' has published "Health Equity in Action: Optimal Interventions to Systemic Drivers of Racial Health Inequities." <ref>https://www.heiasummit.com/assets/action-guide-07142023-single.pdf</ref> This action guide resulted from a summit held with partner co-conveners, including The Century Foundation, the National Minority Quality Forum, the Morehouse School of Medicine, and the National Association of County and City Health Officials. The Summit brought together thought leaders from industry, research and academic institutions, healthcare settings, advocacy organizations, and others to surface key opportunities to address racism and structural inequities that contribute to racial and ethnic healthcare disparities.

*'''Hawai’i Department of Health.''' This is an example of a training which promotes cultural humility by focusing on the connections made through cultural wisdom. <ref>https://aanhpi-ohana.org/event/anchoring-our-health-through-cultural-wisdom-renewal-requires-internal-connection-through-exposure/</ref>

*'''The National Association of County and City Health Officials (NACCHO)''' offers a free online course titled “The Roots of Health Inequity.” This is not an “101” on health equity, but rather a useful tool for agencies ready to take an “intermediate” course requiring approximately 10 hours over a few weeks, with regular office hour support provided. The 10 modules in the course unpack the root causes of health inequity, weave the histories of public health and social justice efforts, and examine power dynamics, such as structural racism. <ref>https://www.naccho.org/programs/public-health-infrastructure/health-equity/</ref>

*'''Recovery Village''' provides a guide on how to participate in World Drug Day, an international day dedicated to raising awareness about SUDs and the importance of treatment and equitable access. <ref>https://www.therecoveryvillage.com/drug-addiction/news/world-drug-day/</ref>

= Promising Practices =

*'''The Health Equity Advisory Team (HEAT)''' is a national arm of the Health Care Payment Learning & Action Network (HCPLAN). It works to identify and prioritize opportunities to advance health equity through alternative payment models (APMs). HEAT’s goal is person-centered and focuses on leveraging APMs to help make needed care more accessible, drive better patient outcomes, and reduce disparities. The team comprises a diverse group of regional and national health equity implementers and subject matter experts committed to mitigating health inequities in the nation’s health care system and applying APM design principles to intentionally address factors that drive health inequities. <ref>https://hcp-lan.org/health-equity-advisory-team/</ref>

*'''Minnesota.''' The Minnesota Department of Human Services (DHS) met with leaders of community-based organizations working to advance racial equity in health care and published a report titled, “Building Racial Equity into the Walls of Minnesota Medicaid.” <ref>https://www.lrl.mn.gov/docs/2022/other/220230.pdf</ref>

*'''Nebraska.''' The Winnebago Tribe operates the Winnebago Comprehensive Healthcare System which centers cultural traditions and beliefs in its work. <ref> https://winnebagohealth.com/</ref> It takes a community-focused approach to health and wellness and uses the Indigenous Social Determinants of Health. <ref>https://nnphi.org/relatedarticle/indigenous-social-determinants-of-health/</ref>

= Sources =

Apply a Health Equity Lens

2025-02-20T22:15:50Z

BasilSavitsky: /* Key Information */

= Introductory Paragraph =

This is the first in a pair of related articles on health equity and disparities as it pertains to the field of substance use. This particular article focuses on defining health equity and introduces general resources associated with building health equity. The second article, “Addressing SUD Disparities,” focuses on various populations who more frequently encounter health inequity and avenues to increase health outcomes across these disparate populations. <ref>https://www.yoursafesolutions.us/wiki/Intersectionality_and_Addressing_Disparities</ref>

Health equity is a broad term that describes the ability of everyone to have a fair and just opportunity to attain their highest level of health. The first step in understanding health equity is to recognize that the opportunity to be healthy is not equally available everywhere or for everyone in the community. This leads to a more personal understanding of the importance of increasing health equity and paves the way to addressing the root causes of health inequity. Many factors impact our ability to achieve health equity, such as our race, ethnicity, sex, gender identity, sexual orientation, disability/disease type, language, religious, socioeconomic status, health care coverage, access to healthy food, transportation, and geographic location among others. Since all of these factors are different for each of us as individuals, we all have a different opportunity to obtain health. When we are impacted by health inequity, it contributes to our quality of life, disease type, disability status, and even death.

It has been well-documented that there are differences in health outcomes for different groups of people. Populations that are more likely to experience health inequity include people of color, Native Americans, LGBTQI+ individuals, individuals with disabilities, and those with low socio-economic status. The lack of health equity and inequity has become amplified in social issues involving substance use disorder. Recently, the term has become more highly politicized; however, there is exhaustive historical research and data demonstrating clear disparities in health. It is typical for this work to become politicized because policy and funding decisions are usually intermixed with issues that impact health equity, like access to housing, environment, education for example.

= Key Information =

Health equity requires an active commitment to identify groups in your community that are more negatively impacted by substance use and remove obstacles that keep them from being able to achieve their greatest potential for health. This includes increasing opportunities to access care, reducing active, problematic substance use, and increasing outcomes across disparate populations.

There are two strategies embedded within health equity work. One approach is to increase access to substance use services and to increase positive health outcomes. The complementary approach is to remove barriers that cause health disparities. This requires going deeper into the root causes of intergenerational patterns and understanding the differences in values that underlie cultural behaviors. Likewise, reversing disparities that exist as a result of policy decisions that systematically disadvantage some populations over others will create new avenues for advocacy.

'''Key Terms'''

One way to understand the objectives for advancing health equity is to look at the language of this work. We can decouple the term health equity from related, but distinctly different terms, such as cultural competency, cultural humility, and the social determinants of health. ''Cultural competency'' can be understood as the foundational level. It typically involves methods for decreasing cultural offense. In communities, an example of this would be increasing the offering of materials and services in multiple languages. In contrast, ''cultural humility'' requires a higher order of understanding. It moves from an awareness of what the differences are to why the differences have caused inequity. Addressing the ''social determinants of health'' is a systems approach that provides a complex set of solutions.

Working across the continuum of care takes a systems approach. This positions our communities to take on more complex systems work, such as that associated with social determinants of health. It is difficult to work for long in the behavioral health field without bumping into multiple interrelated systems, creating a foundation to advance in the territory of social determinants of health. It is useful to realize the potential difficulties and to adjust expectations of outcome accordingly. This creates the foundation for advancing cultural competency and cultural humility in the territory of social determinants of health.

*'''Cultural Competence''' is central to each of the five phases of the Strategic Prevention Framework (SPF). See three SAFE Solutions articles titled “Collect and Share Data,” “Build Capacity,” and “Plan, Implement, and Evaluate.” <Add links> Cultural Competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients. A culturally competent healthcare organization seeks to understand the culture of the population served, recognizes the impact of cultural differences, fosters internal learning opportunities to improve cultural knowledge among care teams, and modifies patient care to meet the patient’s unique needs. There continues to be an increase in training in cultural competency. However, since addressing the substance use disorder epidemic is a complex problem requiring a complex and coordinated set of solutions, much of the implementation of learned skills remains superficial.

*'''Cultural Humility.''' Health equity requires more than being culturally competent. It requires an examination of our personal biases. While cultural competence can be seen as operational at the community scale, cultural humility is grounded in personal relationships. It transcends one-way communication by moving into a two-way communication, which involves suspension of judgment and active listening. For example, the commonly used term, “target population,” carries a subtle message that leads to talking at people, rather than working with them. Cultural humility shifts the focus of communication from content to engagement. An example from youth engagement can be drawn from the work of Roger Hart (1992). <ref>Hart, R. A. (1992). Children’s participation: From tokenism to citizenship. Florence, Italy: United Nations Children’s Fund International Child Development Centre. </ref> His “youth participation ladder” has five phases which move beyond the non-participation of tokenism:
**Assigned, but informed
**Consulted and informed
**Adult-initiated with shared decision-making
**Youth initiated and directed
**Youth-initiated with shared adult decision-making
Building cultural humility is a very layered process and is never finished. The main point is to be aware of the different values, behaviors, and institutions of various populations and to address those respectfully and purposefully.

*'''Social Determinants of Health (SDOH).''' The CDC defines SDOH as “the nonmedical factors that influence health outcomes — the conditions in which people are born, grow, work, live, worship, and age.” Five key areas in which this work is advanced include:
**healthcare access and quality
**education access and quality
**social and community context,
**economic stability, and
**neighborhood and built environment

'''Building Capacity for Health Equity'''

It is useful to keep in mind a common phrase in the recovery community: “Nothing about us, without us.” This speaks to the fact that there are unique needs for various populations and that the people being served should have a central voice in the planning and delivery of your coalition’s initiatives. Such a systems-change intention taps our leadership and communication skills because it requires coalitions to build meaningful partnerships, establish trust with each other and within the community, and allow for the time and space to identify shared priorities and evaluate outcomes for continuous improvement. Overall, health equity requires a focused intention to cultivate new partnerships with people from different backgrounds. A challenging task within the health equity domain is understanding the readiness of the coalition members to recognize the systemic nature of health inequity within the substance use crisis and increasing the ability of the coalition to generate the level of systemic community change that is required to address the social determinants of health. There is usually a readiness to close disparity gaps, but the ability may not be there yet. Coalitions should work towards building a plan that focuses specifically on achieving greater health equity in their community as it relates to behavioral health. A culturally competent organization seeks to understand the culture of the population served, recognizes the impact of cultural differences, fosters internal learning opportunities to improve cultural knowledge among care teams, and modifies patient care to meet the patient’s unique needs.

A few guideposts follow for community groups looking to improve their response to substance use and to make health equity a priority:
*Collect demographic data including race, ethnicity, language preference, and other indicators that track trends over a period of time and allow for comparison across different populations,
*Identify and report on disparities regularly in order to maintain accountability,
*Work in partnership with other sectors (like housing, criminal justice, education, etc.) to incorporate unique perspectives and allowing for better integration of services,
*Offer culturally and linguistically competent care (i.e. interpretation services, respecting and offering diverse dietary options),
*Situate services in geographical areas that are easily accessible to people across the entire community,
*Develop culturally competent management programs,
*Increase diversity and minority participation including those with lived experienced,
*Involve the community in the decision-making process,
*Train staff on sociocultural factors and recognition of personal biases, and
*Make health equity a priority and educate others, including policymakers.

= Relevant Research =

*'''World Health Organization.''' A landmark work titled “Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health,” is the final report of WHO’s Commission on Social Determinants of Health. This research set the stage for the work being done on social determinants since then. <ref>CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization, retrieved from https://iris.who.int/bitstream/handle/10665/43943/9789241563703_eng.pdf;jsessionid=D2EB5F0D0BC71039E0E64D1450E8E5AD?sequence=1</ref>

*'''This article''' delineates a more recent assessment of research directions for SDOH. <ref>Palmer, R.C., Ismond, D., Rodriguez, E.J., & Kaufman, J.S. (January 2019). Social Determinants of Health: Future Directions for Health Disparities Research. American Journal of Public Health, 109, S-70-S71. DOI: 10.2105/AJPH.2019.304964 retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC6356128/</ref>

*'''JUSTICE SQUARED''' (Just Leaders for a Just Health System) provides a library of over 5000 resources including leading research on health equity. <ref>https://www.racialequitytools.org/resources/fundamentals</ref>

= Impactful Federal, State, and Local Policies =

*In 2023, the White House published “The U.S. Playbook to to Address Social Determinants of Health.” <ref>https://www.whitehouse.gov/wp-content/uploads/2023/11/SDOH-Playbook-4.pdf</ref>

*The US Department of Health and Human Services hosts the Social Determinants of Health Workgroup which includes six lead federal agencies. Its work is focused upon eight “Healthy 2030” objectives, such as reducing poverty and increasing employment and housing opportunities. This is paralleled by the Healthy 2030 Substance Use Workgroup which has and 25 measurable objectives. <ref>https://odphp.health.gov/healthypeople/about/workgroups/substance-use-workgroup</ref>

*SAMHSA has examined health equity in great detail. It provides many resources that discuss how to improve cultural competence in the areas of substance use and mental health. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4849.pdf</ref>

* The National Institute for Minority Health and Health Disparities (NIMHD) provides funding for the Health Equity Action Network (HEAN), a national consortium of health researchers and community partners. <ref>https://health-equity-action.org/</ref>

* CDC sponsors "Health Equity in Action" which highlights the work of CDC and CDC-funded projects that work to reduce health disparities and advance health equity. <ref>https://www.cdc.gov/health-equity/in-action/index.html</ref>

*The National Academy for State Health Policy (NASHP) focused its 2024 annual conference on health equity, promoting “whole-of-government” strategies to encourage cross-agency and system-wide collaboration in establishing policies to address health disparities <ref>https://nashp.org/nashps-annual-conference-highlights-state-strategies-to-advance-health-equity/</ref> Their publication, “Data Strategies to Understand and Address Health Disparities” indicates that there remains variability between states regarding data collection and analysis procedures on health equity. The NASHP report highlights examples of states which are leading in implementing data strategies. <ref> https://nashp.org/data-strategies-to-understand-and-address-health-disparities/</ref>

= Available Tools and Resources =

*'''The School of Medicine at the University of California, Davis.''' This 2-minute video provides a quick introduction to health equity by differentiating it from the term “equality.”

*'''Pfizer Multicultural Health Equity Collective''' has published "Health Equity in Action: Optimal Interventions to Systemic Drivers of Racial Health Inequities." <ref>https://www.heiasummit.com/assets/action-guide-07142023-single.pdf</ref> This action guide resulted from a summit held with partner co-conveners, including The Century Foundation, the National Minority Quality Forum, the Morehouse School of Medicine, and the National Association of County and City Health Officials. The Summit brought together thought leaders from industry, research and academic institutions, healthcare settings, advocacy organizations, and others to surface key opportunities to address racism and structural inequities that contribute to racial and ethnic healthcare disparities.

*'''Hawai’i Department of Health.''' This is an example of a training which promotes cultural humility by focusing on the connections made through cultural wisdom. <ref>https://aanhpi-ohana.org/event/anchoring-our-health-through-cultural-wisdom-renewal-requires-internal-connection-through-exposure/</ref>

*'''The National Association of County and City Health Officials (NACCHO)''' offers a free online course titled “The Roots of Health Inequity.” This is not an “101” on health equity, but rather a useful tool for agencies ready to take an “intermediate” course requiring approximately 10 hours over a few weeks, with regular office hour support provided. The 10 modules in the course unpack the root causes of health inequity, weave the histories of public health and social justice efforts, and examine power dynamics, such as structural racism. <ref>https://www.naccho.org/programs/public-health-infrastructure/health-equity/</ref>

*'''Recovery Village''' provides a guide on how to participate in World Drug Day, an international day dedicated to raising awareness about SUDs and the importance of treatment and equitable access. <ref>https://www.therecoveryvillage.com/drug-addiction/news/world-drug-day/</ref>

= Promising Practices =

*'''The Health Equity Advisory Team (HEAT)''' is a national arm of the Health Care Payment Learning & Action Network (HCPLAN). It works to identify and prioritize opportunities to advance health equity through alternative payment models (APMs). HEAT’s goal is person-centered and focuses on leveraging APMs to help make needed care more accessible, drive better patient outcomes, and reduce disparities. The team comprises a diverse group of regional and national health equity implementers and subject matter experts committed to mitigating health inequities in the nation’s health care system and applying APM design principles to intentionally address factors that drive health inequities. <ref>https://hcp-lan.org/health-equity-advisory-team/</ref>

*'''Minnesota.''' The Minnesota Department of Human Services (DHS) met with leaders of community-based organizations working to advance racial equity in health care and published a report titled, “Building Racial Equity into the Walls of Minnesota Medicaid.” <ref>https://www.lrl.mn.gov/docs/2022/other/220230.pdf</ref>

*'''Nebraska.''' The Winnebago Tribe operates the Winnebago Comprehensive Healthcare System which centers cultural traditions and beliefs in its work. <ref> https://winnebagohealth.com/</ref> It takes a community-focused approach to health and wellness and uses the Indigenous Social Determinants of Health. <ref>https://nnphi.org/relatedarticle/indigenous-social-determinants-of-health/</ref>

= Sources =

Intersectionality and Addressing Disparities

2025-02-18T21:13:56Z

BasilSavitsky: /* Promising Practices */

2025-01-31T19:44:35Z

BasilSavitsky: /* Key Information */

= Introductory Paragraph =

The primary purpose of this article is to demystify systems change science. Anyone working to change social norms is, by definition, aspiring to change a variety of systems which are resistant to innovative solutions. Anyone involved in working across the continuum of care or doing multi-sectoral work is, by definition, breaking down silos (See the SAFE Solution article titled, “Activate Your Community.”) Systems change science simply highlights the most effective ways to make those changes happen.

The secondary purpose of this article is to introduce the relationships between the themes covered in greater detail in the other articles in this collection of articles on system-building. For example, all of the articles of the Strategic Prevention Framework (SPF) incorporate data, whether it is in needs assessment, prioritization of implementation choices during planning, or in evaluating outcomes. Likewise, the process of advocacy (see “Advocate for Policy Change”) is dependent not only upon data but also on the effective communication of measurable outcomes (See “Build Education and Raise Awareness”).

= Key Information =

In keeping with the objective of demystifying systems change science, it may be useful to keep in mind the saying, “the whole is greater than the sum of the parts.” This comes from the systems approach, which is really just a way of thinking. It focuses on the big picture and on seeing the relationships between the component parts of the system. In a way it is bifocal vision — seeing both the forest and trees. It invites seeing patterns and underlying structures. Such a vantage point equips us to identify optimal courses of action to create change most effectively. For example, one motivated champion in a coalition may have more community impact than ten people who are members because of their departmental obligations, so finding three more comparable champions helps the coalition to leverage change more effectively than just focusing on growing the size of the coalition.

A systems approach also takes a deep view. It focuses on changing the source of conditions, rather than addressing symptoms. For example, in addressing recidivism or the "prison revolving door," a systems approach fosters tighter linkage between the judicial systems and numerous community systems. In another example, when county commissioners examine the amount of their annual budgets allocated to foster care, they are doing systems work when they seek root causes and fund programs which target substance use disorder within families. The prevention community has done a good job of promoting the need to balance “downstream” work with an “upstream” and proactive approach. Systems thinking goes further and looks at the groundwater. In many respects, a focus on protective factors creates a context for linking with allies working in related fields, such as substance use prevention, suicide prevention, and the prevention of gun violence or domestic violence (See the SAFE Solution article titled, “Apply a Multi-Sectoral Approach.” <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Multi-Sectoral_Approach</ref>) Likewise, the deep view of a systems approach encounters underlying values and worldviews that shape the landscape of the work we are doing around substance use.

One by-product of taking a systems-thinking approach is the ability to transcend binary-thinking which limits choices to only black or white. In the treatment world, medicated-assisted treatment (MAT) is an example of "finding the gray." Motivational interviewing is another therapeutic model which focuses on person-centered immediate goals which promote progress on client-centered terms, rather than measuring results only upon the long-term outcomes which a therapist might hold.

'''Examples of System-Building'''

Any form of multi-sectoral collaboration is inherently systems work. Building coalition membership with representation from stakeholders who represent different agencies requires acting on a broad view. Bringing together health promotion and law enforcement agencies is a complex systems task because they tend to work on opposite ends of the upstream/downstream continuum. Drug take-back are a useful mechanism for forging this type of collaboration. (See the SAFE Solution article titled, "Expand Prescription Drug Take-Back and Disposal Programs.) <ref>https://www.yoursafesolutions.us/wiki/Expand_Prescription_Drug_Take-Back_and_Disposal_Programs</ref> Likewise, fostering collaboration between the medical community and the faith community reveals the kind of language translation that is needed because one tends to speak of curing while the other operates in a healing modality. In a similar fashion, advances in chronic pain management as an alternative to prescription medication is fostering a multi-sectoral collaboration between doctors and alternative health practitioners. (See the SAFE Solution article titled, “Expand and Enhance Chronic Pain Prevention and Management.”) <ref>https://www.yoursafesolutions.us/wiki/Expand_and_Enhance_Chronic_Pain_Prevention_and_Management</ref>
Community/Campus initiatives are also examples of systems work. Whenever effort bridge two or more of the five zones of the social-ecological model (individual, family, peer, school, community) they reflect a systems approach.

While system-building may seem complex at first, when the extent to which we are already engaged in working across multiple systems, it becomes much simpler. However, simple is not necessarily easy. One area of doing the hard work is in the community-wide norm change associated with stigma reduction (See the SAFE Solution article titled, “Reduce Stigma.”) Another example is work done to address social determinants of health. One cannot work very long in prevention, treatment, or recovery without encountering the “negative synergy” often caused by multiple concurrent barriers in transportation, housing, and employment systems (See the SAFE Solution article titled, “Apply a Health Equity Lens.”) Four more detailed examples are provided below, with specific action pathways:

*'''Harm Reduction.''' Any inroads that are made either in the realm of multiple recovery pathways or in harm reduction are proof of at least some degree of success in navigating through a systems approach. The distribution and training of how to use Naloxone continues to be an effective way to reverse opioid overdose and save lives. Other programs, like needle/syringe exchanges, reduce the risk of infection and prevent the spread of other diseases. Resistance to these programs is reduced when they are paired with providing information about treatment options and other available support in the community.
**What training on Naloxone administration is available in the area?
**How is this service being marketed to ensure organizations across the health system know it is available? What are the most effective ways to expand distribution of Naloxone and add other harm reduction measures?
**Are there ways to improve linkages to care?
**What can the coalition do to reach more people, especially in areas with the highest rates of overdose, to expand harm reduction efforts?

*'''Recovery Supports.''' Housing, education, childcare, job training, and job placement assistance are just some of the recovery support services needed to help people in early recovery. Without these supports, many people can become frustrated or hopeless - increasing their chances of relapse. Communities with strong supports for people newer to recovery have seen positive results.
**What types of recovery support services exist in the region?
**Who are the key organizations working on one or more recovery supports?
**Are area employers engaged? What about area workforce development entities?
**Who can help expand these efforts as part of the coalition?

*'''Peer Support Networks.''' Peer Support Specialists and Recovery Coaches can play a vital role across numerous systems change initiatives. Working together with police, health services, treatment providers, and recovery support networks, they often provide an initial link to care for someone seeking help after an overdose or just wanting help. In many instances, they continue to work with people for longer periods of time - helping them find and get through treatment, as well as to provide support in meeting needs to maintain recovery.
**How are peers being utilized in the area?
**Is there room to expand current efforts and add more peer support through additional training and funding?
**If more peer specialists and coaches could be added in the region, who is needed to help make that a reality?

*'''Collaboration with the Criminal Justice System.''' It is generally recognized that, in contrast to long-term incarceration, a person suffering from SUD can be helped to a far greater degree through various diversion and treatment programs which can lead to a life in recovery. Socially and economically, this is tremendously beneficial to society.
**What options are there for those in the criminal justice system in terms of diversion, drug court, treatment while incarcerated, and treatment/support services for those leaving incarceration?
**Are there areas that need to be added or improved?
**Given what programs currently exist, what improvements could be made within the state and local criminal justice systems in terms of additional or expanded programs to help those with SUD find treatment - either through diversion programs or treatment for those incarcerated?
**Are key figures who are part of the system willing to participate in a coalition?

= Relevant Research =

*Extensive work has been done in systems research in the physical and biological sciences, but less in the social sciences, especially focused on social systems associated with SUD. The classic introduction to the field is provided by Peter Senge who defines systems thinking as “a way to see interrelationships rather than things ... patterns of change rather than static snapshots.” He calls it a sensibility for subtle interconnectedness that is increasingly necessary in a world fraught with complexity. <ref>Senge, P. (1990). The fifth discipline. New York: Doubleday.</ref>

*A summary of work in changing social systems can be found in the work of David Stroh. <ref>Stroh, D. (2015). Systems thinking for social change. White River Junction: Chelsea Green Publishing.</ref>

*The World Health Organization promotes systems thinking as a way to mitigate negative behaviors, anticipate positive synergies, and create system-ready policies. <ref>Savigny, D. d., & Taghreed, A. (2009). Systems thinking for health systems strengthening. Alliance for Health Policy and Systems Research. World Health Organization.</ref>

*The University of NC Center for the Business of Health examined optimal strategies for the use of opioid settlement funds. They provide the results of a literature review on five strategies most likely to be used by NC communities — recovery support, Naloxone distribution, post-overdose response, evidence-based addiction treatment, and criminal justice diversion programs. <ref>https://cboh.kenaninstitute.unc.edu/opioid-project/research-opioid/</ref>

= Impactful Federal, State, and Local Policies =

*'''The National Prevention Strategy (NPS)''' was developed as a result of the Affordable Care Act of 2010 (ACA). <ref>https://web.archive.org/web/20111004043040/http://www.healthcare.gov/prevention/nphpphc/strategy/report.pdf</ref> The National Prevention Council which authored the NPS is in itself an example of a systems approach, as it involved the efforts of seventeen different federal agencies. The Strategy explicitly places the responsibility for health and safety to the linking of community services with the empowerment of people and the elimination of disparities. It not only promotes the integration of SUD and mental health services, it does so by focusing on the relationship of both to diet, exercise, tobacco-free living, reproductive health, and injury and violence prevention. One example resulting from ACA and the NPS is the mandate for local hospitals to regularly work with the health departments in their county to collaboratively generate their needs assessments.

*'''SAMHSA''' is inherently defined as a systems agency by including both substance abuse and mental health in its name. SAMHSA has also been instrumental in advancing ROSC (Recovery-Oriented ''Systems'' of Care). See the SAFE Solutions article titled "Create Recovery-Ready Communities" for more information on ROSC. <ref>https://www.yoursafesolutions.us/wiki/Create_Recovery-Ready_Communities</ref> In addition to promoting the five data-driven phases of the Strategic Prevention Framework, two key concepts inform and are embedded within all five phases:
**Sustainability. This is a system-building strategic posture, because it requires a long temporal view. However, SAMHSA promotes sustainability as more than just an approach to financing coalition efforts. It also intends for coalitions to develop and sustain their human capital.
**Cultural Competency. Any projects funded through SAMHSA are required to meet certain inclusivity requirements, such as provision of resources in multiple languages. However cultural competency also extends much further into addressing health equity in building the capacity of a diverse coalition and ensuring all populations within a community are served. This creates a foundation for taking on the systems-level change required to address social determinants of health.

*'''HHS 5-Point Plan.''' HHS developed a comprehensive strategy to improve access to prevention, treatment, and recovery support services. The strategy aims to support individuals to achieve long-term recovery and to prevent the health, social, and economic consequences associated with opioid misuse and addiction: <ref>https://www.ahrq.gov/sites/default/files/wysiwyg/topics/impact-opioid-final.pdf</ref>
**'''Better Addiction Prevention, Treatment, and Recovery Services.''' <ref> https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref> This involves working across the continuum of care. It has evolved to explicitly include harm reduction.
**'''Better Data''' strengthens public health reporting to improve the timeliness and specificity of data and to inform a real-time public health response.
**'''Better Pain Management''' advances the practice of pain management to enable access to high-quality, evidence-based pain care which reduces the burden of pain for individuals, families, and society while reducing the inappropriate use of opioids. <ref>https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref>
**'''Better Targeting of Overdose Reversing Drugs.''' This has a particular focus on high-risk populations. Increasing the availability and distribution of overdose-reversing medications ensures broader provision of these drugs to people most likely to experience or respond to an overdose.
**'''Better Research.''' Supporting cutting-edge research advances our understanding of pain, overdose and addiction. This leads to the development of new treatment and identifies effective public health interventions to reduce opioid-related health harms.

* '''The National Action Plan for Adverse Drug Event Prevention (ADE Action Plan)''' identifies common, preventable, and measurable adverse drug events and aligns the efforts of federal health agencies to reduce patient harms from these ADEs nationwide. <ref>https://pmc.ncbi.nlm.nih.gov/articles/PMC6280931/</ref>

= Available Tools and Resources =

*'''SAMHSA.''' One example of systems work from a multi-sectoral approach is fostering collaboration between coalitions and the faith community. SAMHSA provides the “Faith and Community Engagement” website which notes that over 800 faith-based community partners have been among its grantees. The website offers information on grant funding and provides resources for community leaders. <ref>https://www.samhsa.gov/faith-based-community-engagement</ref>

*'''The US Department of Health and Human Services''' hosts an online Partnership Center for Faith-based and Neighborhood Partnerships. This site includes the “Opioid Epidemic Practical Toolkit: Helping Faith and Community Leaders Bring Hope and Healing to Our Communities.” <ref>https://www.hhs.gov/about/agencies/iea/partnerships/opioid-toolkit/index.html</ref>

*'''SAFE Project''' offers “Bridging Prevention Recovery (BPR): A Community Approach to Systems Change” which is an evidence-based program model designed for substance use disorder prevention and recovery professionals. It is offered in-person and virtually, guides community leaders through an action-oriented model to systemically integrate prevention and recovery systems to strengthen programs and improve outcomes. BPR is a 3.5 day training program that culminates with 6 technical assistance sessions tailored to each community’s unique set of needs to support implementation and sustainability of joint prevention and recovery community projects. Certification as a trainer is also available. <ref>https://www.safeproject.us/bridging-prevention-recovery/</ref>

*'''The Recovery Ecosystem Index Mapping Tool''' was developed by NORC at the University of Chicago, East Tennessee State University, and the Fletcher Group, Inc. to better understand the strength of recovery ecosystems in communities nationwide. This tool helps users assess important elements of the recovery ecosystem in their communities and leverage data to inform community efforts to support individuals in recovery. The online geo-spatial search engine allows users to evaluate availability of treatment services, recovery residences, harm reduction organizations, employment opportunities, and prevention organizations which are critical features of a recovery ecosystem. <ref> https://rsconnect.norc.org/recovery_ecosystem_index/</ref>

*'''The University of Kansas''' through its Center for Community Health and Development offers the “Community Tool Box” which includes 16 different online toolkits Toolkits help a community to get a quick start on key activities in community work. <ref>https://ctb.ku.edu/en/toolkits</ref>

*'''The Search Institute''' has surveyed over 6 million youth in their acquisition of specific developmental assets which have been shown to both reduce risky behavior and enhance positive youth development. The Search Institute developed a set of 40 assets (20 internal skills and 20 inter-personal supports) which can be fostered in an “it takes an asset village” approach. <ref>https://searchinstitute.org/</ref>

*'''The Annie E. Casey Foundation''' provides a document on their website titled, “Developing A Theory Of Change: Practical Theory of Change (TOC) Guidance, Templates and Examples.” TOC helps funders and leaders of a social change effort clearly articulate their objectives, discuss equity considerations, define roles of decision-making authority and enable useful measurement and learning. <ref>https://www.aecf.org/resources/theory-of-change</ref>

*'''The Tamarack Institute''' provides an online course on the community impact model which is a widely used approach to forming cross-sector coalitions. <ref>https://learningcentre.tamarackcommunity.ca/foundations-of-collective-impact</ref>

*'''The Center for Appreciative Inquiry''' offers trainings, workshops, and consulting projects in an asset-based approach to organizational and social engagement that utilizes questions and dialogue to help participants uncover existing strengths, advantages, or opportunities in their communities, organizations, or teams. <ref>https://centerforappreciativeinquiry.net/</ref>

= Promising Practices =

*'''Maryland.''' The Maryland Collaborative to Reduce College Drinking and Related Problems has a mixed membership of public and private schools and community colleges and has grown to a representation of 19 of the state’s 42 campuses. It has a voluntary membership model which includes a requirement of annual board participation on the part of campus presidents. The Collaborative has two faculty co-directors and three staff members. <ref>https://marylandcollaborative.org/</ref>

*'''North Carolina.''' The Campus & Community Coalition (CCC) serves as an example of the kind of work accomplished through the collaboration of the University of NC and the surrounding community in Chapel Hill. In 2014, the launch of CCC was provided through joint funding for the Coalition's full-time coordinator by UNC, the Town of Chapel Hill, the Orange County Health Department, and the Orange County Board of the Alcohol Beverage Commission. <ref>https://downtownchapelhill.com/coalition/</ref>

= Sources =

Apply a Multi-Sectoral Approach

2025-01-31T19:32:52Z

BasilSavitsky: /* Key Information */

= Introductory Paragraph =

Creating a community coalition is one of the most effective ways to solve complex systems-level problems. Applying a multi-sectoral approach to coalition-building is at the core of generating a local movement. A coalition is simply a group of individuals and organizations with a common interest who agree to see the problem through each other’s eyes and work together toward a common goal. The more sectors, such as law enforcement, health departments, and school systems, are involved, the more "eyes are on the ball" -- and the more that effective communication skills are required. A coalition concentrates a community’s focus on a particular problem, creates alliances among those who might not normally work together, and keeps the community’s approach consistent. This page provides an overview on how to use a multi-sectoral approach, based on the experiences of communities across the country.

= Key Information =

'''Why Start A Coalition?''' The substance use disorder epidemic (SUD) is a complex problem requiring a highly coordinated and cooperative response from communities. The increase in non-fatal and fatal overdoses in recent years has caused many communities to realize that individual organizations cannot afford to work in silos. Communities addressing a crisis as large as the addiction epidemic will be poised for success if they have a unified strategy and a focus on broader common community goals, rather than on singular programmatic goals. There is clear understanding that partners across sectors must align and work together to develop and implement effective strategies to improve their collective response to the SUD epidemic. Communities, both large and small, can develop solutions that work for all of those touched by the opioid and addiction crisis, by bringing together and working with a broad range of stakeholders. Many local communities have successfully assembled coalitions to improve their response to the SUD epidemic. There is no one-size-fits-all set of practices for creating an effective coalition. The suggestions that follow are based on the experiences of many communities and are meant to serve as a guide for those looking to form a new coalition or expand and improve upon one that already exists.

'''Who Can Start A Coalition?'''
Anyone can. Coalitions and task forces are often started by locally elected leaders, public health departments, public safety agencies, community organizations, or even passionate individuals engaged in the fight to save lives and reduce harm created by drug misuse and SUD. Typically, coalitions are formed as a response to increased rates of overdose and overdose deaths. Regardless of who takes the initiative, it is important to be inclusive and identify stakeholders whose ultimate goals align. Get started by looking around the community and determining if there are similar existing efforts in which to get involved or add value. It’s important not to duplicate efforts. Is there a mechanism or coalition body already taking a comprehensive approach to addiction that can be leveraged?

'''Potential Partners and Their Roles.'''
There are many potential partners who can be invited to join the coalition and improve the community response to SUD. The following list is not intended to be all-inclusive, and it is not a requirement to have all of these agencies at the table. These are suggestions based on the types of partners which are most often brought together. It is important to establish a team of optimal size and with sufficient authority to plan and implement ideas and strategies effectively and efficiently. Does the team include leaders with the perceived power and authority in the community to make decisions and drive the implementation of new strategies? Does it include individuals who are trusted in the community and have connections to people and neighborhoods who can support grassroots efforts? Any or all of the following partners in the coalition can engage the broad community to build momentum:

'''Government/Public Sector:'''

*Locally elected officials
*State/local drug prevention office
*Public safety officers/officials
*First responders, including EMS and Fire Departments
*Health department
*School administration or school board
*Criminal judges and court professionals

'''Law Enforcement:'''

*Police and/or sheriff
*High Intensity Drug Trafficking Area (HIDTA) office
*Drug Enforcement Agency (agency in charge)
*School Resource Officers (SRO's)
*Criminal judges, court professionals, and correction officers

'''Education Leaders:'''

*School district leadership
*School principals
*Teachers
*Parent Teacher Associations (PTA) and other youth-serving organizations
*Colleges, universities, institutions of higher education, community colleges, and trade or technical schools

'''Community Leaders:'''

*Lions Club, Rotary, Elks, veteran’s groups
*YMCA, 4H, Boys & Girls Clubs
*Family support groups and recovery allies
*Youth and young adults including youth sports programs
*Faith community
*Housing providers

'''Business Leaders:'''

*Chamber of Commerce
*Employers
*Union leaders
*Local philanthropic organizations

'''Medical Community:'''

*Primary care physicians
*Nurse practitioners
*Emergency room doctors and staff administration
*Dental professionals
*Community behavioral healthcare providers
*Pharmacists
*Providers of health plans and insurance

'''Treatment and Recovery:'''

*Treatment professionals
*Substance use disorder counselors
*Harm reduction organizations
*Recovery support organizations

'''Community Members with Lived Experience:'''

*Persons in recovery and active substance users
*Family and friends of those in active use or recovery
*Families of those lost to overdose

'''Initial Outreach.''' Getting the desired partners to the table is not always easy. Although there are a number of ways to contact these groups, in-person and direct contact is always preferable. Several types of resistance may need to be addressed. Some organizations are not naturally inclined to work with other agencies. For example, the harm reduction and law enforcement communities are not always natural allies in some communities. However, some very powerful work can be done when these two groups do come together and see the problem through each other’s lenses. Some organizations might not want to get involved because of their own perception of capacity (this is more work for me) or stigma (this is not my problem). It may be necessary to expend considerable effort to convince these groups that it is in the entire community’s interest to reverse the epidemic and that everyone has a contribution to make.

It is important to build trust from the outset. Some common advice heard from those who have been through the process of bringing together a coalition include:

*'''Honor the Work that has Been Done.''' Everyone fighting this epidemic is doing their best and should always be recognized for their efforts.
*'''Initiate.''' It does not matter how many community leaders attend first meeting. It could be five or as many as twenty. The important thing is to find people who are willing to work together to thoughtfully and comprehensively address a specific problem. Although the topic that brings all of the stakeholders together is difficult, it is the coalition leader’s job to bring energy and optimism to the movement. Because solutions might look different to each of the stakeholders, defining the common problem precisely is essential. A primary initiation goal should be to agree upon a meeting rhythm in which the coalition frequently gathers to review progress, update its plan, and share success stories.
*'''No Judgement.''' The rise of the current epidemic has been created by a series of events outside of any local jurisdiction. It is not the fault of local governments and community leaders fighting the epidemic.
*'''Common Goals'''. As part of initial discussions, it is important to talk about what all partners typically have in common - the desire to save lives and reduce suffering. While partners will vary in the approaches they use, and which they may feel are more effective, all involved want to see the same end result. It is important to focus on what the partners share in terms of outcomes they want to see and to allocate time to discuss how greater collaboration will benefit the efforts of all involved.

'''Continuous Outreach.'''As the coalition progresses, the needs of the coalition will change over time. Usually, the composition of the coalition will change as well. There are many examples where organizations may need to expand services or take on new roles to address the SUD epidemic, especially in underserved areas of the community. This might include:

*Police working with peer recovery specialists/coaches in cases of overdose
*Community organizations taking on prevention/education/training roles
*Hospitals coordinating with area treatment providers to help overdose patients

Do new roles need to be taken on by government agencies and/or community groups? If so, who and what new roles would be helpful? Who should the coalition include to create new or expanded partnerships in the region? Ideally, what role(s) would they take on? As a coalition matures, it develops a capacity to move beyond an exclusive focus on risk factor reduction and develop more functions linked to enhancing protective factors. (See SAFE Solution article titled, “Address Risk & Protective Factors for Individuals, Families, and Communities." <ref>https://www.yoursafesolutions.us/wiki/Address_Risk_%26_Protective_Factors_for_Individuals,_Families,_and_Communities</ref>) Increasing the scope of work on protective factors creates opportunities to link with new allies working in related fields, such as substance use prevention, suicide prevention, and the prevention of gun violence or domestic violence. While each partner may have different objectives in their efforts on risk factor reduction, their strategies for enhancing protective factors are often identical. This creates a natural bridge-point for increasing collaboration.

= Impactful Federal, State, and Local Policies =

'''The Drug-Free Communities (DFC) Program''' is a nationwide, collaborative effort led by the White House Office of National Drug Control Policy (ONDCP) and CDC in which hundreds of local coalitions have participated. Funding provides up to $125,000 per year for five years to local community coalitions to prevent and reduce youth substance use. <ref>https://www.whitehouse.gov/ondcp/grant-programs/dfc/</ref> Applicants are required to prove they are working towards multi-sectoral collaboration in the submission of letters of intent documenting the commitment of various types of agencies during the implementation of the grant. The coalition work must use evidence-based frameworks and address the unique community challenges surrounding substance use and overdoses. Annual data has shown a marked decrease in youth substance use. <ref>https://www.cdc.gov/drugoverdose/featured-topics/drug-free-communities.html</ref>

= Available Tools and Resources =

'''SAMHSA''' promotes implementation of a systems approach in the advancement of recovery-oriented systems of care (ROSC). <ref>Substance Abuse and Mental Health Services Administration. (2010). Recovery-oriented system of care (ROSC) resource guide. Rockville, MD: U.S. Department of Health and Human Services. </ref> It has published "Engaging community coalitions to decrease opioid overdose deaths: Practice Guide 2023." <ref>https://www.samhsa.gov/resource/ebp/engaging-community-coalitions-decrease-opioid-overdose-deaths-practice-guide-2023</ref>

'''Faith communities''' can support strategies to address substance misuse and support recovery in their community. Churches, synagogues, mosques, and other faith groups can be a valuable bridge to the community. The U.S. Department of Health and Human Services has a dedicated Center for Faith and Opportunity Initiatives with an accessible online toolkit containing ideas to help engage your spiritual community, educate and build community capacity, and respond to the opioid health crisis. <ref>https://www.hhs.gov/about/agencies/iea/partnerships/opioid-toolkit/index.html</ref> Other resources include:
* The Opioid Epidemic Practical Toolkit: Helping Faith and Community Leaders Bring Hope and Healing to Our Communities.<ref>https://www.hhs.gov/about/agencies/iea/partnerships/opioid-toolkit/index.html</ref>
*One Body Collaboratives <ref>http://www.onebodycollaboratives.org/</ref>
*Meet the Need, a software package which can help engage and equip churches to participate in their communities. <ref>https://meettheneed.org/</ref>

'''Harm-reduction organizations''' are nonprofit groups that advocate for public access to Naloxone, needle exchanges, and in some cases safe-use zones. They promote Good Samaritan laws protecting users from arrest if they call 911 to save a friend. In many communities, harm-reduction and law enforcement are polarized. Law enforcement personnel are often perceived as thinking only about arresting and jailing people for the illegal possession of drugs, while harm reduction organizations are perceived as focused on the complete legalization of all drugs. While each group certainly applies a different approach, both of these perceptions are false. Ensuring that law enforcement and harm-reduction organizations are coordinating and collaborating is absolutely essential in the fight to end the opioid fatality epidemic. Harm-reduction coalitions have been essential in convincing law enforcement agencies to enact pre-arrest diversion programs. These programs provide low-level users the opportunity to seek treatment in lieu of facing charges or arrest. Law enforcement also must be at the table when harm-reduction organizations are planning new initiatives or programs.
* The Law Enforcement Action Partnership has compiled harm-reduction strategies supported by law enforcement professionals. Its list is useful in starting the conversation between these two communities, which are both focused on saving lives.<ref>https://cdn.americanprogress.org/content/uploads/2019/01/10055812/DaytonOpioids-fig9-693.png</ref>

= Promising Practices =

'''National Efforts:''' There are many national coalitions and organizations that provide useful information and resources for local coalitions. These national groups are widely varied and numerous. Therefore, it is important to research these organizations so local coalitions can verify that their goals and priorities are aligned with any national organization they choose to become involved with. A few examples follow, but there are many more at the national and even regional level.

* '''Community Anti-Drug Coalitions of America (CADCA)''' CADCA is the premier membership-based non-profit organization representing adult and youth coalition leaders throughout the United States and internationally - all working to make their communities safe, healthy, and drug-free. CADCA's model for community change represents a comprehensive, evidence-based, multi-sector approach to reduce underage and binge drinking, tobacco, illicit drugs, and the abuse of medicines.

* '''Coalition to Optimize the Management of Pain Associated with Surgery (COMPAS)''' Mission: To educate all those involved in pain management decisions about acute pain management strategies that minimize the need for opioids. COMPAS also provides education on how to implement multimodal analgesic strategies and how to measure success for patients and hospitals alike.

* '''Fed Up! Coalition to End the Opioid Epidemic''' A grassroots coalition seeking action from the federal government to bring this public health crisis to an end. Fed Up’s mission is to use united voices in a call for immediate, comprehensive and sustained federal action to end the opioid addiction epidemic. <ref>https://feduprally.org/</ref>

'''An Exemplary State Effort:'''

'''New Jersey''' There are nearly 400 Municipal Alliances in New Jersey -- all organized to provide substance use prevention education services.
Each alliance focuses on its community’s particular needs and may include: <ref>https://www.sussex.nj.us/cn/webpage.cfm?TID=7&TPID=6596</ref>
*parenting workshops to enhance parent’s ability to assist their children to live a healthy and drug free lifestyle,
*peer leadership programs to train students to develop leadership skills and goal oriented behaviors and to be role models and helpers to other students,
*drug awareness events that offer families and community members drug-free activities while providing information about substance abuse and community-wide prevention programs, and
*collaboration with the Division of Senior Services to provide education on potential consequences of medicinal interactions with other medicines, over-the-counter drugs, or alcohol.

'''An Exemplary Local Effort:'''

* '''Dayton, Maryland -- Community Overdose Action Team (COAT)''' Dayton provides an example of a highly structured coalition. Their organizational chart details this structure and summarizes the role of each component within the COAT. <ref>https://cdn.americanprogress.org/content/uploads/2019/01/10055812/DaytonOpioids-fig9-693.png</ref> Other local coalitions might not be as complex or highly structured, but this example helps to provide ideas of what could be considered.

= Sources =

Intersectionality and Addressing Disparities

2025-01-29T20:55:14Z

BasilSavitsky: /* Available Tools and Resources */

Intersectionality and Addressing Disparities

2025-01-29T20:54:34Z

BasilSavitsky: /* Available Tools and Resources */

Integrate Substance Use Prevention & Mental Health Services

2025-01-29T00:13:32Z

BasilSavitsky: /* Promising Practices */

= Introductory Paragraph =

A national study shows that one in five Americans has a mental health issue. <ref>https://www.nimh.nih.gov/health/statistics/mental-illness#:~:text=Mental%20illnesses%20are%20common%20in,(57.8%20million%20in%202021).</ref> In this study, young adults between the ages of 18 and 24, indicated that more than 61 percent of respondents who had used opioids not prescribed to them had done so primarily to relieve anxiety and stress. <ref>https://marychristieinstitute.org/announcements/survey-finds-risky-opioid-use-among-college-age-youth-with-limited-knowledge-of-the-danger-or-where-to-get-help/</ref> Early identification, screening, accurate diagnosis, and effective treatment of mental health and substance use conditions can alleviate suffering for individuals and their families dealing with behavioral health challenges. Early access and detection of mental health conditions can expedite recovery, enhance educational and employment opportunities, positively impact relationships, and ultimately improve quality of life.<ref>https://www.mhanational.org/issues/position-statement-41-early-identification-mental-health-issues-young-people</ref>

Mandated screenings for physical health concerns are in place for issues such as vision and hearing. Similarly, early detection of mental health and substance use should occur for young people who may be vulnerable to these issues. These screenings should occur as they do for early detection of physical conditions in venues such as schools, primary health care providers, and other community areas. Communities should be given the tools and support necessary to identify signs of mental health or substance use issues at the earliest possible time. This position is endorsed by the United States Preventive Services Task Force <ref>https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-depression-suicide-risk-children-adolescents</ref> and the American Academy of Pediatrics, specifically for depression in youth over age 12. <ref>https://www.additudemag.com/mental-health-screening-aap-anxiety-depression-youth/</ref> Early detection and screening will reduce the likelihood and consequences of delaying care.

Resources such as access to comprehensive mental health and substance use evaluations should be available to parents and guardians whenever warning signs are observed. <ref>https://mhanational.org/MentalHealthInfo</ref> Access to adequate care can reduce barriers to learning and improve educational, behavioral, and health outcomes for our youth. The most effective services promote collaboration among all of the people available to help. Pertinent individuals include families, educators, child welfare caseworkers, health insurers, community mental health providers, and substance use treatment providers. Reducing barriers and creating incentives can improve collaboration across systems and funding sources.

In order to improve mental health detection and treatment outcomes, some barriers need to be addressed. Health disparities such as lack of health insurance, cultural factors that discourage mental health treatment, and socioeconomic status need to be addressed to ensure adequate care to all individuals. Disparities in communities may be a factor in the early diagnosis and treatment of mental health conditions and can increase mental illness challenges in already vulnerable and underserved individuals, families, and communities.<ref>https://www.nimh.nih.gov/about/director/messages/2020/addressing-disparities-advancing-mental-health-care-for-all-americans</ref>

= Key Information =

'''Mental Health and Drug Addiction'''

Mental health and drug addiction are undeniably linked. According to the National Institute on Drug Abuse “Many individuals who develop substance use disorders (SUD) are also diagnosed with mental disorders, and vice versa. Multiple national population surveys have found that about half of those who experience a mental illness during their lives will also experience a substance use disorder and vice versa.” <ref>https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness
</ref> Studies have shown that around 1 in 4 individuals that have a serious mental illness also have an SUD. <ref>https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness</ref> Many people attempt to use drugs to self-medicate their mental illness or escape their situation, so understanding mental health is essential to any prevention or recovery effort. The National Alliance of Mental Illness (NAMI) has distilled the following statistics from SAMHSA and CDC: <ref>https://www.nami.org/mhstats</ref>

* 1 out of 5 U.S. adults experience mental illness each year <ref>https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf</ref>
* 1 out of 20 U.S. adults experience serious mental illness each year <ref>https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf</ref>
* 1 out of 6 U.S. youth, aged 6-17, experience a mental health disorder each year <ref>https://jamanetwork.com/journals/jamapediatrics/fullarticle/2724377?guestAccessKey=f689aa19-31f1-481d-878a-6bf83844536a</ref>
* 50% of all lifetime mental illness begins by age 14, and 75% by age 24 <ref>https://www.ncbi.nlm.nih.gov/pubmed/15939837</ref>
* Suicide is the 2nd leading cause of death among people aged 10-14 <ref>https://www.nimh.nih.gov/health/statistics/suicide.shtml</ref>

'''Youth Are Struggling with Mental Health Issues'''

A nationwide U.S. survey of over 1,300 youth conducted in 2018 shows evidence of a growing mental health crisis affecting 14 to 22-year-olds. The survey, sponsored by Hopelab and Well Being Trust (WBT), found that many teens and young adults who were experiencing moderate to severe symptoms of depression utilized online resources for help. Common uses of the Internet included researching mental health issues online (90 percent), accessing other people’s health stories through blogs, podcasts, and videos (75 percent), using mobile apps related to well-being (38 percent), and connecting with health providers through digital tools such as texting and video chat (32 percent).<ref>https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/</ref>

'''Co-Occurring Disorders'''

Co-occurring disorders, or dual diagnosis, refers to simultaneous having a mental health disorder and an SUD. It is common for people with addictions to also suffer from depression, anxiety, or more severe mental illnesses such as schizophrenia or bipolar disorder. Research shows that people who use alcohol or other drugs early in life are more likely to have mental or emotional problems. It’s also true that many people with mental illnesses “self-medicate” with alcohol or other drugs to numb emotional pain, relieve anxiety, or quiet their thoughts. In the past, the medical profession treated one disorder first, typically the substance use disorder, before addressing the other. It is now understood that treating both simultaneously leads to better outcomes. Any successful addiction treatment program will include a mental health assessment and treat co-occurring disorders at the same time.

'''Depression'''

Stigmatization of depression can reduce the likelihood of people reaching out to get the mental care they need. Instead, depressed people may ask for prescriptions to treat physical ailments, and use these prescription drugs to treat their emotional pain. Other factors to consider are listed below:

* Because depression is under-diagnosed and under-treated, depression and opioid abuse are strongly concurrent.<ref>https://doi.org/10.1097/j.pain.0000000000000658</ref>
* People with depression show abnormalities in the body’s release of its own opioid. chemicals<ref>https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/</ref>
* Depression tends to exacerbate pain—it makes chronic pain last longer and impacts the recovery process after surgery.
* Depression nearly doubles the risk that someone already using opioids will continue to use them long-term.
* Depressed people are about twice as likely to misuse their painkillers for non-pain symptoms.
* Depressed individuals are between two and three times more likely to ramp up their own doses of painkillers.
* Adolescents with depression are also more likely to use prescription painkillers for non-medical reasons and to become addicted.
* Depressed people are likely to keep using opioids, even when their pain has subsided.

'''Rural Areas'''

Shortages of mental-health providers are prominent in rural areas where the opioid epidemic hit the hardest. Some have suggested that providing mental health care to those suffering from chronic pain may help detangle the relationship between pain and depression.<ref>https://vrphobia.com/about-us-old/</ref> Overall, improving detection and treatment of mental health conditions includes improved early screening, assessment, and access to treatment as well as outreach and education in communities.

'''Homelessness'''

The unhoused population poses a unique opportunity to address the challenges of integrating substance use and mental health services, as well as in advancing work on health disparities and social determinants of health. Efforts made in harm reduction have highlighted the need for increasing awareness of the intersection of three primary issues facing unhoused people within their social contexts -- economic hardship, mental illness, and/or substance use disorder. The complex intersection of these three distinct but related issues amplify the stigma associated with each issue by itself. While awareness of co-occurring disorders has increased, public perceptions of safety versus the delivery of essential social and behavioral health services has generated confusion on effective solutions to a rapidly growing problem. This often polarizes support for increased law enforcement and support for increased social services. Medication-Assisted Treatment (MAT) is one domain with the substance use field which is successfully navigating this apparent conflict. Various policy recommendations to control the prescription of opiates and the treatment of opioid addiction have been made by the National Healthcare For Homeless Council and are detailed in the SAFE Solutions article titled "Expand Access to Medicated Assisted Treatment/Recovery (MAT/MAR) <ref>https://www.yoursafesolutions.us/wiki/Expand_Access_to_Medicated_Assisted_Treatment/Recovery_(MAT/MAR)</ref> Two of these policy recommendations are listed below: <ref>https://nhchc.org/wp-content/uploads/2019/08/addressing-the-opioid-crisis-priorities-for-the-hch-community.pdf</ref>
*Reduce stigma and treat addiction as a disease. The main barrier to any type of treatment for persons experiencing homelessness is a lack of stable housing. In addition, drug screens are often required when accessing housing, and employers often require drug screens for employment. Landlords and employers need to accept Buprenorphine prescribed as part of a MAT plan as a medical treatment process, and not have it count negatively against a person by including it as a prohibited substance. Addiction needs to be seen as a disease and not a moral failing, and engagement in MATs as a health care intervention should not be a liability to accessing housing or employment.
*Train all health care disciplines on addiction. Expanding awareness of addiction and providing substance abuse education for medical students, residents, practicing physicians, and all other health care providers is essential. Curricula which treat substance use conditions similarly to other chronic disorders and provide more adequate basic preparation need to be implemented. In addition, continuing education opportunities to learn about evidence-based practices for the treatment of SUDs need to be provided, and programs to support the adoption of MAT, screening, brief intervention, and referral to treatment need to be identified and implemented.

'''Recovery-Oriented Systems of Care (ROSC)'''

ROSC reflects a systems approach which has been successful in improving the quality of SUD service provision. <ref>The Surgeon General’s Report on Alcohol, Drugs, and Health. (2016), Drug-Free Communities, Retrieved from: https://obamawhitehouse.archives.gov/sites/default/files/ondcp/dfc/AdministratorEnomotoMeetDFCTeamPresentation.pdf</ref> It is an approach which requires collaboration between agencies -- with a person-centric posture. ROSC has utility for adoption within the prevention community, perhaps as PROSC (Prevention AND Recovery-Oriented Systems of Care). ROSC is described in the SAFE Solutions article titled, "Create Recovery-Ready Communities." <ref>https://www.yoursafesolutions.us/wiki/Create_Recovery-Ready_Communities#Available_Tools_and_Resources</ref>

= Relevant Research =

'''Prevention and Early Intervention in Youth Mental Health.''' This research article addresses the need to move the provision of mental health services from a secondary prevention approach (early intervention) to a series of primary prevention strategies -- reducing the onset of mental illness by promoting mental health for all youth. "Evidence suggests that it would be unrealistic to consider promotion and prevention in mental health responsibility of mental health professionals alone. Integrated and multidisciplinary services are needed." This calls for broader community engagement that is guided by mental health professionals. <ref>https://ijmhs.biomedcentral.com/articles/10.1186/s13033-020-00356-9</ref>

'''Findings of the Early Detection and Intervention Center Dresden.''' This article summarizes research on adolescents and young adults who sought help for bipolar disorders. The intervention and treatment recommendations provide insight into the complexity of prevention and intervention in one specific mental illness context, thus, facilitating an understanding of the challenges associated with prevention of co-occurring disorders. <ref>https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-021-00227-3</ref>

= Impactful Federal, State, and Local Policies =

'''SAMSHA Infant & Early Childhood Mental Health Grants''' are authorized under the 21st Century Cures Act. <ref>https://www.samhsa.gov/early-childhood-mental-health-programs/iecmh-grant-program</ref> The purpose of this program is to improve outcomes for children, from birth up to 12 years of age, by developing, maintaining, or enhancing infant and early childhood mental health promotion, intervention, and treatment services.

'''Project AWARE (Advancing Wellness and Resiliency in Education).''' SAMHSA also provides State Education Agency grants to develop sustainable infrastructure for school-based mental health programs and services and to ensure that school-aged youth have access to and are connected with appropriate and effective behavioral health services. With Project AWARE, SAMHSA aims to promote the healthy social and emotional development of school-aged youth and prevent youth violence in school settings. Through this program, schools are implementing evidence-based, culturally appropriate prevention programs that support youth at the universal, selective, and indicated levels. <ref>https://www.samhsa.gov/grants/2021/project-aware</ref>

'''Medicaid -- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)''' is designed to ensure that Medicaid benefits meet the needs of youth with SUD. States must comply with their obligations under Medicaid’s EPSDT requirements which enable youth to address their substance use disorders, to receive treatment and continuing care, and to participate in recovery services and supports. <ref>https://www.medicaid.gov/federal-policy-guidance/downloads/cib-01-26-2015.pdf</ref> NAMI provides guidance on advocacy for mental health screening associated with the EPSDT program. <ref>https://www.nami.org/Advocacy/Policy-Priorities/Improving-Health/Mental-Health-Screening</ref>

'''HRSA Pediatric Mental Health Access''' The purpose of this program is to promote behavioral health integration into pediatric primary care by supporting pediatric mental health care tele-health access programs. <ref>https://mchb.hrsa.gov/training/projects.asp?program=34</ref>

= Available Tools and Resources =

'''SAMHSA:'''
*'''SAMHSA 988 website.''' An easier-to-use 988 Partner Toolkit is now searchable and designed to help you better navigate the bank of the materials available for promoting 988 in your community. The toolkit has all the same video PSAs, social media promotions, print materials, logo and branding, radio, FAQs, messaging, and other 988 marketing materials. You can now easily search and filter all 988 materials by target audience, population, language, and resource type, allowing you to find the right materials that resonate with your audiences. <ref>https://www.samhsa.gov/resource-search/988?utm_source=SAMHSA&utm_campaign=a70075912e-EMAIL_CAMPAIGN_2024_01_16_06_24&utm_medium=email&utm_term=0_-a70075912e-%5BLIST_EMAIL_ID%5D</ref>
*'''Resources for Suicide and Substance Use Prevention in Youth.''' This webinar includes best practices for suicide prevention and intervention. <ref>https://store.samhsa.gov/product/Preventing-Suicide-A-Toolkit-for-High-Schools/SMA12-4669</ref>
*'''Comprehensive Case Management for Substance Abuse Treatment.''' This publication is in the SAMHSA Treatment Improvement Protocol Series. <ref>https://www.ncbi.nlm.nih.gov/books/NBK64863/pdf/Bookshelf_NBK64863.pdf</ref>

'''SAFE Project:'''
*'''Bridging Prevention and Recovery (BPR): A Community Approach to Systems Change.''' This SAFE Project program, offered in-person and virtually, guides community leaders through an action-oriented model to systemically integrate prevention and recovery systems to strengthen programs and improve outcomes. BPR is a 3.5 day training program that culminates with 6 technical assistance sessions tailored to each community’s unique set of needs to support implementation and sustainability of joint prevention and recovery community projects.<ref>https://www.safeproject.us/bridging-prevention-recovery/</ref>
*See the wiki titled "Become a Trauma-Informed Community" for more detailed information on the relationship between SUD and trauma-related mental health concerns. <ref>https://www.yoursafesolutions.us/wiki/Become_a_Trauma-Informed_Community</ref>

'''The National Institute of Mental Health''' provides resources on how to find immediate help, health care providers, how to decide if a provider is right for you, how to join a study, and resources to learn more about mental disorders. <ref>https://www.nimh.nih.gov/about/director/messages/2020/addressing-disparities-advancing-mental-health-care-for-all-americans</ref>

'''The American Academy of Child and Adolescent Psychiatry''' provides a service that helps find child and adolescent psychiatrists throughout America. <ref>https://www.aacap.org/</ref>

'''Mental Health America.''' MHA's work is driven by its commitment to promote mental health as a critical part of overall wellness, including prevention services for all; early identification and intervention for those at risk; integrated care, services, and supports for those who need them; with recovery as the goal. <ref>https://www.mhanational.org/issues/position-statement-41-early-identification-mental-health-issues-young-people</ref>

'''National Alliance on Mental Illness (NAMI)''' provides advocacy and education to support all individuals and families affected by mental illness build better lives. <ref>https://www.nami.org/Advocacy/Policy-Priorities/Improving-Health/Mental-Health-Screening</ref> NAMI provides a website, "Mental Health by the Numbers" which provides statistics that can be used to promote mental health awareness. <ref>https://www.nami.org/mhstats</ref>

'''Communities that Care''' promotes a range of youth mental and behavioral health outcomes, including survey tools, a parenting program, and a variety of prevention education programs. <ref>https://www.communitiesthatcare.net/</ref>

'''Early Mental Health Screening and Intervention.''' This clinical practice brief by the American Mental Health Counselors Association (AMHCA) provides information on intervention and screening across the lifespan. <ref>https://www.amhca.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=2ca60afe-8be0-af27-2ad9-7100b61ad636&forceDialog=0</ref>

'''Identifying Mental Health and Substance Use Problems of Children and Adolescents: A Guide for Child-Serving Organizations.''' This manual offers guidance and tools for identifying mental illness or substance use issues early in children and adolescents in various setting, such as in schools, the juvenile justice and child welfare systems, and when receiving primary care. <ref>https://store.samhsa.gov/product/Identifying-Mental-Health-and-Substance-Use-Problems-of-Children-and-Adolescents-A-Guide-for-Child-Serving-Organizations/SMA12-4700</ref>

'''Mental Health During Global Conflict.''' People across the world may find they struggle with their mental health during times of global conflict. This does not affect only those in active combat. These are humanitarian crises, impacting an entire community or region and beyond. This page addresses how mental health might be affected by major conflict events like war, terrorism, geopolitical tension, territorial disputes, and political instability. <ref>https://mhanational.org/crisis/global-conflict?eType=EmailBlastContent&eId=5fab664b-5726-42b6-a0da-0c1fcf0fba92</ref>

= Promising Practices =

'''Centers for Medicare & Medicaid Services''' has launched its Innovation in Behavioral Health (IBH) Model in collaboration with state Medicaid agencies in Michigan, New York, Oklahoma, and South Carolina. IBH is designed to deliver person-centered, integrated care to Medicaid and Medicare populations, including those who are dually eligible, with moderate to severe mental health conditions or substance use disorder (SUD), or both. <ref>https://www.cms.gov/priorities/innovation/innovation-models/innovation-behavioral-health-ibh-model</ref>

'''Virtual Reality Medical Center (VRMC)''' has been working since the 1990s to use virtual reality to treat mental illness. An early clinical trial of their software found that after an average of seven sessions, 45 percent of those treated no longer screened positive for PTSD and 62 percent had reliably improved. VRMC uses simulation technologies for: <ref>https://vrphobia.com/about-us-old/</ref>

*Treating patients with anxiety disorders
*Training for both military and civilian populations
*Enhancing various educational programs
*Desensitization
*Sessions at home
*Reduction of the number of sessions people need

'''M3 Information ''' provides a mental health screening tool that measures outcomes based on a 27-question diagnostic checklist targeted for adults aged 18 and older. The M3 Checklist accurately measures outcomes based on question responses for major depression, bipolar disorder, anxiety disorder and post-traumatic stress disorder (PTSD). <ref>https://www.m3information.com/</ref>

'''MyStrength''' is a digital platform that integrates state-of-the-art technologies to support people in addressing mental and behavioral health issues. It can be integrated with a professional practice to allow them to see more patients more efficiently and better meet the needs of their patients between in-person visits. <ref>https://mystrength.com/</ref>

= Sources =

Expand Early Intervention Strategies

2025-01-29T00:03:48Z

BasilSavitsky: /* Impactful Federal, State, and Local Policies */

=Introductory Paragraph=

Early intervention may be considered the bridge between prevention and treatment services. The goals of early intervention are to reduce the harms associated with substance use, to reduce risk behaviors before they lead to injury, to improve health and social function, and to prevent progression to a disorder. Early intervention consists of providing information about substance use risks, normal or safe levels of use, and strategies to quit or cut down on use. For individuals with more serious substance misuse, intervention can serve as a mechanism to engage them into treatment. <ref>"Facing Addiction in America: The Surgeon General's Spotlight on Opioids" at https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf</ref>

Early intervention can occur when a person is not seeking treatment for a substance use disorder. For example, intervention services can be provided when an individual presents for another condition within a medical or social services context. Community intervention can involve multi-sector partnerships and community leaders and members. Intervention services may be initiated in community settings such as clinics, schools, jails, workplaces, emergency rooms, social services, senior citizen centers, or campuses. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440941/</ref>

=Key Information=

'''At-Risk Populations Who Should Receive Early Intervention'''

Early intervention differs from prevention efforts. Prevention targets the general population with a universal need to understand the risks of substance use disorder. Early intervention strategies focus on those who have just started experimenting or using substances. Likewise, certain individuals, age groups, or families have more risk factors. While the entire community can benefit from early intervention resources, there are populations which have been identified at a higher risk for substance use.

* Adolescents or adults at risk or who show signs of substance use or are experimenting with substances.
* Individuals who have suffered childhood trauma. <ref>https://www.acesconnection.com/</ref>
* Binge drinkers: In 2018, about 67.1 million Americans aged 12 or older were binge drinking in the past month, and about 1.2 million adolescents aged 12 to 17 reported binge drinking in the previous month. <ref>https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf</ref>
* People who use substances while driving.
* Expectant mothers who use substances while pregnant.
* Senior citizens.
* Individuals with co-occurring substance use and mental disorders.
* Homeless population.

'''Components of Early Intervention'''

* Screening, Brief Intervention and Referral to Treatment, or SBIRT. <ref>https://www.yoursafesolutions.us/wiki/Expand_SBIRT_Program</ref>
* Screen for risk factors for substance use such as childhood trauma and ACEs. </span><ref>https://www.acesconnection.com/</ref>
* Reduce Stigma in Community. <ref>https://www.yoursafesolutions.us/wiki/Reduce_Stigma</ref>
* Pre-Arrest Diversion Programs. <ref>https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>
* “Reachable Moments,” such as providing patient education when prescribing opioids for chronic pain. <ref>https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder</ref>
* Utilize Prescription Drug Monitoring Programs (PDMPs) which are state-controlled electronic databases to track controlled substance prescriptions within a state. PDMPs also provide prescribing and patient behavior information to prescribers and other authorities who are granted access to the information.

=Relevant Research=

SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

=Impactful Federal, State, and Local Policies=

*'''Centers for Medicare & Medicaid Services''' funds the Integrated Care for Kids (InCK) Model which works with state and local health service providers to identify at-risk children earlier. Lead organizations, such as health providers, managed care organizations, and public health departments, oversee care coordination and case management among community partners, including schools and child welfare agencies. By focusing on early intervention, children can get treatment sooner and often care is provided in home and community-based settings, rather than in the emergency department. Through this early identification and intervention approach, children can experience better health and wellbeing, both in the short term and over time. <ref>https://www.cms.gov/priorities/innovation/innovation-models/integrated-care-for-kids-model</ref>

= Available Tools and Resources =

'''SAFE Project''':
*'''SAFE Campuses''' provides developmental assistance to support the needs of students in recovery and collegiate recovery communities. The program offers program-specific sessions tailored to various professional degree programs.<ref>https://www.safeproject.us/campuses/</ref>
*'''SAFE Choices''' is a program within SAFE Project that focuses on fostering resiliency in youth development through collaborative and diversified approaches that reduce risk of substance addiction and mental health challenges while empowering SAFE Choices in all stages of youth development.<ref>https://www.safeproject.us/safe-choices/</ref>
*'''SAFE Workplaces''' provides employers and employees, alike, with the tools and resources necessary to address issues of behavioral health and achieve emotional wellbeing in the workplace.<ref>https://www.safeproject.us/workplaces/</ref>
*'''SAFE Veterans''' provides services to connect veterans, active-duty service members, and their families — all military-connected individuals — to the resources they need to address mental health challenges and substance use disorders. <ref>https://www.safeproject.us/veterans/</ref>
*See the wiki titled "Expand School-Based Prevention Programs" for more detailed information on how the school setting for children/adolescents can be used as protective factor from the adverse effects of substance use, misuse, and abuse. <ref>https://www.yoursafesolutions.us/wiki/Expand_School-Based_Prevention_Programs</ref>
*See the wiki titled "Expand SBIRT Program" for more detailed information on the Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool used as an prevention/early intervention method at screening for substance misuse in the general population.<ref>https://www.yoursafesolutions.us/wiki/Expand_SBIRT_Program</ref>
*See the wiki titled "Reduce Stigma" for more detailed information on what stigma is and resources to overcome stigma as it relates to substance use disorders.<ref>https://www.yoursafesolutions.us/wiki/Reduce_Stigma</ref>

'''The Network for Public Health Law "Policies in Schools to Reduce Overdose and Other Drug-related Harm"''' Webinar explores substance abuse policy issues in schools.<ref>https://www.networkforphl.org/resources/policies-in-schools-to-reduce-overdose-and-other-drug-related-harm/</ref>

'''Facing Addiction in America: The Surgeon General’s Spotlight on Opioids.''' The following is taken from the section titled ''Importance of Prevention, Screening, Early Intervention, and Treatment:'' “Currently, few primary care providers screen for or treat substance use disorders. Additionally, it is common for people who misuse opioids to misuse other substances or to have multiple substance use disorders, childhood trauma, or co-occurring physical and mental disorders. This highlights the need for full clinical assessment and comprehensive treatment services that are matched to an individual’s needs.” <ref>https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf</ref>

'''HHS Office of the Assistant Secretary for Planning and Evaluation''' published a report titled "Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment." It includes information on screening and early intervention. <ref>https://www.aspe.hhs.gov/sites/default/files/migrated_legacy_files//187391/BestSUD.pdf?_ga=2.175262753.2025544468.1693431443-868347927.1691445109</ref>

'''Community Catalyst: Expanding Substance Use Prevention and Early Intervention in Schools''' <ref>https://communitycatalyst.org/resource/training-resources-for-the-implementation-of-sbirt-with-young-people/</ref> This online toolkit provides information and resources to mobilize communities to expand school-based services for substance use prevention and early intervention. It describes a set of tools for early intervention and strategies to implement and fund early intervention in schools and clinics.

'SAMHSA''' provides a chart for screening and assessment tools for substance use disorders. <ref>https://www.samhsa.gov/resource/dbhis/screening-assessment-tools-chart</ref>

= Promising Practices =

'''OhioSTART (Sobriety, Treatment, and Reducing Trauma) <ref>https://ohiostart.org/</ref>

The state of Ohio developed OhioSTART to help families dealing with substance use disorder avoid disruptive and costly out-of-home placements and to help keep families together. The goal is to reunify and stabilize families with parents who have lost custody of their children to foster care or another government-approved living arrangement. The intervention program provides specialized victim services, such as intensive trauma counseling, to children who have suffered victimization with substance use of a parent being the primary risk factor. Additionally, the program assists parents of those children with mentors who have firsthand experience with substance use disorder.

'''Project Engage - Delaware''' <ref>https://christianacare.org/services/behavioralhealth/project-engage/</ref>

ChristianaCare is a Delaware-based health system, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs. Project Engage was designed to help hospital patients who may be struggling with alcohol or drug use. It provides early intervention and referrals to substance use disorder treatment. Project Engage integrates peers in recovery, who are called engagement specialists, into the clinical setting in the hospital to meet with patients at their bedside about their alcohol or drug use. Project Engage collaborates with hospital staff to identify and connect patients with community-based substance use disorder treatment programs and other resources. Project Engage has also formed a partnership with the construction industry to offer recovery support to employees from participating construction companies.

'''Project IMPACT''' <ref>https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder
</ref>

Oregon Health and Science University (OHSU) and its partners conducted a needs assessment to map patient and system needs to critical intervention components and develop a business case. Using their findings, the group identified issues address in addiction treatment and intervention:

* Hospitalization is a “reachable” moment: A survey of hospitalized adults conducted by OHSU revealed that 68% of high-risk drug users reported wanting to cut back or quit. Many patients also reported that they wanted to initiate medication-assisted treatment (MAT) while hospitalized, and that they wanted providers who understand addiction.

* Lack of usual pathways to treatment: OHSU Hospital lacked established referral pathways to outpatient addiction care, and wait times were often long.

Their findings resulted in an innovative intervention program: Project IMPACT, or the Improving Addiction Care Team. IMPACT includes two complementary components: First, an inpatient consult service gives patients a safe place to share their stories, improve patient engagement and trust, and to expand inpatient treatment options. Second, partnerships were forged with community providers to create rapid access pathways to treatment and a smooth transition to MAT.

= Sources =

----

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Prescriptions and Medical Response]]

Expand Early Intervention Strategies

2025-01-29T00:03:26Z

BasilSavitsky: /* Impactful Federal, State, and Local Policies */

=Introductory Paragraph=

Early intervention may be considered the bridge between prevention and treatment services. The goals of early intervention are to reduce the harms associated with substance use, to reduce risk behaviors before they lead to injury, to improve health and social function, and to prevent progression to a disorder. Early intervention consists of providing information about substance use risks, normal or safe levels of use, and strategies to quit or cut down on use. For individuals with more serious substance misuse, intervention can serve as a mechanism to engage them into treatment. <ref>"Facing Addiction in America: The Surgeon General's Spotlight on Opioids" at https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf</ref>

Early intervention can occur when a person is not seeking treatment for a substance use disorder. For example, intervention services can be provided when an individual presents for another condition within a medical or social services context. Community intervention can involve multi-sector partnerships and community leaders and members. Intervention services may be initiated in community settings such as clinics, schools, jails, workplaces, emergency rooms, social services, senior citizen centers, or campuses. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440941/</ref>

=Key Information=

'''At-Risk Populations Who Should Receive Early Intervention'''

Early intervention differs from prevention efforts. Prevention targets the general population with a universal need to understand the risks of substance use disorder. Early intervention strategies focus on those who have just started experimenting or using substances. Likewise, certain individuals, age groups, or families have more risk factors. While the entire community can benefit from early intervention resources, there are populations which have been identified at a higher risk for substance use.

* Adolescents or adults at risk or who show signs of substance use or are experimenting with substances.
* Individuals who have suffered childhood trauma. <ref>https://www.acesconnection.com/</ref>
* Binge drinkers: In 2018, about 67.1 million Americans aged 12 or older were binge drinking in the past month, and about 1.2 million adolescents aged 12 to 17 reported binge drinking in the previous month. <ref>https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf</ref>
* People who use substances while driving.
* Expectant mothers who use substances while pregnant.
* Senior citizens.
* Individuals with co-occurring substance use and mental disorders.
* Homeless population.

'''Components of Early Intervention'''

* Screening, Brief Intervention and Referral to Treatment, or SBIRT. <ref>https://www.yoursafesolutions.us/wiki/Expand_SBIRT_Program</ref>
* Screen for risk factors for substance use such as childhood trauma and ACEs. </span><ref>https://www.acesconnection.com/</ref>
* Reduce Stigma in Community. <ref>https://www.yoursafesolutions.us/wiki/Reduce_Stigma</ref>
* Pre-Arrest Diversion Programs. <ref>https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>
* “Reachable Moments,” such as providing patient education when prescribing opioids for chronic pain. <ref>https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder</ref>
* Utilize Prescription Drug Monitoring Programs (PDMPs) which are state-controlled electronic databases to track controlled substance prescriptions within a state. PDMPs also provide prescribing and patient behavior information to prescribers and other authorities who are granted access to the information.

=Relevant Research=

SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

=Impactful Federal, State, and Local Policies=

*'''Centers for Medicare & Medicaid Services''' funds the Integrated Care for Kids (InCK) Model which works with state and local health service providers to identify at-risk children earlier. Lead organizations, such as health providers, managed care organizations, and public health departments, oversee care coordination and case management among community partners, including schools and child welfare agencies.
By focusing on early intervention, children can get treatment sooner and often care is provided in home and community-based settings, rather than in the emergency department. Through this early identification and intervention approach, children can experience better health and wellbeing, both in the short term and over time. <ref>https://www.cms.gov/priorities/innovation/innovation-models/integrated-care-for-kids-model</ref>

= Available Tools and Resources =

'''SAFE Project''':
*'''SAFE Campuses''' provides developmental assistance to support the needs of students in recovery and collegiate recovery communities. The program offers program-specific sessions tailored to various professional degree programs.<ref>https://www.safeproject.us/campuses/</ref>
*'''SAFE Choices''' is a program within SAFE Project that focuses on fostering resiliency in youth development through collaborative and diversified approaches that reduce risk of substance addiction and mental health challenges while empowering SAFE Choices in all stages of youth development.<ref>https://www.safeproject.us/safe-choices/</ref>
*'''SAFE Workplaces''' provides employers and employees, alike, with the tools and resources necessary to address issues of behavioral health and achieve emotional wellbeing in the workplace.<ref>https://www.safeproject.us/workplaces/</ref>
*'''SAFE Veterans''' provides services to connect veterans, active-duty service members, and their families — all military-connected individuals — to the resources they need to address mental health challenges and substance use disorders. <ref>https://www.safeproject.us/veterans/</ref>
*See the wiki titled "Expand School-Based Prevention Programs" for more detailed information on how the school setting for children/adolescents can be used as protective factor from the adverse effects of substance use, misuse, and abuse. <ref>https://www.yoursafesolutions.us/wiki/Expand_School-Based_Prevention_Programs</ref>
*See the wiki titled "Expand SBIRT Program" for more detailed information on the Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool used as an prevention/early intervention method at screening for substance misuse in the general population.<ref>https://www.yoursafesolutions.us/wiki/Expand_SBIRT_Program</ref>
*See the wiki titled "Reduce Stigma" for more detailed information on what stigma is and resources to overcome stigma as it relates to substance use disorders.<ref>https://www.yoursafesolutions.us/wiki/Reduce_Stigma</ref>

'''The Network for Public Health Law "Policies in Schools to Reduce Overdose and Other Drug-related Harm"''' Webinar explores substance abuse policy issues in schools.<ref>https://www.networkforphl.org/resources/policies-in-schools-to-reduce-overdose-and-other-drug-related-harm/</ref>

'''Facing Addiction in America: The Surgeon General’s Spotlight on Opioids.''' The following is taken from the section titled ''Importance of Prevention, Screening, Early Intervention, and Treatment:'' “Currently, few primary care providers screen for or treat substance use disorders. Additionally, it is common for people who misuse opioids to misuse other substances or to have multiple substance use disorders, childhood trauma, or co-occurring physical and mental disorders. This highlights the need for full clinical assessment and comprehensive treatment services that are matched to an individual’s needs.” <ref>https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf</ref>

'''HHS Office of the Assistant Secretary for Planning and Evaluation''' published a report titled "Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment." It includes information on screening and early intervention. <ref>https://www.aspe.hhs.gov/sites/default/files/migrated_legacy_files//187391/BestSUD.pdf?_ga=2.175262753.2025544468.1693431443-868347927.1691445109</ref>

'''Community Catalyst: Expanding Substance Use Prevention and Early Intervention in Schools''' <ref>https://communitycatalyst.org/resource/training-resources-for-the-implementation-of-sbirt-with-young-people/</ref> This online toolkit provides information and resources to mobilize communities to expand school-based services for substance use prevention and early intervention. It describes a set of tools for early intervention and strategies to implement and fund early intervention in schools and clinics.

'SAMHSA''' provides a chart for screening and assessment tools for substance use disorders. <ref>https://www.samhsa.gov/resource/dbhis/screening-assessment-tools-chart</ref>

= Promising Practices =

'''OhioSTART (Sobriety, Treatment, and Reducing Trauma) <ref>https://ohiostart.org/</ref>

The state of Ohio developed OhioSTART to help families dealing with substance use disorder avoid disruptive and costly out-of-home placements and to help keep families together. The goal is to reunify and stabilize families with parents who have lost custody of their children to foster care or another government-approved living arrangement. The intervention program provides specialized victim services, such as intensive trauma counseling, to children who have suffered victimization with substance use of a parent being the primary risk factor. Additionally, the program assists parents of those children with mentors who have firsthand experience with substance use disorder.

'''Project Engage - Delaware''' <ref>https://christianacare.org/services/behavioralhealth/project-engage/</ref>

ChristianaCare is a Delaware-based health system, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs. Project Engage was designed to help hospital patients who may be struggling with alcohol or drug use. It provides early intervention and referrals to substance use disorder treatment. Project Engage integrates peers in recovery, who are called engagement specialists, into the clinical setting in the hospital to meet with patients at their bedside about their alcohol or drug use. Project Engage collaborates with hospital staff to identify and connect patients with community-based substance use disorder treatment programs and other resources. Project Engage has also formed a partnership with the construction industry to offer recovery support to employees from participating construction companies.

'''Project IMPACT''' <ref>https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder
</ref>

Oregon Health and Science University (OHSU) and its partners conducted a needs assessment to map patient and system needs to critical intervention components and develop a business case. Using their findings, the group identified issues address in addiction treatment and intervention:

* Hospitalization is a “reachable” moment: A survey of hospitalized adults conducted by OHSU revealed that 68% of high-risk drug users reported wanting to cut back or quit. Many patients also reported that they wanted to initiate medication-assisted treatment (MAT) while hospitalized, and that they wanted providers who understand addiction.

* Lack of usual pathways to treatment: OHSU Hospital lacked established referral pathways to outpatient addiction care, and wait times were often long.

Their findings resulted in an innovative intervention program: Project IMPACT, or the Improving Addiction Care Team. IMPACT includes two complementary components: First, an inpatient consult service gives patients a safe place to share their stories, improve patient engagement and trust, and to expand inpatient treatment options. Second, partnerships were forged with community providers to create rapid access pathways to treatment and a smooth transition to MAT.

= Sources =

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[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Prescriptions and Medical Response]]