Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA.
Department of Behavioral and Social Sciences, School of Public Health, Brown University, Box G-S121-3, Providence, RI, 02912, USA.
Community Ment Health J. 2024 Apr;60(3):482-493. doi: 10.1007/s10597-023-01198-8. Epub 2023 Oct 30.
Post-overdose outreach programs can play a key role in reducing opioid overdose deaths and increasing access to healthcare services. The design and implementation of these programs, especially in rural communities, remains a gap in knowledge. We aimed to understand the lessons learned from the implementation experiences of the Community, Opportunity, Network, Navigation, Exploration, and Connection Team (CONNECT), a post-overdose outreach program based in a rural community in Massachusetts. We conducted semi-structured focus groups and interviews with 21 community partners after the first year of implementation in 2022. Participants included behavioral health, medical, public health, and public safety personnel involved in the design and implementation of CONNECT. Using a combination of thematic and rapid qualitative analysis methods, we inductively coded transcripts for salient themes. Themes were mapped onto the Health Equity Implementation Framework to better understand implementation and health-equity factors. Facilitators to implementation of this innovation included efficient inter-partner data sharing and coordination, and ability to offer numerous health services to clients to meet their needs. Key partners identified that CONNECT serves clients who use opioids, have previous involvement with the legal system, and reside in low-income areas within this rural region. Unhoused individuals and individuals who do not call 9-11 after an overdose were identified as populations of need that CONNECT was missing due to structural barriers. Partners shared how the context of this rural community came with challenges related to limited access to health services and pervasive stigma towards substance use, while it was also perceived to foster a culture of collaboration and unity among multidisciplinary key partners. Post overdose outreach programs serve clients with complex health needs. The ability to access services for these health needs is shaped by the post overdose outreach program and its key partners, and by the broader community context. As post-overdose outreach programs continue to expand as a promising strategy to address the opioid overdose crisis, there exists a need to contextualize implementation strategies to inform adaptations and develop best-practices.
中毒后干预项目在降低阿片类药物过量死亡和增加获得医疗保健服务方面可以发挥关键作用。这些项目的设计和实施，特别是在农村社区，仍然是知识的一个空白。我们旨在了解基于马萨诸塞州一个农村社区的中毒后干预项目——社区、机会、网络、导航、探索和联系团队（CONNECT）的实施经验中吸取的教训。我们在 2022 年实施的第一年之后，对 21 名社区合作伙伴进行了半结构化焦点小组和访谈。参与者包括参与 CONNECT 设计和实施的行为健康、医疗、公共卫生和公共安全人员。我们使用主题和快速定性分析方法相结合，对转录本进行了归纳编码，以提取突出主题。主题被映射到健康公平实施框架上，以更好地理解实施和健康公平因素。该创新实施的促进因素包括高效的合作伙伴间数据共享和协调，以及为客户提供众多健康服务以满足其需求的能力。关键合作伙伴确定 CONNECT 服务于使用阿片类药物、以前与法律系统有过接触、居住在该农村地区低收入地区的客户。无家可归者和中毒后不拨打 9-11 的个人被确定为 CONNECT 由于结构性障碍而遗漏的需要人群。合作伙伴分享了这个农村社区的背景带来了与有限的获得医疗服务和对药物使用的普遍污名化相关的挑战，而它也被认为培养了多学科关键合作伙伴之间的合作和团结文化。中毒后干预项目服务于有复杂健康需求的客户。这些健康需求的服务获取能力受到中毒后干预项目及其关键合作伙伴以及更广泛的社区背景的影响。随着中毒后干预项目作为解决阿片类药物过量危机的有前途的策略继续扩大，需要对实施策略进行背景化，以提供适应和制定最佳实践的信息。
