The R1 Foundation Provides evidence-based and best practice tools, training and resources to underserved communities.
Underserved communities are identified as those receiving fewer services and encountering barriers to accessing services (e.g., economic, cultural, linguistic, etc.). Communities that we work with are at a higher risk and have a higher prevalence rate of mental illness and substance use disorder. These communities do not have the resources available to ensure a supply of evidence-based and best practice tools, training and resources to match the demand and the need required to combat the ongoing crisis and epidemics they are facing.
The crucial issue for evidence-based substance use and mental health care for veterans is more important than ever before due to the considerable number of veterans returning from combat missions who have experienced episodes of PTSD and other mental health conditions. More than 1.5 million of the 5.5 million veterans seen in VA hospitals had a substance use disorder or mental health diagnosis in 2016. This represents about a 31% increase since 2004.
While Military Health System, Veterans Health Administration, and community/private systems are innovating to improve their treatment and services, issues with mental health care access and quality persist. Shortages of trained, culturally competent clinicians; driving distance; and perceptions about the consequences of seeking care may make present obstacles for veterans, service members, and family members in accessing mental health and substance use disorder care. - (rand.org)
According to the U.S. Government Accountability Office, 2.1 million veterans received mental health treatment from the U.S. Department of Veterans Affairs in the five year period from 2006 through 2010. A study by the Substance Abuse and Mental Health Services Administration revealed that only 50 percent of returning vets who need veteran mental health treatment will receive these services.
A 2018 report of mental health care for veterans found that the mental health workforce had insufficient capacity to address the needs of service members:
In addition, the study found that the existing workforce lacked sufficient training in evidence-based practices, and there were inadequate organizational systems and tools to support mental health quality improvements.
Veterans from rural communities are at a particular disadvantage as they face challenges such as limited options for assessment and treatment, and providers’ lack of awareness
In 2018, 8.9 million young adults reported having a mental illness. More than 2 in 5 went untreated & of the 5.1 million with a substance use disorder, nearly 9 in 10 did not get treatment. - SAMHSA
In 2016, SAMHSA reported that:
At-Risk youth in need of substance use treatment may benefit from evidence-based substance use treatment that addresses their specific needs; however, the research suggests that few receive any or adequate substance use treatment.
Compared with adults aged 26 or older, lower percentages of adolescents and young adults who needed substance use treatment received treatment
From the Surgeon General’s 2019 Report:
Science has shown that adolescence and young adulthood are major “at risk” periods for substance misuse and related harms. Second, most of the major genetic, social, and environmental risk factors that predict substance misuse also predict many other serious adverse outcomes and risks. Third, several community-delivered prevention programs and policies have been shown to significantly reduce rates of substance-use initiation and misuse-related harms.
Integration of mental health and substance use disorder care into general health care will not be possible without a workforce that is competently cross-educated and trained in all these areas.
Prevention programs and interventions can have a strong impact and be cost-effective, but only if evidence-based components are used and if those components are delivered in a coordinated and consistent fashion throughout the at-risk period. Parents, schools, health care systems, faith communities, and social service organizations should be involved in delivering comprehensive, evidence-based community prevention programs that are sustained over time.
A total of 552,830 people were experiencing homelessness on a single night in 2018. This number represents 17 out of every 10,000 people in the United States - (HUD’s Annual Point-in-Time Count)
According to the Substance Abuse and Mental Health Services Administration, 20 to 25% of the homeless population in the United States suffers from some form of severe mental illness. In comparison, only 6% of Americans are severely mentally ill - (National Institute of Mental Health)
Addiction in the underserved chronically homeless populations is rampant. There is no agreement as to whether substance use disorders cause homelessness or vice versa, but no one disagrees that each exacerbates the other. While 235,823 homeless individuals were admitted to U.S. treatment programs in 2009, research findings suggest that services are still lacking for homeless populations.- (SAMHSA)
Approximately one-third of all homeless people show symptoms of mental illness. Homeless people, who are predominantly low-income, uninsured residents of mostly low-income communities, share with other low-income residents of such communities a range of difficulties in getting care when they need it. The most significant barriers to access are financial. At the same time, the homeless encounter a range of additional barriers to health care. - (NIH)
The past 20 years have seen significant increases in the numbers of individuals incarcerated or under other forms of criminal justice supervision in the United States. These numbers are staggering—approximately 7.1 million adults in the United States are under some form of criminal justice supervision. An estimated one-half of all prisoners meet the criteria for diagnosis of mental illness, drug abuse or dependence - (NIH)
Despite the positive outcomes associated with in-jail treatment, two-thirds of jails do not offer treatment (SAMHSA). About two-thirds have self-help programs and about 30 percent have detoxification programs. Of jail inmates who reported ever having used drugs, only one in eight had participated in any treatment (even broadly defined) since their admission, and most of those reported were self-help programs (NIH).
Community and Peer Groups
The Department of Health and Human Services (HHS) characterizes underserved, vulnerable, and special needs populations as communities that include members of minority populations or individuals who have experienced health disparities.
According to the Surgeon General 2019 Report:
Effective community-based evidence-based treatment programs can reduce substance misuse. Research shows that for each dollar invested in evidence- based prevention programs, up to $10 is saved in treatment for alcohol or other substance misuse–related costs.
Community coalitions, composed of individuals and organizations from multiple sectors of society engaged in substance misuse issues, have been effective in getting people into treatment by conducting outreach to connect them to appropriate evidence-based and best practice tools, training and resources.
Many local communities’ educational campaigns target the general public to improve understanding about substance use problems, increase knowledge of community health and safety risks, and promote access to available evidence-based resources..
In local communities, evidence-based resources are not without their challenges: - (NCMJ)
The need for broad support and knowledge among a range of stakeholders in the community
The ability to provide for ongoing, continuous education and awareness, in order to deal with changing leadership and personnel
Lack of knowledge about the various evidence-based practices, and the potential “fit” of these practices with the local community’s needs and resources
Capacity to implement evidence-based practices within the local provider community
Resistance to shifting from treatment-as-usual to an evidence-based practice
Funding streams that may not be structured to encourage or support evidence-based practices
The need for policy development that ensures the preferred utilization of evidence based practices
Rural and Non Mainstream
Nearly one in five U.S. residents lives in a rural area. According to most estimates, individuals living in rural locations experience mental and substance use disorders at rates that are similar to (and sometimes higher than) those of their urban counterparts.
Despite having a similar need for services, people in rural areas have less access to the behavioral health continuum of care than do people in urban areas. Although funding cuts, workforce shortages, and other systemic issues hinder access to timely and appropriate behavioral health treatment and services in urban and rural areas alike, people in rural areas face additional barriers, such as a lack of adequate internet infrastructure, a need to travel long distances to see specialty providers, and a lack of anonymity about receiving treatment. - SAMHSA
The CSG Justice Center reports that there are few rural specific evidence based practices, or resources to establish them.
Few resources exist in rural systems to facilitate change and innovation.
Rural areas suffer from chronic shortages of mental health professionals.
Specialty providers highly unlikely to be available in rural areas.
Comprehensive services often not available.
Substance abuse can be especially hard to combat in rural communities due to limited resources for prevention, treatment, and recovery. According to The 2014 Update of the Rural-Urban Chartbook, the substance abuse treatment admission rate for nonmetropolitan counties was highest for alcohol as the primary substance, followed by marijuana, stimulants, opiates, and cocaine.
Factors contributing to substance abuse in rural America include:
Low educational attainment
Rural communities have been especially affected in the past few years by rising rates of poverty and unemployment, two key community-level risk factors for addiction and mental illness. Getting treatment in rural communities is much harder than in urban areas. There is limited access to evidence-based tools that help treat addiction in rural areas because of stigma, misunderstanding, and a lack of accessibility.
A 2015 American Journal of Drug and Alcohol Abuse article, Rural Substance Use Treatment Centers in the United States: An Assessment of Treatment Quality by Location, reports that rural substance abuse treatment centers had a lower proportion of highly educated counselors, compared to urban centers. Rural treatment centers were found to offer fewer wraparound services and specialized treatment tracks.