Integrated Care of Greater Hickory, Inc.

A multi-sector Consortium seeks to expand its capacity and impact in our communities through implementing the Cleveland and Lincoln Counties Rural Communities Opioid Response Consortium (CLRC-ORC). A continuum of services and a network infrastructure and expansion approach is needed to improve education, prevention, access to treatment, understanding of treatment and to reduce the stigma of SUD/OUD so at risk and current SUD/OUD neighbors can receive the help needed. The following goals will be addressed through the fifteen (15) mandatory activities for all Rural Communities Opioid Response Consortiums. The goals address the gaps and needs identified in the community via review of Consortium Member work and reports, discussion with stakeholders to prepare for this application, analysis of local MCO and Provider Network data, and interviews with those in treatment of SUD/OUD and concerned members of the target communities. The goals are numbered but this does not indicate a preference or belief that any goal is of higher importance. We have three overarching goals that we will address with this opportunity. Each has one or more subgoals that more specifically target identified needs (see Needs Assessment section below) and focus available resources across relevant Consortium Members. Goal 1: Increase the Continuum of Services from Prevention to Recovery by Improving Access and Provision of Services and Resources. Services and resources are scattered across the target counties and fall short of what is needed to address the target population. This includes evidence-based practices, recovery-based practices and communities, peer support, and resources to address deficits in Social Determinants of Health (SDOH). Subgoal 1.1: Reduce shame, fear, guilt, and distrust for persons with SUD/OUD both internally through reducing perceived and self-stigma and externally by reducing stigma beliefs of community members. Stigma reduction activities will be used to address professional and community education, recognition that addiction is not a choice but a chronic disease, and that recovery is possible and can be actively supported by the professional and lay communities. Subgoal 1.2.: Increase stability and independence of persons with or at risk of SUD/OUD. Support for SDOH needs with specific focus on homeless SUD/OUD will be targeted with activities linked to mandatory objectives. Efforts will increase screening where homeless gather, i.e., “tent cities”, increase treatment access, assist with finding stable housing and employment when consistent with the individuals voice and choice, and improve safety for individuals and the community. Subgoal 1.3. Improve access to resources for all while decreasing systematic disparities in access to resources and evidence-based services. There are systematic disparities in 2 access for minority populations with special emphasis on African Americans. In the Target Population section below, we address the evidence of disparities. Goal 2. Offer Training and Education Across Stakeholder Groups to Improve Knowledge and Capacity for SUD/OUD Change while Emphasizing Networking and System Development to Maximize Communication, Data Sharing, and Sustainability. Education and training opportunities will be targeted to professional stakeholders but also to business and lay groups, e.g., the faith community, through collaboration of Consortium Members and Peer Support Specialists (PSS). Trainings to introduce and support the Law Enforcement Assisted Diversion (LEAD), First responders access to PSS, and others will be prioritized. If funded, creating a more specific training calendar and ensuring that trainings are not redundant will be completed as a startup task. The Data Coordinator/Evaluation Team will track all contact and training data including knowledge gain and satisfaction. Subgoal 2.1.: Address common underlying causes of SUD/OUD that increase transition to active SUD/OUD and that impede recovery with focus on trauma. There are many underlying issues related to SUD/OUD including but not limited to poverty, discrimination, housing insecurity and trauma. With this goal we specifically address Trauma defined as physical abuse, sexual abuse, neglect and exposure/witnessing abuse of others, e.g., domestic violence. Trauma is often unrecognized by SUD/OUD providers and rarely discussed in community due to shame and guilt. The stigma of trauma exacerbates the risk of developing a SUD/OUD and interferes with treatment efforts. Education efforts will be used to help integrate a trauma informed approach across the service continuum, improving retention in treatment and recovery outcomes. Goal 3: Develop and expand the SUD/OUD workforce across stakeholder groups including but not limited to professionals with DATA 2000 Waivers, screening sites, emergency intervention confidence and reach (e.g. Naloxone distribution), and Peer Support Specialists. The increase in SUD/OUD individuals along with opioid deaths and overdose events has strained the local system and has also fragmented the community, causing discord, anger, and concern. COVID -19 has further exacerbated workforce deficits. At the same time, it is difficult to find a community member that has not been touched directly or through an associate by the opioid epidemic. Increasing and improving workforce capacity and identification of SUD/OUD persons in need in a sustainable way is a key objective. Subgoal 3.1.: Increase voice and influence of persons recovering from SUD/OUD while leveraging their lived experience to improve the service continuum. With this goal we will increase the number of Certified and certification seeking PSS. There are approximately 800 PSS’s active in NC with about half working in substance use (SU). In the targeted rural area, there are 20-25 CPS’s focused on SU with nearly all attached to service delivery providers. We will work to train and embed peer supports in historically underserved areas, e.g., in homeless shelters, that have disproportionate numbers of SUD/OUD clients. This will include using grant funds to embed up to two peers in nontraditional locations. 3 We recognize that our approach and goals are ambitious. The groundwork for the Consortium has been being developed through local support and activities and we believe that this is now the time to address gaps and resources comprehensively and systematically. While some effective practices are in place the approach to the SUD/OUD problem is piecemeal and has not adequately incorporated different perspectives and approaches, for instance some differences between service providers and law-enforcement perspective on how to help the population. Further, clustering of resources in single towns, disparate treatment beliefs (professional services providers and recovery communities agree on the goal of recovery but can lack trust in the others approach), and at times poor communication has slowed progress. Our approach will address these issues.