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A Timely Analysis of a Community-Level Approach to Holistic Recovery Support

As communities across the country continue to grapple with the fallout from the coronavirus pandemic, attention is slowly turning to its long-term effects.  Job losses, isolation, and limited access to social, financial, and medical support services have all taken a toll on family budgets and local public health and economic systems alike.  While the hardships inflicted on entrepreneurs, students, and working families have been thoroughly documented in unemployment statistics, school closure numbers, lower test scores, and lost business revenue, one area that has received less attention has been the impact on those struggling with substance use disorders.  Although the full extent of the long-term damage to public health and mental and behavioral well-being may not be fully understood for years to come, evidence is starting to emerge that mortality and hospitalizations from the pandemic extend far beyond just those who suffered coronavirus infections.  In fact, data from the National Center for Health Statistics during the first year of the pandemic showed that overdose deaths nationally soared to roughly 93,000 fatalities, a 30% increase from 2019.  In Kentucky, the effects were even more dramatic, with the state experiencing a 50% spike in overdose mortality during the first year of the pandemic, ranking it third in the nation for increases in drug-related deaths. 

Amid the backdrop of these alarming and tragic figures, communities have scrambled for solutions to stem the tide of overdose deaths and seek out holistic recovery services for those battling substance dependency.  However, even before the pandemic added new urgency to this public health epidemic, one such innovative recovery support program was starting to take shape in a handful of localities across central and eastern Kentucky—the Kentucky Access to Recovery (KATR) program, a partnership between the Kentucky Opioid Response Effort (KORE) and Fahe.

Fahe commissioned an independent review of KATR in the Letcher County area in the months just prior to the onset of COVID. The findings of the review documented an observable, transformative impact within the rural places it serves, not only on the patients, clients and participants in recovery programs themselves, but also for local businesses and the surrounding economy.  According to Dr. Jayme Walters, a researcher from the study team, “After analyzing every interview from the clients, coordinators, and vendors, I can see the hope and renewal that KATR and Fahe are bringing to these rural areas. The program itself is well-structured and offers unique support that no other organization is providing. But what’s more is the people –– the coordinators, vendors, partners, and clients. I was overwhelmed by their commitment, optimism, and care for each other and their communities.”   

Fahe recently hosted a webinar to present the findings of the research, which explored the impact of the Kentucky Access to Recovery (KATR) program in Letcher County. “Access to Recovery: What We Learned in Rural Kentucky” by Aubrey Jones, Ph.D., (University of Kentucky); Jayme Walters, Ph.D., (Utah State University); and Aaron Brown, Ph.D., (Western Carolina University), documents the economic and social impacts of community-level investments through KATR and helps deepen the public’s understanding of how social relationships and community development organizations can contribute to successful recovery outcomes.

The webinar can be viewed in its entirety here:

What is Kentucky Access to Recovery?

KATR currently serves clients in recovery in 37 counties throughout Kentucky with local hubs in Boone, Jefferson, Jessamine, Madison, Bourbon, and Letcher (Whitesburg) Counties. Notably, KATR does not offer treatment for substance use disorder itself, but rather provides the supporting resources and services needed for patients to persist and succeed in their long-term recovery journey. Fahe helped launch KATR in 2019, initially serving just 15 counties. Thanks to the partnership with KORE and funded via a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA)1, the program has since expanded to offer a holistic assortment of wrap-around support resources for hundreds of additional clients in recovery.

Specifically, KATR provides access to wrap-around recovery support in the form of housing, transportation, dental care, employment support, and other essential needs and services designed to help patients focus on their clinical rehabilitation and eliminate the barriers that can sometimes derail successful recovery outcomes. It has several requirements to meet eligibility, such as a diagnosed opioid or stimulant use disorder, verified and steady enrollment in a treatment or recovery program, and income earnings below 200% of the federal poverty level. While KATR does offer supplemental support that is meant to bridge gaps in traditional care programs, it does not replace existing social and financial aid services.  Therefore, individuals are required to attempt to receive assistance funds from existing programs first.

The Findings

The information for the Access to Recovery report was gathered through both a quantitative analysis of administration data and a qualitative analysis of interviews conducted with program coordinators, members of the community, and program participants2.  Its findings indicate that KATR is contributing to a measurable increase in the quality of life for people with substance use disorder and yielding short and long-term benefits for the surrounding Letcher County community as a whole.

The KATR program’s holistic approach to recovery is perhaps the biggest driver of its success in Letcher County, the study suggests. KATR provides an entire ecosystem of economic and social supports that addresses many of the underlying determinants of successful versus unsuccessful recovery outcomes. Whereas a lack of transportation to access job opportunities or mounting rent and utility debt might otherwise trigger stress-induced relapses for individuals in recovery, KATR clients were observed to experience improvements in coping, meaningful activities, and other domains related to quality of life satisfaction.  Moreover, the study indicated that both program participants and their communities at-large can experience better quality of life outcomes overall when substance dependency is treated comprehensively and combined with the right climate of community-based social and economic supports to facilitate sustained engagement in one’s course of treatment. 

In fact, program participants recounted that their enrollment in KATR led to important behavioral changes and helped them build new habits in their recovery process.  Over 90% of the participants saw funding allocated to areas such as basic needs, dental care, housing, transportation, or vocational support, affording them a new stability and predictability to engage in constructive routines.  As a result, enrollees reported improvements in their mental and physical health, increased self-confidence, and even improved outlooks for their future.  For instance, several beneficiaries of KATR-funded dental care noted upticks in their self-esteem following long-neglected dental procedures that restored their ability to confidently smile around their peers. These positive changes have led to increased self-sufficiency and reports of mended familial ties that were broken due to substance use disorder, most notably the restoration of child custody.

Furthermore, by utilizing local vendors and businesses to supply these essential goods and services to enrollees, KATR also contributed to positive economic impacts in Letcher County.  Local dentists, clothiers, retail shops, landlords, and other commercial hubs have all reported measurable revenue increases directly generated by program participants, adding financial stability to their businesses.  This phenomenon reflects the wider spectrum of economic benefits by helping people in recovery re-enter their local economies as participants in community commerce.  Alongside the medical, behavioral, and social benefits of recovery also follows a newfound ability to rejoin the workforce and overcome financial isolation, contributing to market transactions and adding value to the larger economic environment in which enrollees can now participate as both consistent, steady consumers and wage-earners.   

In addition to these observed economic impacts, participating vendors also noted positive changes in their perceptions and attitudes towards people coping with substance use disorder.  Interacting with KATR enrollees on a regular basis allowed vendors and business owners to establish relationships and better empathize with people recovering from substance dependency, engendering a more welcoming social environment for participants in their community.  This reduced stigmatization further allowed for smoother re-entry into the workforce and social circles, perpetuating a virtuous cycle that drew enrollees towards sustained economic and social enfranchisement and away from the pitfalls of isolation and financial discouragement that can sometimes lead to relapse.

 As co-researcher Dr. Aubrey Jones concluded in her review of KATR, “The Kentucky access to Recovery program offers a unique perspective to assisting individuals on their recovery journey.  The holistic approach to meeting the basic needs of the clients is a strength of this program… It is evident from the interviews our team has conducted that the KATR program has not only had an impact on the clients’ recovery journey but has given them a sense of hope and dignity once previously withheld from individuals with substance use disorders.”

Recommendations

According to the report, KATR is performing as intended by successfully yielding life-changing benefits to program participants and the Letcher County area as a whole. The researchers noted that, in addition to the design of the program, the KATR staff was also responsible for its observed successful outcomes based on qualitative and quantitative measures of their performance, commitment, and engagement with both the community and enrollees. Along with the study’s findings, the report also offered a number of data-informed recommendations that may help the KATR program achieve even more substantial impact for the communities and participants it serves.

On the organizational level, these recommendations include:

  1. Diversifying funding streams to facilitate a wider array of needs to be met by various program service functions;
  2. Increasing community and vendor awareness about the program and issues related to substance use disorder; and
  3. Exploring alternative communications methods with hard-to-reach clients (i.e. identify and resolve obstacles that may hinder clients from following-up with program communication).

On the community level, recommendations beyond the scope of KATR further include:

  1. Facilitating other social support services such as affordable housing, employment training, and mutual aid (Alcoholics Anonymous, Narcotics Anonymous, etc.);
  2. Improving access to and reliable connectivity for phone and high-speed internet services, both of which can also contribute to business development and add more abundant economic opportunities;
  3. Considering the development of transportation alternatives for people who are severely impacted by lack of public transportation; and
  4. Exploring housing alternatives, such as increased sober living access, for people who are exiting inpatient rehabilitation, allowing them to avoid old settings associated with their substance dependency struggles.

With KATR’s proven and documented track record of success, state and local governments have an opportunity to implement and expand their own recovery support programs based off of the findings of KATR’s model design.  Such programs are known to contribute to better public health, lower crime rates, less indigent emergency medical care, and reduced homelessness.  These benefits then further translate into easing the associated costly demands on taxpayer-funded services and elevating the lived experiences of residents throughout a community.  Scaling-up programs like KATR with public and/or private investment can seed transformative change for entire states and localities tomorrow and produce real economic multipliers that can help families across the country finally reach their American Dream.

Read the full report—Kentucky Access to Recovery: What We Learned in Eastern Kentucky

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  1. The Kentucky Access to Recovery (KATR) program exists because of the Kentucky Opioid Response Effort (KORE), supported through a Substance Abuse and Mental Health Services Administration (SAMHSA) Grant H79TI083283.
  2. Human subjects research approval was obtained through the University of Tennessee Knoxville and KORE under 45 CFR 46.110(b) (10, categories (6) and (7). The research team conducted quantitative analysis of administrative data and qualitative analysis of interviews conducted with program coordinators, members of the community, and program participants. GIS analysis helped provide insights on access to services and vendors.

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