Over the Hills and Through the Hollers: How One Program is Assisting Residents of Appalachian with Opioid Use Recovery.

Introduction: The consequences of increasing opioid misuse in the U.S. over the last two decades have been severe, contributing to hundreds of thousands of lives lost and heavy tolls on individuals, families, and society. The Appalachian Region has been hit particularly hard, with its predominantly rural landscape seeing disproportionate increases in opioid misuse and overdoses. These cases have been difficult to address due to poor treatment access and capacity constraints in many areas of Appalachia. Purpose: The current study focuses on evaluating The Kentucky Access to Recovery Program (KATR), which provides services to individuals recovering from opioid addiction residing in several counties in Eastern Kentucky. Its purpose is to understand the impact of KATR on service recipients' access to recovery services and supports. Methods: Semi-structured interviews were conducted with 12 service recipients, three service providers, and four vendors of support services related to housing, transportation, medical/dental care, employment, and childcare. Qualitative data were analyzed using thematic analysis. Results: Themes related to individual-level impacts were identified and discussed, including behavioral changes related to recovery, physical and mental health improvements, relationship repair, regaining custody of children, provision of needed supports, and ability to gain employment and improve finances. Study findings showed that KATR had meaningful impacts on the lives of service recipients by helping meet needs and reducing barriers to their ongoing recovery. Implications: Through its use of vouchers for support services and basic-needs provision, KATR demonstrates a potentially effective strategy for increasing access to health-related social services for persons in recovery in predominantly rural areas.

Non-prescribing clinicians' treatment orientations and attitudes toward treatments for opioid use disorder: Rural differences.

INTRODUCTION: The United States has experienced substantial increases in opioid use for more than two decades. This growth has impacted rural areas where overdoses have risen drastically during this time period and more often involve prescription opioids than in urban areas. Medications for opioid use disorders (MOUDs) are highly underutilized in rural settings due to lack of access, inadequate prescribing, and stigma. METHODS: The study collected data using a cross-sectional online survey of nonprescribing clinicians (NPCs) involved in the treatment of substance use disorders (SUDs) in the United States. The study used multiple recruitment methods to obtain a purposive sample of NPCs from a variety of geographical contexts across the nation. The survey assessed demographic and practice characteristics including rurality of practice location, exposure and training related to MOUDs, treatment orientation, treatment preferences for opioid use disorder (OUD), and attitudes toward MOUDs. The study compared treatment preferences for OUD and attitudes toward MOUDs based on rurality of practice location. We tested a mediation model to determine whether the relationship between rurality of practice setting and attitudes toward MOUDs is mediated by treatment orientation. RESULTS: Most of the 636 NPCs surveyed favored a combination of MOUDs and psychosocial treatment. Compared to clinicians practicing in suburban or urban areas, self-identified rural clinicians were more likely to favor MOUDs alone as most effective and less likely to endorse a combination of MOUDs and psychosocial treatment. Although most NPCs were supportive of MOUDs overall, many endorsed misconceptions related to MOUDs. Rural clinicians were less likely to perceive MOUDs as effective or acceptable compared to those in urban settings. Results of a mediation analysis indicated that practicing in a rural location compared to in an urban location directly and indirectly influenced attitudes toward MOUDs through an effect on treatment orientation. CONCLUSIONS: NPCs play important roles in the implementation of MOUDs, and while efforts to increase their knowledge of and exposure to MOUDs have contributed broadly to more favorable attitudes toward MOUDs among NPCs, this study's findings indicate that additional efforts are still needed, particularly among NPCs who work in rural settings. Findings also indicate that, among rural clinicians, increasing knowledge of and exposure to harm reduction principles may be a necessary prerequisite to engaging them in the implementation of specific harm reduction strategies such as MOUDs.

Impacts of the COVID-19 Pandemic on a Rural Opioid Support Services Program.

During 2020, Kentucky saw the third highest increase in overdose deaths in the U.S. Employment issues, inadequate housing, transportation problems, and childcare needs present barriers to accessing treatment in rural areas. These barriers and others (e.g., technology) arose during the pandemic negatively affecting individuals in recovery and service providers as they adjusted services to provide primarily telehealth and remote services. This study examines the impact of COVID-19 in its early stages on an opioid use disorder (OUD) support services program in a nonprofit located in rural eastern Kentucky, part of the central Appalachia region. A qualitative design was applied, employing semi-structured interviews in early fall 2020. Participants were associated with one OUD support services program, including service recipients, program coordinators, and business vendors. Guided by the Social Determinants of Health framework, two-cycle coding-descriptive coding and pattern coding-was utilized. Codes were sorted into three patterns: changes to daily life; financial impacts; and service access and provision. Overall, early stages of COVID-19 brought increased stress for individuals in recovery, as they were taking on more responsibility and navigating a changing environment. Coordinators were under pressure to provide services in a safe, timely manner. Vendors vocalized their struggles and successes related to finances. These findings can help organizations make realistic adjustments and policymakers set reasonable expectations and consider additional financial support.

Mental Health and Weather Extremes in a Southeastern U.S. City: Exploring Group Differences by Race.

The connection between mental health and weather extremes is a public health concern, but less studied to date than physical health. This exploratory study examines the mental health impacts of two kinds of weather extremes increasingly linked to climate change-summer heat waves and extreme winter weather-in a low- to middle-income population in the Southeastern U.S. The distribution of mental health impacts, and potential pathways to them, are examined with a focus on race. Data are from a random-sample survey of 426 participants and are analyzed with bivariate statistics and path analysis. Self-reported mental health impacts, in both seasons, were common in our study, with White participants tending to report worse impacts than participants who identified with other racial groups. Physical health had direct effects on mental health across several models, overall and by racial group. For summer heat waves, concern about climate change and social cohesion had direct and indirect effects, respectively, on mental health in White participants only. For extreme winter weather, preparedness had a direct negative effect on mental health in White, but not Black, participants. Results suggest that there may be racial differences in the influence of human and social capital factors on mental health related to weather extremes, warranting further study of this critical topic and with larger racial subgroup samples.

Pathways to Retention: Job Satisfaction, Burnout, & Organizational Commitment among Social Workers.

Purpose: Job satisfaction, burnout, and organizational commitment remain concerns for human service organizations. Few studies have utilized a large sample of social workers to investigate these factors while also considering practice setting. In the present study, work-related burnout, satisfaction with workload, and satisfaction with organizational environment are examined as factors contributing to organizational commitment while comparing the measurement and predictive strength of these factors based on practice setting. Method: Confirmatory factor analyses and structural equation modeling were used to estimate and compare factors related to organizational commitment with a sample of 1,786 social workers practicing in the United States. Results: Satisfaction with organizational environment showed a strong positive relationship with organizational commitment. Work-related burnout was confirmed to have a negative relationship with organizational commitment. No measurement or structural model differences existed between social workers from different types of practice settings. Discussion: Findings suggest that increasing satisfaction with organizational environment is a better target for retaining employees than reducing workloads. Results emphasize the need for human service organizations to foster work environments which provide a climate of wellness, support, and recognition of employees' contributions at work.