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. From this place of necessity, New Mexico has pioneered innovative harm reduction and treatment work. The state was the first to train EMS responders on narcan administration, the first to pass a Good Samaritan 911 law, and one of the first states with a methadone program within a county jail.
Access to treatment for addictions is receiving important attention nationwide. As the federal government, states, and communities address this issue with new resolve and funding, the timing is right to strengthen community-based innovations in primary care and behavioral health settings that can be scaled or shared with other organizations. 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-informed care, accessibility, and harm reduction as pillars. The organizations have teamed up to deliver high quality evidence based and culturally relevant healing modalities as the “Strong Roots” (“Raices Fuertes” in Spanish) program. Strong Roots incorporates medication-assisted treatment with buprenorphine, home buprenorphine inductions, case management, coaching, culturally relevant mind / body / soul approaches with massage, acupuncture and reiki, as well as counseling and therapy. Healing circles and talking circles are rooted in indigenous practice and include sharing of stories, supporting one another, and integrative healing modalities. Through this program, the focus is personalized but the approach is a community one — patients can opt into exploring civic engagement opportunities to help decrease social isolation and increase a sense of purpose.
Casa de Salud is a nonprofit grassroots health center that 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 — including western medicine, nutrition support, massage, acupuncture, reiki, and traditional Mexican healing modalities. Patients interact both with clinicians and with student health apprentices (who perform medical assistant skills and harm reduction services at the clinic) — these student health apprentices go on to become the future healthcare workforce of New Mexico, taking with them the skills and relational experiences of working with New Mexicans struggling with addictions. Casa de Salud provides low-cost, high-touch relational care, and works to push against the medical industrial complex that has left communities out of touch with their power around their health.
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 behavioral health center devoted to the recovery and healing of individuals, families, and communities suffering from emotional and psychological distress. Its comprehensive model of care works to decrease health disparities in Bernalillo County by providing: 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 structural inequalities, generational poverty and trauma, and lack of social capital – and are further complicated by a lack of access to holistic and evidence-based treatment. The two organizations wish to address the wicked problem of 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.
Current / Ongoing Strategies
Strong Roots (Raices Fuertes in Spanish) reflects the long historical strengths of our community despite generational trauma and poverty of many families in the South Valley and Albuquerque. The team members involved in our Strong Roots program are supporting our patients by acknowledging their strengths, and by using trauma informed and restorative practices to work intensively with them in an outpatient clinical setting. For us this means intentionally lowering barriers to entry to care (including hosting weekly orientations and starting patients on buprenorphine medication the same week they express interest), designing a welcoming environment at every step of their recovery process, checking our own attitudes, and giving patients multiple chances versus having punitive strikes or rules. We also have limited mandatory requirements, many options to choose from for their recovery, and believe in patient autonomy and individualized recovery processes versus a more prescriptive plan around their care.
The team has dedicated time to meeting each week to discuss what is working and what can use improvement. We are able to iterate on our work quickly and dynamically. We are also meeting regularly as a transdisciplinary team, to discuss patients and work together for their best care. These regular meetings also afford space in otherwise busy clinic environments, to talk about our approach to addictions, including language we use among ourselves and with our patients and community.
Our orientation process is unique, with clinicians and team members sitting in a circle with our patients, on the same level as them, and framing the issue of opioid dependency as something affecting the entire community — and that patients are not weak or alone in their recovery process.
These include culture building within our transdisciplinary team of providers, healers, counselors, and case managers; infrastructure and dedicated time for patient case discussions; success in providing buprenorphine for patients who qualify with opioid use disorder in the same week that they express readiness for treatment; voluntary engagement by many of our patients in the healing circles, acupuncture and reiki, and counseling and case management; and retention of many patients in our program. We have also seen real decreases in lengths of future sentences for prison, as well as in recidivism, with our patients, as a result of the structure and support the program provides. One example is of a woman whose sentence was reduced from 37 years prison time to 3 years community service as a result of her engagement in the program and a judge’s positive response to this. We are also seeing organic growth of informal peer support among our patients and have engaged with patients to inform how we can improve the program.
Anticipated Future Outcomes:
These outcomes include qualitative and quantitative evaluations of our program in partnership with an evaluator; more intensive resource development for patients coming out of jail or prison who need additional case management and coaching services; development of a formal peer support network; formalization of civic engagement opportunities and measurements of success in this work; and deepening of community resources and partnerships. We also hope to build a sustainability plan and develop a toolbox of ways in which primary care clinics can integrate aspects of our work into their treatment approaches.
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.
Formalization of dynamic evaluation plan with qualitative and quantitative processes; Strengthening of coordination of care among all providers at our two organizations; Ongoing iteration and improvement of the program’s intake and offerings to our community; Deepening of community partnerships; Strengthening of advocacy around treatment options in the county jail and in the county; formalization of civic engagement opportunities and measurements of success for our patients.
Development of protocols and tools that can be shared broadly; strengthening of financial sustainability plan for this program’s work; deepening of civic engagement opportunities and patient leadership opportunities; development of media strategies to publicize the successes of our work as well as to build storytelling network to change attitudes about addictions.
These include various agencies including local treatment providers, county officials, the county jail and county detox center, law enforcement, and the state department of health.
Independent qualitative and quantitative evaluation with outcome measures designed by our program and our patients, and that can regularly inform our practices and also be shared widely.