So, again, I'm here on behalf of your response network. I'm going to talk to you a little bit about social. Determinants of health specifically, as they apply to rural communities, and I just find it so ironic that I am the only person of color. In this room, and I am going to talk about social determinants. And my God has a sense of you, but I am here on behalf of your response network and just to give you the lean and clean as you probably. Already know, this is just technical assistance that is provided and it's free of charge. I am part of a team of 12 advanced implementation specialists and usually what happens is requests come in and then, you know, depending on the level of request. Don't present it to my team and we decide, you know, who's a wheelhouse that falls in. And then we go out at that point. It's just a matter of, do you want us in person? Or do you want us virtual? So, last week, I was in Syracuse. I'm in Maine right now. I'm going to go home and Monday. I want to fly out to Nebraska. And then my wife said, you're not doing anything else after that. So I won't be doing anything else. After that, so let's just here's the contact information. You'll be able to, you know, I spent over 20 years running inpatient facilities. Specifically around substance use disorder and my 1st, 8 to 10 years was with adolescence. I started out, I had an afro and I worked with adolescence. Nonetheless, nonetheless, my only regret about the opioid response network is that it wasn't around when I was running those facilities because where else, you know, there was a ton of times and those administrators in the audience know that it's not that you don't want to train your staff up to be the best that they can be, but sometimes our bottom line budget didn't support that. And, or when you're working residential, that's 24, 7, so pulling people out that, you know, to be able to have someone come, I think is a great thing. So. There's a lot of research out there that says that we stay better engaged and we learn more when we know where we're going. Right? So these are the learning objectives up there that I'm going to do my best to touch on today. So just looking at the concepts of social determinants of health, it's important that we build a platform or that I attempt to build a platform because if I was to say social determinants of health, what does it mean to you? We might all might have just a little different twist. So I want to build a platform so that we're all pushing up off the same platform and we're looking out of the same lens that is so, so, so important. We're going to look at some and recognize some of the unique challenges that happens with the social determinants of health and those disparities that are involved with it. And then transitioning to identify some key components. And there's a list of them on there. There's stability, education, health care access. We're going to look at it. Right. We're going to look at it. Then hopefully gain some knowledge right around evidence-based strategies and best practices. I was sitting in the back there and I don't see him here now. I guess he might have left. But nonetheless, he says, so, hey, you're a physician. I said, well, yeah. He says, so what's your take on social determinants of health? Like how's your presentation going to be? I'm like, man, is this a screening or are you interviewing me for a job? Which one is it, you know? But my response to him was, you know, I don't know if I so much have a take about it. But as we go through this, you know, I highly doubt there's going to be anything up here that's going to really make anyone say, oh, my, you know, I didn't really know that. But, you know, when we talk about social determinants of health, they're so simple, but yet they're unaddressed in a lot of areas. And until as helpers and health care providers, we can all get on the same board. And my wife speaks to it so eloquently. Here's what she says. She says, you know, when there are ships out on the sea and the tide rises, all ships rise when they're out there. Not just one or two, not just two or three. They all rise. And so until we can get to that point, it's going to be somewhat of a struggle. Back home, we say, put your money where your mouth is. Right. And we say, you know, you can talk about it, then you should be about it. So, again, it's not going to be nothing up here glaring that's going to say, oh, my God, you know, there's O.M.E.G. moments as my grandsons say, crap, that's an O.M.E.G. moment. So nothing like that. And then understanding the role of culture, right? And the social factors in shaping those health disparities. If we eliminate culture out of the equation, we're already at a loss, right? Culture needs to be taken into consideration in all the work that we do. Am I correct in saying that? Right. And I challenge you to broaden your lenses. You know, a lot of times when you present the whole concept of culture, people get near this narrow lens and we start thinking, you know, just really specifically about race. But it's so much bigger than that. Case in point, I was sent to a private school from first to eighth, a Catholic private school. And during those eight years, I was the only person of color in any of my classes. Ironically, when I would leave there, I would come home. I was in a home with my grandparents. We stayed in a home right across the street from the projects that was ninety nine point nine percent black. Right. Two things happened when I was in our private school. One, I got introduced to the best marijuana known to mankind. OK, but two, I got introduced to a different music called classic rock and I really liked it and I still like it. Right. But the problem was when I would come home and I was brought this, you know, one Christmas, I got this great big radio. When I would come home, I would go here in the projects and I was blast class. You can only imagine some of the things that came out of what was said in there. Why do I tell you that story? Because for the average person to look at me, they say, oh, he's definitely R&B and hip hop. Well, no. So culture is so much bigger than that. Are you with me up until this point? All right. Do me a favor. Everybody stand up real quick. Just stand up. All right. All right. Look to the person next to you and say it's not how we start. It's how we finish. All right. We're going to finish this thing. Thank you. Thank you. Sit back down. See, somewhere along the line, there were these planning meetings that happened that I was a part of. And, you know, I must have missed one because going last has never been my thing. I might have backed out of this division where you're going last. I don't think I can do it. So let's look at it. The social determinants of health in rural communities. These are the things we're talking about. Access to health care, economic stability, education, social support networks, physical environment, cultural and social norms, and then health behaviors. Right? We're talking about a lot of times rural areas have that limited access to health care. You know, in 2014, my wife and I, who said they had worked at a recovery center? Is they still here? Someone up here on the panel said that. Did someone say they worked at a recovery center? Yeah. So in 2014, my wife and I started a recovery center called Locked in the Awakening. And it's been one beautiful thing. And out of all the hats that I wear, there's nothing more special than me sitting down there at that center and just interacting at boots on the ground level. The reason why I spoke to that is because where we're located, about 20 minutes north of downtown Pittsburgh in Pennsylvania, I consider, we consider to be rural. The people in the city don't consider it to be rural. But I can tell you, 20 minute drive in either way, if I drive 20 south, I'm going to be right down in the heart of the city. If I drive 20 minutes north or in any other direction, I'm going to be surrounded by cornfields and backhoes and all that stuff. Right? And so we look at that. We're going to look at that. We're talking about those limited access to health care. And then we know, and nothing that I'm saying up here, I mean, this has all been studied out and there's a lot of studies around it. So this isn't, you know, Dr. Way presenting anything new. I'm just picking up the pieces and throwing it out there. We know that there may be higher levels of poverty in those communities. Right? We look at things like education, the lower education attainment levels in rural communities. We look at things like, you know, in rural communities, it's often that tight knit. Right? It's tight knit. Well, that could be good and that could be bad. I came from a community that was tight knit. I wish it wasn't. I wish it wasn't because the type of community that tight knit that I came from was generational. Generational substance use disorder. So whenever I stand before you and I say I'm a person on long-term recovery, I'm saying a lot when I say that. What I'm saying is I'm the only person after four or five generations that I've traced back that ever broke away from substance use disorder. So that tight knit could be, it could be a devil's sword at times. And then we look at, you know, just little things, access to clean water, air quality, you know, the whole housing concept comes into play when we talk about it. And how about our cultural beliefs and the norms? You know, we all have stuff that we bring into the rooms. Right? And sometimes it's stuff that I'm bringing into the rooms into this experience has been ingrained in me for a very, very, very long time. And it's hard for me to make any shifts in my lenses because it's just who I am. But where I come from, we talk about discovering it and managing it. Right? So I know that I have stuff. So when I stand here before you right now, I'm not just a presenter. I'm someone that's been married for over 28 years and been with my wife for 34. I have seven grandsons. I'm someone that grew up in a home with my grandparents, old school upbringing. Right? But all that, I have strong opinions. I have strong values. Right? All that shapes that. And so when we look at those cultural beliefs and social norms, we have to know that the participants, the clients that we're working with, they're bringing all that too. And for us not to take that into consideration, we're not only setting us up for failure, we're setting them up for failure. Are you still with me? Yes. I'm like a Baptist preacher. You got to talk back. Right? And so the lifestyles and things like the dieting, physical activity, tobacco use, substance use. I did not know that everybody did not use substance growing up. I thought everybody used substance. Why? Because I looked to the front of me, that substance use disorder. I looked to the left. I looked to the right. I looked behind me. That was my world. We have to know that individuals and participants, clients that we're working with are coming in, a lot of them are coming in with that same thing. And sometimes as helpers, right, being a helper can be a double-edged sword. Because most of us that are helpers, we come in with this passion. Right? And we come in with a passion to help. I've never met anyone that says, you know what, I want to work in a helping field. And by the way, I like to be horrible at it. Like no one's ever, ever said that. Right? But we all come in with this passion to help. But it can be a double-edged sword. Because passion will only take us so far. And one thing that I know about the majority of us that work in a helping field, no matter what level we're at, we are fixers. We're fixers. So we sit down, you present the problem, and we are in your future. Yeah, no, true. And so a lot of times what we find out is that we're dragging people to where we think they should be as opposed to walking alongside of them, letting them guide. Am I making any sense at all? Years ago, three kids, two daughters and a son in the middle. And years ago, they were three years apart. And I remember them saying, oh, we want to get a dog. We want to get a dog. And I said, we're not getting no dog. They said, we want to get a dog. I said, listen, if you guys get a dog, you got to take care of it. Oh, yeah, we'll take care of it. We'll take care of it. They said, yeah, yeah, we're going to walk it. We're going to clean up after it. Yeah, right. So nonetheless, I'm making coffee in my kitchen, and I see the youngest one, our youngest one, Gabby, she's coming, this was a Cocker Spaniel, right? She's coming across the kitchen with this Cocker Spaniel. The Cocker Spaniel got all four brakes on. I mean, she's literally dragging on. And I said to her, I said, honey, I said, what are you doing? She says, he wants to go for a walk. That dog did not want to go for a walk. I share that story with you to say this, is that a lot of times, you know, with that passion, we can find ourselves dragging them to where we think they should be. Am I still making sense? All right, cool. I feel a little energy kicking up. Let's keep it going. Recognizing and addressing the unique challenges. So it's real simple. This is basic math. You know, there's no, how can I say it? I'm going to say some things that I didn't plan on saying, but I'm going to say them anyway. You know, years ago, whenever, I'm an offspring of the crack epidemic. So my addiction took me into a full-blown crack addiction, which, by the way, I met my wife in a full-blown crack, the one that I said I got married to, I met her in a full-blown crack addiction. The reason why I bring that up is because we all know sitting here in this room at that time, drug use was criminalized. Am I correct in saying that? Right? So when I went to treatment, they, you know, they, first of all, they forced me in there. And then second of all, it wasn't that you want to go to, I mean, this long list, you know, I didn't have none of that presented to me because it just wasn't there. You know, it was not presented to me in that manner. And so when we look at those unique challenges, it's really not that tough to tweak this and get the rudders in the right direction. So every year we take on an advocacy project down at the center, Lost Dreams Awakening, which I'm so glad that they did. They didn't put the opioid response, they put a recovery center on there. Yeah, I love that. Thank you. Thank you. Thank you. But years ago, you know, every year we do an advocacy project. But what we saw years ago, we say, you know what, this thing with opioids, it's like, you know, that Care Act and all that was coming down to play. So we loaded up two buses, we got two buses, we went to Washington, D.C., and we advocated. We were out there and we advocated for treatment and for medication, all that stuff that came into play. And we got it, right? And so we started seeing all these options that popped up for people who have substance use disorder. And it's been beneficial. We're still experiencing a lot, as a lot of the presenters have presented, but for the most part, to have that option that we never had, it's real beneficial, right? And so when we look at the social determinants of health, it's just a matter of saying, hey, what is working? And who is it working for? You see, because back home, when they present the data about overdoses in our county going down, they leave certain things out where I'm from. They leave outbreaks in those studies. And they try to convince people that things are getting better. And we say they are getting better. But for who? Because in the Black community, in the Hispanic community, it's not getting better, it's getting worse. And this is something, when we talk about the social determinants of health, listen, when one community suffers, we all suffer, right? And so, you know, I was talking specifically about rural, and I get just as passionate about any community that's suffering around substance use disorder, because I know that there's some things that we can do if we all row in the same direction. I'm not sure what it's like here in the state of Maine, but back home in Pennsylvania, we're always going to be behind substance use disorder, and here's why. We talked about collaboration and getting together, and we know no one provider can do it all. It takes every one of us in this room from different levels and different things to come together to really make an impact on this. But the problem back home is substance use disorder doesn't know no boundaries, but county and state dollars do. So, a lot of times when people are transitioning from county to county, state to state, those services don't follow them, because why? The money's not following them. Am I making any sense at all? Right? And so, we have to look at those things. So, we do community needs assessments. When we're looking at recognizing and addressing the unique challenges, and we want to identify those specific challenges, right? And then we want to engage the community members. I've done so many presentations on how to engage certain communities, and I say it unanimously. You don't need me. Go to the community. Ask the community how you can engage them. What can you do for them? What can you get? How can you provide services? See, we're real big back home of putting up, and I refer to back home because I don't want, I don't want to, I don't really know what's happening in Maine, so I don't want to make like I do, right? But we're real big on putting up these facilities and all this brick and mortar, and then we say, here we are, come on and get our services. Guess what? We got to take the services to them sometimes, right? We have to take it to them. So when we want to engage any community, and we look at that unique challenge, how many treatment team meetings did I sit in as an executive director or a VP of treatment facilities, and they would say, clinicians would say this, oh my, we're thinking about making these changes, but we just don't know how the participants or their clients are going to respond. Well, did you ask them? Ask them. They'll tell you exactly what's what, and so, you know, we have to look at those, take those community needs assessments to that level. You know, I can't sit up here, talk as the VP and say, hey, this is what they need. I don't know. I learned a very important lesson. I learned mostly all my lessons when I worked with adolescents, right? And I'll never forget, I had just became a counselor, and I was so excited when I became a counselor. Man, you could tell me not. Excited. Oh, that was one of the best days of my life. And I'll never forget a Friday, a young adolescent comes into the facility, and they said, they called me Mr. Vaughn. They said, Mr. Vaughn's going to be his counselor. I said, okay. I said, you know, it's Friday, just got paid, going to have a nice weekend with my wife. I said, but you know what? Let me go over and introduce myself to the young fellow. So I go over to him, he takes one look at me, and he starts crying for use. He's from Waynesburg, Pennsylvania. Young white adolescent, about 12 years old. Only thing black in Waynesburg is the road. I'm his counselor. He starts crying for use. So I said, you know what, I need to call my mom and ask her to get you on the phone call with your mom. So I take him home and get him on with mom. He says, mom, you got to get me out of here. I'll never smoke weed. I'll never do cocaine. He says, I'll go to school every day. He says, I am here. I don't know these people. And on top of that, my counselor is black. And I knew right then and there that he was the resource. I knew right then and there that I needed to ask this adolescent really good questions and get to know him. I know what it's like to do drugs. I never got high in the cornfield, man. I don't know what that's like to do meth in the barnyard. You understand what I'm saying? I don't know that. I don't know that. And so when we look at communities and do these assessments, we got to take everything into consideration. Partnerships and collaborations have been talked about a lot here because we know that it's going to take all of us to do it. It's going to take all of us to really be rowing in the same direction to make an impact. And we know that when we collaborate, that leverages those resources. So my organization might be able to provide them lunches. Your organization might be able to provide them transportation. Your organization might be able to provide them good counseling and clinical stuff. Are you understanding? And so we don't all have to do it, but we got to be willing to partner. Here's the challenge. Sometimes we function in silos and sometimes we feel like what we have is just for us. And I don't want to share with you because if I share with you, your organization might start out shining my organization. So this is us. This is ours. We have to lower it down. Just you know what? The same thing that we work with participants around is applicable to us. We have to lower those barriers. We have to be willing to share our resources. We cannot afford to have, and I'm going to screw this up. My wife says I screwed up. Was that the Daffy Duck syndrome? We used to say mine, mine. Or was that the Donald? He said, mine, mine. It's all mine. It's all mine. We can't have that. We have to be willing to share partnership and collaboration. And then we look at things like tailored solutions. Listen, we can all be from the same county, the same city, but we're still different. We can all have the same color of skin, but we're still different. You know, we say a lot as providers, oh, we don't do cookie cutter, right? All of our stuff is tailored in this specific, but then we put these corridors up and we say, if you fit these corridors, then you're good for our services. But if you don't fit these corridors, guess what? You don't belong here. We have to be willing to look at each and every community, each and every participant as though they're the only one. Because guess what? They are. And so we have to be able to dial it up. When I was in grad school, I had a professor ask me, he said, Vaughn, what is your theoretical orientation? And I looked him this square in the eye and I said, you know, I like to consider myself to be a little eclectic. And he said, you only said that because you don't know. And I said, you're absolutely right. So I dove into it and I realized that I'm first center. I'm laid back, man. I like you to do all the work, right? But when I took that approach out there in Gibsonia, Pennsylvania, where it was primarily white affluent families out there, that laid back style, I was knocking them out the park. Just laid back, real smooth. And then they came to me and they said, we want you to run this program in the inner city of Wilkinsburg. And I said, oh yeah, I can do that. I can do that. I went down there with that laid back approach. They paid me a lot. Why do I say that? We all have this approach that we're comfortable with. And to some degree, it should reflect our characteristics, you know, who we are character. But we have to be willing to dial it up on the fly. And so when we talk about Taylor Solutions, we have to be willing to dial it up on the fly, depending on what individual, depending on what family, making sense. Yes. Investment in infrastructure. Well, what are we giving them? What do they got? Look around. I mean, what do they have, right? Do they have sufficient transportation? Do they have healthcare facilities? Do they have broadband internet access? You know, when COVID hit at our recovery center, I was faced with one of the biggest decisions that I had ever faced. And the decision was this. We have over 10,000 people come to our recovery center every year. And we have a ton of different meetings that meet there from 12 step to life recovery, rain. I mean, there's a ton of meetings. And so do I close the shop and let these people just do whatever they do? Or do I keep the place open? Some people were saying, you need to close it, man, because you're helping spread the virus. Other people were saying, don't close it. If you close it, we're going to die. That's what they would say to me. And it wasn't until our state sent me an email and said, please, whatever you do, she says, you guys see so many people down there. Don't close. She said, don't close. And that was my deciding factor to stay open. And what I realized during that time is everybody was right. If you thought we should close it, you was right. If you thought we needed to stay open, you was right. We were faced with a lot of different decisions and challenging ones. But when we talk about infrastructure, we have to make sure that we can walk into a community and look at it and say, do they have what they need to be able to improve their health, wellness, and quality of life? If they don't have it, then we got some work to do. Healthcare access, mobile clinics, increasing those number of providers in rural areas. How many are there out there? Why aren't there more? What do we need to do to get more? Not just looking at it and say, well, they don't have none. I guess that's how it is. No, what do we need to do to get more? What do we need to do to get more? And it's all of our responsibilities to raise, to blow the bullhorn. When we see these things aren't prevalent in rural communities, it's all of our responsibilities to blow the bullhorn. We should be on the bullhorn screaming. What are we going to do about this? Are you still with me? And economic development, job opportunities, entrepreneurship, diversifying local economies, investing in workforce training, what's there? Is there something there for them? Where is it at? Why isn't it there? I can tell you what, if you want my vote, you damn sure better answer these questions for real, because voting is powerful. And we know that. And so we're looking at this, why isn't it there? But these are some of the challenges we see in rural communities, education and workforce development, that quality of education and training. I just saw in the news this morning here, I don't even know if it's somewhere around here, because it happened to be main news, it was a school that was closing down because they had none of the necessary work on it and stuff. And the lady got on there and she said, I don't know why they didn't do it, because we've been paying money towards this, but it's not getting done. See, she's doing the right thing. Ask good questions. Shine a light on who needs to be shined on, right? Let's make it. Enhancing those opportunities for lifelong learning and skill development, taking what you got, what you got, bring it. Let's take that. Let's enhance it. Let's build upon it. Let's provide you the resources. But these are some of the challenges in a rural community. Social support and community engagement, right? Are there any type of support networks? What's there? Are we promoting social cohesion? How are we building it? How can we enhance it? How can we plant it, right? Supporting those community-based organizations, volunteer groups, recreational programs. Where are they at? Are they there? We need to support them, right? I think there's nothing more powerful as a helper, and I've held a lot of different positions, but my most powerful position that I believe I ever hold is a volunteer. It's just to have the heart to want to give, to want to give, right? Environmental stewardship comes into play. We're looking at the sustainability practices that really protect those natural resources that are out there, and not just constantly letting people come in and just build and knock things down and tear things down. We got to stand up. We got to talk about it. Policy advocacy. We advocate. Years, every year when I was working in drug and alcohol, there was always this big thing, I'm going to lose track of time. How much time we got? Until 3.30? Okay, I'm good. I don't want to miss my dinner appointment at that place. But every year when I was working in drug and alcohol, there was this thing that came out every year, and everyone would be biting their nails. Oh, I can't wait to see what's the governor's budget. What's the governor going to do for drug and alcohol? What's the governor going to do for drug and alcohol? And from my remembrance, every year, everybody was somewhat disappointed back home about what the governor did or didn't do for drug and alcohol. And then one day, I was riding home on my last assignment. I had an hour drive there and an hour drive home. No matter how fast I started, it was an hour. But it gave me a lot of time to think, and I was thinking, I said, you know, if I'm the governor and I'm stroking this check, I'm not stroking the check based on what you tell me. I'm going to stroke a check based on what I see. And it dawned on me in that moment, I thought about people like myself who identify as being in long-term recovery, but a lot of people don't know about it because I go to my pathway meetings and I share there. And then when I integrate myself back in society, I don't say anything because of stigma, right? But I'm a success. I'm doing it, right? But there was a ton of people like me. And that made me think that in order for things to really change, they need to see that there are people like me that are making them the benefit of you providing treatment. And so we started this thing where the whole concept that we got on board with Faces and Voices and people like Bill White and Don Coyus and Joe Powell down in Texas that said, hey, we need to put a face and a voice on this thing. And so we put a face and a voice on it. So now people can see more people are recovering out loud. It's easier for me to stroke a check if I can see the benefits. Does that make sense? So when we talk about policy advocacy, it's important. It's important. How are we doing in the back? That's my friend back there. She took care of me. Yes. Okay. So we look at evidence-based strategies. We're looking at things like the integrated care model, addressing both the physical and the mental health needs alongside with those social determinants. So it has to be like this perfect storm that comes together, right? And I think someone spoke on it earlier. I mean, when we come, we're coming with a lot of stuff, right? And if you're just trying to treat part of me, treat all of me, take care of all of me, right? Not just part of me, take care of all of me. And so that takes that integrated care model, right? And we're looking at things like, how can we have like these one-stop shops? Because that's a problem. Hey, listen, if I'm struggling with emotional wellness and substance use disorder, don't expect me to go to three or four different buildings with three or four different appointments. Send me somewhere, send me to a one-stop shop, man, where you can take care of all of me within that setting. You know, back home, right? Sometimes with some of these outpatient assessment, you know, and I hear, you hear so much out of the recovery center because you just hear it all, right? And you just hear it. And I would hear things like, oh yeah, I went, I was finally ready to get treatment and I went and they told me to come back next Thursday. What? Next Thursday? Do you know what can happen between now and next Thursday? You know, John Shinholster speaks about it there in Virginia, my buddy John Shinholster, he said this, he said, Joe, you know, I was the only place that'll do that. You come in on a Monday, we tell you to come back next Thursday. He said, but if I go up to Lowe's and steal chainsaws, I get services immediately. Immediately I get services. They'll lock me up and they don't put me away. So we got to look at these integrated care models, community health workers, you know, train and deploy those community health workers and to help bridge the gap. And by all means, if I come to you for services, try to have somebody that'll look for someone like me. And if you didn't, if you can't hire someone that looks like me, at least train your staff in a way that they understand my culture when I come in, right? Because that is so, so, so important. And so these community health workers can bridge the gap, right? That gap between the provider and a community member, that community health worker can bridge the gap. Telehealth and telemedicine, we know it to be a great strategy, right? But it works best if the client has access to a genuinely private space on a regular basis. That was, I'm getting to that age now where I start to tell a story and then I forget, but then something else reminds me of the story. But this is, I was going to tell this about in my pathway that I go to, you know, when the pandemic hit, they said, okay, everything's going virtual. And I said, I get it. You know, I understand it. And I have a lot of respect. I've lost some loved ones to the COVID. I'm sure many of you have, you know, people who have been affected by that, but you got to know those of us with substance use disorder, when we're active, like when we're active, listen, if I have a computer, I'm selling it, man. I'm not going to have no, I'm not going to have no access to come on a Zoom meeting. So we need to take that into consideration, right? It's one thing for me to be able to provide the services, but do you have the tools to even sign on? Do you even know how to sign on the Zoom? Do you know how to function? As opposed to me just saying, hey, we got this telehealth and telemedicine. So we have to really take our time and make sure that there's an understanding right with that client or that participant. Not sure what it's like here, but back home, transportation is a big thing. And I can see by some of you nodding heads, it's probably a big thing here too. And so, you know, how do we provide that transportation assistance? And we need to collaborate, you know, we have Pat Transit, we have Westmoreland County Transit back home that I had to go back and forth just to get bus tickets to be able to, you know, help people get around the different things. But that's something that, you know, that's, if we have that transportation assistance, now you're helping me. Hey, listen, I want to get there. I have all intentions on being there. I just don't have a legitimate way. Now I could call my drug dealer and he or she could get me there. Or I could call someone that I was using and they'll get me there. Or you could provide me a nice way of means of transportation, a safe means of transportation. Financial assistance programs. Everybody needs a hand sometimes. And my wife says this. She said, this is a hand up, not a hand down. Right? This is a hand up, not a hand down. And so, you know, do we have these programs? What about sliding fees? You know, specifically those of us that are providers, you know, do we have these sliding fees? Do we do any pro bono work? I have ulterior motives. Why do pro bono work in my practice? Here it is. I believe as long as I'll keep doing it, I'll always have. That's me. I know as long as I'm willing to see someone that don't have anything, right, I will always have all my needs and wants to always be met. And I got to tell you today, it's so true. And so what do we do around that? Do we have any subsidized healthcare services, you know, medication assisted programs, discount of pre-transportation vouchers? What are we doing around this? How are we giving a hand up? A lot of people say, well, that's a hand out. You know, you're enabling them, enabling me. You want to enable me? You want to enable someone with a substance use disorder? Don't provide me services. Let me keep using. That's enabling. So we look at things like community-based support groups. Are there any there? If not, can we get some champions within the community to perhaps start something, right? So when I walk into a space and I assess it and I see the needs and no one's stepping up, I'm going to make it happen. I'm going to make it happen. That's just, I'm just designed that way. I've never been one to just sit back and talk about it. My grandfather used to say it all the time. He said, don't talk about it, be about it. So what are you going to do? Are you going to step up? Are you going to coach or mentor someone to be able to step up in that role? And then culturally tailored interventions. Very often when I go do my presentations at different organizations, I look on this screen and I say, do y'all have class? Do y'all have class? Culturally, linguistic, and appropriate services. You got class. And we should be able to answer yes to that. We should be able to answer yes to that. So we look at these culturally tailored interventions, the educational material that we're putting out there, right? And by the way, what level does it read at? We did a language audit down at the center and we were so excited because we got our first tri-fold and I'm all pumped up. We said, ooh, ooh. So I said, do a language audit on a building. Well, that thing came in like a junior in college. Come on. We got to back the town a little bit, but we do that. When you look at it, you say, okay, we see different shades of color on there. That's a good thing, right? We want to see different communities of population represented when we're looking at this because it can't just be all one thing. It can't be all one thing. Am I making sense at all? All right. We're getting there. We're hitting a home. We're hitting a home. Collaboration. We talked about that with social service agencies, right? Just getting together, even in this room right here. I can only imagine that there's some people here that might not even know other organizations or that you know, but you really don't know what they do. And so now I heard someone in the back table there, they looked at was, they said, you got your cards with you? And she was like, yeah, I got my cards with me. And I said, man, that's awesome because you never know who you're going to meet. Exchange cards. And then so very often we come to platforms like this and we exchange cards and we get all this information and then we go back and we just get back on the grind again. No follow through. We don't reach out. And I encourage you and I challenge you that after this experience that you had here today, when you leave here, it cannot be business as usual. Something had to change. What are you taking with you? What are you taking away from? You just spent the whole day in this room. For what? It got to be bigger than CEUs. Although they are important, right? So we look at these things. Employment and vocational training programs. I talked about that, offering that, making sure that it's in place. Peer support. There's nothing more powerful than peer-to-peer. Let me say that. Yeah, you can clap. There's nothing more powerful than peer-to-peer. That's just a powerful move. We know it to be powerful. But do these communities have that, right? Are there recovery coaches with lived experiences, right? My buddy, Pat McHale, we were both VPs. And Pat, he never did a drug in his life. And he had no idea. But he was a good clinician though. And see, a lot of times, you don't have to identify as being a person in recovery to be able to do good work in this field. Because I look at recovery bigger than substance use. Recovery to me is someone having something going on in their life that's just not too cool. And that you make a decision to do something about it, whatever it is. That's recovery. And my buddy, Pat McHale, tells a story. He says, this client came in and said, you can't help me. You don't know what it's like to be homeless. You don't know what it's like to overdose. You've never been to jail. He just went one side of Pat and down the other. And Pat said, once the client, the participant, bless you, once he stopped and came up for air, Pat looked him dead square in his eyes. Somebody in here needs to hear this. He looked him dead square in his eyes. And he said, you have absolutely right. I don't know how it is to overdose. I've never been to jail. I've never done a single drug in my life. So those are the things that you want to learn. Probably not your best candidate. But if you want to learn how to live a successful life and increase your wellness, that I know how to do. So peer support, recovery coaching, back home, our state certification is the CRS. But you have to identify as being in recovery to do that. We like the Connecticut model, the Recovery Coach Academy. But you don't have to identify as being in recovery. And you can help somebody. Makes sense. It's important that these communities have health and education, literacy programs. How are we addressing that? These are ways that we take these evidence-based strategies by implementing health, education, and literacy programs. Providing those resources and workshops and educational materials. We got to say, listen, in order to do better, we got to know better. But you can't expect me to do better when I don't know better. I don't have none of the resources in my community to even know. No one's coming into my community doing trainings. No one's coming into my community doing educational things. So I don't know. We got to take it to them. And of course, very seldom, in any approach that we take, do we hit bullseye. Very seldom. We can have these great ideas. I think my man was talking about the ACER. He said, I don't know how many pages he said. I said, oh, he said, I've seen so many things that need to be corrected. And he was transparent. He said, it's very seldom that we hit the bullseye. But we go back and we reevaluate. And we look at ways to do quality improvement. As a helper, as a clinician, as a frontline worker, as an administrator, there is nothing worse than thinking that you are knocking it out of the park and really you're not even in the stadium. That's horrible, right? And how do we find out if we're in the stadium? We ask good questions. We reevaluate. We do self-assessments. We're preparing ourselves to bring the best version of ourselves to the experience whenever we go into these communities, right? I'm coming. I'm coming educated. I'm not just going in rural Pennsylvania and not knowing what time of day it is. I'm coming educated. I did my work. I have a good sense of what you're going through. I can't totally relate because I'm not from your community, but I sure enough have taken the time to educate myself so that when I come to you, I'm bringing the best version of myself. I think anything short of that is a shame. The role of culture and social factors come into play. There's an impact, the cultural beliefs and practices. And I see them winding up here. I'm going to be on time. I got to make that. Did I tell you I got to make that dinner? So we look at the role of culture and social factors. We look at the impact, cultural beliefs and practices, and we know that it influences health behaviors, perceptions of illness, and healthcare-seeking behaviors, different cultural norms regarding dieting and exercise come into play. Anyone know Dave Chappelle? He cracks me up. Oh God, I can't go here because I'm going to mess up my time. Anyway, we talk about strategies, right? Being culturally competent, that culturally competent care. My colleagues and I, we stay away from that word competent when it comes around culture, but I leave it in my slides because there's still a lot of literature around it. But we believe no one is ever fully competent when it comes to culture. We think of things in more terms of culture humility, meaning that I'm fostered to learn some of the things that I thought have changed and I'm still, I'm just in the process here. Community engagement, you know, we talked about that too as a strategy. We know language and communication barriers. I talked about making sure we're looking at what we're putting out there as far as triangles and information. What's on our website? How does it look? Very often I'll walk in our center and I'll imagine myself being a participant. I put my participant hat on and I walk in that center and I just look around and I say, what do you think? How would you feel, if you were someone coming off the streets, walking in here, right? We all need to do that. So we look at interpretive services, be careful with that. I got myself a $210,000 bill one time with interpretive services and my VP wasn't happy, but I told him I wasn't going to federal court, you go to federal court. I'm providing services, man. So yeah, true story. Health literacy programs, we talked about that. Stigma and discrimination. We know stigma has, it's still nasty. You know, my colleagues back home, they did a study, it had a big end to probably close to 25,000 people participated in this study. And it said in their study, over close to 80% of people want a person who identified as being in recovery, being their neighbor. We got some work to do, right? But we do the anti-stigma campaigns. We look at that, that public awareness, nothing beats stigma down better than a good story. I've encountered people, you know, cause sometimes I've been blessed. So I come in, you know, I'm educated and I won't say that I identify as a person in recovery. I'll just make like I'm a clinician or an administrator until they start talking funny and that stigma come up. Then I disclose it, right? Then I hit them when I say, oh yeah, by the way, you know, I am, but we've nothing. But when I tell even those cases that I consider to be severe, whenever I tell them my story, whenever I tell them my story, you can see the change in their face. So storytelling, that's the stigma buster. Community resources, we talked about that. Making sure they're available, strengthening community networks, building partnership is important. Intersexuality, how does all this connect with one another? You know, what are the natures of the social identities such as race, gender, class? Don't shy away from conversations around race and gender. Don't let it be an elephant in the room. Go right at embracing, talk about it. You know, when I was working at the adolescent facility, that was a 42-bed facility, every day now I would see a black adolescent come through. Primarily all white adolescents came through. And so I asked a good question around that. And so we started getting some black adolescents there. The very first thing I talked to them about was what's it like being here in this facility where your neighborhood is predominantly, it's not all black. Now they have you out here and the only thing you see black is me. What is that like for you? I'm not going to dance around it. I'm going to go right at it. Making sense? Access to education, we talked about that. Those resources, we need to make sure that they're there. Now I got one last piece here and I want to talk about it with the adolescents. Can you allow me to do this for a couple minutes? All right, cool. Adolescents are our future and we need to do everything that we can to make sure that they got what they need. Do you agree that? Yeah. And so we know when we look at the social determinants of health and adolescence in a rural community, that access to the quality of education and resources or lack thereof may impact that adolescent. So we look at that and that plays into things like their academic performance or lack thereof, their social development, health, their future opportunities are gone before you even know it. My man in the back said, you know, social determinants of health start before birth. That's what he told me and I said, you are absolutely right. And so when we look at the adolescence and things around healthcare, you know, that limited access. Growing up, I never, ever went and applied for public assistance. And it wasn't because I thought it was better than public assistance. Hell, everyone in my community was getting public assistance. I didn't go apply for it because by the time I filled out all them papers that they wanted me to fill out, I could have had three or four scores all over the block. So I wasn't leaving this when I could make something happen here. I'm not going down there to fill out all those papers. And also I don't want to mess my mom's benefits up by going down their line, right? So we think about that, you know, so with adolescence, that limited access to healthcare, the specialized care, the mental wellness care, economic stability, right? I'm dependent on my family, right? I'm an adolescent, I'm dependent on my family and depending on where my family falls, then that sort of impacts my quality of life and the things that I have resources to. But here's the thing about substance use disorder, don't give a damn about socioeconomic status. It don't care if you come from a single parent home or a two-parent home. It doesn't care what type of neighborhood, what type of car you drive or none of that matters what's on your W-2s or your 1099s. None of that matters with substance use disorder. And so we have to be mindful that we attack it all the same. But adolescents have an extra slice cut out for them because someone was even talking about the age of consent, how is that handled? You know, all that comes into play with our adolescents. And then that social support network, you know, those networks, those peer relationships, the family dynamics, here it is. Well, I'm coming from generations of substance use disorder as far back as I can remember. That's what I'm bringing to you at the assessment. You know, how did my community play a role? And I told you, I thought everybody did substance. I didn't know no one didn't do substance because that was my community. That's what I came up in, right? Those environmental factors, the air, water quality, growing up in a home with my grandfather right behind the railroad tracks, that was nasty, man. That was nasty. You know, I look back on that, I'm lucky to be standing here breathing right now all the nasty, toxic things that came out of that. And we saw a lot of that in Detroit with the water. I just heard today on the news, they still have to fix all those pipes. That's horrible. But those environmental exposures, right? I'm an adolescent. I can't do anything about it. I can't go out on my own. I can't get my own home. I'm here. That substance misuse and risky behaviors, we know that comes into play, right? Because depending on where I'm, where am I at? Who am I surrounded with? What's my neighborhood? Like who, you know, I used to tell my children, I said, you know, dad don't have to be an inspector to figure out what's going on. Show me your friends, I'll show you your future. Show me your friends. I don't have to go sneaking around and asking questions. I just look at who you surround yourself with. That digital access, we know that to be, you know, social media, that's a double-edged sword. A lot of things can be researched and found, but there's a lot of dark things we talked about. Some of the presenters talked about, you know, the drugs and everything that we can get access to. Adolescents can do that. You know, my one grandson, I was looking at pornography. I know my daughter had to take his phone off. I mean, you know, that digital thing is dangerous and technology, but it's also beautiful too. That's all I have for you. I don't think I left you any time for questions, but I'll feel some if anyone has some or any additional comments.

social determinants of health

rural communities

race

culture

socioeconomic status

healthcare access

community engagement

health equity

adolescents