CRT

In 2017, Connecticut’s death rate from opioid overdose death was twice the national rate. Women, sexual minorities, and transgender individuals are all particularly at risk for opioid use disorder and overdose death as the result of prescribing practices, minority stressors, and social and behavioral determinants. According to a study of sexual minorities and incarceration, 9.3% of men in prison, 6.2% of men in jail, 42.1% of women in prison, and 35.7% of women in jail self-identify as a sexual minority. In addition, according to the 2015 U.S. Transgender Survey conducted by the National Center for Transgender Equality, 2% of respondents reported incarceration in the past year. Given how these populations are impacted by OUD and incarceration, it is crucial to tailor recruitment efforts for opioid treatment programs, such as Medication Assisted Treatment (MAT).

Community Renewal Team (CRT) is Connecticut’s oldest and largest community action organization. After receiving a Medication Assisted Treatment – Prescription Drug and Opioid Addiction (MAT-PDOA) grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2018, CRT was enabled to implement a Medication Assisted Treatment (MAT) Program for individuals experiencing Opioid Use Disorder (OUD) through the use of Suboxone (buprenorphine). This program is predominantly targeted to recently incarcerated individuals, as well as women and sexual and gender minorities. CRT now seeks to increase the number of women, sexual minorities (lesbian, gay, and bisexual), and transgender individuals so that they represent 20%, 18%, and 4% of enrollees respectively. Given this increased risk of opioid addiction and the importance of recruiting these populations to MAT programs, CRT will use the findings and recommendations from this project to adjust current recruitment practices and implemented new ones in order to increase the recruitment of these populations to CRT MAT.

1. Provide recommendations for recruitment strategies tailored to CRT MAT’s target populations.
2. Given research limitations during Covid-19, identify best practices in MAT website content and design based on MAT-PDOA grantees’ websites.

Prior to Covid-19: Interviews with MAT program staff about their recruitment practices.

During Covid-19: Website combing of 130 SAMHSA MAT-PDOA 2018 grant recipients.

• Organization name and grant description first collected for SAMHSA website.
• Organizations without websites, without information on MAT, and those with greater or differing resources from CRT (County governments and Universities) were removed from the sample, leaving 61 websites.
• Combing focused on content related to specific audience targeting and recruitment as well as ease of access to MAT information on the website
• Data from 61 websites were then organized by where on the website MAT services were located, the types of medication that were offered (if specified,) and language or photos targeted specific audience. The final sample represented MAT programs from all US geographic regions.

Our project would not have been possible without the assistance of many individuals. First, we would like to thank the Community Renewal Team in Hartford, Connecticut for their time and for creating this opportunity for us. We thank our faculty advisors Emily Wang, MD, MA and Lisa Puglisi, MD as well as the public health librarian Kate Nyhan for their guidance during the initial stages of this project and the formulation of the literature review. Finally, we’d like to thank Dr. Debbie Humphries (our professor) and Antonia Caba (our Teaching Fellow) for their consistent support and guidance on this project over the course of the semester.

Access to information on MAT: Many of the websites had information regarding MAT and their MAT program(s) but more often than not, that information was buried many pages deep in their website (usually 3-4 but as many as 5-6). Additionally, some websites had different information on MAT in different locations on their website. This lack of simple accessibility to information may serve as a barrier for those seeking MAT. Websites differed in the accessibility of MAT information. MAT information located fewer clicks from the website homepage was easier to access. The mean number of clicks from the homepage to MAT information was 2.9. Only 5 (8%) organizations had a click count of one, and only 1 (2%) organization had a click count over four. Accessible information may serve as a facilitator to MAT treatment.

Points of Contact: Providing multiple options as points of contact may provide easier access to folks looking to start MAT. Websites differed in the options they supplied for reaching out for information and scheduling appointments. 18 (30%) organizations had prominent or easy to access contact information on their websites. Some only provided the general phone number for the organization while others offered specific options for a phone number, email, general submission form to schedule an appointment, and fax (on occasion).

Success Stories: Some websites provided either dedicated pages or sections of the MAT webpages to success stories from their MAT program. Featuring diversity in this way may be helpful for further recruitment of hard to reach populations and, in general, is a helpful tool to showcase individuals who have positive experiences in a MAT program.

• Websites with fewer clicks from the homepage to MAT pages may facilitate recruitment.
• Multiple options for contact types and contact points may facilitate recruitment.
• Webpages or features of “success stories” help to show the types of people MAT can be helpful for and may aid in increased visibility of diversity in MAT programs.

New/Adjusted Website Considerations:

• Consider giving “Medication Assisted Treatment” or “Substance Use Treatment” its own clickable link under the “Get Help” Tab of CRT’s website. This can be linked to the existing MAT page on the site.
• While a phone number and email are currently provided on CRT’s MAT site, it may be additionally helpful to include a general submission form/contact form for scheduling appointments or asking questions.
• Consider featuring success stories from CRT’s MAT program either on the MAT web page or on a separate web page that has a clickable link on the current MAT webpage.
• While CRT’s MAT program is predominantly targeted to recently incarcerated folks, consider including a diversity and inclusivity statement concerning non-discrimination in the MAT program and acceptance of all types of people.

Additional Recommendation(s):

• Strengthen old and potentially develop new partnerships and working relationships with other organizations in the Hartford area that serve sexual minorities, gender minorities, and women to increase community presence and trust within these populations.

• Initial intent of the project was to conduct focus groups and/or interviews with clients, CRT staff, and staff at other MAT programs with regard to current recruitment practices. However, due to the interruptions resultant from the COVID-19 pandemic, we were unable to gather information this way.
• Not all MAT-PDOA recipients have a website or content about MAT on their websites, limiting the amount of useful content.
• Useful information and what was considered “notable and helpful” about website content was subjectively determined by those implementing the project.
• Time constraints limited the scope of content searching we were able to conduct as well as the formatting of the final product.

1. James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.
2. Meyer, I. H., Flores, A. R., Stemple, L., Romero, A. P., Wilson, B. D., & Herman, J. L. (2017). Incarceration Rates and Traits of Sexual Minorities in the United States: National Inmate Survey, 2011-2012. American journal of public health, 107(2), 267–273. https://doi.org/10.2105/AJPH.2016.303576
3. Abuse, N. I. on D. (2019, March 29). Connecticut Opioid Summary. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/connecticut-opioid-summary