Yale Psychiatry Grand Rounds: March 3, 2023

March 03, 2023

Information

The Imani Breakthrough Project: A Cultural and Faith-Based Harm Reduction Recovery Initiative for Black and Latinx Communities in Response to Our Opioid Crisis

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00:00Thank you, thank you. Thank you
00:02so much Doctor Crystal for that.
00:04Wonderful introduction.
00:05I really appreciate that.
00:10So let's get started.
00:12I just wanted to just thank you all
00:15for taking this morning to be with us.
00:17We are truly excited to
00:19present and grand round.
00:21So we have a full team are fully
00:24money team are here to just share our
00:27insights about some of the work that
00:29we've done with IMANI programming.
00:31And joining me today are Reverend Robin
00:34Anderson who is our church liaison,
00:37Cheryl Indie, she was our biostatistician.
00:40Kimberly Black men,
00:42who is our project director,
00:44Graziella Reyes,
00:45who is our next site coordinator,
00:48Mark Costa, who has a diversity
00:51supplement with Doctor Ayanna Jordan.
00:53And I, Sylvia Cooper and Pastor Jose
00:56Rodriguez are both facilitators for your
00:59money and not with us is our wonderful my,
01:04my multiple Pi copilot, Dr.
01:07Yana Jordan.
01:08So we are also representing.
01:11Start today,
01:12so thank you.
01:16So I want to do a land acknowledgement
01:19all land and Connecticut
01:20was once native territory.
01:22It's our duty to acknowledge that many of
01:25the institutions where we work or conduct
01:27research are indeed on native land.
01:29So it's important that we give thanks.
01:32Atlantic acknowledgements do not exist
01:34in the past tense or historical context.
01:37Colonialism is a current,
01:39ongoing process, and we need.
01:42And we need to be mindful of
01:44our President participation.
01:49This is our money organizing team.
01:51And as you can see,
01:52there are so many people and I
01:54don't have time to name them,
01:55but we have folks who are
01:58physicians and psychiatrists.
02:00We have mental health providers.
02:02We have substance use providers
02:04from the Community.
02:04We have community members, we have pastors.
02:07We have people with lived experience.
02:09We have people at the state level.
02:11Thank very thankful to Commissioner Nancy
02:14Navaratna as well as our Assistant Secretary,
02:17Doctor Miranda.
02:18Commitment, who originally funded this
02:21work and also to one of my mentors,
02:25doctor Larry Davidson.
02:26And I just wanted to say special
02:29thanks to the churches, pastors,
02:31facilitators and people that
02:34lived experience attending Imani.
02:36And in memory of the many that we have
02:39lost to the opioid and overdose epidemic.
02:45This is a photo of our Imani facilitators.
02:50So wonderful group. We would not be
02:52able to do this work without them.
02:54They are our folks on the ground.
02:58And this is a photo of Ari many pastors and
03:02this was us do any money pastors training.
03:04You can see Doctor Yana Jordan with
03:07the big smile up top and and also
03:10Reverend Robin Anderson our church
03:12liaison and right here in New Haven
03:15that below we have a pastor kiss.
03:18Kelsey still I I just wanted to point
03:20out that Reverend Robin and Pastor
03:23Kelsey have both been a part of the
03:26YCI cultural ambassadors as well.
03:31So I want to start with a poem
03:33that was developed by my friend
03:35and colleague Imani Harrington.
03:37Imani is a playwright at
03:40activists from San Francisco,
03:42and she and I wrote a book of plays and
03:45monologues and poetry called a positive
03:49negative women of Color and HIV and AIDS.
03:52We need to. We need you,
03:54our brothers, our sisters, our people.
03:57Help us reaffirm ourselves
03:59and loving ourselves.
04:01Hold us when we can't stand because souls of
04:04shoes have traveled on backs for so long.
04:07We need you, our brothers,
04:09our sisters, and our people.
04:13And to me.
04:14This poem is really get gets at
04:16the essence of why the work that
04:18we do in community and the work
04:20that we do in Imani is essential.
04:23Because the work really is about
04:25helping people reaffirm that
04:27love that they have for others
04:29as well as them themselves,
04:31and it's also about helping
04:34ourselves reaffirm that love.
04:37Why Imani breakthrough Imani
04:39means faith in Swahili.
04:44Sorry about that.
04:46We aim to promote health and healing
04:48for ourselves and our communities.
04:50How is this accomplished?
04:52Through a participatory process.
04:53We create a sense of unity.
04:56We create a sense of
04:58collective responsibility,
04:59a sense that we are all in this together.
05:03I want to talk briefly on the
05:05evolution of the mini program because
05:07you'll hear various different
05:09components of the Amani programming
05:11to that and it's a wonderful slide
05:13that was developed by Charlie.
05:15Nice. Thank you.
05:16So Imani started in 2017,
05:18it was originally funded by demons
05:21through the state targeted response to
05:24the opioid crisis and then through the
05:27state opioid response funding through
05:29Samsa and this was to address address.
05:33The opioid crisis where now they're
05:35five major urban cities and Connecticut,
05:38Hartford, New Haven,
05:39Bridgeport,
05:40Waterbury and New Britain.
05:42We initially started with four black
05:46churches and then we're able to receive
05:49additional funding to add on for
05:51that Latinx churches in Connecticut.
05:54So now we are at 8 churches in Connecticut.
05:57Then we were truly blessed.
06:00Ryan and I submitted for NIH.
06:03Comment fun.
06:04You are one mechanism to actually
06:06do research on the immani project
06:09where we are doing a randomized
06:11clinical trial with medication for
06:13addiction treatment as an option and
06:16we're doing that in six Connecticut
06:19churches and 2023 really brings
06:21new Imani program initiatives.
06:24We again are happy to say that
06:26we are starting in Rhode Island
06:28contract signed as well as New
06:30Orleans contract also signed
06:32and we're going to be starting.
06:35And probably in the hopefully
06:36in about 2 to three weeks.
06:40So why are you mining and why are
06:42churches as we know black people now
06:46outpace white people and OUD dabs?
06:49And largely that's because of the fentanyl
06:53and xylidine increase in the drug supply.
06:58And as you can see from the graphs,
07:00the numbers are continuing to rise.
07:05Latin X and black adults are less
07:07likely to access substance use
07:10treatment of traditional setting.
07:12For racial ethnic minorities in the US,
07:14they're less likely to seek
07:16mental health treatment.
07:17Less likely to start drug and alcohol
07:20treatment and when and if they do start,
07:23they're less likely to
07:24stay involved in treatment.
07:26So we're seeing a lower treatment
07:28engagement and this is where the black
07:30and Latinx churches can be helpful.
07:32They can also be helpful in terms of
07:35addressing the social determinants of health.
07:37And as you can see,
07:38these are the various different
07:40areas that need to be addressed.
07:43Not only addressing issues of substance use,
07:46but also legal involvement,
07:49having no insurance,
07:51dealing with issues of stigma
07:53and discrimination and othering,
07:55dealing with hopelessness,
07:57outdated policies, vicarious trauma,
08:00lack of housing, unemployment.
08:02Really. Insecurity?
08:05Lack and lack.
08:06Next, churches are effective partners
08:08in helping people live healthier lives.
08:10We know that in the literature
08:13really points to that religion
08:15and spirituality are important,
08:18particularly for Black and Latinx people,
08:21and people have talked about how
08:24religion and spirituality have been
08:26essential in helping them cope with
08:28psychological distress in urban
08:30communities and particularly urban
08:32black communities, 65 to 80% of adults.
08:3510 Church regularly and 75% of Black
08:38Latinx populations attend church regularly.
08:40And even for those of us who
08:42may not attend church like me,
08:44I know that my mother is
08:46somewhere praying for me.
08:48Many studies also highlight the
08:50importance of church and drug
08:52and alcohol recovery programs,
08:53and they seek help from their clergy,
08:56from pastors, from deacons,
08:59deaconess,
08:59and from other members of the church.
09:01What's key to the development of the
09:04Amani Breakthrough project is community
09:06based participatory research, CBPR,
09:08which I know most of you know what it is,
09:11but to really do CBPR effectively,
09:14it's really important to to look at
09:16this from a equitable standpoint.
09:19And that really means that it
09:21involves community members,
09:22key stakeholders,
09:23researchers and all others in
09:25all aspects of the research,
09:28not just in terms of,
09:30you know,
09:31for instance,
09:31Yale showing up into the Community,
09:33but right from the beginning,
09:35from concept to all aspects of design from,
09:40you know,
09:41including implementation
09:42as well as dissemination.
09:46And that's what we do with Imani.
09:48So chief through the start of Imani
09:50when Ayanna and I first initiated this,
09:53we pulled together all of those
09:55community members and then we set out
09:57to do community conversations and
09:59really learn through those community
10:01conversations that involve not only
10:04faith-based leaders and members,
10:05but people with lived experience.
10:07And through this process we identified
10:09that it was really important that
10:11we develop a faith-based recovery
10:13programming and we combined.
10:16Two projects that we currently
10:18have been working on,
10:20the research that we've been working on,
10:21including in a lot of our work,
10:23which is the 5 bars developed
10:25by our very own doctor,
10:27Michael Rowe, who's now Meredith,
10:29and the 8 dimensions of Wellness
10:31developed by our colleague Dr.
10:32Peggy Swarbrick.
10:33And also we decided that it was really
10:36important that we include education.
10:38We were not paid by THEMIS to
10:41conduct education with the churches.
10:43It was our partnership.
10:45That Reverend Robin and also
10:48with Michelle Stewart kopes,
10:50that led to us saying that
10:52there needs to be education.
10:54It's important that the the parish
10:56is educated as well as the community
10:58is educated about what's going
10:59on in terms of the opioid crisis
11:01and that was developed under the
11:04direction of Reverend Robin Anderson.
11:08As I mentioned,
11:09these are the two program models.
11:11And as you can see,
11:12there's the citizenship,
11:13which is really based on the rights,
11:15responsibilities, roles,
11:16resources and relationships.
11:18And that sense of belonging.
11:20That's really critical as a person is
11:22connecting back to their social networks,
11:24particularly for people who have this,
11:27you know, disconnected from that social
11:30network primarily because of their
11:32involvement in substance substance use.
11:34And we also have the 8
11:36dimensions of Wellness,
11:37again developed by.
11:39Warbrick.
11:39Now,
11:40many of you are probably familiar
11:42with the 8 dimensions of Wellness
11:44because it's endorsed by Samsa,
11:46but it was developed by Peggy Swarbrick.
11:51What's unique about Imani is that,
11:53you know, it's really culturally
11:55informed harm reduction.
11:57All of our folks receive access
11:59to fentanyl strips as well as
12:01Narcan and training as a justice to
12:05social determinant determinants.
12:07It involves mutual mutual support,
12:09intensive wrap around support,
12:10as well as really sticking to the
12:13components of the Amani philosophies.
12:16The other thing you should know is
12:18that all the facilitators are trained.
12:21In each church,
12:22we have a person with lived experience
12:25who serves as a facilitator,
12:27and that's lived experience from
12:29substance use as well as a church member.
12:35And also, these are just
12:37the components of Imani.
12:38You see, there's two parts.
12:39There's part one, which is 12 weeks of
12:42classes and activities focused on Wellness.
12:45And here's where the facilitators
12:47combined the 8 dimensions and the 5R's.
12:50And then in week four,
12:51they receive wrap around coaching
12:54and individuals can choose who
12:56they want to have as a coach.
12:58And Part 2, which they call next steps.
13:00And that was added on,
13:03you know, and Pastor.
13:04Reverend Robin,
13:05that talked more about that.
13:07But the the next step component
13:09consists of 10 to 12 weeks of mutual
13:12support and it's also just continuing
13:15that group education component.
13:20And I just really now want to pass
13:22this over to our church liaison,
13:24Reverend Robin Anderson,
13:25who's just going to share her
13:28insights about the Imani programming.
13:29And I just want to say thank you,
13:31Reverend Robbins, this would not
13:33be possible without your support.
13:36Thank you so much, Doctor Bellamy.
13:41We thank God for you and Doctor Ayana
13:44and also the team for the great work
13:47that you are doing and continue to do.
13:50And even in terms of really developing
13:54this wonderful program that I tell
13:56everybody wherever I go that Amani
13:59is the greatest program that I've
14:01ever seen and even over in my 40
14:04years of being in the clinical field.
14:06To see a program that's in the
14:09community where people live,
14:12that's also making a great
14:14difference in their lives,
14:16it's something that is phenomenal.
14:18The I just also want to say also that
14:21this is the first project that I've ever
14:25worked on that is a true partnership.
14:28Many times people have come to the
14:30faith community to gather information,
14:32but not necessarily to come to get our
14:35input to work together side by side.
14:38To be part of the development
14:41of an initiative,
14:43a program that is also making
14:46a great difference.
14:47So the my name again is Robin Anderson.
14:50I am not only in the church liaison,
14:52but I'm also the pastor of
14:54the Blackwell Church as well.
14:56And the Amani project when
14:59we first came together.
15:00Also just to say something
15:02about really the church.
15:03The church is always been an
15:06integral part of every community.
15:08We never see our churches
15:11as just our Members,
15:13but we see our churches as part
15:15of the Community and the concerns
15:17and to be able to Minister to
15:20those that are in the Community.
15:22Also, many people will never join our church,
15:25may not ever be a part of our church,
15:28but certainly when they need help
15:29or when something is going on in
15:31their family or family members
15:33have things that are going on
15:35with their other family members,
15:36they always come to us and come
15:39to the church.
15:40I can't tell you how many times
15:41I've been in emergency room,
15:43have gone to the hospital,
15:45have been at homes and which persons
15:47have OD through the in the community
15:50or part of being the membership of our
15:53church and which we have not been about.
15:55That is the life of the pastor
15:58and the church.
15:59We see the world as our parish and also
16:03the church also is always continue to
16:07be part of also even those persons.
16:10That die from a substance use
16:12or any other things.
16:13We are the ones that actually
16:15you the eulogize and also bring
16:17comfort and care to the community.
16:20So I am so glad that the this Amani
16:23project has always included us in
16:26that process. So how do we start out?
16:28Well,
16:29we came together with a focus group
16:31with people in the community as well
16:33as churches and pastors and we came
16:36together and we began to discuss the
16:38fact that many people were going.
16:40In and out of US programs like a
16:43revolving door and that something
16:45needed to change and something
16:47needed to be different.
16:49And so we at that meeting at
16:51that focus group,
16:53everybody agreed that we need
16:55to have a different model.
16:57And so when we when we said that that
16:59we need to have a different amount,
17:01this is just not working.
17:02And we thank God for Doctor Bellamy
17:05Bellamy and also Doctor Jordan,
17:07who also said well,
17:08let's create a different model and so.
17:11Again, this is also to me another
17:13opportunity to me to be able to for us
17:16to come together and develop this model,
17:19but also to be part of this
17:21participatory what we call research.
17:23And that was also another introduction
17:26to persons really understand that
17:29participatory research does work and it
17:31does exist through the Amani project
17:34and so even today on the prayer line,
17:36just to show the concern that
17:38pastors and people have this morning.
17:41They were talking about also opioid
17:44overdoses and some a community.
17:46One of the pastors mentioned
17:48that there was six people in the
17:50last week that had overdosed.
17:51And so just really talking about
17:53what are some of the things
17:54that we need to do and can do.
17:56But the Amani project also is again
17:58fits into our model of really healing
18:01that our ministry is to heal,
18:04to bring hope and to empower others.
18:07And so in this process and
18:09developing the Amani project,
18:10we sought to look for churches.
18:12That would also be involved in this
18:15project that not just for thinking
18:16that it was going to be outreach just
18:19for ministry but really to embrace it,
18:21but also had other things that were
18:23going on in their churches that could
18:25provide what we call wrap around services.
18:28So the churches that are listed there
18:30that are involved in the project,
18:33many of them are even through our
18:35asset mapping that we actually did,
18:37we talked about what are some of
18:39the things that we can do to wrap
18:41around services for those that are.
18:43Actually coming to be a part of the services,
18:45because many churches have doctors,
18:47they have lawyers,
18:48they also have case managers,
18:50they have social workers,
18:52they have community health workers,
18:54they have peer peer support persons
18:56that are right there in their church.
18:59And what kind of things can we do to
19:01continue to wrap services around and
19:03to continue to work with those that
19:06will be coming to our church for services.
19:08And so a part of that came the birthing of
19:11many churches around counseling ministries.
19:13Some churches have continued to
19:15provide either US or support groups
19:18for persons that are in their churches.
19:21Many churches also have food pantries.
19:23Some of them have employment services,
19:26employment readiness.
19:26And those kinds of things came out
19:29of the conversation of what are some
19:31of the other things that we can do
19:33to assist persons that are coming
19:35to the Amani group.
19:37The facilitators that we have are
19:40dynamic also and also because they
19:42are part of the.
19:43Community, they are also part of the church,
19:46but they're also part of the
19:48community also in which
19:49they're serving and and the church
19:51that they also are there in.
19:52So they have a investment in
19:54this work and you'll hear some
19:56of those things a little later.
19:58The other thing is that we all.
20:00Sure that our pastors,
20:02that our church community and our community
20:05will also educated around opioid use,
20:08around substance use and the effects
20:10that it is having in the Community,
20:12especially in the community of black
20:15persons and also Latinx persons.
20:18And so we made sure that we
20:20went around educating people,
20:21letting people know that the
20:23program exists and even though each
20:25every church would not, is not,
20:27does not have the program but also that
20:29other churches can actually send people.
20:32To this program and they do do that.
20:34We've had one of our churches
20:37that have also received an award
20:40for the outstanding services that
20:42they're providing through a national
20:45organization that focuses on black
20:48health and well-being the bomb
20:50of Gilead and that's the Barrack
20:53Memorial Church right here and also
20:55New Haven we've had graduations.
20:57I'm at one point we we had churches it
21:00was supposed 25 persons were part of the.
21:02But the group got so large, they had to do 2.
21:05We've had up to 70 people that
21:07have graduated.
21:08We've been covered over or through the media.
21:11Some persons in the groups have also wanted
21:14to tell their story of publicly also.
21:17And so those kinds of things
21:20have also happened.
21:21And then a part of the
21:23group again is 22 weeks.
21:25It started out with just the 12
21:27weeks and then after the first,
21:29the second cohort, the pastors came together.
21:32He said that persons are still
21:34coming to the church,
21:36they don't want to leave this,
21:37they don't want to leave the group.
21:39They feel like they still need more.
21:41And so out of that, the pastors are,
21:44along with Doctor Jordan and Doctor Bellamy,
21:47developed the next step of groups,
21:50which are 10 weeks in which they are coached.
21:53They're also linked to whatever
21:54resources and services that are
21:56needed that will continue to help
21:58them to move forward in the way that
22:01they actually have designed that.
22:02They want to move forward in their lives.
22:06Also,
22:06we,
22:06the participants receive a lot
22:09of the facilitators are paid for
22:11their services and the participants
22:13receive $10 a week for coming.
22:15And some people say,
22:16well,
22:16how can you do that because that
22:19may send them back out to you.
22:21What I want to tell you that after about
22:23four weeks they don't even remember.
22:25You have to chase them down sometimes
22:27to give them their stipends.
22:28But also one particular group
22:31of Barrett in new.
22:33Decided that they were going to
22:35take this is the participants
22:36decided that they were going to take
22:39a $2.00 away from their stipend
22:40and they were going to save it.
22:42And at the end of the 22 weeks,
22:45they gave it to an organization
22:46as a way of
22:48giving back or what I call a being a blessing
22:51and Thanksgiving for what they're receiving
22:53and how their lives have actually changed.
22:56We continue to know that this project works.
23:00You will see the data, the outcome.
23:02That you will see on today that measures
23:06up against any traditional services that
23:09this program is making a difference.
23:12This program is also,
23:13as we talked about earlier,
23:15the ammani United,
23:16which we'll be talking about later.
23:19Now we're bringing also services
23:21right there in the church for
23:24medically addiction treatment,
23:26right there in the church.
23:28This is just groundbreaking and
23:30making a difference in the community.
23:33I want to get out of the way because I
23:35want you to hear from 2 facilitators
23:37that are doing a magnanimous job
23:39and the work that they're doing
23:41and they will share today what
23:44Amani looks like on the ground.
23:47Sylvia Hooper and Jose,
23:49if you would go forward.
23:52Thank you. Pastor Jose.
23:55And Sylvia.
23:59Thank you, Reverend Robin.
24:02I've been a part of the Miami
24:04breakthrough project for five years.
24:06I'm a person with,
24:07lived and lived with experience and
24:10I've been working with the Miami
24:12for years now and I can tell you
24:15that this has been one of the most
24:18humbling experience in my life.
24:20The atmosphere brings people together,
24:22creating a sense of community.
24:24Their role in recovery is to identify with
24:27their own journey of how to be a part of our.
24:30Society.
24:30Again, the class participants
24:32understand the resources available to them,
24:35such as a right to quality healthcare
24:38available to them and the ability to
24:40be able to advocate for themselves.
24:43A sense of self esteem.
24:45This is also done through participants
24:48meeting individually with their coaches.
24:50Their right to belong in our society
24:53and community is important to them
24:55and they see it each week in class.
24:58Although they continue to
24:59address their substance use,
25:01folks have learned they can still participate
25:05in volunteering and obtaining a job.
25:07The group sessions focuses on each
25:10other and drawing strength from the
25:12class and what we call a safe space.
25:15The dimensions of Wellness is
25:16a guiding tool in their lives.
25:19We just finished a cohort.
25:21And a 62 year old gentleman
25:24just enrolled in a GED class and
25:28obtained his first library card.
25:31This is not a fairy tale,
25:33but there are many happy endings.
25:37I'm gonna direct you to Pastor Rodriguez.
25:42And greetings to you all.
25:44Humbly honored to be here on this panel.
25:47So I'm Pastor Jose Rodriguez from Oasis,
25:49a blessing Christian center here
25:51in our city of New Britain with
25:5428 years of live experience.
25:55I'm also a facilitator for the
25:57Imani breakthrough project.
25:58For three plus years,
26:00providing bilingual meetings to
26:02our Black and Latinx participants.
26:05The Money Breakthrough project have set
26:07a landmark in our city in New Britain.
26:10It's been a beacon also of hope.
26:12In our community,
26:13where we've seen lives have been changed,
26:16families have been restored,
26:18and also so many participants have
26:20reintegrated back into society,
26:22you know, with some powerful,
26:24powerful, amazing testimonies.
26:25You know,
26:26three of them actually just
26:28amazingly just stood out.
26:30We had this young African American
26:33couple who were both homeless in
26:36the Friendship Center and just
26:38before the Immani graduation,
26:40not only did they obtain a housing.
26:43Voucher. But they both obtain employment.
26:46And you know, I mean, as pastors,
26:48I mean that's, that's that's our job.
26:50And you know, she gave us a call,
26:53she was going to an interview.
26:54We went out our way.
26:55We cut off phone calls and took
26:57her to that interview.
26:59That meant much to her.
27:01Like I said,
27:02they both obtain employment and
27:04the church was able to furnish
27:06also their new apartment.
27:07We have another participant,
27:09another Imani graduate,
27:10who after graduation,
27:11he decided that he wanted to.
27:14Go to an inpatient program.
27:15So we connected them with one
27:17of the programs in Waterbury
27:18and after the eight months.
27:21He's now one of the head
27:23staff of the program.
27:24You know I I think as a member
27:26of clergy of the screening
27:28process also for participants,
27:30we've noticed that's been
27:32you know a lot faster.
27:34We have another participant who
27:36also graduated who also lost two
27:38of her sons just you know due
27:40to STD due to her her addiction.
27:42So we worked with her closely during the
27:4622 week program and she knew what she wanted.
27:49She stayed focused,
27:50making these positive moves.
27:52And not only did she successfully graduated,
27:55but before the graduation,
27:56we worked hard or she worked hard,
27:58in other words, to get her voucher,
28:00her housing voucher,
28:01she got her apartment.
28:02And not only did she get her apartment,
28:04but she also got her two sons back.
28:06And both of her sons are actually
28:09members of our church and they're
28:11connected with our youth group.
28:13And that's been a huge blessing, you know,
28:16for us and also for our community.
28:18And I think that the.
28:19You know the, the, the five Rs.
28:21Yeah.
28:21You know the citizenship component,
28:23you know consisting of the
28:25responsibilities their resources,
28:27the relationship that they
28:28build back with the Community,
28:29even with their family and
28:31their rights and their sense
28:33of belonging has been very key.
28:36You know with these,
28:37you know with their lives and and I'm just,
28:40I'm just humbly honored,
28:41you know to be part of the
28:43money Breakthrough project.
28:44And now I turn it over to Mark.
28:47Thank you. Thank you, Pastor Degas.
28:49And I want to say thank you to Doctor Bellum
28:52and Doctor Jordan for your leadership
28:54and thank you for the whole IMANI team.
28:56It has been such an honor to be part
28:59of this collective effort to address
29:02opioid crisis and substance use
29:04among black and Latinx communities.
29:06But an important question that we
29:10need to to to, to address is who
29:12is coming to the money program.
29:14So we collected data.
29:17Around 2018 to 2022 and out of 100,000 and
29:22500 participants in the money project,
29:25this is a picture of who they who they are.
29:29Next please.
29:30So we can see here that the
29:34participants of Imani,
29:36they bring a lot of health disparities
29:38and the social determinants of health.
29:41We can see that 75% have been
29:44hospitalized at least once a 65.
29:47This and has a history of incarceration.
29:49A 74% have experienced homelessness
29:53sometime in life and.
29:5743% experienced childhood abuse,
30:0065% has experienced violence as an adult,
30:04and importantly, 67 percent,
30:0770%, almost accordingly,
30:09we're not receiving substance use services.
30:12So these are people with
30:14tremendous health disparities,
30:15but also disconnected to
30:17the healthcare system.
30:19And I'll pass it to Charla.
30:26As you've heard, the Imani project focused
30:29on swarbrick's 8 dimensions of Wellness
30:31and rose 7 domains of citizenship.
30:34This is a chart of the
30:36dimensions of Wellness scale.
30:37It consists of 92 items,
30:39and it's summarized with eight domains.
30:43The item and mean score range
30:44from one to four, with the higher
30:46scores indicating greater Wellness.
30:48These are the results from
30:49baseline and Week 12,
30:50with the green representing
30:52baseline and the Yellow Week 12.
30:54It's represents a subset of participants
30:56with complete data who didn't
30:58have the maximum score baseline.
31:01There's a statistically significant increase
31:03in all 8 dimensions of Wellness over time.
31:08But similarly,
31:09the Citizenship Enhancement Questionnaire
31:10was designed to measure community belonging,
31:13connection and investment,
31:14and it has 45 items that load onto 7 domains.
31:18The mean scores range from one to five,
31:20with higher scores representing
31:22better functioning.
31:23And this graph shows change
31:25from baseline to week 12,
31:26and the change was in all of the areas,
31:29and it was statistically significant
31:31in six of the seven areas.
31:341.
31:35Because this was community
31:37based observational pilot,
31:38this was before the
31:39randomized clinical trial.
31:41The data collection was
31:43inconsistent and incomplete.
31:44So patients were interviewed,
31:46participants were interviewed
31:47at baseline at Week 12,
31:49and again at week 2242% of those who began
31:54the intervention were retained at week 12.
31:57And 32% were retained at week 22.
32:03Ralph.
32:05And an important part of our data collection
32:10and data analysis is the qualitative,
32:12qualitative component.
32:14So this is some, some quotes from
32:19participants that we published in the
32:21social work and mental health journal.
32:24I just want to share with
32:25you some of their quotes.
32:26So one participant said after
32:29completing the program that the
32:32last 15 years of my life I did a
32:34lot of programs and never finished.
32:37I was super negative about life.
32:39I never had self worth.
32:41There are other people just like
32:42me that have a lot of problems.
32:44Graduation from this program, open doors.
32:46I got my GED and I'm going
32:49to see what my purpose is.
32:52Another quote from another
32:54quote from another participant.
32:57He was saying that spiritually is motivating.
33:02Sometimes it is the only thing that
33:06you have helps me validate my feelings
33:08because I have so many thoughts and
33:12I believe that that is important.
33:14My power comes from my thoughts,
33:16my values too.
33:18And another important quote is I went,
33:21I went to mandatory programs.
33:23It is hard when you don't,
33:26when you don't want to go to this place,
33:28you are not there.
33:30How will you, how will you talk?
33:32If you don't want to,
33:34sometimes you want to keep
33:37barriers and here it is. OK.
33:39So people are saying that they
33:41are able to exercise choices,
33:44that they are not mandated
33:45to follow any program.
33:47And this is sort of an important
33:50part of the success of Imani.
33:53Thank you.
34:00Thank you so much and and it it was
34:04that data and that analysis that led
34:07to our ability to get A to apply
34:09for a NIH Common Fund U-1 and it
34:12was through the mechanism of the
34:15transformative research to address health
34:18disparities and advance HealthEquity.
34:20And I wanted to just point out that
34:23eleven of us nationally got funded
34:25through this mechanism and this mechanism
34:27allows do you one building allows.
34:30For us to get additional sort of
34:33support from and NIH as well as Nida,
34:36we have a program officer,
34:37program scientist,
34:39a program administration administrator,
34:41lots of folks from NIH and Nida,
34:44at least three or four people who
34:46join us at least once a month in our
34:49research meetings and just really
34:51to be there to provide support.
34:54They're there to hear Reverend Robin
34:56start off with her prayer for us,
34:58start off with our inspiration.
34:59So it's.
35:00And and awarding rewarding experience.
35:06I just wanted to point out like some
35:08differences of briefly the priority
35:10population for the UO one is Black and
35:13Latinx individuals who are currently
35:16using opiates or who have misused
35:19opiates within the last 30 days.
35:21And that's really important to point out
35:23because as you can see from the data that
35:26that the cost has showed that there were
35:29white individuals involved in that study.
35:31So we do allow or open up the.
35:35Intervention for anyone who walks
35:37in the doors of the mini program.
35:39Sorry, that's funded by
35:40Demus as well as sampsa,
35:42but this and this viewer one is only
35:45for black and Latin X individuals.
35:48And as you can see,
35:48these are the mining intervention components
35:51as well as the target mechanisms.
35:55And what I do want to point out is
35:57that and what's different here is that
36:00this is a randomized control trial.
36:02So as you heard Mark when he
36:06read the qualitative data,
36:08choice was really central.
36:10So we wanted to make sure that choice
36:14was factored into this research design.
36:18So in week four,
36:20after hearing about the how medication
36:23for addiction treatment works,
36:26they get to watch a video that's that's
36:29been developed by Doctor Ayana Jordan
36:31as well as Doctor Andrea Mandiola and
36:35it's shown through the Imani classes.
36:37They are also got a chance to have the
36:41doctors doctor Fabiola and doctor near
36:44Tara join them via telehealth to address.
36:48Any questions that they have related
36:51to MATC through substance use to
36:54their experiences with dots etcetera
36:57and so at that point they get to
37:01decide do I want to be randomized?
37:04And that's different, right.
37:06So if they want to be randomized,
37:08then they are either randomized into
37:12medication for addiction treatment
37:14or to referral and leakage into
37:17traditional settings in the community.
37:19So those are the two randomization options.
37:23And as you see,
37:25these are our primary outcomes initiating SU,
37:27DMP engagement and MTSU.
37:30The appointments and decrease in
37:33substance use and our secondary outcomes
37:36are the 8 dimensions of Wellness,
37:39you know,
37:40citizenship and community enhancement,
37:42increase in quality of life and a
37:45decrease in barriers to healthcare.
37:52For reminding United record recruiting
37:54across the first three sites resulted
37:57in 107 screenings, of which 86
38:01individuals met eligibility criteria.
38:03We aim to recruit 22 people per cohort.
38:06We started at Varick Memorial,
38:08our first Black church,
38:09where 21 individuals were consented
38:11and completed baseline assessments.
38:14Of those, twenty were engaged and
38:16attended 12 of 23 group fashions.
38:19Two people chose to be randomized.
38:21Wanting to telehealth and wanting
38:23to referral and linkage this site.
38:25Graduated and completed their
38:26first cohort a few weeks ago.
38:29At Apostolica Renovacion,
38:31our first latinex church,
38:3421 people were consented and
38:36completed baseline assessments,
38:3812 were engaged in attending groups,
38:4010 people randomized into 10 people
38:44randomized 4 into telehealth
38:47and six into R&amp;L.
38:48This site will complete 12 weeks
38:51of intervention on Monday.
38:52At Blackwell Memorial,
38:53our second Black Church,
38:5516 people were consented 9
38:57engaged and attending groups 2.
38:59Randomized one into telehealth, one into R&amp;L.
39:02This site is at 8 weeks of intervention.
39:05The remaining three churches are slated
39:07to start over the next four months.
39:13Telehealth in the churches a glimpse of
39:16what the telehealth appointments look like.
39:19Our clinical team is led by the
39:22extraordinary doctors Ayana Jordan,
39:23Andrea Mondello and Ted Iennaco.
39:27Our stellar on site providers or doctors me
39:30and Tara Anderson and Fabiola Abuelo Cruz.
39:33Initial appointments are
39:34scheduled for 45 minutes.
39:36Participants are provided with
39:37a private space to meet with
39:39their provider in the church.
39:40Researchers connect the participants
39:42to the providers using a tablet and
39:45accessing the telehealth video link.
39:48They introduced the person to the
39:49provider and then exit the room.
39:51The provider conducts the intake and at
39:54the completion of the the appointment,
39:56the provider informs next steps whether
39:58to schedule a follow up appointment
40:01labs or if a prescription is needed.
40:04The provider completes a summary visit
40:06after each visit and the participant
40:09completes a monthly post visit.
40:11Form providers follow the participant
40:14for 24 weeks and then transitions or
40:17discharges participants accordingly.
40:21Good news, Imani intervention
40:24is literally saving lives.
40:26Sylvia, who spoke earlier,
40:27was one of the facilitators at Veracruz,
40:30jumped into action after having
40:32concerns about a participant,
40:34administered Narcan and called
40:36911 to get into the hospital.
40:39Had it not been for her assessment,
40:41critical thinking and commitment
40:42to the people we serve,
40:44he would not have been able
40:46to share his testimony and
40:48gratitude for the IMMANI program.
40:50The amazing.
40:51Facilitators and group members who
40:53attribute who he attributes his life to.
40:56Alimani facilitators and researchers
40:59are trained to administer Narcan,
41:02provide fit in all strips to participants
41:05and execute protocols to address non
41:08responsive participants when required.
41:10Additional successes include
41:12connecting with community and
41:14other systems of healthcare.
41:16Having a church liaison,
41:18going out to meet people where they are at,
41:20doctors of color,
41:21doing math in the church and
41:23making connections,
41:24developing and Imani.
41:39Yeah, my thank you froze.
41:44So I'll carry on.
41:47Developing a facilitator guide and
41:50curriculum at a glance to ensure
41:53fidelity while maintaining the
41:55cultural and linguistic relevance.
41:58And that's been a success as
42:00well as participants starting
42:02their own connections even after
42:05the end of the intervention.
42:07They're they want to start
42:08their own group and churches
42:10taking ownership of recruitment,
42:11outreach and engagement activities.
42:13That's really key.
42:14Sorry, Kim, I jumped in on you.
42:21The money is where the people are.
42:23Because we are doing this together.
42:26We are creating a lion sheet collaboration,
42:31partnership and sense of belonging.
42:34Imani team in the community get together
42:37to organize community conversation.
42:39We invite participants to go with the
42:43facilitators and some of us for theater move.
42:46We organize community
42:47genius and conversation.
42:49About life and also about the program.
42:52We present money and every
42:54place that we are invited to,
42:56and not only in the United States,
42:58but also outside the United States.
43:01We are so glad because you're able
43:04to spread the word and our team,
43:07facilitators and communities
43:09are invited us to talk about the
43:13programmer in great stations,
43:15interviews and small and
43:17big groups at the community.
43:20And like Reverend Robert said,
43:23we are so glad in blessing
43:26because in 2020 very cool, one,
43:28one of the best faith-based
43:31programs in the United States.
43:33We have created a sense of community,
43:35we create a sense of belonging and
43:37that's is the beautiful in mind.
43:40So doctor sherrell.
43:45First of all, I just want to say
43:46thank you so much.
43:47Yana and I are truly blessed to have
43:50such a great team and I appreciate all
43:52of you for wanting to be a part of
43:55this presentation today and that's amazing.
43:58So here, you know, just the clothes,
43:59these are some of our challenges
44:01and and while you have seen our
44:04successes related to recruitment,
44:06it's also an ongoing challenge.
44:07I know that many researchers are,
44:10you know, sort of struggling with
44:12recruitment right now where our numbers
44:14are up and we're happy about that.
44:16But it's just an ongoing challenge.
44:17It's really important to
44:19have that partnership.
44:20People from the churches are facilitators,
44:22are going out into the community and
44:24meeting people where they're at.
44:25And they're so key because we have such
44:27a population that's pretty transient.
44:29You know, they're here,
44:31here one place one day,
44:33another place another day.
44:34And that brings us to the second challenge,
44:36which is which is keeping folks engaged
44:39beyond base baseline assessment.
44:41So because this is the RCT,
44:43we're now doing all of these
44:45assessments and after that.
44:46Assessment.
44:46You know, there's a few weeks before
44:48the actual intervention starts,
44:50right?
44:50So we have to make sure that we
44:52are able to be able to find people
44:54so that they are able to start the
44:56intervention when it does start.
44:58Fidelity across sites.
44:59We're doing an amazing job at
45:02maintaining fidelity across sites.
45:04Sylvia Cooper as well as Shelina Toure,
45:08who started our first Imani.
45:11They then go out and share with
45:12them and make sure that the sites
45:15are maintaining fidelity.
45:16With our training, however,
45:18we also it's a challenge because
45:21while we want fidelity,
45:23we also want to make sure that we are
45:26really dishonoring the cultural and
45:29contextual factors of neighborhoods
45:31and it's really important that
45:33we allow that to happen as well
45:35and figure out a way to study it.
45:37Referral linkage remains an issue
45:39because you know the whole point of
45:41this doing this study is because
45:43there is lower treatment engagement.
45:46For Black and Latinx communities.
45:48So how can we improve that?
45:51You know,
45:52more needs to be done with community
45:54providers,
45:55more of them need to understand
45:58particularly how they come from
46:00culturally informed perspectives
46:02in terms of opportunities.
46:05Post group activities,
46:06while we're not studying it,
46:08figuring out like what happens after Imani,
46:11you know,
46:12it's a natural bond that has
46:14happened for participants and they
46:16want to continue it, you know,
46:18and just figuring out how do you,
46:20how do you continue to study
46:22this as part of the research.
46:23Very thankful for the opportunity to
46:27support Doctor Costas Diversity Supplement,
46:30which is through Nida as part of
46:32our UO one and he's adding on a
46:35piece looking at social networking.
46:36And that social networking will
46:38allow us to see what are some of
46:41the factors related to people's
46:43ability to to get that support that
46:46they need from supportive people in
46:48the Community and really looking at
46:51community engagement and expansion.
46:52And as I mentioned, we're now in new
46:56sites where we often get the request
46:58and we're working on components now to
47:01build out family offerings for Imani.
47:04And I just wanted to point out,
47:05you know, we present.
47:07Has Graziella mentioned all over?
47:09You know the the world about Imani, wherever,
47:12whenever someone wants to hear about it,
47:15we're happy to go and talk about it.
47:18We've done documentary appearances.
47:19You know Doctor John, Dr.
47:22Ayanna, Jordan,
47:23her like 20,000 Twitter followers are all
47:27following her as she's talking about Imani.
47:31We are going to be in the Sam's
47:33against newsletter piece coming
47:35out in May and we continue through.
47:37Community engagement activities.
47:38So thank you so much for being with
47:42us this morning and just going to
47:44open this up to any questions that
47:47folks might have and I'm going
47:49to stop sharing just so that we
47:50can see all of your lovely face.