Midwest Initiative Seeks to Reduce Opioid Use in Rural and Tribal Communities

State and local leaders can better invest in evidence-based programs to combat opioid use disorder (OUD) when they understand how to most effectively prevent overdose deaths, provide treatment, and ensure that communities have the resources they need. Amid an ongoing national opioid overdose crisis made worse by the COVID-19 pandemic, many community initiatives are working to limit overdoses and save lives.

The substance use prevention and treatment initiative of The Pew Charitable Trusts is supporting six such initiatives over the next two years in a partnership focused on helping them evaluate their programs and encouraging broader adoption of successful, innovative models.

This profile is part of a series.

Increasing recovery capital in the Midwest

University of Minnesota Extension, the outreach and community engagement arm of the University of Minnesota, is partnering with the school’s College of Pharmacy, county public health agencies, tribal leadership, and South Dakota State University to improve and sustain an approach to OUD treatment known as recovery capital. That strategy is based on the idea that five types of support—social, physical, cultural, community, and human—can be combined to help people recover. The partners are working to create local solutions to address the opioid crisis, including a focus on harm reduction training and community forums to address stigma.

Importantly, they are developing and deploying an American Indian Resource and Resiliency Team (AIRRT) to support the needs of tribal communities through culturally adapted holistic health education. A focus on this population is key, as American Indians represent 15.8% of OUD treatment admissions in Minnesota but only 1.5% of the state’s population. AIRRT’s specialized responsive programming promotes Indigenous wellness approaches rooted in acknowledgment of historical trauma, mind-body medicine, digital storytelling, and “two spirits”—the Indigenous belief that some individuals house both male and female spirits.

The partners’ Midwest Tribal Opioid Meta-Evaluation (MTOM) project will assess program outcomes and processes used in three previous efforts aimed at reducing and preventing opioid use in rural Midwest and Northern Plains tribal communities. Evaluators will use a recovery capital framework to examine the role of protective community resources, such as culturally relevant care, basic needs services, substance use disorder treatment facilities, behavioral health clinics, and OUD medications. Effective use of these resources helps to reduce the impact of risk factors such as historical trauma, social determinants of health, and health disparities.

Research shows that positive recovery capital, which includes social, physical, cultural, community and human support, increases the likelihood of recovery. Alternatively, the absence of any of those supports can lead to negative recovery capital, which challenges the recovery process, and can exacerbate the opioid crisis for vulnerable communities.

Conducting a meta-evaluation

Relying on culturally responsive Indigenous evaluation and the recovery capital framework, the MTOM team and partners at the Johns Hopkins Bloomberg School of Public Health’s Center for American Indian Health Great Lakes Hub will engage in a data- and community-driven process to guide analysis of all data. This meta-evaluation, bringing together the results of three previous efforts, will help better assess program effectiveness.

The iterative evaluation plan follows three phases, beginning with a review of programming from the three previous projects, including analysis and synthesis of evaluation data already collected. In the second phase, the team will work with program staff and community stakeholders to reach a shared understanding of overall program goals and how they can be achieved, examine what systems change looks like, and identify areas for improvement. The goal is to define recovery capital within a rural tribal context.

The final phase of the evaluation will synthesize findings from the programs. Researchers plan to identify and develop a set of indicators, assessment tools, and measures that can be disseminated to other tribal communities. The project is slated to end in 2022, with publication of results to follow. The MTOM team will work with local tribal communities to identify methods, audiences, and other best practices for effectively distributing results and maximizing their usefulness to key stakeholders in Indian Country.

For more information on this initiative, please contact Leslie Paulson, [email protected].

Beth Connolly is the project director and Leslie Paulson is an officer with The Pew Charitable Trusts’ substance use prevention and treatment initiative.