At the Intersection: Where Practice Meets Culture - DPH‘s Multicultural Needs Assessment Project

The following is excerpted from DPH’s May 2020 report:  Georgia Opioid Strategic Planning, Multi-Cultural Needs Assessment. “An interdisciplinary team of Kennesaw State University researchers captured the voices of Georgians related to resources, services, and treatments for opioid and substance misuse disorder through a Multicultural Needs Assessment Project.” The information contained in this report may be useful for behavioral health providers and policymakers looking for ways to strategically plan for improvements in opioid and substance use treatment service delivery and better outcomes for the diverse and underserved populations we serve.

Background:  Problem and Significance

“Much of the media and political focus surrounding overdose deaths from the opioid and prescription drug epidemic centers around the middle-class White population (James & Jordan, 2018). We have not adequately examined the epidemic’s impact on other ethnic, racial, and cultural groups, and thus, we do not completely understand the experiences and needs of these different communities based on their context, their culture, and the systems that impact their access to services (Alegria et al., 2015). For example, African Americans are 14% less likely to initiate substance abuse treatment than Whites (Acevedo et al., 2012), but the reasons why are not entirely clear.

“We also do not know much about the experiences that lead diverse sub-populations towards substance use disorders (SUD) and opioid use disorders (OUD), nor do we know much about their experiences when they seek help, treatment, or information. Understanding the barriers that these populations face is especially important for vulnerable populations, such as people with mental illnesses and the elderly (Bauer, et al., 2005, p. 13).”

“Interestingly, there appears to be a significant gap between resources and information needed by individuals from different cultural and racial groups, and what is available in communities. This mismatch seems pervasive among all groups, particularly based on the Surgeon General’s report, which states that only one in 10 suffering from SUD nationally receives the treatment they need (SAMSA, 2016). Also, among people who access treatment or services, African Americans and Latinos are more likely to have unsuccessful initial treatment sessions, which can discourage them from returning to the setting (Guerrero et al., 2013).”

“In Georgia, notwithstanding the Multi-Stakeholder Opioid and Substance Use Response Plan, the understanding about lived experiences of individuals from different cultural groups is still sparse (e.g., African Americans, people who are homeless, Latinos, elderly, veterans, and LGBTQ persons). In other words, we have not adequately examined the experiences of different ethnic and racial groups within Georgia to incorporate into the GDPH Opioid Strategic Plan.”

Executive Summary:

“ Georgia has attempted to respond to the current opioid and prescription drug abuse crisis by developing a coordinated multi-stakeholder and multi-system strategic plan. However, the voices and experiences of populations from diverse cultural backgrounds were not adequately understood, captured, or represented in the state’s strategic plan. Consequently, the Georgia Department of Public Health initiated a state-level Multi-Cultural Committee to conduct preliminary research to better understand the experiences and needs of African Americans, Latinos, seniors, college students, transgendered persons, individuals who are homeless, and veterans. This understanding was captured from the perspectives of the individuals representing these sub-populations as well as the service providers who serve these groups. The researchers employed systems thinking and design thinking orientations to guide this study. Some of the key findings and recommendations from participants are as follows:

• The emotional pain was a major trigger for starting substance/opioid misuse.
• Participants were sensitive to the level of judgment they experienced while accessing services, resources, or treatment. They discussed the importance of their counselors/therapists being more empathetic and offering culturally appropriate care that responds to their specific needs and situations.
• Spirituality was an important component of the participants’ recovery process.
• Participants identified barriers to accessing housing due to prior convictions, lack of employment, federal policies, and stigma associated with substance misuse.
• Participants would like physicians to be better trained in making appropriate diagnoses and referrals for care/treatment.
• Information about prevention and interventions should be disseminated through culturally appropriate mediums.
• Participants recommended strategies to reduce the stigma surrounding substance and opioid misuse disorder.
• Peer support should be consistently available across all cultural groups.
• Treatment programs need to address poly-substance misuse and also provide harm-reduction strategies (e.g., clean-syringe exchange).

With this research, we have captured some of the voices and experiences of populations from diverse cultural backgrounds that were not adequately understood, captured, or represented in the state’s strategic plan. This study lays the groundwork for additional, and more in-depth, research to understand the experiences of the populations (since we only captured the voices of 56 participants). Additionally, this report’s findings and recommendations can be used by the stakeholders and service providers implementing the state’s current strategic plan. . . .These recommendations are drawn from the professional literature, from focus group members, and from key informants.”

Read the full report