Connecticut Department Research Articles

589. Late Onset Invasive Group B Streptococcal Disease Outbreak in a Neonatal Intensive Care Unit Identified Through Whole Genome Sequencing — Connecticut, 2020–2024

Abstract Background Group B Streptococcus (GBS) is a major cause of neonatal sepsis. Outbreaks of GBS late-onset disease (LOD), defined as infection during the first 7–89 days of life, are uncommon. In September 2023, 4 GBS LOD cases were reported by a neonatal intensive care unit (NICU) to the Connecticut Department of Public Health (DPH). We investigated to characterize the outbreak and guide response. Methods We identified patients with invasive (i.e., GBS isolated from a sterile site) LOD hospitalized in the NICU through review of data from DPH’s Active Bacterial Core Surveillance Program during January 2019–April 2024. We distinguished outbreak cases through whole-genome sequencing (WGS) of associated bacterial isolates. Single nucleotide polymorphism (SNP) analysis with a cutoff of ≤12 SNPs defined a case as outbreak-related. We abstracted medical records to collect case data. We performed 3 on-site assessments of infection prevention and control (IPC) practices and policies. To monitor response effectiveness, we performed weekly GBS colonization screening (aural, oropharyngeal, rectal sites) of infants admitted to the NICU during December 2023–April 2024. We performed WGS on GBS isolates associated with each colonization. Results We identified 12 outbreak-related cases during January 2020–April 2024 based on WGS. Median case interval, time between illness onset, was 85 days but ranged from three days to 458 days; 3 outbreak-patients died. Chart abstraction and on-site assessments indicated the milk room as an area for potential transmission. Variability was noted in adherence to appropriate hand hygiene, personal protective equipment use, and environmental cleaning throughout the NICU. Screening identified 7 colonized infants; GBS isolates from 3 infants matched the outbreak, and 1 colonized infant developed LOD. We recommended addressing IPC gaps and continuing GBS colonization screening to monitor for ongoing transmission. Conclusion This investigation highlights the integration of WGS with classic epidemiology to distinguish outbreak-related cases with long intervals between identification. In LOD GBS outbreaks where IPC gaps appear to contribute to transmission, colonization screening and WGS can evaluate effectiveness of implementation of protocols to address IPC gaps. Disclosures Meghan Maloney, MPH, Pfizer Global R&D: Former employee, separated in 2009. I do have a retirement entitlement which I do not actively manage/no stock options. PGRD offers periodic buy outs

Observational pilot using a Data to Care intervention strategy to promote HCV re-engagement and cure for persons with HIV/HCV co-infection who are out of care

BackgroundWith Direct Acting Antivirals for Hepatitis C virus (HCV), cure is possible in > 95% including those with HIV/HCV co-infection. Achieving strategic targets for cure requires addressing barriers including suboptimal care engagement. We adapted Data to Care (D2C), a public health strategy designed to identify and link persons out of care (OOC) for HIV, for persons with HIV/HCV co-infection untreated for HCV.MethodsIn partnership with Connecticut Department of Public Health (DPH), persons OOC for HIV (defined as no HIV surveillance laboratory tests from 10/1/2018–10/1/2019) were matched to a list of persons co-infected with HIV/HCV (through 12/31/2019). We used a three-phase follow-up approach (pre-work, case conferencing, and Disease Intervention Specialist (DIS) follow-up) to track outreach outcomes and re-engagement/HCV cure success.ResultsThere were 90 HIV/HCV co-infected persons who were OOC for HIV. The pre-work and case conferencing phases determined that 33 (36.7%) had previous HCV cure or were in treatment. There were 41 eligible for DIS-follow-up of which 21 (51%) were successfully contacted and 7 (33%) successfully re-engaged (kept appointment with HCV provider). No new HCV treatment initiations were recorded.ConclusionsUsing a D2C approach, we identified and conducted outreach to persons who were OOC for HIV to promote HCV treatment. This approach resulted in intensive data clean-up and outreach efforts which produced modest re-engagement and no HCV treatment initiations. Future studies should develop alternative and complementary interventions to promote effective re-engagement and HCV treatment.

Sustainability Evaluation of Highway Sign Support by Field Testing and Finite Element Analysis

The primary objective of this study is to evaluate the sustainability of highway sign supports through field testing and finite element analysis. The study aims to develop a predictive maintenance model to evaluate the service life of these structures. Sign support systems are important structures in the Connecticut Department of Transportation (CTDOT) bridge management system. Periodic sustainability inspections and maintenance activities are needed as a long-term, cost-effective maintenance strategy. The research involved non-destructive field testing of a cantilever-type highway sign support, followed by finite element modeling using Highway Sign Structures Engineering (HSE) by SAFI software. Data from accelerometers, strain gauges, and anemometers were collected and analyzed to validate the model. The experimental setup was done in collaboration with CTDOT. The data was collected and analyzed, and it was used to verify the three-dimensional finite element (FE) model developed, which was used to test the structure's design capacity. The study found that the sign support structure experienced significant wind loading on a few occasions, with stress levels reaching about 20% of its elastic limit. The finite element model accurately predicted structural behavior under design load conditions, demonstrating its potential for predictive maintenance applications.

Risk Analysis of Connecticut Department of Transportation Projects during the COVID-19 Pandemic

Risk Analysis of Connecticut Department of Transportation Projects during the COVID-19 Pandemic

Connecticut Implements a Team-Based Approach to Cardiovascular Disease Prevention Using Community Health Workers and Mobile Medical Devices.

The Connecticut Department of Public Health's Early Detection and Prevention Program uses an integrated approach to deliver breast and cervical cancer screening services, cardiovascular disease risk assessment, health coaching, and the identification of social determinants of health to women from economically disadvantaged and minority communities. Statewide contracted providers who represent twenty hospitals and their fee-for-service providers employ community health workers (CHWs) to conduct outreach, screening assessments using mobile medical devices, and risk reduction counseling in community settings to reduce service access barriers, while also engaging eligible women who may not typically frequent clinical services. Mobile medical screening devices enhance healthcare accessibility by enabling screenings to be conducted in a participants preferred setting, whether it is a clinic or within the community, with the added benefit of delivering rapid screening results. Utilizing these results, CHWs provide risk reduction counseling to develop individualized health action plans at the outreach session.

Hepatitis C Virus Care Cascade by Race/Ethnicity in a Statewide Correctional Population, 2019-2023.

Hepatitis C virus (HCV) care cascade data by race/ethnicity for US correctional populations are sparse. To evaluate the HCV care cascade by race/ethnicity for a state correctional population. This retrospective cohort study used Connecticut Department of Correction data for incarcerated individuals tested, diagnosed, and treated for chronic HCV infection with direct-acting antivirals (DAAs) from 2019 to 2023. HCV care cascade outcomes, including testing, treatment, and cure rates, were compared by race/ethnicity. Poisson regression was used to estimate prevalence ratios (PRs), with adjustment for demographic and legal status factors. A total of 24,867 patients tested for HCV (88.9% men, mean (SD) age 35.6 (11.8), 32.7% White, 37.9% Black, 28.4% Hispanic, 0.6% Asian, 0.4% American Indian/Alaska Native (AIAN), 34.7% sentenced ≥ 1year). Both HCV exposure and chronic HCV were highest for White (27.1% and 15.2%) and lowest for Black individuals (4.6% and 2.6%) (P < 0.01, for both outcomes). While incarcerated, 63.2% of chronic HCV patients started DAAs, and treatment rates did not significantly differ by race/ethnicity (P > 0.05). For those treated and having post-treatment lab data available, cure rates were 98.8% or better for all racial/ethnic groups (P > 0.05). In the adjusted regression analyses, HCV treatment initiation was lower for those sentenced < 1year (PR, 0.76; 95% CI, 0.67-0.87) and unsentenced (PR, 0.85; 95% CI, 0.80-0.91) than those sentenced ≥ 1year. The adjusted prevalence of advanced fibrosis stage/activity grade was not significantly associated with race/ethnicity. In this cohort study, less than two-thirds of chronic HCV patients initiated DAA treatment during their incarceration, and for those with available data, nearly all were cured. While there were disparities in HCV exposure and chronic HCV infection, significant racial/ethnic differences were not observed for treatment initiation or cure rates. Further efforts are needed to increase HCV treatment, especially for patients with shorter incarceration periods.

Associations between trauma exposure and irritability within the family unit: a network approach.

Pediatric irritability is a pervasive psychiatric symptom, yet its etiology remains elusive. While trauma exposure may contribute to the development of irritability, empirical research is limited. This study examined the prevalence of irritability among trauma-exposed children, identified factors that differentiate trauma-exposed children with and without irritability, and employed a network analysis to uncover associations between irritability and trauma exposure in the family unit. Sample included 676 children (56.3% male, mean age = 9.67 ± 3.7 years) and their parents referred by the Connecticut Department of Children and Families to Fathers for Change - a psychotherapy intervention designed to reduce intimate partner violence (IPV) and child maltreatment. Child's trauma exposure, post-traumatic stress disorder (PTSD) symptoms, and irritability were assessed pre-intervention using self- and caregiver-report. Parents self-reported their childhood and adulthood trauma exposures, PTSD symptoms, irritability, psychopathology, and IPV. Across caregiver- and child-reports, 16%-17% of children exhibited irritability. Irritable children experienced greater trauma exposure, interpersonal violence, emotional abuse, and PTSD severity. They had caregivers, particularly mothers, with greater trauma histories, IPV, and psychopathology. Network analysis revealed 10 nodes directly correlated to child's irritability including child's PTSD severity, parental IPV (specifically psychological violence), and parental psychopathology. Results provide initial empirical evidence that pediatric irritability is linked to trauma exposure, suggesting trauma histories be considered in the diagnosis and treatment of irritability. Interventions addressing caregiver trauma, IPV, and psychopathology may ameliorate pediatric irritability. Future studies could benefit from adopting network approaches with longitudinal or time series data to elucidate causality and points of intervention.

Advancing Newborn Screening Long-Term Follow-Up: Integration of Epic-Based Registries, Dashboards, and Efficient Workflows.

The Connecticut Newborn Screening (NBS) Network, in partnership with the Connecticut Department of Public Health, strategically utilized the Epic electronic health record (EHR) system to establish registries for tracking long-term follow-up (LTFU) of NBS patients. After launching the LTFU registry in 2019, the Network obtained funding from the Health Resources and Services Administration to address the slow adoption by specialty care teams. An LTFU model was implemented in the three highest-volume specialty care teams at Connecticut Children's, involving an early childhood cohort diagnosed with an NBS-identified disorder since the formation of the Network in March 2019. This cohort grew from 87 to 115 over the two-year project. Methods included optimizing registries, capturing external data from Health Information Exchanges, incorporating evidence-based guidelines, and conducting qualitative and quantitative evaluations. The early childhood cohort demonstrated significant and sustainable improvements in the percentage of visits up-to-date (%UTD) compared to the non-intervention legacy cohort of patients diagnosed with an NBS disorder before the formation of the Network. Positive trends in the early childhood cohort, including %UTD for visits and condition-specific performance metrics, were observed. The qualitative evaluation highlighted the achievability of practice behavior changes for specialty care teams through responsive support from the nurse analyst. The Network's model serves as a use case for applying and achieving the adoption of population health tools within an EHR system to track care delivery and quickly fill identified care gaps, with the aim of improving long-term health for NBS patients.

Pneumocystis jirovecii pneumonia: a case report

Introduction and importancePneumocystis jirovecii (PJP) pneumonia is a serious life-threatening condition in immunocompromised individuals and is often associated with human immunodeficiency virus (HIV) + patients. We describe a case of PJP pneumonia which provided a diagnostic challenge in a patient who presented with no known risk factors leading to a delay in initiation of appropriate antibiotic therapy.Case presentationA 71-year-old previously healthy white/Caucasian male presented with subacute hypoxic respiratory failure due to multifocal pneumonia with diffuse bilateral ground glass opacities with consolidations despite prior treatment with antibiotics and steroids. He was admitted and started on intravenous broad-spectrum antibiotics but continued to deteriorate, eventually requiring intubation and transfer to the ICU. Bronchoscopy revealed PJP and treatment was initiated, but the patient developed refractory shock and multiorgan failure, and ultimately died. It was later discovered that he was HIV-1 positive.Clinical discussionPJP, as a potential cause of his presentation, was not considered given that our patient lacked any overt risk factors for PJP pneumonia. He continued to worsen despite broad spectrum antibiotic therapy and hence bronchoscopy was pursued. His clinical profile, in hindsight, was suspicious for PJP pneumonia and early PJP-directed antibiotic therapy may have prevented a fatal outcome, as in this case. There was an element of cognitive bias across multiple providers which may have contributed to the delay in treatment despite his rapid clinical decline while on conventional pneumonia treatment protocol. His diagnosis was later evident when his BAL-DFA grew PJP in addition to his low levels of CD4 and CD8 cells. He was found to be HIV-1 positive five days after his death; there was a delay in this diagnosis since all positive HIV tests from the hospital are reported as ‘pending’ until the presumptive positive sample goes to the Connecticut Department of Public Health State laboratory for the confirmatory test. PJP-targeted therapies were initiated later in our patient’s hospital course when the infection had progressed to refractory septic shock with multiorgan failure and eventual death.ConclusionPJP pneumonia is a fatal disease if not recognized early in the course of illness, and the patient usually undergoes multiple antibiotic regimens before they are diagnosed and receive appropriate clinical care. The gold standard of diagnostic testing for PJP is by obtaining bronchial washings through a flexible bronchoscopy and the turnaround time for such results may take a few days to result. A significant proportion of patients may not have any overt risk factors of immunosuppression and early empiric treatment for PJP may be clinically appropriate as the delay in diagnosis may be associated with significant morbidity and mortality risk.

A 16-Year Chronicle of Developing a Healthy Workplace Participatory Program for Total Worker Health® in the Connecticut Department of Correction: The Health Improvement through Employee Control (HITEC) Program.

Health Improvement Through Employee Control (HITEC) is a 16-year program directed toward the health of corrections personnel and developed through the application of the principles of Participatory Action Research (PAR) and participatory ergonomics. Its impetus has always been the adverse health status of the corrections workforce: early mortality, depression, obesity, and hypertension. The HITEC program trained small "Design Teams" (DTs) of front-line personnel in participatory methods for intervention design for health improvement and organizational change in line with the Total Worker Health® principles. Periodic surveys and physical testing were introduced for longitudinal assessments. Comparative interventions at comparable sites included DTs without a priori assignation, problem-focused kaizen effectiveness teams (KETs), and bargaining unit-centered DTs. DT resilience and the replacement of members who transferred facilities or retired was aided by novel cooperative administrative structures. DT-generated interventions included stress lounges, changes in critical event report writing, a joint program with trained inmates to improve air quality, and training in staff mental health and sleep behavior. A specialized peer-to-peer Health Mentoring Program (HMP) paired new officers with trained peers. Many interventions and program features were institutionalized, thus improving prospects for self-supporting program longevity. Participatory interventions designed and supported by the corrections workforce were found to be both feasible and exceptionally effective.

Lung cancer screening in the prison population.

114 Background: The United States incarcerated population is large and aging resulting in greater incidence of cancer. Inmates are a vulnerable population with increased rates of tobacco use that can place them at risk of developing lung cancer. The goal of this study is to determine whether inmates within the Connecticut (CT) Department of Corrections (DOC) with a history of smoking are screened for lung cancer and to implement a process by which they may be screened. Methods: We conducted a retrospective chart review of patients within the CT DOC that have been diagnosed with a lung nodule or lung mass between the years 2018-2021. Each chart was reviewed to determine if these patients met the current United States Preventative Service Task Force (USPSTF) guidelines for lung cancer screening with low dose CT scan (LDCT). After identifying an opportunity for improvement, we then implemented a shared decision-making clinic to screen inmates. Patients were scheduled for LDCT if they met eligibility criteria and consented to CT scan. Results: 28 patients of charts reviewed were identified as eligible for LDCT screening from the years of 2018-2021. These results showed that 9 (32%) patients out of 28 had LDCT completed. 7 (25%) of these patients had biopsy proven lung cancer. 300 inmates residing within the CTDOC were found to have a significant smoking history. Thus far, 11 patients have been evaluated in our shared decision-making clinic. 7 patients met criteria for LDCT and underwent CT scan. All 7 patients require annual follow up for 3 years. 1 patient declined meeting with our providers. We will continue to offer screening to all eligible and consenting inmates. Conclusions: Through our study we have identified a need to improve screening for lung cancer in the DOC population. We have implemented a process by which inmates can be screened with help from our DOC, Pulmonology, and Radiology colleagues. We will continue the current process to screen and obtain consent for the 300 inmates identified as having a significant smoking history. To our best knowledge, this is the first study that demonstrates a sustainable workflow to screen DOC inmates for lung cancer.

Lessons Learned From the Connecticut Response to COVID-19 in Nursing Homes During the First 2 Years of the Pandemic.

Nearly half of all SARS-CoV-2-related deaths in the United States occurred in long-term care facilities during the early pandemic. In Connecticut, statewide mitigation of this impact involved a collaboration between the Connecticut Department of Public Health and the Yale School of Public Health, alongside existing relationships with the long-term care industry and individual facilities. This close government-academic-industry collaboration facilitated the creation of a robust COVID-19 surveillance system that allowed for real-time analysis and identification of nursing homes where outbreak support was needed. The collaboration further facilitated vaccine and booster deployment to Connecticut nursing homes at a speed that outpaced much of the country. The impact of these interventions is demonstrated through COVID-19 case and death burdens among nursing home residents and the greater Connecticut population during each wave of the pandemic. We outline the evolution and impact of these alliances and how they enabled us to prioritize facilities, interventions, and the distribution of limited resources and training throughout the pandemic. We further detail lessons learned over the first 2 years of the pandemic. Such partnerships strengthen our ability to respond effectively to public health crises and should be created and/or maintained in the face of continued pandemic threats.

Rehabilitation of Corroded Steel Bridge Girder Ends using Partial-Height Ultra-High-Performance Concrete Encasement

Beam end corrosion is one of the most prominent types of deterioration on simple-span steel bridges. To address this concern, the Connecticut Department of Transportation and the University of Connecticut have jointly developed a repair method for corroded steel girder ends using ultra-high-performance concrete (UHPC) encasement. In this repair, shear studs are welded to the undamaged portion of the web and encased in UHPC to create an alternate load path for bearing and shear forces. This novel repair method has been implemented in multiple states. The widespread promotion of steel girder end repair with UHPC demonstrates the need for literature on field implementations and alternative designs. This paper advances the findings from a field implementation completed in Connecticut in October 2021, which was the first instance of a partial-height repair in the country, the first application of the repair to a weathering steel bridge, and the first use of flange studs to restore shear capacity at the junction of the web and bottom flange. Two of the girder ends were fully instrumented to collect data on the performance of the repaired locations. The paper presents an overview of the bridge, discusses the design and implementation of the repair, provides short-term monitoring data showing its successful activation, and discusses lessons learned throughout the process. It is anticipated that the findings put forward provide support for the use of UHPC encasement as a promising method for the repair of corroded steel girder ends.

The Recovering Citizenship Learning Collaborative: a system-wide intervention to increase citizenship practices and outcomes

PurposeThis paper aims to describe the Recovering Citizenship Learning Collaborative (RCLC), a training, consultation and implementation effort for 13 local mental health authorities and two state hospitals.Design/methodology/approachThe learning collaborative used a Recovering Citizenship approach, which holds that recovery occurs in the context of people’s lives in their communities and society, that is, their citizenship. The RCLC was implemented by the Connecticut Department of Mental Health and Addiction Services (DMHAS) in the USA and the Yale Program for Recovery and Community Health along with lived experience leaders. The RCLC supported system change through training DMHAS staff on concepts of recovery and citizenship and developing agency action plans, with the long-term goal of improving citizenship-oriented care at the agency-level and recovery and citizenship-related outcomes for people receiving services.FindingsLessons learned include the importance of assessing organizational readiness for change, addressing leadership investment and attention to systemic barrier, and offering tools to promote structure and accountability. Next steps are supporting agency action plans through technical assistance, state-wide educational offerings and a resource library.Research limitations/implicationsSystemic barriers are considerable and must be addressed before system transformation is possible.Practical implicationsThe authors are hopeful that the RCLC has been part of overcoming those challenges and can be a tool for building foundations for improving citizen practices and people’s citizenship-related outcomes.Social implicationsNext steps are sustaining agency action plans, ongoing agency-specific technical assistance, ongoing state-wide educational offerings and a resource library.Originality/valueThe RCLC has provided tools and supports to build the foundation for improved citizenship practices and client outcomes at the multiagency system level.

Developing a Data-Driven Network Screening Procedure for Systemic Safety Approach

Systemic analysis is considered an important safety analysis approach that is complementary to the Highway Safety Manual hotspot analysis. The network screening step in systemic analysis is to identify sites with characteristics that are associated with specific types of severe crashes. Traditionally, determining the risk scores involves subjective criteria. This research aims to develop a data-driven approach to replace the subjective methods used in the past. To achieve the research objective, this study collected roadway and crash data from the Connecticut Department of Transportation. A data-driven crash risk factor categorization methodology is proposed to estimate accurately the performance measures indicating crash risks. Moreover, this study proposes and compares four different risk scoring matrices to identify an optimal risk scoring method that is attuned with the principles of the systemic approach to safety as well as providing additional insights on justifying the systemic safety analysis results. The proposed methodology is implemented to conduct network screening for severe roadway departure crashes and later validated using severe aggressive-driving related crashes. Risk-based network screening results indicate that risk scores derived from normalized crash over-representation provide additional emphasis on sites with low traffic volume that are associated with high severe crash counts. The highest modified crash rate was obtained using normalized crash over-representation based risk scores indicating that the proposed network screening methodology can not only identify roadway attributes that are correlated with severe crashes but also account for low-volume roadway sites with severe crashes. The validation analysis indicated proposed method is transferrable to different emphasis area related crashes.

The Collaboration between Occupational Therapy and Psychology in Treating Adolescents in a Psychiatric Residential Treatment Facility. Multisensory Immersion Room as a Treatment Intervention

This article highlights the collaboration between the fields of occupational therapy (OT) and psychology in the development of a Multisensory Immersion Room (MSIR) within a Psychiatric Residential Treatment Facility (PRTF). An MSIR was designed to expand clinical treatment programming at the Albert J. Solnit Children’s Center-North Campus, within the Connecticut Department of Children and Families. The collaborative assessment between psychology and OT delivers a superior understanding of a youth, which is advantageous to planning treatment in an MSIR space. A case study is utilized to showcase this collaboration, while simultaneously paving the way for future providers.

Whether or not the weather matters: A retrospective review assessing the influence of weather on SARS-CoV-2 transmission

Background: Since the start of the COVID-19 pandemic, many variables have contributed to surges in cases such as the presence of variants, vaccination status, and comorbid medical conditions. However, other factors can be considered including temperature, precipitation, and periods in large congregations. The spike in SARS-CoV-2 infections during the winter has made it seem plausible that transmission may be affected by meteorological factors. A study by Birukov et al demonstrated that a 1°C increase in temperature was associated with a 3.08% reduction in daily new cases and a 1.19% decrease in daily new deaths. We propose that SARS-CoV-2 transmission will decline more rapidly when either precipitation or temperature is higher; thus, in warmer regions with less precipitation daily cases, hospitalizations and deaths will be lower. Methods: This is a retrospective study of statewide data in Hartford County, Connecticut, collected from May 2020 to June 2022 assessing percent positivity reported in daily case count, hospitalizations for COVID-19, and deaths from COVID-19 collected from the Connecticut Department of Public Health COVID-19 database. Information on weather conditions, including temperature and precipitation, were collected from the National Weather Service pertaining to Hartford County. Trends in variables related to patient outcomes were compared to weather conditions within the county of Hartford. Moreover, certain periods within the various seasons that typically involve large gatherings and public holidays (eg, New Year’s Day, Memorial Day, 4th of July, Labor Day, Thanksgiving, and Christmas Day) were further analyzed. Results: There appears to be an inverse correlation coefficient of −0.422, between confirmed daily cases and mean temperature in Hartford County, indicating that as temperature increases, confirmed cases decrease. This phenomenon is also observed with confirmed daily deaths and mean temperature, with a correlation coefficient of −0.463. Moreover, there is an even more significant relationship between hospitalization cases and mean temperature, with a correlation coefficient of −0.667. Furthermore, the year-end holidays (Christmas Day and New Year’s Day) were associated with a significant spike in confirmed daily cases, hospitalizations, and deaths.However, the relationship between confirmed daily cases, hospitalized cases, and confirmed deaths against mean precipitation in Hartford County demonstrated no significant relationship, reporting correlation coefficients of −0.042, −0.044, and −0.044, respectively. Conclusions: Our available COVID-19 and weather data show that temperature is inversely correlated with daily cases, hospitalizations, and deaths. However, with regard to precipitation, there was no discernable relationship between the variables.Disclosures: None

Ending a Treatment Relationship

Ending a Treatment Relationship

Breaking through social determinants of health: Results from a feasibility study of Imani Breakthrough, a community developed substance use intervention for Black and Latinx people

Racial and ethnic disparities in substance use intervention design, implementation, and dissemination have been recognized for years, yet few intervention programs have been designed and conducted by and for people who use substances. Imani Breakthrough is a two-phase 22-week intervention developed by the community, run by facilitators with lived experience and church members, that is implemented in Black and Latinx church settings. This community-based participatory research (CBPR) approach is a concept developed in response to a call for action from the State of Connecticut Department of Mental Health and Addiction Services (DMHAS) with funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) to address rising rates of death due to opioid overdose, and other negative consequences of substance misuse. After nine months of didactic community meetings, the final design involved twelve weeks of education in a group setting related to the recovery process, including the impact of trauma and racism on substance use, and a focus on citizenship and community participation and the 8 dimensions of wellness, followed by ten weeks of mutual support, with intensive wraparound support and life coaching focused on the social determinants of health (SDOH). We found the Imani intervention was feasible and acceptable, with 42 % of participants retained at 12 weeks. In addition, in a subset of participants with complete data, we found a significant increase in both citizenship scores and dimensions of wellness from baseline to week 12, with the greatest improvements in the occupational, intellectual, financial, and personal responsibility dimensions. As drug overdose rates among Black and Latinx people who use substances continue to increase, it is imperative that we address the inequities in the SDOH that contribute to this disparity gap so that we can develop interventions tailored to the specific needs of Black and Latinx people who use drugs. The Imani Breakthrough intervention shows promise as a community-driven approach that can address these disparities and promote health equity.

Ezra Griffith, M.D., to Receive Chester Pierce Human Rights Award

Ezra Griffith, M.D., to Receive Chester Pierce Human Rights Award