HealthEast Foundation

Report date
October 2019

What has been most instrumental to your progress?

The key to the sustainability of the Karen addiction treatment program was getting it institutionalized and financially self-supporting. The cultural and linguistically specific Karen addiction treatment program that was created by KCDC has now been incorporated into the HealthEast Addiction department. There is an intensive outpatient group that meets twice weekly for 12 weeks and then an aftercare recovery management group that meets weekly for 12 weeks. These groups use the curriculum created by our team incorporating Karen ways of thinking and cultural values. There is a monthly on boarding group to prepare participants about group norms and understand the context of treatment. The groups are billable services and co-facilitated by an American licensed addiction professional employed by HealthEast and a Karen leader (Tada) who has years of experience and was funded by the Bush Grant. There are consistently 2-5 new referrals monthly from probation officers, churches, clinics, thus making it the most successful program in the HE addiction department and financially viable. HE has committed to hiring Tada as a permanent employee and making the Karen Recovery program official
Sharing our lessons learned about creating cross-sector collaboration that involves truly sharing power and incorporating cultural adaptations at the paradigm level was another of our priorities. We were able to publish a peer-reviewed academic article and present at an international conference on refugee health. We have also conducted trainings for several hospitals and mainstream organizations. We continue to get invitations and questions about ways other communities around the country can utilize our strategies in working with Karen patients within their own settings.
There has been a substantial increase in drugs and alcohol problems among Karen Youth and limited access to prevention and treatment for them. KCDC recently was able to expand its focus to incorporate more focus on youth. We worked closely with the Karen youth leaders to outline the needs and possible outreach opportunities that they perceived as most needed. Through these conversations it was determined that a dedicated position as Youth advocate /outreach worker is needed to connect the churches and agencies working with youth and to develop culturally relevant prevention materials and supporting access to treatment. We have been able to partner with the Karen Organization of MN to secure grant funds for this position and the position was filled last month. In addition, the Fairview youth residential treatment facility is planning to move from Chisago,MN to Maplewood in the next year, which would make accessing treatment and availability of interpreters much easier. Since KCDC is already partnering with the Fairview Addiction department for the Karen Men's program, there is potential for partnering with for the youth as well.

Key lessons learned

KCDC created the only Karen language AA-style community support group in MN and USA. It has been run by a bilingual Karen man who attends English AA meetings and has been translating materials and facilitating Karen meetings weekly. Because the concept of AA and addiction support groups did not exist in the Karen culture, we have been paying him to create this program and develop/translate the material for the meetings. Also because transportation for many Karen patients is unavailable, we have also been paying the KOM driver and van to transport patients to and from the weekly meetings. Both of them are paid via the grant. The hope was that after a few years this program would become self sustaining. The AA meetings in other communities are all volunteer, and we hoped that with better understanding of the need, the Karen community would grow to support this. We have been in discussion with Karen churches and the American AA meeting leaders about ways to have ongoing support to keep the Karen meetings going beyond the grant funds. This is still in process.

Reflections on the community innovation process

Inclusiveness - We developed all of our interventions, programs, and curriculum with the direct input from Karen leaders. Our work creating culturally-specific programs was done at the paradigm level - not just mere translation but including different ways of thinking and understanding. All presentations for mainstream agencies always included both American and Karen KCDC staff. I have a strong belief that it is not my place (as a the KCDC director and physician) to speak on behalf of Karen people and that I can only speak as a provider for the Karen and that a Karen person needs to speak for themselves about the Karen experience. The youth advocate position arose out of months of meetings of Karen youth leaders exploring what they thought was most needed.

Progress toward an innovation

Karen patients are no longer getting denied addiction treatment. There is now a process for referral, assessment, intake and treatment for Karen speaking patients along the full spectrum of care - detox, inpatient, residential, outpatient, aftercare, community AA support group. There are still multiple systemic barriers to this process, including availability of interpreters and transportation and insurance coverage, but the work flow and process have been established, the Karen Recovery Program with outpatient treatment is institutionalized and financially viable, and there is commitment from the HealthEast/Fairview addiction department to continue the program and work on addressing the barriers. The courts and probation officers are happy to have a program for their Karen clients and have been the biggest referral source. The St Paul Police have been participating in the KCDC community collaboration meetings and now partnering around youth initiatives for Karen.

What it will take to reach an innovation?

We had hoped to create "response teams" at the Karen churches with all 12 Karen churches having 3 dedicated members (one for youth, women, and men) that would be the identified support persons within each church and the key point of contact for other agencies (clinic, KOM, probation, therapists, etc) to partner with in supporting individuals and family dealing with substance use issues. We conducted several meetings and training for Karen church leaders and pastors and presented this concept. There was a mixed response of 1) is this the pastors responsibility or can he just pray with them, 2) we are already helping families but we don't often know what to do, 3) drugs and alcohol are the "cancer of our community and killing our people" and we too see the need, 4) who has the time or capacity to take on these roles as the "response team". Without funding or staffing to develop this model and build this program, we were not able to get enough organized or get enough buy-in to make this happen. The new youth advocate is working with the churches, and we hope this may be a different opportunity to build capacity within the church in a more concrete way with the focus on youth.

What's next?

1) Complete the research on the efficacy of the Karen specific curriculum and develop trainings and methods for sharing this work
2) Support the Karen youth advocate to develop culturally and youth relevant prevention materials and activities to engage Karen youth as well as resource coordination for accessing treatment. We plan to support KOM in creating this youth program and developing partnerships with the Karen churches, schools, and local police.

If you could do it all over again...

I am not sure if there is one piece of learning. This has been such an iterative process with making revisions and modifications as new ideas arose from the Karen community or changes in corporate leadership impacted the development of the program or staffing/ funding changed. KCDc has morphed in so many ways to be responsive to the needs of the patients as well as addressing the systemic barriers.

One last thought

The Bush Foundation has been an amazing and inspirational organization. The Bush Fellowship for Dr. Sniffen created the opportunity for both personal and professional transformation and was the genesis of KCDC. The Bush Community Innovation grant allowed the ideas and initiative of KCDC to come to fruition, institutionalizing access to addiction treatment and raising awareness about addition for the Karen community and supporting the cross-sector growth in adapting services for other languages and ways of thinking.