HealthEast Foundation CI Report – Interim

What has been most instrumental to your progress?

Being able to prove financial benefit and demand for services was helpful in finally getting the HealthEast Addiction department to finally be willing to integrate the Karen Recovery Program into their service line with a dedicated addiction counselor, new referral /intake coordination process, and transition from 12 weeks closed treatment groups to ongoing open enrollment treatment groups with service coordination using our Karen specific curriculum. Hopefully institutionalizing the program and recognizing the demand for services (there are currently 40 people on the wait list) will create sustainablilty. There is still struggle in getting the addiction department managers to recognize that the backbone of the program is the Karen staff who do much of the case management, phone calls, and group facilitation and that these staff members are grant funded. I am still negotiating the creation of positions for the Karen staff so their involvement, which is essential, can be ongoing.

Creating a collaboration in which the partners feel invested in the work and that the joint strategies are beneficial to all parties involved. For example, the Commander of the Maplewood Police has been a consistent partner of KCDC for years. Through his contacts and authority with the city, he and his staff worked with KCDC to create an educational video about DUI laws and probation. They even created a mock traffic stop for the video. He believed it was in the best interested of the city to invest these resources to create this video because it would be beneficial for community education talks as well as when the police are interacting with Karen drivers.

Community and culturally driven initiatives have better possibilities of resonating with the intended audience. By allowing the Karen voices space to be heard where traditionally they are absent (like curriculum development, video creation, trainings for mainstream providers), they are able to share their wisdom and ways of doing things that might be somewhat different from how they might be approached otherwise. By allowing the Karen professionally (who had 9 years of experience in addiction treatment in the refugee camp but no recognizable degree in America) lead the development of the first Karen-specific substance use treatment program in the U.S. we were able to incorporate topics related to the refugee experience and resettlement stress as well as identify areas were the individualistic mainstream treatment programs fall short.

Key lessons learned

Despite the years of building trusting relationships with varied partners, there are external forces that are out of our sphere of influence that create significant barriers. For example: 1)The staff turnover at the HealthEast Addiction department, including changing managers and counselors mid treatment group,2) The merger with HealthEast and Fairview created a climate of constant change, restructuring of departments and leadership and shifting priorities. This made advocating for system change and health equity and introducing new protocols challenging. Face-to-face discussions and written proposals helped to develop some corporate “buy in” about the value of this program, but is subject to change 3) The national and state political climate with healthcare reform and immigration at center stage has created unpredictability as well as causing changes in insurance coverage and access to care and medications increasingly more difficult to navigate, 4)core KCDC staff moving on to new chapters in their lives partly for opportunity but also from motivation and commitment fatigue of doing this work for several years.

Having with staff from the community that we are working with and who have shared lived experiences of the patients has the risk of being triggering. Working with patients with addiction and mental health struggles is challenging for anyone, but when it is similar to their own current situations (parent or spouse that they live with who has these struggles) it can be overwhelming. In addition, if the staff have a history of trauma (like a refugee experience), hearing the stories of the patients can be re-traumatizing. Plus the professional and personal boundaries can get blurred for the community leaders who are both professionally involved but also the church leaders, interpreters, and/or family members for the same patients. We have had a few staff resign because the stress of working with these complex cases got too overwhelming and triggered their own traumatic memories.

Reflections on inclusive, collaborative or resourceful problem-solving

Inclusiveness – KCDC prioritizes centering the community voices and perspectives in everything we do. By having bidirectional learning so that the refugee community and the mainstream agencies learn from one another and build on their respective strengths. We work for change at the paradigm level, which involves recognizing that mainstream American approaches are not neutral but have their own paradigm and acknowledging other ways of knowing and doing things has validity, and thus making change not just at the translation level but at the conceptual level. Creating space for the community voices to be heard in large cross-sector meetings also involves having smaller Karen only meetings to create the safety and trust to share their ideas and prepare to collectively bring them to the larger meetings. Having some meetings in the Karen language with interpreters for the English speakers, rather than the other way around. The Karen leaders take pride in saying ‘we do things in the Karen way’, which acknowledges this project is not imposed on them but from them.

Other key elements of Community Innovation

KCDC believes in shared power. We do this by actively allowing and trusting multiple leaders to leverage their own spheres of influence.This approach required letting go of control and deeply trusting each other’s intentions, competence, and understanding of what was specifically needed in various situations. The Karen and American co-directors came to see themselves as standing back-to-back each leveraging their power in their own sphere of influence while standing together to move the program to fruition. For example, the American co-director could leverage power in the grant, health, and agency arenas while the Karen co-directors had influence and respect of the Karen leader and community and could leverage incredible human capital resources.

Understanding the problem

The need for access to quality addiction treatment is a challenge all across the USA especially with the opioid crisis; however access to culturally relevant treatment that acknowledges the need to explain the context of what treatment is and how it works and honors the refugee experience and resettlement stress is even harder. There are only a few programs that offer such treatment and their capacities are limited. The Karen Recovery program which is an outpatient program that serves adult men has a wait list and there are new referrals coming weekly. Advocating for some of these patients to access inpatient or residential treatment based on the severity of their disease has been monumental if not impossible. The number of Karen youth using drugs, mostly meth, has increased dramatically but access to treatment has still been challenging, especially if they need interpreters. KCDC has started to bring together Karen youth leaders and youth programs and probation officers to find ways to work together to address prevention and treatment for Karen youth.

If you could do it all over again…

I honestly do not know. I feel there has been so much that has occurred that was not foreseeable and out of my control (politics, mergers, KCDC staff leaving for career opportunities or triggered trauma, addiction department staff turnover and the department willing to integrate the Karen program but reticent to let go of the status quo, funding changes, etc). I also feel we have tried to be as adaptable and responsive to changing needs and resources as we could with a high level of flexibility in our approach. We have tried to utilize as many opportunities as we could with national presentations, published article, trainings for community, providers, faith leaders, schools and yet there is still so much untapped potential and waning resources and energy. Our learning continues and is ongoing as we try to keep the momentum of KCDC going.