Community Assessment of Behavioral Healthcare's Response to the Opioid Crisis

Background and Purpose

With the increase in opioid use and drug-related deaths in the United States, there is a need to understand how community behavioral healthcare organizations are responding to this epidemic. The current study implemented an organizational needs assessment examining how health and human service organizations in the Charlotte-Mecklenburg area were responding to clients that had a suspected opioid disorder diagnosis.

Methods

An organizational needs assessment was developed and administered electronically to local behavioral healthcare organizations to identify strengths, weaknesses, opportunities, and threats to addressing the opioid crisis. The email contained an information sheet outlining the nature, purpose, and ethical considerations of the study as well as a link to the online survey. The survey inquired into various dimensions of opioid-specific and substance-use disorder treatment. Approval from the University of North Carolina at Charlotte Institutional Review Board was obtained prior to administering the survey.

Results

A total of nine behavioral health organizations completed the assessment. Respondents indicated the surveys were completed by clusters of teams consisting of administrators, supervisors, and direct-care staff. The participating organizations served a total of 17,500 individuals with opioid and other substance use disorders annually. Notable strengths included: 7 of the 9 (77%) organizations providing assistance with finding housing for persons in treatment; nearly half of the organizations offered transportation assistance to treatment and self-help groups (44%; N=4); over half (N=5; 55%) provided peer-support services; only 2 agencies kept a wait-list (22%), and the average length of time between first contact and treatment initiation was 6.25 days (SD=7.48); over half (N=5; 55%) offered medication assisted treatment (MAT) to clients; and 3 of the 9 (33%) organizations offered services free of charge to clients who could not afford to pay. Notable weaknesses included only 3 (33%) of the organizations offering services in a language other than English; only 1 (11%) organization offering a sliding fee scale to clients; and only 3 (33%) routinely offered MAT during detoxification. In addition, while nearly all organizations report helping clients find housing, securing housing for persons in SUD treatment was noted as one of the greatest threats to maintaining treatment involvement.

Conclusions and Implications

The strengths of the organizations were evident in the extraordinarily brief waiting time for clients, and the provision of excellent ancillary services, including transportation, support in finding housing, and peer-support services. Yet, housing was identified as a significant area of need for clients, and a significant barrier to continuation of treatment. In addition, participating agencies reported struggling to provide adequate access to MATs to all of their clients, with just over half of the agencies having opioid-specific treatment programs. In addition, agencies reported a significant range of clients having opioid use-disorders, which may be indicative of a gap in service. Lastly, the majority of agencies reported that they did not provide services in languages other than English, which may present an additional barrier to treatment in Charlotte given the prevalence of Latinx communities.