In this interview, Linda Mahoney (BHDDH) discusses the Imani Recovery Program in RI—a collaborative, culturally centered, and community-driven faith-based opioid recovery initiative.
Could you start by telling us a bit about yourself and your role?
My name is Linda Mahoney and I work for the RI Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH). I have the honor of being designated as the State Opioid Treatment Authority (SOTA), which means I have oversight over the state’s Opioid Treatment Programs. I also serve as the Co-Chair of the Recovery Workgroup and Treatment Workgroup for the Governor’s Opioid Overdose Prevention & Intervention Task Force.
Could you provide a brief introduction to the Imani Recovery Program?
The “Imani” (Swahili for Faith) recovery program is a collaborative, culturally centered, and community-driven faith-based opioid recovery initiative: the Imani Breakthrough project first started in Connecticut.
“The opioid crisis has become a complex and multifaceted societal challenge. For Black and Latinx individuals, access and engagement in effective treatment remains a high concern. Developed as the result of a collaborative culturally responsive initiative, the Imani Breakthrough program has been hosted by Black and Latinx churches in CT. It has proven to have helped participants improve their lives, feel valued by society, connect with others, and have positive relationships with their loved ones and community.”
The Imani Recovery Program in RI will work within the state’s faith-based communities to support members of Black and Latinx communities that may be concerned about an alcohol or substance use disorder (SUD) and have had personal reservations about entering treatment due to fears of discrimination and stigma. The goal is to be able to acquire recovery supports and overall wellness in one’s own community. The Imani program in Connecticut was originally designed by local religious leaders to engage local church members in recovery to receive evidence-based training on how to support and engage others to find improved overall wellness, whether it be support for food, housing, transportation, medications, or treatment.
This acclaimed program first started at Yale University after receiving a Connecticut State Opioid Response (SOR) grant for implementation. This same team at Yale is now contracted with RI’s Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) to mirror their successes here in RI. Yale’s training staff will offer technical assistance and recovery support training and coaching for all members engaged in the program.
You can learn more about the Imani Recovery Program by clicking here.
What was the impetus for the Imani Recovery Program? Why do you think it was important to implement this program in RI specifically?
A few years ago, the Governor’s Opioid Overdose Task Force Treatment Workgroup became engaged in an effort to identify focus populations that needed to receive increased support in order to improve access to treatment and reduce opioid overdose deaths. If you visit www.Preventoverdoseri.org you can see that from 2016 – 2018, RI really started seeing an increase in opioid overdose deaths, especially within our BIPOC communities.
In response to the overdose data collected, the Governor convened a Task Force with a number of experts with an aim to reduce overdose deaths through a focus on four primary pillars: prevention, rescue, treatment and recovery. The Task Force designed an opioid data council that addressed the importance of using data to learn more about those we were losing and those who were at highest risk. The goal was to utilize this data to maximize our financial resources and effectually reduce overdose deaths. Through this process, we did see a beginning reduction in overdose deaths. In 2019, RI experienced a large influx of Fentanyl and overdoses began to rise across the state. In 2020, the U.S. lost just over 100,000 people, and the treatment workgroup realized we needed to do more to meet people where they lived instead of waiting for people to find a way to treatment.
EOHHS Secretary Womazetta Jones was key in initiating this work by emphasizing the need to better understand how different communities are being affected by opioid use disorder (OUD). From the data, we learned that the rate of deaths was decreasing among white Rhode Islander’s primarily due to the decrease in opioid prescriptions resulting from stricter guidelines around prescribing, but then we noticed that the numbers among Latino and Black populations were rising quickly, not only in RI but in surrounding states. Black residents in RI have faced a higher rate of fatal overdoses each year compared to other residents with an increase of 50% between 2017 and 2020 (14% annual growth rate). Hispanic and Latino residents have increased 63% between 2016 and 2017 (13% annual growth rate).
The state started conducting focus groups to better understand the barriers to treatment, since the data for Black/Latinx populations admitted to any forms of SUD treatment was lacking. Of course, there are a multitude of complex social issues including stigma and discrimination that inhibit access to treatment for Black and Latino individuals, but we learned from the focus groups that those who wanted to seek support would more often seek help from their faith-based communities rather than treatment centers. We began to think about how we could partner with faith-based organizations to help provide more people in RI with a pathway to recovery and support. The Imani Recovery Program seemed to be a perfect fit.
How is the Imani Recovery Program model unique as compared to other recovery programming? Could you speak to some of the reasons why the program focuses on providing support through faith-based communities?
We have heard from many of our faith-based leaders about how many family members have questions around how to support loved ones with issues related to addiction. Through the Imani Recovery Program, we focus on providing faith-based leaders and the community with education around the disease of addiction and various supportive pathways, including information around medications to assist individuals with an OUD. The plan is to bring treatment and resources into the communities through telehealth and/or mobile treatment vans, while addressing and mitigating the various fears, discriminations and biases that communities hold against those battling the disease.
There has certainly been a longstanding awareness of how important spiritual support can be for individuals experiencing a substance use disorder (SUD). For instance, the Faith Infusion and Recovery Effort (FIRE) program and much of the prevention work currently being done in RI is focused on ways to help reduce stigma and discrimination around SUD. So, while utilizing this faith-based pathway for recovery is not necessarily a new concept, the implementation, funding, and structure of the Imani Recovery Program is new and certainly makes the program unique. Our hope is that by creating a new infrastructure for this different recovery pathway, we can help individuals who are not comfortable or ready to walk into a 12-step support meeting to receive support and even increased access to treatment.
Could you tell us a bit about how the Imani Recovery Program is structured?
The program is initially 12 weeks and focuses on two promising practices, the first of which is the “8 Dimensions of Wellness” developed by Dr. Swarbrick. This is a person-centered, non-judgmental practice that aims to engage people, not by focusing on their issues, but by focusing on meeting everyone’s needs for improved health and wellness. The practice addresses SAMHSA’s 8 dimensions of wellness: 1) Emotional, 2) Occupational, 3) Environmental, 4) Financial, 5) Physical, 6) Social, 7) Intellectual, and 8) Spiritual. Self -Assessed metrics help people understand their growth in each dimension.
The second promising practice is the “5 Rs of Being a Community Member”, which focuses on helping community members learn their rights, roles, and responsibilities as a community member, as well as understand the resources and relationships within their community. Once people complete the initial tier of the program, they can choose to participate in optional support groups for an additional ten weeks. The goal is to help people build recovery resources by way of feeling safe and comfortable to improve life in one’s own community.
The Imani Recovery Program focuses on being collaborative and community driven. Could you tell us about the collaborative nature of this program and the people and organizations involved?
To start, BHDDH funds the program and we have contracted with Yale University to help us structure the program. When we first were getting started, we invited everyone from various churches, ministries, and alliances to come together for their input. The faith-based organizations were wonderful, and they have been an integral piece of developing RI’s Imani program. Faith leaders talked about using sermons to help reduce stigma and support community understanding, specifically around SUD being a brain disease and not a character flaw. This has aligned well with the faith-based approach as it focuses on accepting people where they are and working to reduce judgment towards others.
We have asked church elders to help us identify individuals from the faith community who would be interested in receiving training to become Program Facilitators. Program facilitators can be previously trained as peer recovery specialists, or they can be individuals in sustained recovery themselves, addiction counselors, etc., but it is very important that they are part of the church community. BHDDH will be training program facilitators through a free, three-day Yale training event. After completion of the program, they will then be paid to help engage community members to join the groups. Attendees will receive a small convenience fee to incentivize their participation.
BHDDH has recently hired Ericka Mack-Andrew as the Imani Project Manager, and she will be working with our faith-based communities to assist in applying to become one of the four first RI Imani based programs. As the Project Manager, she will play a key role in helping to reduce any potential fears that faith-based leaders might have around contracting for state funding. As a reminder, this is a pilot program, so we will start by working with three-four faith-based organizations over the course of three years to collect data and support future funding.
How can the RI substance use prevention community help to support this program?
The prevention community already works at the community level and are keenly aware of champions in the recovery community. BHDDH staff member Ericka Mack-Andrew will need community support in order to find people in recovery who might be interested in becoming a facilitator at their local church. If you know of a church that has a large population of African American or Latino participants and may be interested in learning more about the Imani program, please reach out to Ericka at Ericka.Mack.CTR@bhddh.ri.gov. Once the churches have been identified and are ready to begin classes, the prevention coalition members can help engage people to attend.
How do you envision the Imani Recovery Program evolving? What are some of the broader goals of this work?
Views around substance use can be very different in different cultures and even in different age groups. Sometimes there can be misconceptions around medications used to treat OUDs, and sometimes there is just fear around accessing treatment. So often we hear people say, “What will people think of me? What will they think of my family?”
The power to change really starts with knowledge. As faith-based community members gain support and education around the importance of building wellness and acceptance through the Imani Recovery Program, they can play a really important role in reducing fears about accessing treatment. This program has the potential to build better understanding of what it takes to sustain recovery and the recovery resources needed to be successful.