Tripwires and Brick Walls: Innovative Solutions to Structural Barriers to Treatment and Recovery

Care for people who have substance use disorder (SUD) is often fragmented, which means that individuals seeking help usually must navigate complex and unfamiliar systems without adequate structural support. Common barriers to accessing care and remaining in treatment include transportation, community supervision requirements, co-occurring chronic medical conditions, and a basic lack of system flexibility. Often these barriers are perceived as minor challenges with easy solutions. If one lacks a car for transportation, for example, then providing bus passes should help in getting people to their medical appointments. But if there is no bus system or climbing into a bus is physically impossible, what originally seemed to be a small tripwire has suddenly become an immovable brick wall.

This session will discuss innovative solutions to many of these common challenges from both rural and urban perspectives. Utilizing peer supports to provide recovery support while also providing transportation, creating a DOC Recovery Care Team to problem-solve conflicts in supervision requirements in real time, integrating medical and behavioral healthcare physically as well as structurally, and expanding telehealth through partnerships with treatment programs, schools, and public health departments are some of the solutions the speakers have implemented. Outcomes of their efforts will be discussed, as well as their own brick walls and tripwires. The solutions and programs in this session are the products of funded initiatives underwritten by grants from National Institutes of Health/Health Resources and Services Administration, U.S. Department of Agriculture, or Johns Hopkins Hospital, and have been implemented in either the City of Baltimore or in the rural Owen County and Carroll County in Kentucky.