Presenter:
Huston Cadette
North Carolina's (NC) Healthy Opportunities Pilots ("Pilots") program aims to improve health outcomes by linking the health and social sectors to address nonmedical drivers of health, such as food insecurity, in qualifying Medicaid enrollees in certain regions. While the program is currently paused due to state budget negotiations, NC remains in a perinatal health and food insecurity crisis, which may intensify with recent federal changes to SNAP and Medicaid in the reconciliation bill. Food insecurity is associated with adverse perinatal outcomes, creating an opportunity to improve perinatal outcomes through "food is medicine" (FIM) programs and access to affordable, high-quality, nutrient-dense foods. We studied the associations between food insecurity and perinatal health in NC through a landscape analysis of county-level data on perinatal health and food insecurity outcomes. We also conducted a literature review of Medicaid policy levers to improve these outcomes. We identified that the Pilots are in counties with higher food insecurity, child food insecurity, and adverse perinatal outcomes compared to the rest of NC, making the services critical to helping improve perinatal outcomes. Improved access to nutrition supports, through NC Medicaid services and/or linkages to community and government nutrition supports, can improve perinatal health. Given the pause on the Pilots, our policy recommendations are (1) for NC Medicaid and the NC General Assembly to restart the Pilots for the pregnant population in current regions and expand services to all pregnant Medicaid beneficiaries, (2) for Medicaid health plans to provide medically tailored home-delivered meals, pantry stocking, or home visiting programs (to improve linkage to nutrition supports) for high-risk pregnant individuals outside of the Pilots using managed care authorities, and (3) for providers to improve rates of food insecurity screening of pregnant and postpartum people, including at well-child visits. NDSURE - NCCU DUKE SUBSTANCE USE RESEARCH EDUCATION Presenters are organized alphabetically by last name. Key Structural Barriers and Facilitators to an Enhanced Primary Care Model for People with Opioid Use Disorder Leaving Incarceration
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Presenter: Huston Cadette
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Opioid overdose (OD) is the leading cause of post-incarceration death, with individuals having an eight times greater risk of OD within two weeks of their release. Research shows that medications for opioid use disorder (MOUD) reduce OD, relapse, and recidivism. Thus, there has been increased interest in improving access to these medications during and after incarceration. Yet significant gaps in care remain, including inconsistent availability of MOUD in carceral settings and underdeveloped systems for ensuring continuity of MOUD post- release. The Transitions Clinic Network: Post Incarceration Addiction Treatment, Healthcare, and Social Support (TCN PATHS) study is evaluating the TCN model of enhanced reentry primary care for people with OUD to determine whether TCN improves the post-incarceration opioid treatment cascade of care. We report on findings from the third aim of the TCN PATHS study, focusing on the appropriateness of the intervention and multi-level barriers and facilitators. Between November 2024 and March 2025, 24 semi-structured qualitative interviews were conducted with stakeholders in clinical, carceral, and community settings who were involved in the oversight or provision of MOUD programs or carceral care. We transcribed the interviews verbatim and coded using a codebook of deductive themes from the interview guide. I then conducted a thematic analysis of the following codes: "TCN Program Strengths & Facilitators" and "TCN Program Challenges/Barriers & Suggestions for Change." The following themes emerged. Key strengths included well-trained, communicative, and helpful staff. Primary challenges included external factors affecting care (e.g., transportation, housing), and patient mistrust in the health system. Suggestions included improving interagency (correctional, clinical, community, political) collaboration. These results suggest that elements external to the TCN program greatly affect patient care and therefore must be addressed in collaboration with TCN. Future work may explore methods for improving interagency collaboration in order to increase post-release MOUD access.
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Duke University / 2025
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Presenter: Huston Cadette