Taking Action Summit: Racial Health Equity in Rural Addiction Treatment: Considerations for Treating Minoritized Populations in Rural Settings
Hello, good afternoon. Thank you for joining us for this session. My name is Dr. Gloria Baciewicz and I would like to welcome those who are joining us through the virtual platform, and also those who have joined us right here at the Eastman School of Music.
I not only have the pleasure of introducing Dr. Myra Mathis, I also have the pleasure of working with her every day at Strong Recovery. We are both addiction psychiatrists there. Dr.
Mathis is from Rochester, and she was initially educated in Rochester as well. She graduated from the University of Rochester with a BS in biochemistry, and later received her MD degree from University of Rochester's School of Medicine. She went to Yale University Department of Psychiatry for her psychiatry residency, and she remained there for a year of addiction psychiatry fellowship afterwards. She's certified in general psychiatry and addiction psychiatry.
She's currently a senior instructor in psychiatry at the University of Rochester. She is interested in diversity and health equity. She serves on the Medical Center Health Equity Steering Committee and the University of Rochester Committee on Community Engagement for Racial Justice. She is also co-chair of a national committee called the Opioid Response Network Work Group of Black and African American communities.
And she's also taking the lead in developing an addiction psychiatry fellowship for our Department of Psychiatry, since more psychiatrists to work in the substance use disorder treatment field are sorely needed. Patrick just announced the housekeeping matters with the Q & A period. We will have a short Q & A period after she's done speaking and it will be the same thing. We'll probably alternate between questions from here, which we'll have a microphone for, and also questions from the virtual platforms.
Okay, Dr. Mathis. (audience applauding) - Thank you, Dr. Baciewicz, for the introduction. And thank you all for joining us this afternoon.
I'm gonna attempt to remove my mask and hopefully not disturb the mic. All right. So again, thank you for your time and for joining us this afternoon. We're gonna spend some time talking about racial health equity and rural addiction treatment considerations for minoritized populations in rural settings.
Next slide, please. So before we get started, I want to take a moment to recognize and honor the lives of individuals who were killed in the Buffalo Massacre this past weekend. We are all reeling from another incident of racial terror in our country, and so close to the location where this conference is being held. So I would like to honor their lives with a moment of silence as I state their names and their ages.
Beginning in the left upper-hand corner, Ruth Whitfield, age 86. Celestine Chaney, age 65. Heyward Patterson, age 67. Roberta A.
Drury, age 32. Margus Morrison, age 52. Geraldine Talley, age 62. Aaron Salter, age 55. Katherine Massey, age 72.
Andre Mackniel, age 53. Pearl Young, age 77. Thank you for joining me in a time to honor their lives and their memory. As we move forward, I'd also like to do a land acknowledgement to acknowledge the original keepers and stewards of this land that we are on currently in Western New York, the Onondaga people, members of the Haudenosaunee Confederacy.
We acknowledge and recognize the genocide, colonization, and assimilation of indigenous people that took place on this land, that has taken place in the past and in present tense. Mindful of these realities, we commit ourselves to the work of understanding reconciliation and restitution. Next slide, please. And next slide, please.
So for this session, the objectives that I hope we will all leave after engaging in this time together, we'll review the rates of overdose deaths among racially minoritized populations, recognize the role of targeted faith-based and culturally-informed health interventions in treating racial and ethnic minority groups with substance use disorders, and identify strategies to adapt those targeted health interventions for minoritized racial and ethnic populations in rural settings. Next slide. So first, we are at a conference dedicated to stigma and health equity. How do we define health equity?
Equity is the absence of avoidable, unfair, remediable differences among groups of people. Whether those groups are defined socially, economically, demographically, or other means of stratification, including geographic stratification. Health equity or equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential, and that no one should be disadvantaged from achieving this potential regardless of where they live, regardless of what they look like, regardless of their cultural, ethnic, or racial heritage. Next slide, please.
So health inequities are then differences in health status or the distribution of health resources between populations and groups arising from the social conditions in which people are born, grow, work, live, and age. Next slide, please. So today we're going to talk a lot about the intersection of race and place, where you are, who you are, and how you are racially identified. Next slide.
This graph here is showing us drug overdose mortality rates by race and ethnicity. And I'm gonna take a minute to walk us through what each of these lines are representing. So the purple line represents the rates of drug overdose mortality in indigenous, so American Indian and Alaskan Native populations per 100,000. The blue line represents that same rate in Black or African American communities.
The green line represents that same rate among Latina communities. And the red line represents that rate among white communities. And looking at this graph, what we can see, first, we see the very sharp rise in overdose deaths for all racial and ethnic groups that have been identified between the time periods of 2018 to 2020. There is a fainted dotted line shortly after the 2019 time marker that marks the start of the pandemic.
And we see again the sharp rise in overdose deaths that has taken place due to the social isolation, rates of unemployment and the tremendous impact that COVID-19 has had on our society. We also see that the rates of overdose deaths are highest among indigenous peoples. Currently, the rate of overdose deaths in indigenous communities is 30% higher than that of white communities. The second highest rate of overdose deaths in the United States currently is among Black communities, and the rate of overdose deaths in Black communities is 20% higher than that of white communities.
So what does that tell us about this evolving crisis and how we need to adapt and modify our strategies to addressing it? Next slide, please. This particular set of data goes a little bit further into the numbers that we just talked about, and it is looking at the annual rate of change in overdose mortality by race and ethnicity. And so, the bar graphs represent how things have changed in various racial groups from one year to the next.
I don't know if this is a pointer. Yes, no, maybe? Okay. Yes. All right. This will help.
So here, as we look at the start of what is considered our current overdose crisis, we see that initially the only group for which there was an increase in the rate of overdose deaths was among white populations. And of course, we recognize this over many years in overdose crisis. As the crisis evolves, again, one thing that may be less noticed in larger national data is the consistently increasing rate over many years for native populations, even starting at the very beginning of the overdose crisis. And as we've already talked about with native populations and where they sit geographically, many, the majority of native communities are in rural settings.
Another time point that I would like to address is this time point here in about 2015 where we see, apart from what has happened during the pandemic, the largest single-year change in the rates of overdose deaths for Black communities. And for many, what that represents is the influx of fentanyl in the contamination of the drug supply and not just for individuals who are predominantly using heroin or other opiates, but for those who are using cocaine and other stimulants. And again, the very pronounced impact of the pandemic on all racial and ethnic groups, most largely being seen among Black and native populations.
But it's very important to note that the annual percent change from 2019 to 2020 is also significantly high for Latinx populations. Next slide, please. And when speaking about Latina populations or Latinx or Hispanic populations, there are many different names, but it's important for the group to identify itself, various trends have been identified. And so, certainly we've seen some of those trends in the data that's already been outlined.
But I would like to highlight the second paper by Manuel Cano, which demonstrated that among stateside Puerto Ricans in 2018, Puerto Rican men age 45 to 54 had the highest rate of overdose death compared to any other US demographic. And the reason why I highlight that particular study is because we tend to look at national trends and groupings and numbers, but we do not always appreciate the diversity within those subpopulations, right? And so, within the subpopulations of a Latina community, we have to consider the various impacts that may play out based on, not just how individuals are identified from a racialized perspective, but also their nationality and other aspects of their ethnicity.
And this concept and this idea of paying attention to those subpopulations and keeping our attention on the marginalized within the margins really helps us to think more critically about what it means to be a racialized minority in a rural setting. Next slide, please. So racialized minorities in rural settings do exist. So first, it's just to state that they do, that they can be found in rural settings.
And certainly, they may not be represented to the same degrees that they are represented in urban settings, but they can be found there. And with that in mind, we have to be queued into the particular ways in which they are marginalized, both as a result, again, of their race, but also their place. I wanna highlight in particular migrant workers from Latina communities that are highly concentrated in rural settings, and that this is another part of those subpopulations that we must be keyed into as we're thinking about addressing the full spectrum of rural health and substance use disorders.
Next slide, please. So this is far from just a white problem. And we do need to respond to the overdose crisis as a racial justice issue. We cannot see it as only racialized in one way.
And as many sort of individuals from public health scholars have identified, even anthropologists studying how our societies treat substance use disorders over time, they have noted and acknowledged that there has been a re-racialization of substance use in this current crisis to make it seem as though it is only a white problem. And with that re-racialization of substance use as only a white problem, there has been this robust infrastructure that's been created to address the needs of individuals with substance use disorder. And as we are seeing these trends shifting into populations that are minoritized, as we see the rates of overdose increasing dramatically in those populations, that same robust response at a national level, at a state level, at a local community level must be keyed in to the needs of racially minoritized groups and individuals.
Next slide, please. So I'd like to take a moment to talk about a frame called structural competency, which can help us understand the intersection of race and place. Structural competency asserts that health outcomes and lifestyle practices are shaped by larger socioeconomic, cultural, political, and economic forces. And anyone working in rural health absolutely knows this.
We know that the outcomes of the individuals, the health outcomes of the individuals that we treat are not just based on the person or their disease process alone. It has so much to do with what resources are available, the socioeconomic, cultural, and political forces that shape their lives. Next slide, please. And so, structural competency, it not only takes on this frame of understanding and contextualizing health outcomes, but it also includes a skill set.
And that is that clinicians then must be able to recognize and respond to that larger social context with self-reflexive humility and community engagement. Next slide, please. Utilizing these principles of structural competency, Bourgois et al. developed the domains of structural vulnerability and marginalization.
And these domains can sort of correlate to many of the social determinants of health, but it considers the many ways in which someone can be structurally marginalized, and the ways in which that structural marginality impacts their health and wellbeing. Financial security, residence, where someone lives, risk environments. So risk environments includes risk of exposures, various types of health exposures, exposures in terms of sort of who has access to safety in their lived environment versus who does not have access to safety. Food security, food deserts, the social network.
And really when we think about this aspect of a social network, one question that helps us hone in on that is, do you have someone that you can call when you are in crisis? So you may know people. In rural towns, everyone sort of knows everybody, but who do you call when you are in crisis? Do you feel safe enough to call someone and say, "I need help."
Legal status. Now, this is incredibly, incredibly important for racially minoritized groups. In rural settings, this is even more salient for so many reasons. One being think considering migrant workers and their citizenship status.
And so, the barriers to care include various levels of their anonymity being breached. Legal status is also getting at involvement with the carceral system. And of course, we've talked a bit even in our previous session about how criminalization of substance use disorders ends up being a lifelong sentence far beyond someone serving their time for whatever the crime at the time, at least what was considered a crime, might have been. Education.
And again, how these issues related to legal status impact access to education, and deeply important for racially minoritized population's discrimination. I will pause there because we will address that a little bit more in a couple of slides. Next slide, please. So again, these aspects of marginalization for minoritized groups in rural settings include so many layers and factors.
Access to care and resources. That is a challenge in all rural settings, right? But how does that challenge then become compounded for racially minoritized groups? There is the dual impact of discrimination and stigma, and this is both internal and external stigma.
And when I say internal stigma, there is the internal stigma for the individual. But there's also the internal stigma within their sub community, and then the external stigma coming from members outside of their community, right? So if someone can overcome the barriers of internal stigma that keep them from wondering whether or not they are worthy of engaging in treatment and worthy of having a more fulfilling life outside of their substance use disorder, if a person can overcome that internal stigma, they may then run into the stigma of their community. And we've talked about the loss of anonymity and those small, tight-knit communities that have great resources and great comfort and strength, but then can also have those challenges when someone has been othered within the community.
And the external stigma and discrimination. So this will dovetail into the lack of culturally-responsive medical care broadly, but then substance use treatment more specifically and the fear of discrimination in settings due to a history of medical maltreatment. And that certainly many people know about the Tuskegee experiments. And that is very, very well-known in terms of an example of not only federal government sort of sponsored experimentation on Black individuals and how that was also perpetuated by academic medicine.
But there are countless, countless examples, and even ongoing examples of medical maltreatment as it relates to medical research and inappropriate informed consent in communities of color. So all of these barriers are then compounded in multiple layers for individuals in rural settings who are attempting to access care. We've talked about the concern for deportation. We've talked about the concern for carceral system involvement and how that is reflected in both historical and present day structural racism.
Next slide, please. And very quickly, with carceral system involvement, this disrupts social networks and family systems, leaves people unable to access federal loans or grants for higher education, housing instability, disrupted employment, increase of overdose post-release, and the racially disparate impact due to mass incarceration. Next slide, please. And I really want to take a moment to appreciate this particular slide that helps us understand and really visualize the lifelong impact of a prison sentence for an individual.
And so, what we see on this side is the rate of unemployment in the US population absent of any history of incarceration. And of course, small but notable disparities exist both by race and gender. For individuals who are formerly incarcerated, those disparities become dramatic. And again, there is both a race and gender disparity in terms of the risk for unemployment.
So for Black women who are formerly incarcerated, their rate of unemployment is 43.6% compared to a rate of unemployment of 6.4% for individuals who do not have a history of incarceration, for Black women who do not have a history of incarceration, and then 4.3% for white men and women who do not have a history of incarceration.
In Black men, that rate is 35.2%, again, compared to 4.3% for white men and women who do not have a history of incarceration. And six point, I'm sorry, 7.7%
for Black men who do not have a history of incarceration. Next slide, please. The same race and gender disparity also exists for homelessness. And so, in the general public, individuals who have no history of incarceration have a rate of homelessness at 21 per 10,000 in the population incarcerated once, 141 per 10,000 in the population incarcerated more than once, 279 per 10,000 in the population.
So these rates are not stratified by race. In the graphs next to it, what we can see are rates of homelessness for Black and Hispanic men who have a history of incarceration compared to white men who have a history of incarceration. And then for Black women compared to white women with a history of incarceration. So this shows the general impact of a history of incarceration on homelessness.
And then here we see that impact again stratified by race and gender. Next slide, please. So recognizing all of these challenges, all of these barriers, the many ways in which systemic factors are then stacked against patients who are trying to engage in treatment, trying to figure out how to navigate a very complex healthcare system with the varying degrees of stigma, discrimination, and again, this intersection of race and place. How do we help them, right?
What do we do? So access to care includes the timely use of personal health services to achieve the best outcomes. What does that look like? So this gets at the fact that the initiation of treatment, from initiation of treatment to outcomes to treatment, we have to comprehensively appreciate the spectrum of barriers from practical, including financial insurance coverage to cultural, psychosocial, and then even clinician-specific factors.
Next slide, please. So this access spectrum, which actually is adopted from Healthy People 2020, and here we are in 2022, includes varying levels. So many people think about healthcare access, they think about coverage and insurance coverage, which is absolutely important, right? That's the first step in terms of how we are able to get paid for our work or that patients can then be able to have some sort of an economic leverage to be able to present as payment for the healthcare services.
Coverage then bleeds down to access, which is more of a general concept around accessibility. Where are the resources in my area? Are those resources actually accessible to me? I can have healthcare coverage, but if I can't get to the place that provides me treatment, then it's not really access.
And then there is the timeliness of the services if you are actually able to access it. Again, all things that individuals working in rural communities are very familiar with. So once I finally make it to the place that has the services, if I can get there, how quickly will I be served? Is there a wait list for this treatment program?
How long is the wait list? When am I actually going to get to the service that I'm covered for and finally have access to? And then who meets me when I get there? What's the workforce?
We're in a room full of capable and qualified people, and we're in a space where we are learning to be culturally responsive, and also structurally competent. Next slide, please. And I just wanted to point out this paper from the American Journal of Public Health published in February, 2022 that states what we all know and summarizes the many factors that we've been discussing as it relates to structural competency. And that is that state and policy-level factors have a greater association with positive treatment outcomes than individual factors.
We spend a lot of time working with the individual person, but it's the policies that have more of an impact on those treatment outcomes than the work that we are doing on an individual level. That's why that large group session that we had just before this is so critical to think about who those leaders are at a policy level to help us make those policy changes that enable us to effectively do our work. The policy-level and state-level factors also include things like community distress, which is inversely related to treatment outcomes. And we know that in rural communities that are deeply distressed by a variety of social and economic factors.
We also have to remember that Black populations and other racially minoritized groups are more likely to live in areas with poor housing and lack of opportunities and access to employment and education, etc. Next slide, please. So again, what do we do about it? I'm really, really excited to share with you about an initiative called Imani Breakthrough.
So the Imani Breakthrough Project is a community-based participatory research project providing evidence-based substance use disorder treatment through a faith-based, culturally informed harm reduction recovery program. The interventions were delivered in Black and Hispanic churches. And key to the program success is building relationships. Next slide, please.
So this slide, unfortunately, I am not able to show the video that accompanies it, but you will have access to the slides that does have a link to the video that accompanies this slide. And I will briefly describe what the video entailed. So the video is of a publicly available presentation by members of the Imani Breakthrough team. And the particular clip that I wanted to show you today is from the perspective of the church liaison of the team, Reverend Robin Anderson.
And she spoke specifically about the role of churches in minoritized communities as a place of support, as a place of social outreach and engagement that clergy members do not just see themselves as pastors of the individuals who come to their congregation on any given day. That they see themselves as pastors of a community, that they see themselves as caretakers of communities. And in rural settings, if you are going to have success in engaging racially minoritized groups and populations, then one of the critical places is within faith communities. So this may be churches for Black and Latina populations, but this also includes the indigenous healing practices and making sure that we have connections with members of the indigenous community who see those indigenous healers as leaders and stewards and elders in their communities.
Next slide, please. So Imani is Swahili for faith. And what is Imani Breakthrough? These were the principles that were set out by this team, and I must say that the team, again, it includes researchers, an addiction psychiatrist, a psychologist, it includes individuals with public health background, it includes individuals with lived experience, it includes individuals from the clergy community.
And there was extensive time given many listening sessions where they sat down with clergy members and heard about what they are seeing in their communities. For many folks, when it comes to mental health concerns in rural settings, their pastor, their religious leader, that's the first person that they're turning to. And many individuals see their substance use disorder as an outgrowth of those mental health concerns. And as we've already discussed, for many people that is a reality.
And so, pastors and clergy members often have an ear to the ground in terms of what is happening in those communities and what the needs are. And so, there were multiple listening sessions with these community stakeholders to get a better assessment and understanding of the problem, what their perspectives were, how they were seeing it, who they knew that were struggling, what barriers they were encountering. And to ask them what is the best way for us to help, to not assume that we know what to do, to not, as was previously mentioned, parachute in from our big cities and our academic centers and tell people what they need, but to listen, to build relationships and to hear from the people who are impacted by the crisis, what they need and how we can support with the resources we have.
So how do we do this? By creating a sense of unity that we are in this together. When you show up over and over and over again, people realize that you're committed, and you're not just there for one meeting, and then you're going to leave. You're actually invested in the health and wellbeing of that community.
Create a sense of collective responsibility, that we are going to shoulder this together, that we're not blaming, we are not blaming the members of the community for the crisis. And of course, those in this room know that that is not only ineffective, but inaccurate. And through a participatory process, that every step of the way we're checking in with our community partners and we are making sure that what we're doing is effective. We may have a plan and we built that plan in partnership, and then we run with it.
And later on down the line, we see that our community partners aren't quite as enthusiastic as they were before. Stop, check in, and make sure that each step of the way their feedback is being incorporated, that they are being heard and that they recognize that this is a we situation. That we are leading together, we are working together, and we are addressing the crisis together. Next slide, please.
So following this deep investment in the participatory process with clergy members and pastors and leaders, individuals with a substance use disorder who are then engaged and enrolled in the Imani Breakthrough project, go through a two-part process. Part one includes a group education component where they have 12 weeks of classes and activities focused on wellness enhancement. General wellness enhancement, not just, how much did you use? But actually general wellness enhancement.
The eight dimensions of wellness, again, that's adopted from SAMHSA. Spiritual, emotional, physical, financial, environmental, social, intellectual, occupational, that the classes were centered around these principles and thinking about the totality of someone's life and wellbeing. We think so much about how this crisis leads individuals at the margins and those who are the least of these to feel isolated and alone. And by incorporating these dimensions of wellness, we are highlighting the importance of connection, wholeness and wellbeing, the five Rs of citizenship, roles, responsibility, relationships, rights, What does it look like to be a full citizen of this community, not someone that is isolated and has to hide?
Part two, wraparound support in coaching. So after that intensive of 12 weeks, then you continue on with 12 weeks of mutual support. Just groups where folks get together, listen and talk with one another. This program is expanding from these initial principles to then go on to offer medications for addiction treatment through telehealth given by racial and ethnic match providers.
So that utilizing telehealth, we can connect individuals with Black, Latina and native providers to offer treatment for substance use disorder. So next slide, please. Quotes from participants and conversations about Imani. So in the beginning, I was not able to recognize that things could get better.
I learned from everyone here that I could be better every single day. I improved myself. I'm better for myself. I came to believe that I don't need it.
Drugs. I really like to talk. I like the feeling. I'm not afraid to talk no more.
The last 15 years of my life is, hmm, I did a lot of programs and never finished. I was super negative about life. I never had self-worth. There are other people just like me that have a lot of problems.
Graduating from this program opened doors. I got my GED and I'm going to see what my purpose is. Autonomy. I got to take back my control.
I'm the one that makes my reality. This is not an obligation. You don't have to follow the curriculum, as you do in other programs. I went to a mandatory program.
It is hard when you don't wanna go to the place. You're not really there. How will you talk if you don't want to? Sometimes you want to keep barriers, but here it's okay.
Culture and faith. I don't know if it is God, I don't know if it is something else. I know that when you have a power in your heart, we are connected with something that changes your life. I have faith and I don't believe in God.
It is important to respect what you believe. I believe in each other. Spirituality is a motivation. Sometimes it's the only thing that you have.
Helps me validate my feelings because I have so many thoughts and I believe that is important. My power comes from my thoughts, my values too. Next slide. Next slide.
And one more time. So again, as I'd mentioned, following this really intensive participatory process, individuals are also made aware of the variety of options that exist for them. Many people think that treatment is just about self-help groups, and self-help groups absolutely have their place. AA absolutely has its place.
But we also need to make individuals aware of the range of treatment options that exist, all of the medications for addiction treatment, other treatments that are off-label, as it relates to medication, and of course, harm reduction services. Next slide, please. So in summary and as we've talked about all of these structural barriers and ways in which individuals feel marginalized and isolated, but also, on the flip side of that, how we can use existing social networks to mitigate that sense of marginalization and isolation. We recognize that structurally competent and culturally informed interventions are required to counter the harmful and detrimental effects of health inequities and racism and health.
We have to, again, keep in mind that intersection of race and place. Next slide, please. So what are some recommendations? As the Imani Breakthrough Project illustrates, we have to build those relationships, and relationship building takes time.
And that's just the reality. For many folks who are here, we know that it takes time 'cause we're out there building relationships and we're out there doing the work. Funding priorities to community-based organizations that already have trust within the communities. Often our funding goes to large treatment centers, and then has to be sort of funneled down to the people on the ground.
As we are building relationships and building trust in these communities, in these smaller rural areas, identifying those community centers that need the funding, prioritize funding being as close to the problem as possible. I also wanna emphasize rural-city connections. And I think this is particularly important for minoritized groups and communities because they have those connections. In order to survive, minoritized populations need those rural-city connections for the exchange of information and for the exchange of resources.
This is, in a practical sense, seen in many churches and various denominations where they have sort of the big city version of their church in a particular denomination that then has informal and/or formal connections to the rural extension of that big city church, right? How can we leverage those existing connections to help us to continue to build trust in these communities? Mobile harm reduction resources or units. And when I say that, I'm thinking something that's really sleek, small and agile.
Like, yes, mobile methadone, yes, absolutely. Mobile methadone is also big and clunky and announces you to the world. Maybe a step before mobile methadone as we're working towards getting that done, are small, agile, just like a little car with stuff in your trunk that has nothing on it, no signage, no nothing, just a car, nondescript, driving around, saying hi, opening your trunk, get some test strips, get some syringes, move on. Really pare it down.
(audience applauding) And for treatment programs, increase the racial and ethnic diversity of your staff, and particularly those in leadership roles. I have to shout out strong recovery and Sobriedad Fuerte. We have a Spanish-speaking treatment program, and we have tons of patients coming in from rural areas in Western New York from the Latina population, and it was spread by word of mouth. We didn't advertise.
We actually, I don't know if anyone has physically gone to these locations apart from our patients who received treatment. And again, those are the informal networks that connect the rural and urban areas for these populations. Again, program specific to the structurally and marginalized communities, that we can't just take these one-size-fits-all approaches and think they're gonna work for racially minoritized populations, 'cause we are finding and we know that they don't work. Partnerships between OTPs and correctional facilities, as we'd already discussed, given the high rates of overdose post-release.
And of course, incorporating peer community health workers, that they can be a part of your army of sleek, agile individuals moving in and out of the community that don't draw too much attention, but that make the connections that could be life-saving. And with that, I am featuring the picture of the young man who keeps me. Next slide, please. Sorry.
You guys didn't know. Yes, that's the young man. Keeps me up at night, but was also so kind as to not give me one of his daycare colds so that I can speak today. So I'll take your questions at this time.
Thank you for listening. (audience applauding) - [Gloria]
Okay, no. Stay there.
- Yes, okay.
Okay. Okay, well, my first question was what kind of a little agile small car do you want?
- Oh, that's a great question. That's a great question. So you know what? Actually, now that I'm thinking about rural areas, maybe it needs to be an Excursion that's very, like just fix in and blends in with the whole vibe.
So I'm gonna go with an Excursion. Yeah. (laughing) - [Gloria]
Okay. Okay, we got that. So here's a question from the virtual platform. How can local leaders, politicians in tight-knit rural communities help reduce stigma?
- Hmm, that is a great question. So I think, we've talked about the importance of language. So how are you talking about the problem in all of your public speaking, in your press releases, in your communications within your county? Really digging into any pamphlets that are available through your department of public health, and making sure that we are consistent in the language that we use, not using stigmatizing language, that we are representing diversely in our pamphlets in terms of who's pictured on those pamphlets and what addiction might quote, look like, that we are making it a we problem and not a you or a they problem.
That we're not othering individuals with a substance use disorder. And so, this is a tricky counterpoint, right? Because you are respecting and mindful of individuals' privacy and their anonymity, but we're also, we also recognize the power of an individual story. So who are your champions in your community?
Who are those individuals with lived experience who have navigated addiction in a rural community and have been able to come out on the other side? And making sure that you're supporting those champions, and that they have a platform to share with their community members about how to make those next steps.
Okay, thanks. Any questions from the audience in the Eastman School of Music? Okay. Well, while you're coming down, I'll say another question from the virtual platform.
Dr. Mathis, what is one piece of community feedback that really resonated to you as you were perhaps assessing a program?
- Hmm, good question. So I will speak a bit about, from the lens of the Imani Breakthrough program, I was fortunate enough to be able to participate in some of those early community conversations with clergy members during the development of the program. And I think the piece of feedback that resonated with me the most is that we don't want you to just come in and study us and then leave. We wanna make sure that you're in it for the long haul.
Yep. Yep, that sounds good. Yes, so there was another question.
- [Audience Member]
Is this one working? Can you hear me?
- [Audience Member]
This isn't necessarily a question, but I wanted to share along those lines of sort of being agile in harm reduction, that in Vermont, we're developing a first-of-its-kind mobile application that I'm describing is basically Uber Eats for harm reduction supplies. So you can use this app on your phone and you can request that the syringe service program come and deliver supplies to wherever you wanna meet. Maybe it's at your house, but maybe it's in a parking lot of wherever, and it's an unmarked vehicle and they'll come and you can make that connection. So it's very anonymous.
You're not announcing to the world that you're sort of using these supplies. So it's launching soon and I just wanted to let folks know, and we'll be sure to share information about how it's going and hopefully it can spread.
- That is really exciting. Thank you for sharing. And now we're on this theme of cars, can you tell us what kind of car is going to be delivering here?
- [Audience Member]
Sure. So it used to be a van that was really brightly marked, and the feedback was, please don't do that. And so, it's just like a personal vehicle, like a small vehicle that can get through mud season in Vermont. But so, yeah, you do have to take that into consideration, but yeah, yes.
- So not a Prius, but maybe not an Excursion either. (laughing) - [Audience Member]
Something with four-wheel drive. Yeah.
- There we go. Thank you.
Okay, another, Okay, bye bye.
- Any other questions?
Okay, well, I've got another one from the online folks. How do you respond to concerns about harm reduction strategies when community members express them?
- Great question. Great question. I think when we center the fact that we want to keep people alive, that we also recognize the danger of the current drug supply. That it is very potent, that it is unpredictable, that it has changed dramatically over many years, and particularly in the last seven or so years.
So I say, things aren't like they used to be. It's really dangerous out there and we just wanna keep people alive long enough until they figure out what their next step is gonna be.
Yeah, absolutely. Any other questions from the audience here? Okay, I have another question from the online folks, and this can be our last question 'cause we're almost to the end of time here. And this is a question that I think we've all had at one point or another.
Any advice for people in rural communities wearing multiple hats and stretched thin in making change?
- Wow. Thank you for that question. So the principles of taking care of ourselves always ring true, that we can't take care of others effectively if we aren't taking care of ourselves. So you do sort of have to say, sometimes you do have to say no because you recognize that if you don't say no, then you're going to do all of the other 15 things that are on your plate at a degree that's not as great as they could be.
And so, rather than saying yes to that 16th thing and it's sort of subpar because you really just don't have the capacity 'cause we're human beings and we're not quite machines, then it's recognizing what that capacity is, so that you can do the things really well that you already have on your plate. And that may mean saying no to this other thing that could be really awesome, but just might pull you too far. And mindfulness, that it's a practice that we engage in, that we take time to center ourselves in the middle of our workday, that we take a moment to center ourselves before going in to see a challenging patient.
That you take a moment to center yourself. All of those little aspects of self-care that may not be the, I have a whole day off to do whatever I want, but it means finding ways to fit it in, in the midst of all the busyness and the many responsibilities pulling us in different directions. That's my best answer.
Okay. Well, and that's a good one. Well, thank you very much, Dr. Mathis, for your great perspectives on this topic.
- Thank you very much. (audience applauding)
Myra L. Mathis, MD
Senior Instructor & Addiction Psychiatrist, Department of Psychiatry, University of Rochester Medical Center