Search

Purpose People living with opioid use disorder (OUD) disproportionately encounter the criminal justice system. Although incarcerated individuals with OUD face higher risk for withdrawals, relapses and overdoses, most jails fail to offer comprehensive medications for OUD (MOUD), including recovery support services and transition of care to a community provider. The purpose of this paper is to describe the development and implementation of a comprehensive MOUD program at a large county jail system in Maricopa County, Arizona. Design/methodology/approach The authors used the Sequential Intercept Model (SIM) to develop a community-based, multi-organizational program for incarcerated individuals with OUD. The SIM is a mapping process of the criminal justice system and was applied in Maricopa County, Arizona to identify gaps in services and strengthen resources at each key intercept. The program applies an integrated care framework that is person-centered and incorporates medical, behavioral and social services to improve population health. Findings Stakeholders worked collaboratively to develop a multi-point program for incarcerated individuals with OUD that includes an integrated care service with brief screening, MOUD and treatment; a residential treatment program; peer support; community provider referrals; and a court diversion program. Recovery support specialists provide education, support and care coordination between correctional and community health services. Originality/value OUD is a common problem in many correctional health centers. However, many jails do not provide a comprehensive approach to connect incarcerated individuals with OUD treatment. The Maricopa County, Arizona jail system opioid treatment program is unique because of the ongoing support from recovery support specialists during and after incarceration.

Purpose People of color often face challenges in accessing equitable healthcare. Disparities in healthcare pose very real moral and ethical social justice dilemmas for society, and prevent efforts to improve the nation's health and manage escalating healthcare costs. A diverse healthcare workforce is necessary as a means to help care for an increasingly diverse patient population. Method This paper focuses on programmatic and research information that is a collaborative effort between a number of researchers and educators in schools of medicine and allied healthcare. The paper looks at the current state of racial and ethnic diversity in the health professions and describes the social justice implications of a representative healthcare workforce. Using a “pipeline to practice” model, the authors will present information spanning the pipeline from encouraging high school students of color to enter the allied healthcare professions to introducing undergraduate and graduate students in health professions program to responsive policy making and cross-cultural communication. The authors reviewed the research literature across multiple institutions and professional health programs, and include illustrative case studies. Results The authors found that overall, the healthcare workforce is becoming more diverse however, with the majority of people of color in healthcare jobs remaining in entry-level and often lower paying jobs. The need to increase the diversity of the healthcare workforce in all fields of allied health is a continuing need. The most promising practices tended to be comprehensive programs that include a combination of social support, academic support, and financial support. Discussion This information has great significance for health professions education programs as they strive to diversify their student populations, retain students of color, and provide culturally responsive education and training. This interdisciplinary collaborative perspective illustrates what can be learned from varied health professional programs as well as making new connections across often disconnected practice settings.

Purpose Inadequate networks can prevent patients from being able to see the providers that they trust and depend upon, especially for children insured through Medicaid. To improve our understanding of poor oral health care outcomes, we conducted a test of network adequacy among Medicaid pediatric dental providers in Arizona through a “secret shopper” phone survey. Methods This study tested multiple components of children's access to oral health care, including reliability of provider directory information, appointment availability at the practice level for children covered under Medicaid versus commercial insurance, and compliance with regulatory standards. We contacted individual providers, following a standardized script to schedule a routine appointment on behalf of a 5-year-old patient enrolled in either a Medicaid or commercial plan. We documented the time until the next available appointment, if the practice was reached, and if the practice accepted the specified insurance plan. Results We identified, catalogued, and attempted to call a total of 185 unique practices across Arizona. In four counties, we were unable to identify a single pediatric oral health provider through health plan directories. We observed minimal differences in appointment wait times between callers with commercial insurance and those insured through Medicaid. Conclusions Our findings underscore the need to improve the accessibility of pediatric health services, especially in rural regions. Facilitating access to routine and recommended oral health screenings for children enrolled in Medicaid is imperative to appropriate stewardship and fulfilling our commitment to provide this vital public health resource.

Despite spending more on health care than any other country, the United States has the worst maternal mortality rate among all developed nations. African American and American Indian/Alaskan Native women have the worst outcomes by race, representing a stark health disparity within the country. Contributing factors disproportionately experienced by these minority populations include challenges of access to consistent and high-quality prenatal care, prevalence of underlying conditions, toxic stress due to systemic racism, and unconscious bias in health care. While many of these factors lie upstream in the lives of women, and seemingly beyond the scope of the clinical walls, the downstream health care delivery system can serve as a vital part of the solution via innovative practices, community-based collaborations, and by serving as advocates for the communities served. Such alignments between clinicians, community leaders, policymakers, and patients that extend beyond the health system can serve as the missing piece needed within the clinic to reverse the trajectory of maternal mortality for American women, especially those from traditionally underserved populations.