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The Imani Breakthrough Project: Addressing Mental Health and Addictions in Black and Brown Communities

Drs. Ayana Jordan and Chyrell Bellamy and Team, Yale Psychiatry

Image of Yale Doctors Chyrell Bellamy (left) and Ayana Jordan (right)

In 2020, over 85,000 people died from drug overdoses in the United States with mortality rates skyrocketing for Black and Latinx people by 140% and 118%, respectively, given the presence of fentanyl (a manufactured opioid) in the drug supply. While the national media has focused on opioid-involved deaths among White people, minimal attention has been given to the disparate morbidity and mortality related to opioid use disorder (OUD) and alcohol use disorder (AUD) among Black and Latinx people. Although overall prevalence of AUD is similar across racial and ethnic groups, or in some cases, fewer than White people, there continues to be a disproportionate burden of illness experienced among under-represented minority (URM) populations, complicated by a dearth of culturally informed addiction treatment options. Further, with COVID-19, deaths involving opioids continue to worsen for URM with SUDs, making it more urgent than ever to study culturally informed treatment interventions for these populations. This disproportionate illness burden and lack of access to the gold standard in addiction treatment—Medication-Assisted Treatment (MAT)—has been linked to a host of barriers, based in structural racism, including inadequate access to technology (a point particularly underscored in the current COVID-19 pandemic with greater reliance on telehealth), lack of addiction providers from URM backgrounds, limited education about MAT in URM communities, and an absence of robust culturally informed harm reduction services in these communities.

As drug overdose rates among both Black and Latinx people with SUDS continue to increase, it is imperative that we address the healthcare inequities that contribute to this disparity gap, so that effective interventions can be tailored to the needs of Black and Latinx populations. To tackle the unique challenges of decreased treatment initiation, engagement, and adherence to addiction treatment for Black and Latinx people with SUDs, in collaboration with key stakeholders (Black/Latinx people with and without SUD), we developed Imani (meaning Faith in Swahili) Breakthrough in 2017 through a community based participatory process. Imani Breakthrough is a faith-based, person-centered, culturally informed harm reduction recovery program that takes place in churches. This program provides an innovative approach to engaging vulnerable groups into SUD treatment, by focusing on SAMHSA’s 8 dimensions of wellness (social determinants of health/ SDOH), 7 domains of citizenship, culturally informed education, and referral to medication for addiction treatment (MAT) or any FDA-approved pharmacotherapy for treating a SUD. Built upon the foundation of spirituality, of high cultural significance among Black and Latinx communities, Imani groups are delivered in churches and are administered by trained church representatives, including a person with lived experience of a SUD. By providing culturally informed education, mutual support, and intensive wraparound coaching, in a safe and familiar environment, Imani Breakthrough has been provided to over 1000 persons to date in Connecticut and preliminary evidence shows it directly addresses the barriers that impede access to the most effective MAT available.

Imani Breakthrough was developed to increase access to treatment among underserved minorities with OUD and other SUDs; it also has improved engagement in community and mental health services.This Connecticut Department of Mental Health and Addiction Services (DMHAS) initiative was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and is part of the CT State Targeted Response (CT-STR) to the Opioid Crisis and the State Opioid Response (SOR). Imani has taken place in churches (predominately serving Black and Latinx communities) located in 5 major urban cities in Connecticut: Bridgeport, Hartford, New Haven, New Britain, and Waterbury.

The Imani Breakthrough program consists of weekly group-based mutual support and recovery/education classes with individualized wraparound coaching provided by two facilitators/coaches (first 12 weeks), followed by an additional 12 weeks of group mutual support and wraparound coaching. Facilitators must include one person with lived experience of substance use and one person who is a member of the church (both can be members). Churches provide space to hold the weekly groups, assist in organizing the groups, and assist with recruitment. Churches have also organized to provide additional assistance to individuals (for example, one church in Hartford, CT, provided a space for the participants to take showers and the elders of the churches donated toiletries and towels for the participants). Facilitators and pastors participate in 5-day training and refresher sessions on harm reduction and the pathophysiology of addiction. We address retention challenges by relying on peer facilitators and church leaders interested in doing this work who are already embedded in the Black and Latinx culture, of which they identify.

Imani Breakthrough is centered in lived experience knowledge and the ethos “Nothing about us without us,” a term by Judi Chamberlin and other disability and recovery activists. Imani is developed by people in recovery and primarily people of color. It combines two promising evidence-based approaches (both originally co- produced/designed by people in recovery): The Citizenship Community Enhancement (7 domains of citizenship - measured by the citizens construct including 1) personal responsibility, 2) government infrastructure, 3) caring for others, 4) civil rights, 5) legal rights, 6) choice, and 7) stewardship.; activated by the 5Rs – relationships, rights, responsibilities, resources, and roles; (developed by Dr Michael Rowe) and the 8 Dimensions of Wellness (1) physical, 2) intellectual, 3) environmental, 4) spiritual, 5) social, 6) occupational, 7) emotional, and 8) financial health; developed by Dr. Margaret (Peggy) Swarbrick.

For more information, please see our most recent publication:

Chyrell D. Bellamy, Mark Costa, Janan Wyatt, Myra Mathis, Ariel Sloan, Mariana Budge, Kimberly Blackman, Luz Ocasio, Graziela Reis, Kimberly Guy, Reverend Robyn Anderson, Michelle Stewart Copes & Ayana Jordan (2021). A collaborative culturally-centered and community-driven faith-based opioid recovery initiative: the Imani Breakthrough project. Social Work in Mental Health, DOI: 10.1080/15332985.2021.1930329

A collaborative culturally-centered and community-driven faith-based opioid recovery initiative: the Imani Breakthrough project: Social Work in Mental Health: Vol 0, No 0 (tandfonline.com)

For more information about Imani and how to get involved either as participant or as a site, please contact Graziela Reis, graziela.reis@yale.edu

References:

Furr-Holden D, Milam AJ, Wang L, Sadler R. African Americans now outpace whites in opioid-involved overdose deaths: a comparison of temporal trends from 1999 to 2018. Addiction. 2021 Mar;116(3):677-683. doi: 10.1111/add.15233. Epub 2020 Sep 15. PMID: 32852864.

Hedegaard,  H et. al;. Drugs Most frequently used in  drug overdose deaths, in the US, 2011-2016 . National Vital Statistics Reports, Vol. 67, No. 9, December 12, 2018, https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_09-508.pdf

Jordan A, Mathis ML, Isom J. Achieving Mental Health Equity: Addictions. Psychiatr Clin North Am. 2020 Sep;43(3):487-500. doi: 10.1016/j.psc.2020.05.007. PMID: 32773076.

Wang, Q. Q., Kaelber, D. C., Xu, R., & Volkow, N. D. (2020). COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United States. Molecular psychiatry, 1–10. Advance online publication.