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HUB_mv: an evidence-based non-police led MH/SUD diversion program in rural MA

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HUB_mv: an evidence-based non-police led MH/SUD diversion program in rural MA

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Content HUB_mv:
An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA
Capstone Project Proposal
Brian L. Morris
University of Southern California
Suzanne Dworak-Peck School of Social Work
DSW Program
Professor Loc Nguyen
May 2024

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 2
Table of Contents
I. Abstract...................................................................................................................................3
III. Positionality Statement ........................................................................................................4
IV. Problem of Practice and Literature Review .........................................................................5
V. Conceptual/Theoretical Framework ....................................................................................10
VI. Methodology......................................................................................................................14
VII. Project Description...........................................................................................................20
VIII. Implementation Plan .......................................................................................................25
IX. Conclusions and Implications............................................................................................31
References................................................................................................................................35

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 3
I. Abstract
Certain populations are disempowered by a systemic bias against them. As
opioid overdose death rates spike at unprecedented levels, marginalized people of color are
not only dying at higher-than-usual rates (Panchal, 2023), but also have trouble gaining
access to optimal detox and rehab treatment centers and recovery protocols (Saloner & Cook,
2013). While several police-led diversion programs have succeeded in both locating at-risk
drug misusers and getting them into treatment, not all are effective in reaching across
all aisles to serve disadvantaged populations of color with either an addiction or a mental
health issue. This paper first looks at the wicked problem of Substance Use Disorder (SUD)
as it currently exists in 2024 and the people it impacts most heavily; then, it explores some
novel and innovative ways in which some very proactive agencies have drawn upon drug
treatment and rehabilitative best practices to formulate both policies and measures seeking to
give those beset by SUDs and the mental health issues oftentimes occurring concurrently
with drug misuse a fighting chance; and lastly, it highlights the efforts of the game changing
the HUB_mv model to both identify at-elevated-risk drug users in a rural outpost community,
and the disruptive ways and means to treat them both in the trenches and across several
agency sectors in fair and equitable ways with regard to Martha’s Vineyard’s diverse ethnic
culture. Feedback loops, robust data, Social Determinants of Health (SDoH), and impact
assessments of the HUB_mv model demonstrate its success by breaking down institutional
silos between human service agencies and thereby improving access to services for Black,
Indigenous, and People of Color (BIPOC) and other disadvantaged populations deemed “at
elevated risk” or “already in-crisis." Early indications (40 out of 44 “situations” successfully

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 4
resolved) are that the HUB_mv is connecting imperiled Island populations to health and
social welfare agencies heretofore unknown to our target population.
II. Acknowledgments
This work is dedicated to my higher power whom I choose to call Tim, my older
brother who died from alcoholism in 2000 at the age of 47. May his guiding light continue to
shine onto my darkest places.
III. Positionality Statement
I started out as recycled stardust and have evolved over time into the secular humanist
I am today. I don't believe God exists, but I do believe that you believe; and ask only to
respect that others might not. I am an active and grateful member of the Martha’s Vineyard
recovery community. I am also a recipient of a Masters in Rehabilitation Counseling from
UMass Boston’s School of Global Inclusion & Social Development; previously, I earned my
BA in Sociology from Princeton University. Before coming to Island Health Care, I was the
supervisor of the Recovery Coach program at Martha’s Vineyard Community Services. Here
at IHC, I advocate for those disenfranchised Island populations with substance use disorders
and/or mental health issues, and I believe that stigma kills. I am also a Certified Peer
Recovery Coach, a Community Health Worker, and was awarded a Martha’s Vineyard Vision
Fellowship in both 2016 and 2019. At present, I am working on my doctoral degree (DSW) at
USC’s Suzanne Dworak-Peck School of Social Work. I play lead guitar and man a very hot
mic for a fringe Black Norwegian Death Metal band. As an older, straight, white, male, I
understand that I carry with me centuries of implicit white bias; and see fit to monitor my
north star with the latest, most multiculturally sensitive components of DEIJ best practices.
As someone who flatlined in 2012, I treat every day as a gift and as my last. I am deeply
embedded in the underserved community the HUB_mv intervention is designed to serve. I

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 5
am Brian Morris. And, as immodest as this may sound, I think my initiative would flounder if
not for my own path of redemption, my skills as a Recovery Coach, my ongoing practice as a
Rehabilitation Counselor, and my expanding knowledge field as a DSW candidate at USC.
IV. Problem of Practice and Literature Review
Martha’s Vineyard has a year-round population of 22,000 individuals, all of whom are
within my purview as not only the Executive Director and meeting facilitator of HUB_mv,
but also as a Rehabilitation Counselor at Island Health Care: the Vineyard’s only Federally
Qualified Community Health Center (FQCHC). As well, I am openly and proudly a member
of the Island’s vibrant recovery community as a card-carrying member of both Alcoholics
Anonymous and Narcotics Anonymous, giving me toeholds in the area’s best support groups.
Lastly, I have further access to our targeted population by serving on the Board of Directors
at the Red House, a new and thriving Recovery Support Center situated on our hospital’s
grounds.
My work focuses on certain marginalized populations who are disempowered by a
pernicious alienation against them, and the fact that racial disparities do currently exist in
how we treat those with a Substance Use Disorder. A better understanding of why certain
ethnic groups face barriers to life-saving addiction treatment can address this huge
demographic disparity and public health crisis (Harvard School of Public Health, 2023).
Opioid use and opioid overdose fatalities continue to rise among racial/ethnic minorities.
With the SDoH negatively impacting these poorer communities, unacceptable treatment
outcomes are sadly the norm “more research is needed to further study how to combat the
disempowering impact of poor SDoH determinants on access to treatment, retention,
recidivism, and drug misuse incidence among racial/ethnic minorities” (Burlew et al., 2021,
p.3). With synthetic opioids and marijuana products now sprinkled with fentanyl flooding a

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 6
black market which makes them more readily available—even via online sales to teenagers—
the struggle to find effective and multiculturally mindful treatments with positive health
outcomes for BIPOC populations remain difficult to realize.
The preponderance of available evidence indicates that systemic racism has
deleteriously impacted health outcomes across all touch points (Suntai et al., 2020) and has
caused minority groups to be systemically and repeatedly denied access to SUD treatment
(Yale School of Medicine, 2021). Data will show that African Americans and Hispanics face
more obstacles to accessing treatment services, lower completion rates, and lesser satisfaction
with care as compared to Whites (Mennis et al., 2016). If we are to attentively and
responsibly address these inequities in treatment, we must identify how economic, physical
and sociopolitical forces impact life-and-death medical decisions (Yale School of Medicine,
2021) and meet them head-on with multi-disciplinary team and community-based
interventions that are more multiculturally mindful.
According to the Diagnostic & Statistical Manual of Mental Disorders (DSM-V), the
“essential feature of substance use disorder is a cluster of cognitive, behavioral, and
physiological symptoms indicating that the individual continues to use the substance despite
significant substance-related problems” (American Psychiatric Association, 2013, p. 483). A
lone deficit unique to substance use disorder is the continued use of a substance despite the
knowledge of its deleterious effect on physical, psychological or emotional help. The specific
level of SUD severity is positionally related to a spectrum wherein: mild equals the presence
of two to three symptoms; moderate equals the presence of four to five symptoms, and,
severe equals the presence of six or more symptoms. The two leading predictors of substance
use disorder are genetics and trauma, and the existence of co-occurring factors (e.g. domestic
violence, prostitution, felony, trafficking, HIV/AIDS) and co-morbid conditions (e.g. self-

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 7
injurious behavior, suicide threat, cognitive decay) is not uncommon across the manifestation
of the disease in one’s life story. For most substances, use increases with age and the ethnic
breakdown is evident: Native American youth is the highest, Hispanic white and nonHispanic white youth is within the realm of medium, while Asian American and African
American youth have the lowest rates of use (Sigelman, 2015).
The stigmatization of alcohol and drug abuse imposed by a systemically racist society
can cause an insurmountably uphill battle against recovery. Yet long-held beliefs that
addiction is a character flaw or sign of weakness in a person are starting to erode. Now that
the medical profession sees SUD as a fatal disease that must be treated as such, there is hope.
Patient-centered care for the treatment of opioid and alcohol abuse hinges on new modalities
like harm reduction and the multiple pathways to recovery as espoused by Radical Recovery
guru, William White. Reducing the discrimination of a stigmatizing addiction starts with
psycho-education, prevention, and tolerance. Those with SUD must be open to help but
should not fear recrimination by asking for it. An overhaul of cultural factors must take place,
especially those norms causing African Americans to harbor deep-seated distrust of our
healthcare system, and the need to de-stigmatize addiction (Suntai et al., 2020).
While problematic in and of itself, the disease for which there is no known cure
becomes exponentially more untreatable when one factors in the indifference towards treating
the addict or alcoholic on the kind of empathic and mindful terms that will benefit them
regardless of race. That society may not yet understand fully the populations they are
addressing because addiction is both a deadly medical condition and a disease can be
forgiven; that certain skin colors are more ignored in the treatment of this disease cannot.
Furthermore, stigma hurts. The person of color suffering from a SUD faces uphill battles of
acceptance every step of the way. Disenfranchised populations suffering from a substance use

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 8
disorder and the potentially debilitating effects of a co-occurring mental health or cognitive
condition deserve a level playing field upon which to seek and complete treatment.
Even if accepted into the myriad treatment facilities dotting our national landscape,
evidence supports that people of color fare less well in completing programs. Differences in
completion rates for Blacks and Hispanics were due in large part to disparities in
socioeconomic status, generally speaking; and more specifically, higher unemployment and
housing insecurity (Saloner & Cook, 2013). Suboptimal insurance plans available to our
marginalized populations also factor into the long odds they are up against when seeking
quality addictions healthcare. Unsurprisingly, marginalized populations of color who are
incarcerated, homeless, and suffering from a mental illness have markedly higher rates of
overdose death (S. Wakeman, personal communication, September 22, 2020).
The HUB_mv non-police-led diversion program focuses on treatment / not
punishment and effectively locates individuals at-risk and tees them up for rehabilitation
across a myriad of determinants in a timely fashion to avert a crisis before it happens. The
HUB_mv facilitates collaborative meetings with community partners to identify individuals
or families that meet the criteria for Acutely Elevated Risk (AER) across multiple service
areas, to provide linkages to services grounded in the Martha’s Vineyard community, to
reduce and prevent the risk of harm. It does all of these things through a lens of kindness,
integrity, and multicultural awareness. And it does so to the great relief of many in a rural
hotspot where isolation can rear its head in ways that are harmful to the populations suffering
the most.
The struggle is real. So must the solution be. When more people are dying of fatal
drug overdoses that gun violence and car crashes combined (Rabin, 2021)? Our nation must
do more than just say no to a disease for which there is no known cure and we as a people

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 9
must stop stigmatizing alcoholism and drug addiction in ways that impede safe and equitable
access to the multiple pathways to recovery.
To adequately address the Grand Challenge to achieve equal opportunity and justice
is to first acknowledge that the problem is wicked enough to warrant change; and then, to
implement innovative strategies customized to fix it (Morris, 2023). Discrimination, systemic
biases, and issues of marginalization have long impacted society in ways that are harmfully
imposed. “The systematic denial of opportunity and equal access to basic resources, such as
quality health care and education, results in a range of unjust outcomes that marginalize
entire segments of the population” (Fong et al., 2018, p. 248). It is the purpose of this
capstone to comprehensively provide a research-informed overview of the ways in which
tackling the grand challenge to achieve equal opportunity and justice will hopefully provide
the impetus for positive social change in a society that both needs it and needs to do better at
providing a more equitable landscape of growth for all.
There is nothing equitable about the way healthcare services make themselves
accessible to our Black, Indigenous, and People of Color (BIPOC) populations who may be
further marginalized by substance use disorders and the oftentimes co-occurring mental
health issues that go hand-in-hand with addiction. “Treatment for Substance Use Disorder is
less available for Black, Latinx, and Indigenous people than it is for White people”
(Farahmand et al., 2020, p. 494). In the broader sense, the health outcomes of BIPOC
populations are impacted by “a historical mistrust of government agencies or medical care
providers” (Acevedo et al., 2012, p. 1); and, as it relates to addiction rehabilitation treatment
protocols, “results show that African Americans and Hispanics are less likely to complete a
treatment episode than Whites” (Mennis et al., 2016, p. 158).

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 10
The grand challenge to achieve equal opportunity and justice must by nature include
all segments of the population being served, not just those genetically predisposed to better
health outcomes vis a vis SUD issues and the prompt, top-drawer treatment of those
preemptive conditions. Whereas in most communities police and EMS are the only options to
pre-hospital mental health crisis response, groups such as Crisis Assistance Helping Out On
The Streets (CAHOOTS), Law Enforcement Against Drugs (LEAD), and HUB_mv see this
underdeveloped area as a room for epic growth opportunities in real-time over the next few
years. And while sending clinicians with masters degrees on calls with first responders, the
scope of their purview is limited. The supply of masters-level clinicians is not enough to meet
the demand, but does it need to? (Climer & Gicker, 2021). A well-calibrated and cohesive
team of qualified healthcare professionals and lay people as espoused by models like
HUB_mv has proven efficacious in its first six months in connecting at-risk individuals to
resources heretofore unknown to them, and shows no favorites racially in the process. All are
treated as equal. As well, early returns on LEAD have stressed the value of functional
collaboration among agencies, buy-ins from law enforcement, and the availability of services
for the target demographic (Office for Justice Programs, 2022). It is suggested that more
research is needed to track the efficacy of diversion programs (both with and without police
involvement) and their impact on individuals with co-occurring mental health and substance
use disorders.
V. Conceptual/Theoretical Framework
Critical race theory is a cross-disciplinary examination of how laws and sociological
phenomena are held in place — in the case of implicit White bias, for over 400 years — by
legal structures and the dissemination of power through the lens of institutional racism
(Morris, 2023). Having equal access to quality treatment measures is of paramount

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 11
importance for those with a SUD given that minorities suffer more egregious consequences
from a substance use disorder than Whites, including higher incarceration rates and jail time,
higher alcohol-related deaths, and higher drug overdose mortalities (Acevedo et al., 2020).
Racism is deeply embedded in our nation’s DNA. Through the lens of solutions such as
critical race theory, reparations can help us to commence on a road to recovery.
The set of strategic interventions at the core of HUB_mv is a best practices
integration of multiple healthcare, spiritual organizations, and social service work sectors
(e.g., food pantries, warming shelters, recovery support centers, etc.) working assiduously
together to identify at-risk members of the community and help them in whatever way is
deemed necessary without regard to race, gender, insurance (or lack thereof), or overall
presentation. That there is no such service of its kind currently in place on Martha’s Vineyard
presupposes that the implementation of this intervention is cause for celebratory change in
and of itself (Morris, 2023).
The specific objectives of the HUB_mv intervention are: 1) to build a sustainable
infrastructure for the group’s consortium, which supports an integrated and person-centered
prevention, treatment and recovery support system among Island resources; 2) to implement a
plan of accessible and sustainable services that prevent, treat, and support recovery from the
harms of use, dependence, and overdoses associated with opioids and related substances; 3)
to execute a comprehensive workforce plan that identifies gaps and mines for increased
efficiencies in human service delivery; 4) incorporates tele-health, and multiple pathways of
recovery; 4) build a recovery-oriented system of care (ROSC) that is both responsive,
sensitive to the component of race in rehab treatment admissions practices, and, 5) relies on a
robust data bank and intermediate measures to follow trends in on-Island rehab protocols,

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 12
and, 6) is readily accessible to Islanders in-need, especially those for whom English is not a
native language (Morris, 2023).
A sine qua non element of the HUB_mv model’s efficacy is that all of its members
know how it works. Given that there is a multidisciplinary team (MDT) element to the
proceedings here, all participating individuals and agencies must be working from the same
playbook. Hence, the HUB_mv training module. The approach shares tenets of both
integrated and ecosystem brands of design thinking in equal measures. The training module is
earmarked by a solid understanding of causation, but needs to foster collaboration among
myriad agencies and participants to increase control over outcomes (Ebrahim, 2019). But
further checks and balances are necessary for the HUB_mv intervention to perform optimally
and it does so by managing the many moving parts of its ecosystem in a fashion that produces
results no single actor could manage alone (Ebrahim, 2019), as illustrated in the HUB_mv
Logic Model (See Appendix A).
Furthermore, that the optic of “the police” operating in a predominantly White rural
resort island setting is simply in need of reparations should come as no surprise. And to
change our police culture, repurposed officer training is necessary. Law enforcement buy-ins
of the HUB_mv model are critical to its ongoing success. Mental health and substance misuse
deflection programs operate at their best when all of their constituents are trained on the order
of the epidemiology of SUD and recovery pathways, how to identify substance misuse, the
pernicious origins of stigma related to SUDs, treatment protocols and continuums of care,
Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), and Screening Brief
Intervention and Referral to Treatment (SBIRT) best practices (Reichert et al., 2017). While
police-led deflection programs have grown exponentially in America over the past decade to

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 13
an estimated 850 known sites, research has not kept pace with the growing field. As for nonpolice-led diversion of the type HUB_mv has to offer? Data being accrued is happening for
the first time in real-time. Which is why we have to get it right. Family Systems theory
imbued with the knowledge that a Critical Race theory must by nature adjust the lens through
which amendments are made in the battlefield of our nation’s current drug crisis.
Only has to be alive and have a pulse to notice the impact of addiction on a diverse
population such as the Island’s SUD population. What goes around comes around. Fentanyl,
Xylazine, synthetic cannabis….you name it. Martha’s Vineyard is not immune to any of these
“flavor of the month” trends in substance misuse. And of course alcohol remains public
enemy number one (Morris, 2023). And yet, flying in the face of these disturbing trends is the
undeniable trend that medication-assisted treatment (MAT) for addiction disorders is
terminated more quickly for Black and Hispanic patients, and that scrupulous analysis of 15
years of prescription data show that these racial disparities are widening owing to an array of
contributory factors such as a patient’s inconsistent employment record, inferior insurance
policies, and language barriers. (Baumgaertner, 2022). Again, an oppressive policy of
systemic racism is being held in place by the normalization of inequitable healthcare
treatment of our marginalized populations. Methods to both recognize and address these
issues must include the information gathered by a carefully chosen cross section of the Island
population who have a vested interest in improvements to our public health sector,
particularly those for whom skin color puts them at a disadvantage.
Critical design thinking processes are quick to prescribe the wicked problem, but
oftentimes come up short when speedily implementing a solution to it. Systemic racism, let’s
not forget, has been around for four hundred years and it won’t go away overnight (Morris,

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 14
2023). In my exhaustive approach to gauging local MH / SUD views, policies, and practices
on Martha’s Vineyard, a series of interviews, focus groups, and feedback to a documentary
film reveals several ingredients to the problem and hints at how best to address it. What each
tool relied on was actively listening to the answers of Vineyard residents invested in the
outcome to a problem which increasingly we all here know is growing. From this purview, a
documentary movie on Island SUD which laces together a series of moody stories of
redemption may do little to increase awareness to the insidious nature of the disease itself.
Conversely, open and frank discussions with concerned and involved citizens by far and
away more thoroughly engender serious suggestions as to positive outcomes, particularly
when participants are actively listening for qualitative answers.
VI. Methodology
Locally, the barriers to effective treatment platforms exist primarily in the Portuguesespeaking Brazilian community; nationally, the problem pervades every BIPOC community
imaginable. Currently, HUB_mv has established firm roots in the Martha’s Vineyard primary
and behavioral health landscape. Its expected objectives are already being realized: 1)
HUB_mv provides quicker access to MH/SUD and SDOH services; 2) HUB_mv is easily
accessible and thereby reduces barriers to real-time deployment; 3) Data collection and
analysis has allowed HUB_mv membership to better understand the risk factors that
“situations” face; 4) The structured collaboration of the model improves communication
between social service agencies; 5) Stakeholder analysis allows HUB_mv to recognize
inefficiencies and lobby for their change, and, 6) Baseline trends and “customer” satisfaction
metrics via surveys and feedback loops illustrated in the model’s Design Criteria (See
Appendix B).
In a Black Lives Matter (BLM) world, the HUB_mv model by design relies less on

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 15
law enforcement: only one police person who appears at each meeting in plain clothes and
reaches out as part of a team in an unmarked car. A larger police presence as espoused by
LEAD and CAHOOTS models is a less flattering optic than those with a leadership and
advisory board comprised of Island stakeholders not so top-heavy with a complex and
potentially frightening cop hierarchy sitting around our “table.” HUB_mv answers to its peer
constituents, and not some Board of Directors too far removed from the barriers to treatment
themselves. With opioid-induced death rates among minority groups so precipitously on the
rise in 2023, meeting the double-barrel onus of not only an overdose epidemic but also the
racial disparities in addiction treatment will necessitate an intervention model that engages
with marginalized populations and the clinicians at their service (Harvard School of Public
Health, 2023).
Despite widespread interest in adoption, there has been limited systematic
examination of LEAD implementation, a model for police-led arrest diversion for those with
substance use disorders SUD. In a study conducted in the fall of 2017, the City of New
Haven started a LEAD which had difficulty gaining traction in the recovery community.
Barriers to implementation of intervention models to date include the complex nature of
arrest diversion, the stigma of SUDs, and a preconception of police brutality in any
interaction with law enforcement that borders on a pre-traumatic stress disorder (Joudrey et
al., 2021). And with the notion of “walking back” the decriminalization of all drugs in
Oregon already in play, the CAHOOTS model must by necessity recalibrate its focus to keep
up with the changing times and may be hard-pressed to do so, particularly if steered by law
enforcement.
That deaths owing to a substance use disorder are on the rise is undeniable. That
strategic deployment of an all-hands-on-deck movement can help—by looking at addiction as

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 16
if it were a natural disaster—is plain and simply put, the right thing to do. This past year for
the first time, more than 100,000 Americans lost their lives to an opiate overdose (NIH,
2022). That’s more deaths than gun violence and car crashes combined during the same
period (Rabin, 2021). Medication Assisted Treatment (MAT) has increasingly become a
lifesaver to many battling the throes of addiction, but how it is disseminated to Americans
cuts deeply along racial lines. And, the data supports the disturbing trend our BIPOC
populations are discriminated against in boldly racist ways when it comes to accessing to
adequate detox and rehab protocols and facilities.
Although much of the literature identifies substance use disorders as America’s
number one health hazard, the data reveals enormous gaps in treatment that are racially
divided. In 2018, only 18% of people identified as needing treatment actually received it.
These disparities are greater for minority communities. For Black and Latinx groups in the
US, only 10% and 8%, respectively, diagnosed with a SUD received addiction treatment
(Yale School of Medicine, 2021), while Black clients were less likely to initiate treatment
than White clients (Acevedo et al., 2012). “Economic, cultural, accessibility, or, potentially,
discriminatory and stigmatizing factors may negatively impact the likelihood of treatment
program completion for minorities” (Mennis et al., 2019, p. 158) or, earlier dismissal from a
treatment program owing to suboptimal insurance plans.
When it comes to recovery—and not dissimilar to everything else—people of color
are being underserved. All is not fair with regard to the ways in which America allocates to
its neediest along the lines of the SDoH, too. SUDs often exist co-morbidly with a MH issue.
That addicts and alcoholics are unfairly stigmatized is undeniable. Making matters
exponentially worse is the increasing body of empirical evidence citing unfair access to and
completion of MH/SUD treatment regimens for people of color. By eliminating the systemic

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 17
racism often inherent in the ways Blacks, Native Americans and Hispanics receive medical
and therapeutic substance abuse treatment protocols, achieving equal opportunity in terms of
Alcohol and Other Drug (AOD) addiction recovery reform is then possible.
History reveals embedded and longstanding trends of racial bias and discrimination
around drug use in this country. Currently, a hot button topic is the determination of who is a
criminal and who is patient that plays out across multiple societal and medical touch-points in
America (Hulsey, 2022). Even today, racial disparities do currently exist in the healthcare
arena of SUD treatment. There is widespread suffering and even death caused by the lack of
pain treatment. There is also the potential to stigmatize further racial minorities who may
misuse opioids and other drugs. But more than any other mitigating factor at work is the
perpetuation of America’s history and the parts blatant discrimination and subtle racism play
in it (Whelan, 2020). There is nothing “equal” about the opportunities being afforded to
people of color seeking treatment for a substance use disorder.
Equally indisputable is the notion that not all addicts are “created equal.” We owe it to
all those affected by this pernicious malady to tap into solution-based recovery protocols in
equitable ways that might level the playing field for the addict of color who simply wants to
get clean; and for the racially disenfranchised alcoholic who wants to put the bottle down for
good (Morris, 2021). A lasting and impactful recovery arc should not be denied to anyone
who seeks it, regardless of their socioeconomic status or ethnicity. Even if accepted into the
myriad treatment facilities dotting our national landscape, evidence supports that people of
color fare less well in completing treatment. “Completion disparities for Blacks and
Hispanics were largely explained by differences in socioeconomic status and, in particular,
greater unemployment and housing instability” (Saloner & Lê Cook, 2013, p.158).
Inadequate insurance plans available to our marginalized populations also factor into the long

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 18
odds they are up against when seeking quality addictions healthcare. Unsurprisingly,
marginalized populations of color “who are incarcerated, homeless, and suffering from a
mental illness have markedly higher rates of overdose death” (S. Wakeman, personal
communication, September 22, 2020).
Opioid use and opioid overdose fatalities continue to rise among racial/ethnic
minorities. With the SDoH negatively impacting these poorer communities, unacceptable
treatment outcomes are sadly the norm. “Research is needed to investigate how to overcome
the disproportionate and deleterious impact of social determinants of health on treatment
entry, retention, drug use, and related outcomes among racial/ethnic minorities” (Burlew et
al., 2021, p. 2). And at a time when the CDC reports that overdoses are precipitously spiking
as a result of the increasing spread of illicitly manufactured Fentanyls (IMFs) in the drug
market, the struggle on the street is even more “real.”
That the national AOD epidemic has reached heretofore unseen levels is troubling.
SUD is a chronic and progressive disease for which there is no known cure. Its deeply
entrenched root causes are founded upon compulsive behavior; its ramifications are
farreaching, and its successful outcomes in terms of treatment wear many hats and assume
myriad guises (Morris, 2021). Based on the notion of “fair play” for all, emerging
interventions and treatment plans that properly address how the SUD syndrome manifests
across one’s everyday existence and the part race plays in impacting the normative lifespan of
those living with it are what reform needs to do moving forward.
Institutional and agency policies founded upon systemic bias do little to assuage the
fears of a BIPOC population who feel unease with entering SUD treatment protocols which
further stigmatize the Black or Brown addict or alcoholic. The preponderance of the literature
points to a SUD healthcare workforce that is grossly lacking in terms of cultural competency.

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 19
This adversarial condition results in negative health and wellness results and highlights “the
acute need for multi-culturally-sensitive treatment protocols to bolster treatment program
retention and beneficial post-release outcomes (Mennis et al., 2016). Best practices in SUD
treatment point to the need for services to be distributed more equitably among racial groups
and in ways that are more culturally attuned to the systemically embedded multigenerational
deficits of punitive treatment factors (Farahmand et al., 2020) that drive harmful and
deleterious health outcomes and rates of SUD remission (Recovery Research Institute, 2022).
Sadly, so much of what is egregiously wrong in the way our society treats its
members beset by AOD issues has been ingrained into our national DNA for hundreds of
years. Critical Race Theory goes a long way toward parsing this condition by explaining that
the notion of race is not an organic feature of being brown or black, but is rather a social
construct that is used to discriminate against people of color” (Critical Race Theory, 2023).
That systemic racism is inherent both in the laws and in our legal institutions of the United
States cannot be denied; that it so profoundly impacts our BIPOC and other disadvantaged
populations is equally implausible in terms of the access denied to drug misusers who do not
happen to be white. On a micro-level, my interviews with resident healthcare and civil rights
activists reveal that our people of color are slighted, first, by being stigmatized for being
black and, secondly, are further alienated by having an addiction issue.
HUB_mv is diligent in its pursuit of community-led responses to the Island’s
marginalized populations for whom access to medical and social services is not optimal
(Read The Principles, n.d.). The specific criteria at the core of HUB_mv’s successful
implementation have to do with beneficence, timeliness, multicultural awareness, data
mining, and resource brokering (Design and Design Criteria, n.d.). The HUB_mv humancentered design is a risk- and solution-based problem-solving process that puts at-risk

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 20
humans at the center of its collaborative intervention process. By clarifying a particular
situation’s unique needs, the protocols in place allow for creative ideation in finding the
perfect partners to structure a wellness plan best suited for success. In turn, the services
developed on behalf of clients (e.g. detox, access to insurance, food pantry meals, affordable
housing, etc.) are implemented in non-intrusive ways with the “patient” at the center of the
model (What is Human-Centered Design, n.d.).
VII. Project Description
While the LEAD & CAHOOTS programs have shown promise in some communities,
each is led by law enforcement which presents its own problems both optically and
logistically. Life in a post-George Floyd world ought not to lean too heavily on police in
initiatives designed to help marginalized segments of the population still licking their wounds
from recent police violence against them and populations of color having been subjected to
400 years of systemic racism. It is, for these reasons, that existing police-led diversion
programs are limited in the scope of their purview and effectiveness.
This is why the HUB_mv model includes but doesn’t rely on law enforcement to
execute its program design. Rather, HUB_mv is an island-wide consortium of health and
human service providers who share information and establish rapid interventions designed to
mitigate risks associated with marginalized individuals and to address their clinical, medical,
behavioral, and social needs. In so doing, it is expected to elicit the following outcomes: 1)
Increased and quicker access to services; Improved communication among agencies; 2)
Reduced barriers to support from human service agencies; 3) Identified gaps and increased
efficiencies in human service delivery; 4) Improved client service provider relations, and, 5)
Has a better understanding of the risk factors affecting HUB subjects. All of which speak to
the model’s very fluid Theory of Change (See Appendix C).

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 21
People from racial and ethnic minority subsets have for hundreds of years
experienced disproportionately negative health outcomes resulting from long-standing and
universal biases. From George Floyd to the recent social unrest across myriad platforms,
Black Americans have been at “the epicenter of colliding epidemics, pandemics, and mental
health stressors” (Hulsey, 2022, p. 21). Diversity Equity & Inclusion (DEI) measures now
mandate both elevating equity and activating diversity in ways heretofore unknown in our
national healthcare landscape.
By way of illustration, and boiled down to its most basic numbers, an analysis of the
pernicious national problem reveals the following: 1) The percent of our prison population
identifying as BIPOC: 85% (US Department of Health and Human Services, 2022); 2) The
percent of the Black prison population with a diagnosed SUD: 60% (Rowell-Cunsolo et al.,
2022, p. 234); and, 3) the percent of the prison population who are Black: 38% vs. Percent of
the U.S. population who are Black: 13% (Prison Policy Initiative, 2022). These stunningly
disproportionate figures reveal the discriminatory nature of how America misdiagnoses and
treats its problem with people of color who, through no fault of their own, may be suffering
from a disease for which there is no known cure and get in trouble with the law because of it.
Having an SUD is stigmatizing enough; having one intersected by being black at the same
time is doubly troublesome.
My early “opposition research” into the myriad ways in which communities are
tackling their SUD and SDoH issues revealed that most diversion programs for those with an
addiction disorder usually involve the inclusion of law enforcement and the police in the
implementation of the processes whereby harm against individuals is mitigated by various
means. When first formed in Eugene, Oregon, CAHOOTS was designed as a hybrid service
model serving noncriminal, nonemergency police and medical calls, as well as other requests

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 22
for service that are more SDoH and SUD in nature (Climer & Gicker, 2021). Decidedly
grounded in the community policing principle of community partnerships, defendants who
are either first-time (93 percent) or juvenile (91 percent) were the demographic factors most
often cited as driving the diversion program (Tallon et al., 2018). The health and human
services most called upon were substance misuse treatment, substance use psycho-education,
and mental health treatment (Tallon et al., 2018). But with BIPOC distrust of police services
understandably at an all-time high, CAHOOTS has sometimes struggled to take hold.
Seattle’s LEAD model encompasses multiple components to achieve its intended
goals. It is able to be customized to accommodate a particular community’s needs but at its
core are several universal components: collaboration among stakeholders, a diversion model
based on officer discretion, and wraparound case management services steeped in harm
reduction to assess a client’s needs (Office of Justice Programs, 2022). Another key
component in LEAD is the use of police officer discretion to divert individuals who have
committed a minor offense away from the criminal justice system. Using its harm reduction
approach and reliance on case managers to pick up where law enforcement agencies lead off
has been relatively successful, though complete buy-in from multiple stakeholders—and a
BIPOC population at large—has not been universal (Office of Justice Programs, 2022).
HUB_mv low- and high-fidelity prototypes reveal, on the one hand: an intricate
balance between multiple agencies acting for a common goal; and on the other, a training
module that assures integrity to the intervention model. The HUB_mv model is fully HIPAAcompliant and, relative to its situations, shares the least amount of information with the
fewest amount of parties for the shortest amount of time. Its adherence to the best practices of
informed consent, harm reduction, cultural sensitivity, and conflicts of interest processes
make it a nonpareil paradigm of compliance training best practices (See Appendix D).

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 23
One such model of SUD treatment favored by stakeholders Island-wide is a treatment
which effectively engages those with addiction and mental health issues regardless of color is
the evidence-based program known as cognitive behavioral therapy (CBT). As such, it, too,
successfully diverts individuals from further involvement with law enforcement and does so
without the police being the drivers of its “value-added” based practice.
As an adjunct to traditional one-on-one therapy, the purpose of group CBT sessions is
to foster the development of an awareness as to what anchors one’s recovery path. And the
nonpareil CBT Matrix Model consistently provides accountability to the integrity and fidelity
of its evidence-based program (SAMHSA, 2022). By stressing that accountability to one’s
own issues is the key to strength and dependability, CBT as a program might be a prudent
addition to any program’s solution the the wicked problem of substance use disorder
treatment and its pervasiveness in BIPOC populations. CBT is, in fact, the undisputed
champion of the psychotherapy field and, as such, is effective in its equitable implementation
across multiple populations (David et al., 2018).
Critical race theory is a cross-disciplinary examination – by social and civil-rights
scholars and activists – of how laws, social and political movements, and media shape, and
are shaped by, social conceptions of race and ethnicity. Equal access to quality treatment
protocols is of primary importance for those with substance use disorders since marginalized
ethnic minorities suffer more severe consequences from substance misuse than Whites,
including higher and longer rates of incarceration, increased alcohol use disorder, and higher
drug overdose fatalities (Acevedo et al., 2020). Racism is deeply embedded in our nation’s
DNA. Through the lens of solutions such as that of critical race theory, reparations can help
us to commence on a road to recovery.
Diversion to treatment is not a new concept in the criminal justice system. Impactful

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 24
strategies require the participation of both law enforcement officers and individuals with a
substance use disorder (SUD). But, oftentimes the biggest barrier to alternative modes of
diversion is the police culture itself, while advocacy by community leaders and partnerships
with model stakeholders facilitate opportunities for using non-arrest options. “Clients with
SUDs had positive attitudes about non-arrest programs, but negative perspectives about the
justice system and the police overall” (Barberi & Taxman, 2019, p. 703). As such, each
HUB_mv table is attended by only one designated member of law enforcement representing
all six Island police departments.
Currently in its embryonic stages, HUB_mv has established firm roots in the Martha’s
Vineyard healthcare and behavioral health landscape. Its expected outcomes are already
being realized in the 18 months its beta version has been rolled out: 1) HUB_mv provides
quicker access to MH/SUD and SDOH services; 2) HUB_mv is easily accessible and thereby
reduces barriers to real-time deployment; 3) Data collection and analysis have allowed
UB_mv membership to better understand the risk factors that “situations” face; 4) The
structured collaboration of the model improves communication between social service
agencies, and, 5) Stakeholder analysis allows HUB_mv to recognize inefficiencies and lobby
for their change (Morris, 2023).
As a result, expected outcomes include—but are not limited to—fewer arrests, crime
abatement, lessened overdose rates, a decrease in ER visits, and a decrease in reliance on
Martha’s Vineyard emergency services. And here exists a newfound awareness of available
services, community trust, interagency collaboration, access to services, accurate resource
brokering, time-saving, island-wide safety, and individual well-being. The model is
multiculturally sensitive and identifies people at-risk while they are still upstream and
prevents them from falling further into harm’s way by mobilizing a task-specific “hublet”

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 25
team that goes out into the community the very same day we meet every other Wednesday at
10 am (Morris, 2023).
What promotes change? In terms of someone suffering from SUD, removing one’s
ambivalence toward using. In terms of needed policy proposals, getting in front of influential
lawmakers, community stakeholders, and those who reside in the halls of power and making
addiction reform objectives more attuned to the times in which we live. There exist blueprints
for success in personal and social action that can break down the barriers holding
marginalized populations back. Reform must come so that recovery is embraced through the
lens of egalitarianism, beneficence, inclusion, and mindfulness. Innovative, evidence-based,
and solution-focused interventions should be accessible to all, not in the onerously maladaptive ways in which top-drawer MH/SUD treatment is currently doled out along racial
divides. My design criteria include innovative, evidence-based, and solution-focused
interventions—like my HUB_mv—and should be accessible to all, not in the onerously
maladaptive ways in which top-drawer MH SUD treatment is typically doled out along racial
divides. HUB_mv is a democratic "by us for us” entity striving for equity in healthcare,
particularly in marginalized Island communities (Morris, 2021).
VIII. Implementation Plan
All agency stakeholders and like-minded individuals island-wide are invited to the
HUB_mv table. The “don’t talk about ‘em, without ‘em” edict assures maximum
representation. The only way to engage marginalized populations is to have them invested in
their own outcomes. Actively listen to them! Empower them to change the way they are
being alienated. As well, the “white” status quo needs to realize that their bias is keeping the
BIPOC population “down.” Can they refocus their stance to be more open-minded?.
All hands on deck….political leaders, police, healthcare agencies, clinical

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 26
psychologists, recovery coaches, spiritual advisers, LMSWs, food pantry workers, and so on.
Anyone in our community who can stem the tide of having the burden of this disease
disproportionately impact Black, Latinx, and Indigenous people: Indigenous youth have more
than a 500% incidence of opioid-related overdose deaths compared to the general population;
while Black people are also disproportionately beset by higher incidences of morbidity,
mortality, legal charges, and oftentimes sub-optimal levels of SDoH (Farahmand et al.,
2020).
The time has come to level the playing field so that all populations have equal and
equitable access to top-drawer mental health and substance use disorder protocols (Morris,
2023). Once and for all. It is believed that the HUB_mv non-police led peer-driven
intervention model can both work to that end in the rural resort community of Martha’s
Vineyard and can also ameliorate in large part the SUD and MH issues being felt by
populations of color and those for whom English is not their first language. The landscape
analysis for recovery on the remote island of Martha’s Vineyard should continue to be more
inclusive of populations on the periphery of daily life here.
HUB_mv is already up and running in its beta phase and the results have spoken to
the efficacy of its model and the model’s execution. Thirty-nine of the forty-three situations
brought to the table have been successfully resolved. Sadly, we’ve had two deaths, and, the
two outstanding situations represent parties unwilling to accept our services, which is
certainly their prerogative.
The HUB_mv thrives on healthy and robust data collection (See Appendix E). By
way of illustration, one such example of the valuable information being yielded here speaks
to the risk factors of the 43 individuals who have become situations in-crisis. Three (7.1%)
had two risk factors, twelve (29.1%) had three risk factors; amongst the 16 women, three

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 27
(18.8%) had two risk factors….; of the 26 men, seven (26.9%) had three risk factors, and so
on. From this, it can be deduced from the information gathered on 43 situations, the average
risks per person was 4.1 with the 16 women averaging 3.6 risk factors and the 27 men
averaging 4.5. The data yielded provides strong proof of concept and establishes critical
evidence should fundraising ever enter the equation.
As meeting facilitator and “face of the franchise” I can say that the initiative draws
the support of some seventeen Island agencies working collaboratively in innovative ways to
provide services to marginalized populations. Not a week goes by that I am not approached
by someone on the Island inquiring about membership, and local media (e.g. MV Times,
WMVY) have asked to interview me multiple times. The key ingredient to staying power for
HUB_mv will be to keep it relevant and representative to the morphing needs of Islanders
living at the risk of substance use disorder and mental health issues. We are self-serving and
self-supporting whose members donate their time to the cause, which consists of biweekly
Wednesday morning 60 minute tables and the occasional community outreach. Since my plan
is for HUB_mv and the research behind it to live in perpetuity, it will not be the first
diversion program of its kind to have its constituents asking for a paycheck. In the year since
it went from brainchild to reality, I was donating five hours a week of my time, or roughly
250 hours of service to get it up and running. The rewards have been priceless.
As for financing, all HUB_mv genuinely needs no more than $1K per annum to run
its website and social media platforms, a small price to pay for the sweeping healthcare
services rendered. The MV Rotary Club has graciously volunteered the money and personnel
to cover these expenses to date. My first tentpole event at this juncture will be to host a
podcast called STIGMA ISLAND and featuring interviews with the big four social and
behavioral services agencies here on Martha’s Vineyard: Jenn Vogel, Executive Director of

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 28
our only sober living facility, The Vineyard House; Beth Folcarelli, CEO at Martha’s
Vineyard Community Services; Denise Schepisi, CEO at Martha’s Vineyard Hospital, and,
Cynthia Mitchell, CEO at Island Health Care. This production will go along way towards
shaping the path HUB_mv by necessity must take to remain responsive and relevant. Its aim,
too, is to raise awareness of HUB_mv’s noble causes and to set the table for fundraising
which could be used as scholarships for needy situations to enter and complete detox and
rehab protocols.
By partnering with local agencies, academic institutions, and researchers of a similar
mindset, it is hoped that HUB_mv can leverage its rich data pool into a valuable resource
across many healthcare sectors. Such liaisons can’t help but see that data through a different
lens and perhaps execute some inferential statistical analyses, for instance. Our data is a rich
commodity that will keep on helping to pay our mission forward.
The Center for Disease Control (CDC) reports that minority groups of color have
mitigated access to standard SUD treatments and that this disparity owes largely to factors
other than the scarcity of rehabilitative services (Center for Disease Control, 2022). The
Social Determinants of Health profoundly influence a person of color’s inability to access
top-drawer detox and treatment programs. Income inequalities, whatever their source, can
negatively impact people from marginalized racial and ethnic groups at a greater level than
whites. This disparity can manifest in food and job insecurity, homelessness, transportation
deficits, and, most notably perhaps, poor health insurance. These are real and profound
barriers to SUD treatment and other support services. It is, for this reason, that advocacy for
these disenfranchised numbers is so critical.
And privacy is something the HUB_mv model takes very seriously. As such, we want
to ensure that all “situations” brought to the table are respected in the proper confidential

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 29
manner, with both NDAs and the 4-Filter Process to protect one’s Protected Health
Information securely in place. Participants in the HUB_mv proceedings are asked to be
trained on how it works before actually attending our meetings and partaking of the elements.
It is in this way that privacy, confidentiality, and integrity steer HUB_mv along the multiple
paths to recovery, with duly diligent respect for all of our proceedings.
When you’re looking at ways in which to help a population completely decimated and
downtrodden as a race, it’s important to have a “don’t talk about ‘em without ‘em” attitude
when assembling a group of stakeholders tasked with righting so many wrongs (Morris,
2023). Impact assessments of the model demonstrate its success by breaking down
institutional silos between human service agencies; improving access to services for people in
need more quickly before being in crisis or being harmed; community education about
services people were not aware existed; and reduction of the severity of interventions which
reduced each community’s overall risk level. These programs work because they strengthen
community partnerships and reduce downstream interactions with local police. The most
important stakeholders in healthcare are the patients, providers (professionals), and
policymakers, aka the three ‘Ps’ (Lübbeke et al., 2019, p. 330). Above all, though, the
patients are the most important stakeholders in healthcare.
By way of illustration, CAHOOTS was formed to be a hybrid service capable of
handling noncriminal, nonemergency police and medical calls, as well as other requests for
service that are not clearly criminal or medical, operating with teams of two: “a crisis
intervention worker who is skilled in counseling and de-escalation techniques, and a medic
who is either an EMT or a nurse” (Climer & Ticker, 2021). While this pairing may have
allowed for successful tactical deployments across multiple crisis situations in Eugene, over
the years diversion programs have been wise to adapt a larger more flexible pool of both

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 30
professionals and peer workers from which to mobilize crisis units more task-specifically
leveraged to respond to crisis. Spiritual leaders, recovery coaches, community health
workers, private clinicians, food pantry workers, advocates for the unhoused are but a few of
the volunteers at most diversion programs nowadays. And the fact that they are non-policeled—but involve law enforcement on a less prominent level—makes them more palatable to
all parties involved.
Additionally, CBT has shown promising results in treating substance misuse. But with
all the CBT models to choose from, how to know which one best suits the particular needs of
a specific demographic? A not-so-subtle barrier to treatment at the exploration stage might be
the many CBT protocols that have been developed for treating specific disorders such as
anxiety, depression, bipolar, and substance use, to name a few. The sheer number of
specialized group CBT programs that are available for individuals who suffer from different
behavioral disorders makes an agency’s decisions to choose the one that best meets the needs
of its patient base problematic (Wolgensinger et al., 2015). Conversely, we have stakeholder
facilitators at this level that might upon closer inspection support the preponderance of
research positing that the adaptability of the Matrix Model raises it to the level of a bestpractices psycho-educational intervention most suited for myriad cognitive disorders.
Short-term goals are to better articulate the machinations of the HUB_mv model, and
—by using the specific design criteria most appropriate to implement change—to make it
both more scaleable, more replicable, and more responsive. And, best of all, more available to
all of our underserved BIPOC brothers and sisters. In so doing—in however small a way—
I’d like to think I am doing what I signed up for, and that is to achieve equal opportunity and
justice for a marginalized population of Island BIPOC addicts and alcoholics just looking for
a fair shake.

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 31
Martha’s Vineyard is designated as a rural outpost serving myriad marginalized ethnic
populations. As such, it is looked upon favorably by funding sources both locally and
regionally. Human Resources Services Administration (HRSA), the Massachusetts League of
Community Health Centers, Police-Assisted Addictions Recovery Initiative (PAARI), and the
Martha’s Vineyard Rotary Club are but a few of the entities I’ve considered approaching for
monies to both validate our cause and to further its mission. In the interim, what we do as
stakeholders is volunteer our services free of charge because that’s how it works….if you
work it!!
IX. Conclusions and Implications
All is not fair with regard to how America allocates to its neediest along the lines of
the SDoH and SUDs which often exist co-morbidly with a MH issue (Morris, 2021). That
addicts and alcoholics are unfairly stigmatized through no fault of their own is undeniable.
Making matters exponentially worse is the increasing body of empirical evidence citing
unfair access to and completion of MH/SUD treatment regimens for people of color. By
eliminating the systemic racism often inherent in the ways Blacks, Native Americans and
Hispanics receive medical and therapeutic substance misuse treatment protocols, achieving
equal opportunity in terms of AOD addiction recovery reform is possible. Racial disparities
do currently exist in the healthcare arena of SUD treatment. Doctors who throw pills at
BIPOC populations to treat their pain is a misguided treatment plan, which potentially can
further stigmatize racial minorities who have an OUD. Yet none of these factors compare to
the deeply embedded structural racism at the core of American history (Whelan, 2020) and its
impact on negative health outcomes in alienated populations.
Furthermore, there is nothing “equal” about the opportunities being afforded to people
of color seeking treatment for a substance use disorder. That the national AOD epidemic has

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 32
reached heretofore unseen levels is troubling. SUD is a chronic and progressive disease for
which there is no known cure. Its deeply entrenched root causes are founded upon
compulsive behavior; its ramifications are far-reaching, and its successful outcomes in terms
of treatment wear many hats, and assume myriad guises. Based on the notion of “fair play”
for all, emerging interventions and treatment plans that properly address how the SUD
syndrome manifests across one’s everyday existence and the part race plays in impacting the
normative lifespan of those living with it is what reform needs to do moving forward.
Covid-19 has done little to allow for equitable access to addiction treatment interventions.
The opposite of addiction is connection and during the pandemic people are by necessity not
only losing touch with the resources in place to help them but are also abusing drugs and
alcohol at unprecedented levels in modern America.
While the LEAD & CAHOOTS programs have shown promise in some communities,
each is led by law enforcement which presents its own problems both optically and
logistically. Life in a post-George Floyd world ought not to lean too heavily on police in
initiatives designed to help marginalized segments of the population still licking their wounds
from recent police violence against them and populations of color having been subjected to
400 years of systemic racism. It is, for these reasons, that existing police-led diversion
programs are limited in the scope of their purview and effectiveness.
And this is why the HUB_mv model includes but doesn’t rely on law enforcement to
execute its program design. Rather, HUB_mv is an island-wide consortium of health and
human service providers who share information and establish rapid interventions designed to
mitigate risks associated with marginalized individuals and to address their clinical, medical,
behavioral and social needs. In so doing, it is expected to elicit the following outcomes: 1)
Increased and quicker access to services; Improved communication among stakeholders; 2)

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 33
Reduced barriers to support from human service agencies; 3) Identified gaps and increased
efficiencies in human service delivery; 4) Improved client service provider relations; 5)
Lessened the reliance on law enforcement to handle the bulk of emergency calls involving
MH and/or SUD issues, and, 6) Better understanding of the risk factors affecting HUB
subjects.
Simply put, people of color and/or populations for whom English is not their native
tongue are underserved by most police-led diversion programs. Making things exponentially
worse, a BIPOC population beset by substance use disorders is on the outside looking in
when it comes to relevant treatment practices. The most unsurmountable barrier to treatment
co-morbidity of substance use disorders” (Stein et al., 2015) that act as a barrier to blue chip
treatment, especially when considering marginalized populations cut off from mainstream
healthcare. It’s no wonder, then, that Blacks and Hispanics with an SUD spend more time
completing outpatient SUD treatment than Whites” (Mennis et al., 2019). Language barriers
are one thing; outright racism is quite another.
As long as this nation is asked to endure skyrocketing rates of substance use disorder,
it will live in a political climate for which help in the form of evidence-based practices and
programs like CBT programs and non-police led diversion initiatives must be encouraged
Morris, 2021). Now more than ever, an “all hands on deck” sensibility must be applied to any
mindful conversation about substance use disorder and the very often co-occurring mental
health issues that go hand-in-hand with them. Who better to talk about alienation made
exponentially worse by the added baggage of addiction than a person of color from the
recovery community? Rather than have a forum for addiction reform dominated by
professionals for whom the feeling of feeling dope-sick “while being Black” is foreign, there
must be a seat at any table for individuals are precisely the ones needing the most help. Rosen

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 34
(2022) cited Morris as follows:
We’re offering the island community a proven method to reach people before they’re
in crisis, explained Brian Morris, HUB Coordinator and Mental Health/Substance Use
Disorder Coordinator at Island Health Care. “Oftentimes, we can identify folks who
are on the edge and at-risk. Connecting them with services early can mitigate more
costly interventions down the road. It’s an upstream approach that diverts people
from potential interactions with many systems from criminal justice to emergency
healthcare (p.1).
Relying on the tenets of a Recovery Oriented System of Care (ROSC), the Martha’s
Vineyard HUB_mv “by us, for us” mantra has been able to thrive by leaning on its
membership to guide its undeniable growth in year one of its existence. And HUB_mv
operates with minimal police oversight, by design.
The HUB_mv model facilitates all-island stakeholder meetings with community
partners to identify individuals or families that meet criteria for Acutely Elevated Risk (AER)
across multiple service areas, to provide linkages to resources grounded in the Martha’s
Vineyard community to reduce and prevent the risk of harm. The HUB_mv implementation
design is collaborative, holistic, and proactive and leans heavily on the principle of
connecting people to services and breaking down the silos that usually prevent agencies from
working together. By respecting the integrity of the evidence-based HUB_mv model we can
expect a safer environment. The ROSC is only as strong as the HUB_mv engine humming
along at its core. By diligently serving our marginalized populations and remaining in
compliance with the integrity of the HUB_mv model we get better. In so doing—united as
one—our Island community will continue to heal itself by endeavoring to achieve equal
opportunity and justice….for all.

HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 35
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HUB_mv: An Evidence-Based Non-Police Led MH/SUD Diversion Program in Rural MA 45

Abstract (if available)

Abstract Certain populations are disempowered by a systemic bias against them. As opioid overdose death rates spike at unprecedented levels, marginalized people of color are not only dying at higher-than-usual rates (Panchal, 2023), but also have trouble gaining access to optimal detox and rehab treatment centers and recovery protocols (Saloner & Cook, 2013). While several police-led diversion programs have succeeded in both locating at-risk drug misusers and getting them into treatment, not all are effective in reaching across all aisles to serve disadvantaged populations of color with either an addiction or a mental health issue. This paper first looks at the wicked problem of Substance Use Disorder (SUD) as it currently exists in 2024 and the people it impacts most heavily; then, it explores some novel and innovative ways in which some very proactive agencies have drawn upon drug treatment and rehabilitative best practices to formulate both policies and measures seeking to give those beset by SUDs and the mental health issues oftentimes occurring concurrently with drug misuse a fighting chance; and lastly, it highlights the efforts of the game changing the HUB_mv model to both identify at-elevated-risk drug users in a rural outpost community, and the disruptive ways and means to treat them both in the trenches and across several agency sectors in fair and equitable ways with regard to Martha’s Vineyard’s diverse ethnic culture. Feedback loops, robust data, Social Determinants of Health (SDoH), and impact assessments of the HUB_mv model demonstrate its success by breaking down institutional silos between human service agencies and thereby improving access to services for Black, Indigenous, and People of Color (BIPOC) and other disadvantaged populations deemed “at elevated risk” or “already in-crisis." Early indications (40 out of 44 “situations” successfully resolved) are that the HUB_mv is connecting imperiled Island populations to health and social welfare agencies heretofore unknown to our target population.

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Asset Metadata

Creator Morris, Brian Lee (author)

Core Title HUB_mv: an evidence-based non-police led MH/SUD diversion program in rural MA

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Degree Conferral Date 2024-05

Publication Date 04/10/2024

Defense Date 04/01/2024

Publisher Los Angeles, California (original), University of Southern California (original), University of Southern California. Libraries (digital)

Tag cognitive behavioral therapy,Discrimination,diversion,dual diagnosis,marginalized populations,mental health,OAI-PMH Harvest,social determinants of health,substance use disorder

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Language English

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Advisor Nguyen, Loc (committee chair), Hunter, Allie (committee member), Singh, Melissa (committee member)

Creator Email blmorris@usc.edu,bmorris10@gmail.com

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