Introduction
There are limited official data regarding the consumption patterns, risks, protective factors, and consequences of substance abuse in the chosen community. Therefore, data collection instruments will be developed to bring more precise information. However, there is some media news about the general tendencies regarding the issue. According to these media reports, three particular problems contribute to substance abuse in Skid Row – homelessness, prescription abuse, and starting consumption to cope with depression and other mental health issues.
Most drug addicts in the community abuse opioids, including heroin and powerful prescription pain relievers (“The stories of Skid Row heroin addicts,” 2017). The latter include Vicodin, oxycontin, oxycodone, and fentanyl; this is a nationwide problem as nearly 2 million Americans are prescription addicts (“The stories of Skid Row heroin addicts,” 2017). In the United States, the upward trend in the number of prescribed painkillers continues, which can be considered a crisis. Often, homeless people start using heroin after their pain reliever treatment ends as heroin is readily available on the streets and relatively cheap (“The stories of Skid Row heroin addicts,” 2017). The initiation of drug use is often associated with attempts to independently treat mental issues like depression, although substance abuse only exacerbates the problem.
Magnitude, Location, TimeSpan, Severity, and Changeability
There is a need to fill the data gap regarding the issues of magnitude, location, period, severity, and changeability of the SUD in the Skid Row community. Field data gathering and an extensive analysis of the secondary sources can be used as data collection tools.
Priority Areas
Self-Treatment of Mental Issues and SUD
Many homeless people in Skid Row, with or without addiction, consume the drugs or other substances like alcohol to ease emotional pain or cope with depression. But the drugs only make the situation worse, and many homeless become substance abusers with develop mental illnesses, thus, having a dual diagnosis (“The stories of Skid Row heroin addicts,” 2017). People with a family history of abuse will have a genetic predisposition to addictive behavior and are particularly vulnerable. About 50% of homeless women in Skid Row have mental health problems, and 28% recover from drug addiction (Vasquez & Tu, 2018). According to experts, 4 of 10 people living on the sidewalks in Skid Row are severely mentally ill or have a drug addiction (“What is Skid Row,” 2018).
Prescription Drug Abuse
Many young homeless people start from prescription drug abuse and then switch to heroin and other illegal drugs, which are cheap and easy to get on the streets. According to statistics, from 21 to 29% who receive a prescription for pain relievers subsequently begin to abuse opioids (Vasquez and Tu, 2018). After addiction, heroin can become an alternative since doctors limit the frequency of repeated pills.
Risk and Protective Factors
Homelessness is the major risk factor for SUD among the dweller of Skid Row. Therefore, the charity governmental and non-governmental programs targeted to eliminate homelessness are protective factors, both for prescription drug abusers and for people with dual diagnoses. Mental illness is another risk factor for SUD, which is dangerous since substance consumption exacerbates mental issues. Having health issues that prescription drugs could treat is another crucial risk factor. Therefore, medical monitoring of homeless people in the Skid Row community can be a protective factor. Programs aimed to improve the living conditions on the streets are important since they help people cope with emotional problems.
Problem Statement
Firstly, there is a problem of homeless people, who become drug addicts due to mild mental illnesses and endanger their mental state severely. They have serious mental issues like schizophrenia, paranoid delusions, PTSD, multiple personalities, anxiety, depression, bipolar disorder, and psychotic episodes. Secondly, there are people among the homeless who start as prescription drug abusers and switch to illegal drugs. Both categories are homeless people who do not receive adequate medical care.
Sustainability
During the field data collection, there will be an opportunity to communicate with community champions and leaders, who could give valuable insights into the community’s medical needs.
Interviews
The field data collection is also a great reason to conduct interviews with community leaders who want to be involved in the implementation of the Strategic Prevention Plan.
Cultural Competence
The gathered data could be further used to identify and address the disparities among the homeless in Skid Row, particularly gender disparities, since 90% of homeless women from this group become victims of physical and sexual violence at least once during staying on the streets (Vasquez & Tu, 2018). Culturally relevant risk and protective factors could also be identified during the field data gathering through direct observations and interviews with community leaders.
Capacity Building
Many programs are helping homeless people in Skid Row. These are the Volunteers of America, Los Angeles Mission, the Union Rescue Mission, Fred Jordan Mission, The Jonah Project, LAMP, Downtown Mental Health, and Downtown Women’s Center. There is Los Angeles Poverty Department, its director on the program helping the homeless through art Henriëtte Brouwers, and its founder John Malpede. Star Apartments provide affordable housing, but such programs are needed much more. Downtown Women’s Center is a non-profit that studies women’s health and well-being in Skid Row. Los Angeles Central Providers Collaborative is a group of Skid Row residents, stakeholders, and advocates who study the needs of the homeless related to physical survival and health, like cleaning the streets and placing the toilets and bathrooms. Department of Public Health and LA’s mayor Eric Garcetti are responsible parties among officials.
A plan to build future capacity will be based on engaging stakeholders and volunteers, including residents and other advocates. This SPP suggests creating an agency that will focus on SUD treatment and counseling among the homeless of Skid Row. The initiative plans to work in coalition with Downtown Women’s Center, Los Angeles Central Providers Collaborative, Downtown Mental Health, and Los Angeles Poverty Department. The initiative will try to mobilize communities and increase awareness and readiness to help the non-homeless residents in the area.
The capacity building should be sustainable, which could be ensured by surveying stakeholders to learn their training needs regarding the consequences of SUD and related issues. The SUD informational training will be provided to engage stakeholders with prevention efforts. Some members of the Skid Row community could be included in planning groups as they can share valuable insights about the community’s needs. The team will use culturally competent tools and technologies for prevention efforts, including developing leaflets in various languages.
Planning
The planning process will precede the SPP implementation; objectives, strategies, short-term outcomes, intermediate outcomes, long-term outcomes, and success indicators will be used for planning. The 6-month plan will be developed to implement the initiative with the help of the mentioned stakeholders. At the moment, the community is ready to receive service. In particular, according to media reports, most drug addicts want to stop but do not know how to do it without medical assistance. Therefore, the needs of people with dual diagnoses and other drug addicts, both taking prescription and illegal drugs, should be addressed urgently.
The first and primary objective will be to decrease the number of medically untreated/unaddressed people with SUD and mental illnesses by zero in 6 months. The strategies will include communication with the community leaders who will reach the community members personally. Then, people with dual diagnoses will receive urgent treatment for SUD and their particular mental illness. After being medically healed, the target group will undergo training in supportive programs named Relapse Prevention, Living in Balance, Mindfulness, Parenting, Healthy Relationships, and Substance Abuse Education. After that, they will get counseling on starting a new life and will receive help with housing. The second objective will be an information prevention campaign targeted at people who are not addicted yet but started to take prescription drugs. The strategy will include spreading leaflets in drugstores when a person will buy the prescription drugs.
The indicator for the first objective will be the number of people who visited the Center, and the indicator for the second objective will be the number of people who received the leaflets. The selected strategies will reduce the risk factors of SUD and homelessness for mentally ill people and drug addicts. Medical monitoring of homeless people and programs aimed to improve the actual living conditions on the streets will be the strategies to strengthen protective factors. During the planning, the disparities between men and women will be addressed by finding housing opportunities for women in the first place.
Implementation
There is a currently implemented program, the Star Apartment, which provides housing but leaves the choice of SUD medical treatment at the discretion of the targeted people. These people should also be addressed by the proposed initiative and invited to the Center. The list of tasks for each objective will be as follows: objective one tasks: 1) Finding a place for the Center and hiring doctors by June 15 (organizational team responsibility) 2) Inviting people to the Center by June 15(organizational team and community leaders) 3) Providing SUD treatment for the target group, which takes 1-2 months by August 15 (medical professionals) 4) Providing the parallel medical and psychological treatment for people with mental illnesses by August 15 (medical professionals) 5) Providing educating training from August 15 to October 15 (psychologists educators) 6) Providing lifestyle counseling and new housing opportunities by November 15 (couches and organizational team).
Sub-contractors – community leaders, medical professionals, psychologists, and couches will be invited to participate in the initiative and will be paid respectable salaries; these people will sign work contracts. Members of target communities, besides the community leaders, will be involved in the implementation process to counsel the medical professionals, organizers, and psychologists regarding the needs of community members. All participants of the initiative will discuss the success of the implementation process at the team round-table meetings. The funding is assumed to be provided by the government. Should the funding reduce or disappear, the initiative is counting on the help of the stakeholders and coalition members. The data about program effectiveness will be collected early in the implementation process through the indicators related to each task.
Evaluation
The team will undertake pre and post-tests with the targeted group to evaluate the success of the initiative. Other methodology tools will be direct observation and key informant interviews (with community leaders). For the lifestyle counseling, knowledge tests will be held. Process outcome evaluation will be ensured by meeting the indicators for every task; the team manager will be responsible for completing the evaluation. The evaluation data will be used to signal the gaps in the program implementation. The community leaders will help to gather data for evaluation and share their direct observations. Health disparities addressing will be evaluated through the related indicators. The effectiveness of prevention efforts will be improved by increasing the feedback opportunities for the targeted group. An evaluation report will be created and disseminated among the community members, workgroups, stakeholders, and coalition members; the report will be presented to officials and the media.
References
The stories of Skid Row heroin addicts. (2017). Web.
Vasquez, A. & Tu, A. (2018). “Surviving Skid Row: Women’s stories of assault, fear, and finding friendship.”Huffpost. Web.
“What is Skid Row? The dark side of drugs as told through the ravaged streets of Los Angeles.” (2018). Rooster. Web.