Kentucky’s Commitment to Address Equity

October 17, 2022

The Principles for the Use of Funds from the Opioid Litigation call for states and local communities to address disparities related to drug use in communities of color. In implementing Principle 4: Focus on Racial Equity, jurisdictions have an opportunity to learn from their peers about strategies that have shown to be successful.

The post below is by Dr. Katherine Marks, Project Director for the Kentucky Opioid Response Effort, and Dr. Brittney Allen, Department for Behavioral Health, Developmental and Intellectual Disorders Division for Substance Use Disorder Director about Kentucky’s formal commitment to addressing racial equity and their approach.

At the peak of the opioid crisis, Kentucky was part of the epicenter for prescription drug overdose across the US. Almost two decades later, the landscape of drug use has changed but like much of the country, overdoses are still on the rise in Kentucky. In this wave of the crisis, rates of overdose death are skyrocketing in minority communities. Across Kentucky, there is a growing trend of racial differences in drug use and overdose death disparities. For example, in 2021 rates of fatal overdose increased by 34.3% for Black Kentuckians in contrast to 12.8% for White Kentuckians.

These racial disparities exist for many reasons, including structural racism embedded within service systems. As an example of this, in 2021 the rate of methadone enrollment was four-fold lower for Black Kentuckians compared to White Kentuckians. Accordingly, leaders in Kentucky made a commitment to intervention strategies selected at the policy, provider, and client levels to address these disparities and save lives.

In March 2020, an opportunity came through The National Governors Association (NGA) Center for Best Practices Learning Collaborative when they issued a Request for Applications to support governors with developing and implementing evidence-based interventions to build a sustainable infrastructure that reduces barriers to access for high-quality treatment and recovery supports. Kentucky recognized this as an opportunity to advance an urgent need for equity in its response to the opioid crisis. By employing a targeted universalism framework, which allows organizations and systems to achieve universal goals for all through the use of targeted processes, this work aimed to enhance the system of care and build equitable access for all Kentuckians.

The work from the Center for Best Practice Learning Collaborative was facilitated by a multi-disciplinary implementation team that enabled efficient decision-making, leadership support, and action. 

Areas of intervention included:

• Data: the project was grounded and informed by the disaggregation of data to identify and monitor potential disparities as well as points of intervention. Data sources included Medicaid claims, Department for Behavioral Health data, Vital Statistics, Prescription Drug Monitoring Program, Department of Corrections, and the methadone central registry. 

With data being a priority of the program, the National Governors Association’s analytic expertise and technical assistance accelerated the momentum of the initial project. 

The implementation team analyzed data and built data visualizations to review disparities and support the subsequent provider, client, and policy-level work. Race-specific overdose outcome data are now incorporated into the Office of Drug Control Policy Annual Overdose Fatality Report and are used to increase awareness of disproportionality across the state. Data gaps such as missing race and ethnicity data in Medicaid beneficiary reports were also identified and used to inform ad hoc requests to partner agencies and MCOs.

• Providers: At the provider-level, contract language was added to all Kentucky Opioid Response Effort (KORE)-funded agencies requiring disaggregation of data by race, ethnicity, and other relevant demographic or social determinant of health factors to drive action and at least one equity-focused initiative in grant-funded work. Similar language is now being incorporated in all Department for Behavioral Health contracts.

KORE also partnered with the SAMHSA’s Opioid Response Network to deliver racial equity training to all KORE-funded partners and provide a train-the-trainer to equip the Department for Behavioral Health to regularly offer these trainings and embed equity within their leadership as the statewide behavioral health authority. Adoption of a racial equity tool such as the Government Alliance on Racial Equity to review future grant funding notices of opportunity as well as contracting language is still in progress.

• Clients: Targets at the client-level focused on increasing the capacity of Black Indigenious, People of Color- (BIPOC-) led and BIPOC-serving social-service organizations to deliver KORE-funded overdose prevention awareness, outreach, and engagement interventions. Initially, ten BIPOC-led and BIPOC-serving organizations were funded and projects ranged from intentional service linkage following incarceration, hosting Black-led forums to discuss stigma, activities to decrease stigma towards medications for opioid use disorder and seeking substance use treatment, art initiatives to articulate the impact of overdose within BIPOC communities, language translation of program materials, social media campaigns, and overdose education and naloxone distribution at BIPOC-serving community events. The success of this initiative was supported by:

• • Partnering with BIPOC community leaders to co-design and lead implementation of the project.
  • Creating a broad notice of funding opportunity that retained a focus on reducing overdose while allowing for culturally relevant and innovative proposals to be funded.
  • Reducing barriers to contracting with the state by partnering with a trusted, third-party financial institution with a health equity mission.
  • Facilitating a monthly grantee learning collaborative to support collaboration across projects as well as develop a collective impact project (Recovery Boldly), providing technical assistance from the Opioid Response Network and grant writing training to increase capacity of BIPOC-led and BIPOC-serving agencies to apply for future state and federal grants.

• Policy: Targets included a Governor’s Office-led campaign to: 
  • Increase Medicaid enrollment by Black Kentuckians
  • Develop a Managed Care Organization (MCO) engagement strategy by the Departments for Medicaid and Behavioral Health to specify MCO contract language
  • Implement reporting requirements for disaggregated data by race, ethnicity, and gender to support accountability of Kentucky’s Medicaid insurance providers.

Collectively, this work encompasses an ongoing commitment to cultural humility and an earnest commitment to oppose that which produces or sustains racial inequity while embracing that which supports inclusion and belonging.

The Kentucky Opioid Response Effort (KORE) was established through the Substance Abuse and Mental Health Services Administration State Targeted Response and later, State Opioid Response grants. Housed in the Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities KORE’s mission is to increase equitable access to high-quality, evidence-based prevention, harm reduction, treatment, and recovery support services.

For more information on KORE and their commitment to addressing racial equity, please visit: kore.ky.gov or contact kore@ky.gov.