New Mexico has suffered some of the highest rates of overdose death rates from opioid overdoses, and some of the highest rates of alcohol related deaths in the country, for over two decades. The state has pioneered innovative harm reduction and treatment work in response. The state was the first to train EMS responders on narcan administration, the first to pass a Good Samaritan 911 law, and is one of the only states with a methadone program within a county jail (the 18th largest jail in the country). Casa de Salud and Centro Sávila are two organizations located a few doors down from each other, in the South Valley of Albuquerque, an area of Bernalillo County affected by greater health disparities than anywhere else in the county. Both organizations were created in the context of community, with cultural humility, anti-racism, trauma knowledge, and harm reduction as pillars. Casa de Salud was founded in 2004, as a response to a critical need for safe, accessible, affordable, and transparently priced culturally humble primary care, same-day acute care, syringe exchange services, and addictions care. Patients experience various culturally relevant healing modalities — such as acupuncture, reiki, massage, and traditional Mexican healing — and patients also work with student health apprentices (the future healthcare workforce of NM). Casa de Salud’s addictions treatment program incorporates medication-assisted treatment with buprenorphine, home inductions, culturally relevant and supportive healing circles with integrative modalities, and a focus on re-entry into community from incarceration settings. Centro Sávila opened its doors in 2011 to provide affordable, culturally and linguistically competent behavioral health services in a safe and nurturing space for healing. Centro Sávila is a treatment program devoted to the recovery and healing of individuals, families, and communities suffering from emotional and psychological distress. Its comprehensive model of care provides: outpatient mental health services, case management, health insurance enrollment assistance for Medicaid and the NM Health Insurance Exchange, school-based restorative justice programs, food security support, drug and alcohol counseling and recovery support, and supervision, training and research opportunities for students and health professionals.
Wicked Problem Description:
Casa de Salud and Centro Savila believe that addictions and at-risk drug use are complex issues that are rooted in socioeconomic determinants of health, generational poverty, social capital, and lack of access to holistic, evidence-based treatment. The two organizations wish to address the wicked problems of alcohol and opioid addictions in the primary care and behavioral health settings, through integrating evidence-based medication assisted treatment and creative approaches to civic engagement and collective healing (instead of a focus on individuals and shame).
The tenets of Casa de Salud and Centro Savila’s planned approach include:
- High quality clinical care, relationship-building, time, medicine, therapy, integrative healing modalities
- Utilization of technology in innovative and relational ways – health coaching, telehealth, text messaging
- Utilization of promotoras (health promoters) – peer to peer support and health coaching
- Utilization of out of the box groups for intensive behavioral health change and peer support
- Movement away from shame and personal responsibility, towards collective wellbeing and liberation
- Social support at each step, case management support around social determinants of health
- Building civic engagement to understand oppressions and current community struggles around addictions, and action on these issues to achieve wins, decrease isolation and increase connectedness
This includes measurable improvements in quality of life; engagement in medication assisted treatment, holistic treatment, therapy, and groups; prevention of relapse; increased self-efficacy; decreases in recidivism; increased civic engagement and sense of purpose as well as decreased social isolation; engagement with peer to peer support, sustained integrated case discussions and quality improvement between Casa de Salud and Centro Savila, and scalability of the program (data, curricula, lessons, implementation tools).
Year 1 — Initiation of clinical care group meetings between the two orgs, creation of systems to collect data between the two orgs, civic engagement training with community organizers, initiation of health coaching tools, development of shame-free culturally relevant patient materials, implementation of focus groups.
Year 2 — Initiation of peer to peer support infrastructure and training, ongoing data collection and evaluation, building infrastructure for sharing lessons learned from clinical care meetings and other innovations with others, and further development of human capital within the two organizations, ongoing meetings with stakeholders.
Year 3 — Iteration on successes, strengthening of leadership among peer support and health coaching teams, consolidation of protocols and tools from integrated clinical case discussions and from community organizing, ongoing data collection and evaluation, plan for sharing data through journals and websites.
These will include treatment providers, local community organizing institutions, Bernalillo County, NM Dept of Health, public safety, law enforcement, educators, and the local Elevalle Collaborative.
We look forward to evaluating this project with both quantitative and qualitative measures as described above. We aim to bring on data scientists from the University of New Mexico or from the local UNM Robert Wood Johnson Foundation Center for Health Policy at UNM.