For the past decade, the U.S. has been battling an opioid crisis that has taken the lives of millions and wrecked homes in both large cities and rural communities. Not only has that crisis not gone away, it has created a population that is more vulnerable to the short and long-term impacts of COVID-19. While COVID-19 has grabbed the attention of the world, those with substance use disorder continue to face an ongoing health crisis in the midst of this pandemic.
"Learning from the past, we know that these epidemics hit the most vulnerable populations the hardest," said Debra Litzelman, senior research scientist at Regenstrief Institute and D. Craig Brater Professor of Global Health Education at the IU School of Medicine. "While we absolutely should be focused on COVID-19, the unintended consequence of focusing only on the coronavirus is that we lose sight of other underlying key medical conditions."
Researchers like Litzelman and community organizations whose work focuses on substance use disorder are making sure they can continue to provide services. Litzelman has been helping pregnant women and new mothers who have a substance use disorder through the CARE Plus program. Aimed at decreasing infant mortality, the CARE Plus program, part of IU's Responding to the Addiction Crisis Grand Challenge, offers support to underserved women of childbearing age and pregnant mothers with substance use disorder in Indiana through community health workers.
Before pandemic restrictions, the community health workers communicated with women one-on-one, in the clients’ homes or at other public places of their choosing, connecting regularly to plan how to address obstacles to recovery and link them to essential resources such as housing, food and baby supplies. That communication also includes emotional support through regular meetings, calls and text messages.
“There have been lots of challenges and iterations to how we have restructured our work,” Litzelman said. “But our community health workers have continued to support one another and have been especially creative in how to use our resources and continue to support their clients.”
So far, relationships that already have been established between community health workers and their clients have remained strong. Likewise, some new clients have been enrolled in the program, although their enrollment was done strictly by phone.
With the stay-at-home orders, in-person support for the over 126 current participants and in-person recruitment for the program has moved to phone calls. For LaTasha Timberlake, one of the programs’ community health workers, switching to working from home has included trying to stay in touch with her clients. But continuing to have access to all of the needed resources has been a challenge.
For example, the program typically provides cribs to new mothers to help promote safe sleep habits and avoid sudden infant death syndrome. Community health workers deliver the cribs and help educate the mothers on safe sleep practices. Because the cribs cannot currently be dropped off by the community health workers, the cribs have to be ordered online, which costs more money, takes longer to get into the hands of the mother and eliminates face-to-face education and support.
In addition, like most people, Timberlake’s clients struggle with anxiety. About half of the clients Timberlake works with have lost their jobs.
“Some of my clients have stated that they are scared to go out because they may bring the virus back to kids or family members that are in the home,” she said. “I encourage them to follow the CDC regulations, to wash hands for 20 seconds, sanitize items brought into the home and other tools for staying safe and healthy during this time.”
Community health workers have also pivoted to connecting clients with suboxone-waivered providers, educating clients on how to obtain newly approved multiple-day supplies of methadone in a lock box with naloxone, and instructing them on finding online resources including virtual behavioral health/mental health sessions and recovery meetings such as narcotics anonymous.
While thankful to still be able to help connect clients with resources, there is great value in connecting with someone face-to-face, Litzelman said. The same thing is true with recovery meetings. Online meetings can be a saving grace to someone dealing with a substance use disorder. But for others, physically attending a meeting provides a social interaction they are now no longer able to experience.
“It is not just the resources themselves but also about knowing how to get them and use them effectively,” Litzelman said. “Strong social support is still so important to helping the women enrolled in our program.”
As the pandemic moves forward, Litzelman said she will continue to look for creative ways to meet the needs of the programs’ participants and provide support to the community health workers who are absolutely key to making the program work.
