Project Grant H79SM086733

INTEGRATED TREATMENT PROGRAM - THE NEIGHBORHOOD CENTER SEEKS TO DEVELOP A CCBHC OFFERING INTEGRATED THERAPEUTIC INTERVENTIONS FOR DUALLY DIAGNOSED ADULTS WITH A SPECIALIZED FOCUS ON PERSONS WITH COMPLEX TRAUMA IN ONEIDA AND HERKIMER COUNTIES. VARIANCES IN LANGUAGE, CULTURAL AND RELIGIOUS NORMS (OFTEN SPECIFIC TO MENTAL HEALTH SYMPTOMS, DIAGNOSIS AND TREATMENT), COMPLEX TRAUMA, SUBSTANCE USE AND SOCIAL DETERMINANTS OF HEALTH IN OUR REGION IMPEDE ACCESS TO AND ENGAGEMENT IN SERVICES. IN 2021, THE ONEIDA COUNTY OPIOID TASK FORCE REPORTED A TOTAL OF 361 OVERDOSES WITH 67 OF THOSE BEING FATAL. FROM 2020 TO 2021, THERE WAS A 27% INCREASE IN OVERDOSE FATALITIES IN ONEIDA COUNTY. THE AVERAGE OVERDOSE AGE WAS 37 YEARS OLD BUT THE AVERAGE OVERDOSE FATALITY AGE WAS 42 YEARS OLD (ONEIDA COUNTY OVERDOSE TEAM, 2022). IN 2018, HERKIMER COUNTY HAD 1,681 PERSONS WITH A SELF-REPORTED PRESCRIPTION PAIN MEDICATION MISUSE IN THE PAST 12 MONTHS AND ONEIDA COUNTY HAD 4,654. ADDITIONALLY IN 2020, HERKIMER COUNTY HAD 219 ADMISSIONS TO OASAS-CERTIFIED SUBSTANCE USE DISORDER TREATMENT PROGRAMS AND ONEIDA COUNTY RESIDENTS HAD 1,419 (NEW YORK STATE DEPARTMENT OF HEALTH, 2022). A HERKIMER COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT DOCUMENTED A 19.3 PERCENTAGE OF POOR MENTAL HEALTH FOR 14 OR MORE DAYS IN THE LAST MONTH AS COMPARED TO THE STATE AVERAGE OF 10.7% IN 2016. ADDITIONALLY, THE MENTAL HEALTH PROVIDER RATE PER 100,000 POPULATION SHOWS A 2018 RATE OF 45 AS OPPOSED TO THE NEW YORK STATE RATE OF 268 AND THE UNITED STATES RATE OF 229 (HERKIMER COUNTY PUBLIC HEALTH & BASSETT HEALTHCARE NETWORK, 2019). IN OUR CCBHC, A SPECIALIZED COMPONENT OF THE DUALLY-DIAGNOSED INTEGRATED SERVICES WILL FOCUS ON INTERVENTIONS SPECIFICALLY TO INCREASE OUTCOMES OF ACCESS AND ENGAGEMENT IN SERVICES FOR REFUGEES OR PERSONS FOR WHOM ENGLISH IS NOT THEIR FIRST LANGUAGE. A TOTAL OF 16,482 REFUGEES HAVE BEEN RESETTLED IN ONEIDA COUNTY BETWEEN 1973-2019 WITH THE MOST PROMINENT GROUPS BEING: AMERIASIAN/VIETNAMESE; BOSNIAN; CAMBODIAN; BURMESE; SOMALIAN; BHUTANESE AND FROM THE FORMER SOVIET UNION (THE CENTER, 2019). THE UTICA CITY SCHOOL DISTRICT IN ONEIDA COUNTY ALONE HAS MORE THAN FORTY LANGUAGES SPOKEN; 19.4% OF THE CITY OF UTICA IS FOREIGN BORN AND 29.2% OF THE RESIDENTS SPEAK A LANGUAGE OTHER THAN ENGLISH AT HOME AND ONE IN FOUR HOMES ARE MULTILINGUAL AND MULTICULTURAL (THE CENTER/2012 CENSUS DATA, 2012). "REFUGEES ARE AT SUBSTANTIALLY HIGHER RISK THAN THE GENERAL POPULATION FOR A VARIETY OF SPECIFIC PSYCHIATRIC DISORDERS-RELATED TO THEIR EXPOSURE TO WAR, VIOLENCE, TORTURE, FORCED MIGRATION AND EXILE...WITH UP TO TEN TIMES THE RATE OF POST-TRAUMATIC STRESS DISORDER AS WELL AS ELEVATED RATES OF DEPRESSION, CHRONIC PAIN AND OTHER SOMATIC COMPLAINTS" (KIRMAYER ET AL., 2011; MOYER, 2020). LINGUISTIC AND CULTURAL BARRIERS TO ACCESS AND ENGAGEMENT IN MENTAL HEALTH AND SUBSTANCE USE SERVICES RESULT IN "DISPLACED PEOPLE'S ELEVATED RISK OF PROBLEMATIC ALCOHOL AND DRUG USE...[AND] MAY USE SUBSTANCES AS A COPING STRATEGY TO MITIGATE TRAUMA SYMPTOMS" (MCCLEARY ET AL., 2017). LITTLE RESEARCH HAS BEEN CONDUCTED TO PRODUCE QUANTITATIVE DATA SPECIFIC TO REFUGEE POPULATION SUBSTANCE USE AND AS A RESULT, "FEW CULTURALLY INFORMED TREATMENT PROGRAMS" HAVE BEEN DEVELOPED FOR REFUGEES OR PERSONS FOR WHICH ENGLISH IS NOT THEIR PRIMARY LANGUAGE (MCCLEARY ET AL., 2017). A LACK OF DATA RELATED TO MENTAL HEALTH AND SUBSTANCE USE DISORDERS FOR THIS POPULATION IS QUALITATIVELY ATTRIBUTED TO TWO CONCERNS: UNDERREPORTING BY THE DEMOGRAPHIC AND LIMITED RESOURCES FOR SUPPORT AND TREATMENT. OUR CCBHC SITES WILL SERVE 400 NEW ADULT CLIENTS ANNUALLY WITH CO-OCCURRING DIAGNOSES. THE TOTAL POPULATION SERVED WILL EQUATE 1,828 UNIQUE CLIENTS WITH A CUMULATION OF 7,312 CLIENTS OVER THE FOUR YEAR GRANT PERIOD. MENTAL HEALTH, SUBSTANCE USE AND PRIMARY CARE INTERVENTIONS WILL FOCUS ON TRAUMA AND CULTURALLY-INFORMED CARE AND TREATMENTS: INTERPRETATION AND TRANSLATION SERVICES, CULTURE BROKERS, PEER ADVOCATES FOR