Downtown Providence Opioid Overdose Crisis Research & Findings
Rhode Island is experiencing an unprecedented overdose crisis, ranking 11th in fatal overdoses in the country in 2018. The overdose crisis has been particularly evident in downtown Providence, an area with some of the fewest residents of any zip code in the city, yet the highest burden of opioid overdose-related Emergency Medical Service (EMS) runs.
The Rhode Island Public Health Institute (RIPHI) collaborated on a needs assessment of the overdose crisis in the 02903 zip code, which includes Downtown and nearby areas. As a result, RIPHI has recommended that the city and state offer more overdose services downtown, including in Kennedy Plaza, Burnside Park, and the Providence Place Mall. RIPHI also recommended the state establish a harm reduction and overdose prevention center downtown. To read the full report, click here.
Food on the Move
National Institute of Food and Agriculture
Awards RIPHI a $500,000 Gus Schumacher Nutrition Incentive Program Grant
This project will further improve the Food on the Move (FOTM) program to meet the needs of older adults with chronic disease. FOTM is especially important now, as low-income older adults are faced with additional challenges of getting and affording nutritious food, and managing chronic health conditions amid the COVID-19 crisis. We will increase the purchase and consumption of fruits and vegetables by low-income older SNAP participants by:
- Improving marketing and communications to engage more SNAP participants in shopping at FOTM on a regular basis.
- Developing educational activities that promote management of chronic disease through improved diet.
- Evaluating the impact of our program and disseminating our results to inform state and national programs.
We are particularly focused on expanding SNAP benefits to grocery stores to increase access for families with children, a group facing increase food insecurity and financial uncertainty due to COVID-19.
Emily Adams, a nurse practitioner, talks about the importance of the healthcare services Open Door Health is offering, especially for marginalized populations in Rhode Island.
“As a pediatric nurse practitioner (I was trained at Hasbro Children’s Hospital’s Gender and Sexual Health clinic), my focus is gender-affirming care for pediatric adolescents and young adults. That includes social, medical, and legal affirmation, helping families and kids navigate these systems, talking about hormones and blockers, and helping caregivers use their child’s name and pronouns. I really fell in love with this type of consent-based care — how we collaborate with our patients and make sure we’re not gatekeeping but are truly facilitators of health and education.
Open Door Health has an amazing staff, and I’m grateful to work with a group whose values are so aligned. In addition to gender-affirming care, we offer primary care, HIV prevention, HIV care, HEP C care and treatment, and screening and treatment of sexually transmitted diseases. This includes expertise in HIV, PrEP and PEP (pre-exposure prophylaxis and post-exposure prophylaxis). All of us at Open Door Health have been working with the LGBTQ+ community for a long time, and that’s what brought us together.
Gender-affirming care and the informed-consent model are focused on the idea that nobody has to prove themselves — you don’t have to come in and prove you’re trans enough. You don’t have to say I’ve lived in this body, in this life, for so much time. At the beginning of the appointment, I tell you my pronouns and talk about our approach. Then I will ask, “What is your goal? What do you need from me today?”
When I ask, during the intake interview, about more sensitive information, like substance use, mental health, and sexual health, I remind patients that they can choose not to disclose — I know that not everybody wants to talk about every aspect of their sexual experience at every health care visit. And that’s okay. I also reassure patients that I care about their safety and wellbeing. If somebody is having a really hard time with mental health, then we are going to plan together and make sure that we’re able to move forward.
For so long, there’s been so much gatekeeping around hormones — that you have to have a therapist or psychiatrist sign off. Those are very hard services to access, especially right now. Patients sometimes fear for their safety as they begin their affirmation process and their experience in the world. Trans women and trans women of color are at the highest risk for violence. And so their safety is going to be part of the discussion. We see higher rates of suicidality, self-harm, homelessness, and substance use, and this is not because there’s an intrinsic problem. It’s because of minority stress and the bigger picture about how society is marginalizing these communities.
COMMUNITY REPRESENTATION
We have a community board that represents the people we’re serving, so people have a voice in the direction of their healthcare and what we do. The staff is also representative of the people we serve. We offer onsite phlebotomy services, so people don’t have to go to another lab site where we don’t know how they will be treated, or if they will be stigmatized.
One of our goals is to be a positive presence in our community, and also a place where people can come together and meet and be part of ongoing community activism. It’s been a little hard with COVID-19. But I think just asking about sexual health, and being able to treat HIV and STIs and being knowledgeable about them, can make patients feel safer in talking about HIV and sexual health with us.
DREAMS
We like to say we’re small but mighty. And we are huge dreamers. We see a substantial need for behavioral health, and so we’re thinking about how to get therapists and psychiatrists onsite so we can do same day needs. We also definitely see a need in our immediate community for substance use programs.
We want to make sure we have the social supports in place and the structures to really make sure no one slips through the cracks. And so these are all things that we’re very excited about. Eventually we want to provide all the care our patients need and to be as accessible as possible.
Rather than have LGBTQ+ care be an add-on, we make sure that it is central in the way we document, the way we talk, and the way we address health. From the moment a person walks in our door to when they leave — whether it’s the phlebotomist, the front desk or the care provider — all of us all have the same goal and mission, which is to improve health outcomes and be listening to and serving the community the way they really want and need.
(Special thanks to Melissa Pineda Brown for their help in preparing this story)
Raising the Bar: On Racism, Health and Publication Standards
A training by Dr. Rhea Boyd, Hosted by RIPHI and Open Door Health
This training, held on November 19th, explored racism as a root cause of racial health inequities, and offered an analysis of racial disparities emerging during the COVID19 pandemic, evidenced by disproportionate police violence, within the history of racism in the US.
Given this foundation, Dr. Boyd issued a challenge to researchers, journals, reviewers, and readers to engage racism within their analysis of racial health inequities.
Tiara Mack’s first victory came on September 8, when she beat long-time incumbent Harold Metts to be the democratic candidate for her Providence district. A deeply religious man, Metts was anti-choice and opposed to marriage equality and LGBT rights, preferring to be guided by the bible than the needs of his constituents.
From there, Mack, a black queer woman, handily won the November election and is now poised to take a seat in the State Senate.
She is also a member of Open Door Health’s Community Advisory Board, and has helped to guide the organization as it opened, and as it operates today. She feels strongly about the need for ODH, and her own personal experience in the health care system informs that belief. “As a black, queer woman,” she says, “I have had so many negative experiences with health care providers. I’ve never had a comprehensive reproductive health visit where I left feeling good about my body, and my sexuality.”
The importance of this health center model is illustrated, says Mack, by the diversity of the patients. “When you create a safe, welcoming space,” she continues, “people will come in flocks, as it reflects their values. It is sex-positive and gender-positive, and that is really important.”
Mack has also recently become a patient at Open Door Health. One of the first things she noticed was the intake form – “there were so many inclusive questions, about areas that were important to me. It was really just welcoming.”
As for her upcoming time in the state legislature, she is just as enthusiastic. “The chance to change the narrative, by adding to the diversity of those in positions of power, is exciting. As a long-time activist, I’ve been on the outside working to inform policy, but activism can be enhanced by being in positions of power.” While she had not previously considered the possibility of running for office, she says, “It was a natural progression.”
