Category: Racial Equity

  • Using a Racial Equity Initative to Double Admissions

    Using a Racial Equity Initative to Double Admissions

    Challenge

    Recent research indicates that in New Orleans, a predominantly African American city, approximately 15% of women receiving residential substance use disorder (SUD) treatment are Black/African American (B/AA). This disparity contributes to increased involvement in the child welfare and criminal justice systems and incurs costs for the African American community, the city of New Orleans, and associated parishes.

    Solution

    Volunteers of America Southeast Louisiana (VOASELA) is developing a Family-Focused Recovery (FFR) inpatient program to address this disparity by successfully recruiting, retaining, and helping to facilitate recovery for B/AA pregnant women and those with children.

    Using the evidence-based NIATx Co-Production technique, NIATx consultants worked with VOASELA to co-create a culturally responsive program with the community to align with local culture and needs.

    As a significant and important part of this effort, NIATx conducted 14 structured interviews with B/AA women in New Orleans with lived experience. Based on these interviews, NIATx identified the following recommendations for VOASELA to consider as it prepares to open its inpatient FFR program:

    Before Residential Admission

    • Continue outreach strategies to recruit B/AA women and children as clients to participate in the residential program.
    • Continuously evaluate the recovery coach-recoveree ratio to identify the ideal number of recoverees that should be assigned to a coach to avoid burnout and compassion fatigue.
    • Initiate the planning process to ensure the program creates comfort for all women in treatment, particularly concerning racial balance.
    • Help increase recovery capital (i.e., internal and external resources) and hope for B/AA women seeking treatment by helping identify goals and purpose in recovery.

    During Residential Treatment

    • Foster treatment retention and help women complete the treatment to achieve better outcomes.
    • Become a trauma-informed system of care and create safety for women and girls who have experienced abuse and/or may fear losing custody of children.
    • Provide specialized services for children, including afterschool programming; homework help; sports, drama, and arts; medical, dental and eye exams; mentoring, and parenting classes.
    • Help provide a seamless transition from residential treatment back into the community by creating a Recovery Plan and establishing connections with recovery communities.

    After Discharge from Treatment

    • Provide recovery coaching for at least 90 days post-discharge from residential treatment, integrating support in the client’s natural environment and monitoring the effectiveness of both the relapse prevention and recovery plans.
    • Provide family recovery coaching to work with whole families in recovery.
    • Provide continued support to mothers to increase occupational, education, and vocational recovery post-discharge.
    • Continue to be a resources broker, connecting women with needed resources in the community to help support recovery.

    NIATx then completed a mapping exercise to integrate these recommendations into clinical and administrative work processes and further help VOASELA address and reduce inequities faced by B/AA women.

    Outcomes

    During this period, admissions have nearly doubled in VOASELA’s outpatient and peer recovery support programming. In addition, 60% of the program’s admissions are now B/AA, representing a proportional representation within the community.

  • Cultural Responsiveness: Exploring the CLAS Standards

    Cultural Responsiveness: Exploring the CLAS Standards

    Background

    In recent years NIATx has focused on a “What-How” strategy:

    • A range of evidence-based practices and improvement agendas have provided the “What” (i.e., what we want to implement or improve).
    • The NIATx improvement model has provided the “How” (i.e., how we can effectively implement or improve it).

    Using this model, NIATx has found success in supporting states, provider systems, and organizations in effectively implementing and improving a range of practices. These have included motivational interviewing, substance use screening, peer services, contingency management, regulatory compliance, family engagement, clinic services, and other practices across a spectrum of health and human services.

    Focus on Cultural Responsiveness

    A powerful “What-How” that has recently emerged involves organizational and systemic efforts to improve Cultural Responsiveness (CR). CR includes efforts to understand and engage the wide array of cultural attributes that individuals and groups bring to the service environment. This includes both service staff and customers, such as service recipients, and other community partners.  These cultural features can include language, behaviors, beliefs, values, and customs. A focus on culture tends to create a broader dialogue beyond race and ethnicity, including cultural differences found in different regions, generations, urban and rural locations, gender and sexual orientation, faith communities, etc. 

    Much energy is being focused on CR right now as SAMHSA promotes the Culturally and Linguistically Appropriate Services (CLAS) Standards framework in health and healthcare.  The 15 action steps of CLAS focus on advancing health equity, eliminating disparities, and improving service quality.

    In support of the CLAS Standards, the NIATx Foundation has developed the NIATx CLAS Assessment Tool (NCAT). The assessment features multiple subscales and can be delivered to a team or a broader system to determine the organization’s perspectives and needs related to CLAS. Participant responses to the web-based survey result in scores that represent the four quadrants below, including low or high scores related to the organization’s “world view” and low or high scores related to the organization’s “actions” as they pertain to CLAS.

    Case Study: Alcohol and Drug Dependency Services (ADDS) of Southeast Iowa

    Challenge

    Alcohol and Drug Dependency Services (ADDS) of Southeast Iowa in Burlington, Iowa has a clear understanding of the cultural diversity present in the community and the need to address this diversity to effectively provide services. “ADDS’s challenge is everyone’s challenge,” explained NIATx Foundation’s Mat Roosa, “but because they are progressive and have self-awareness, they see it and the opportunities it can bring.”

    Solution

    ADDS partnered with the NIATx Foundation to complete a CLAS assessment and facilitate a day-long CR training. The objective of this project was to leverage ADDS’s progressive ideals to identify ways to more thoughtfully engage with the community’s culturally diverse groups.

    The ADDS team actively participated in an initial meeting to explore their experience on a range of cultural variables that impact—and sometimes challenge—their care delivery. The staff team then completed the CLAS assessment using NCAT to develop an operational baseline for the organization.

    Upon completion of the assessment, ADDS staff came together with two NIATx Foundation subject matter experts in CLAS/Culture and Process Improvement. This day-long work session supported the ADDS team in:

    1. Understanding the multiple ways that cultural differences impact how they deliver care, and
    2. Developing implementation and change strategies to enhance their ability to engage service recipients.

    Outcomes

    While the population of Burlington, Iowa is 86% white (U.S. Census), the ADDS team was readily able to identify a number of cultural diversity issues that could be the focus of future service enhancement projects. Potential targets include:

    • Improving access for Spanish speaking populations.
    • Engaging youth/college students and senior residents.
    • Conducting outreach to rural and agricultural communities.


    The ADDS team left the CR work session with a clear understanding of their current world view related to culture and associated action plans to improve service access. The team also refined their awareness of the tremendous amount of cultural diversity that exists in the Burlington community, much like any other community.

  • Advancing Racial Equity in Family SUD Recovery Programs

    Advancing Racial Equity in Family SUD Recovery Programs

    Challenge

    Women and their children are increasingly impacted by SUD, and accessible and equitable treatment programs that integrate comprehensive services for both women and children are sorely needed. With a 60% Black population and 30% of children living in poverty, New Orleans is particularly vulnerable in its lack of access to quality SUD treatment—especially facilities that allow the family unit to remain intact and provide equity in access to treatment across racial lines.

    Solution

    Volunteers of America (VOA) is designing an enhanced and equitable substance use treatment model for women and their children for 2023 implementation in New Orleans. The VOA Family-Focused Recovery (FFR) model will be customized for New Orleans, applying a racial sense. Using the evidence-based NIATx Co-Production technique, a culturally responsive program will be co-created with the community. The purpose of this Co-Production approach is to develop a program that aligns with local culture and needs.

    The NIATx technique is based on five key principles:

    1. Partner with community-based lived-experienced individuals and stakeholders to uncover needs and establish preferences for program planning.
    2. Gain commitment and engagement from community and organizational leaders.
    3. Use individuals from outside the system to provide breakthrough thinking.
    4. Engage a respected progressive team leader to integrate innovative ideas into practice.
    5. Conduct pilot and rapid-cycle testing until equity aims are achieved.

    The Co-Production Planning will be centered around a Community Policy Planning Board that includes community stakeholders who are opinion leaders in the Black community. The Board’s purpose is to establish the most pressing needs for pregnant and postpartum Black women with SUDs and to collect their insights into how VOA can most effectively meet those needs. The optimal program operational features generated by the Board will be integrated into a Patient Mapping Exercise to determine structural, workflow, and clinical features the New Orleans program will apply to attract and retain Black pregnant and parent women.

    Outcomes

    VOA will learn from the New Orleans experience; refine the design process for future programs; and use the process to co-create treatment programs in future locations that are inclusive, equitable, culturally relevant, and responsive to their communities. Success will be measured not only by increasing family access to comprehensive SUD treatment and reducing disparities in treatment by aligning programs to the local culture, but also through continuous engagement with recognized community leaders, church leaders, community advocates, and peer-led groups.

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