Providing Culturally Responsive Recovery Supports: Recommendations for Engaging Black Young Adults

Introduction Young adulthood is a time of many transitions—in the past month; or experienced serious mental illness, use disorders (Congressional Black Caucus, 2019; education, work, living arrangements, identity substance use disorder, or co-occurring substance Hatzenbuehler et al., 2008; SAMHSA, 2014). Black formation, and relationships. While the experience use disorder and mental illness than young adults young adults, especially those with mental illness or of mental illness and substance use disorder affect identifying as white or the overall population of young substance use disorder, are also more likely than other the transitions of young adults of all racial and ethnic adults. At the same time, young adults identifying as young adults to experience juvenile justice or criminal backgrounds, the prevalence and types of experiences Black or African American are more likely to attempt justice involvement (Council of State Governments and challenges related to mental illness and suicide than those who identify as white or than the Justice Center, 2015; National Center on Addiction and substance use differ for Black1 young adults in ways overall population of young adults. Additionally, young Substance Abuse at Columbia University, 2010). that have important implications for service delivery. adults identifying as Black or African American are less This issue brief examines the experiences of Black likely than other young adults to receive treatment for Overall, people of color account for 37 percent of young adults with mental illness or substance use substance use disorders when they need it (Substance the population, but account for more disorders and makes recommendations for improving Abuse and Mental Health Services Administration than 60 percent of the national prison population. outreach and engagement.2 [SAMHSA], 2018). Black males ages 18 to 24 are 12 times more likely to be imprisoned than are white males of the same According to the Substance Abuse and Mental Health Several studies document that practitioners are more age (Bronson & Carson, 2019). This disproportionate Services Administration’s National Survey on Drug Use likely to misdiagnose mental conditions experienced overrepresentation within criminal justice systems and Health (NSDUH), young adults identifying as Black by Black people of all ages (Gara et al., 2014; Schwartz means that incarceration and its aftermath alter the or African American are less likely to have used illicit & Blakenship, 2014). Black people are less likely to life chances of far too many young Black people in drugs in their lifetime; engaged in binge drinking in receive appropriate treatment for mental or substance need of treatment and recovery supports.

1 Throughout this document, we use the term Black to include both African and others, such as , Jamaican Americans, and other groups that comprise the more than 37.6 million people who identify as Black in the United States. This usage aligns with recommendations of the National Association of Black Journalists (National Association of Black Journalists, n.d.).

2 While mental illness and substance use disorders are by themselves complex topics, we discuss them together throughout this document in recognition of both the prevalence of co-occurring disorders and of the many commonalities related to challenges accessing treatment and formal and informal supports and building a life in recovery from either. Additionally, many recommendations for culturally responsive supports are applicable to organizations seeking to support young adults with mental illness, substance use disorder, or both.

This document is a technical assistance resource that was supported by contract number HHSS2832012000351/HHSS28342002T from the Substance Abuse and Mental Health Services Administration (SAMHSA). The views, opinions, and content of the document are those of the authors and do not necessarily reflect the views, opinions, or policies of SAMHSA or the U.S. Department of Health and Human Services (HHS). The Black young adult population is made up of many we focus on the experiences and needs of different communities with varying strengths, needs, Black young adults with or at risk of mental BRSS TACS histories, experiences, and perspectives. Much more illness or substance use disorder and offer Recommendations work is needed to develop a clear picture of their recommendations for engaging them in ▪ Provide holistic, integrated services experiences of mental illness and substance use treatment and recovery support services. ▪ Identify and build on strengths disorders and the multiple systemic, developmental, ▪ Go where the young adults are regional, and socioeconomic factors that influence SAMHSA’s Bringing Recovery Supports to their recovery trajectories. The 2018 NSDUH data Scale Technical Assistance Center Strategy ▪ Train staff in trauma-informed care and to highlight both the resilience of young Black people (BRSS TACS) convened two listening sessions understand the context of personal and historical trauma and the extent to which existing mental illness and with young adults who identify as being substance use disorder treatment and recovery Black or African American and in recovery ▪ Cultivate and practice cultural humility services fail to meet their needs. from mental illness, substance use disorder, ▪ Provide space to play or both. The team also held conversations ▪ Cultivate a staff team representative of As the connections between race-based stress, with practitioners serving young adults with those served structural racism, and systemic community-based mental illness or substance use disorders ▪ Honor youth voice and choice violence and health (including mental health and and reviewed both gray and peer-reviewed substance use disorder) disparities are well described literature. This document describes twelve ▪ Prioritize the safety of Black young adults in your program and your community elsewhere, this brief will not delve into the many culturally responsive and developmentally interconnected factors that contribute to differences appropriate practices identified through this ▪ Understand the role of faith and spirituality in the mental illness and substance use experiences process that organizations may consider in recovery pathways of Black young adults (Assari et al., 2019; Hope including in their efforts to improve treatment ▪ Provide young adult peer support services et al., 2015; Motley & Banks, 2018; Neblett et al.; and recovery services and supports for young ▪ Learn about young adults’ families and Sheats et al., 2018; Zapolski et al., 2019). Instead, adults who identify as Black. encourage their involvement

Task 8 Issue Brief 2 RECOMMENDATIONS FOR SERVING BLACK YOUNG ADULTS 12

Provide holistic and integrated services

The experience of a mental illness or development activities that facilitate successful substance use disorder may affect every transition to adulthood. Many young adults aspect of a young person’s life. As one needing treatment or recovery supports also need Black young adult in recovery explained other resources or supports, including education, during our listening session: employment, social connections, and assistance meeting basic survival needs (housing, nutrition, “Recovery is a daily practice that changes safety, health care, and parenting supports your whole life. The difference between for young adults who have their own children). being sober or being in recovery is that your Navigating multiple systems and organizations to life looks different than it did before. You’re meet these needs is overwhelming. Offering a one- responding to situations in a different way stop shop or assistance coordinating services to than you did before, so you experience life address the continuum of needs that young adults differently.” and their families experience supports engagement and retention in treatment and recovery Challenges related to mental illness or substance programming. For smaller organizations, strong use contribute to strained relationships with friends, partnerships with others in the community that family, and other potential sources of support. They include well-defined processes for warm handoffs interrupt or prevent young adults’ engagement are a low-cost way to way to meet the needs of in educational, professional, and personal young people and their families.

Providing Culturally Responsive Recovery Supports: Recommendations for Engaging Black Young Adults Task 8 Issue Brief 3 Identify and build on strengths A growing body of literature points to leverage these as sources of support. For example, to the importance of shifting from Black faith institutions, fraternities and sororities, a deficit-based service delivery and self-identified families all play key roles in model to a model that emphasizes fostering resilience, educating people about mental culture, family contributions, and illness and substance use disorders, and supporting the adaptability and resilience of recovery. Organizations seeking to support the young people of color (Cokley et al., recovery and resilience of Black young adults gain 2014; Watkins, 2019). Strengths- knowledge and important connections by taking based approaches consider time to learn about and develop relationships with culture, family, and community as other entities in their community that are already resources for supporting treatment, recovery, and engaged with Black young adults and their families resiliency. Supporting young people’s recovery must in different ways, such as faith communities and begin by asking “What’s working well?” to gain a full Black professional and service organizations. and complete picture of their strengths, talents, and steps to become more strengths-based. For sources of innate resiliency. Culturally specific models such as rites of passage example, organizations might start by reviewing programs (Caldwell et al., 2017) and campus- intake and assessment protocols as well as staff In addition to recognizing and leveraging each young based peer support models like the University of training and written communications to explicitly adult’s individual and family-level assets to support ’s Project Rise program hold promise and prioritize exploration, identification, and leveraging their recovery, culturally responsive practitioners may be good options for many young people. All of personal, family, community, and cultural endeavor to learn about the strengths of the organizations, including those that do not offer strengths throughout all stages of the organization’s communities and cultures of individuals served and culturally specific programming, can take concrete involvement with a young adult.

Go where the young adults are Many young adults are reluctant to visit clinics or offices on young people use this approach, including Roca providing mental health or substance use disorder services. in , Larkin Street Youth Services Their reasons may include concerns such as these: in , and The Door in . Moving ▪ not wanting others who might make assumptions to individualized supports out into the community observe them, and preparing peer support workers and other ▪ safety concerns related to traveling through different direct support practitioners to engage young adults at the neighborhoods, places where they already choose to spend time—such as parks, libraries, shopping centers, schools, community ▪ constraints on time, centers, or gyms—facilitates engagement. Co-location also ▪ lack of transportation resources, and communicates to young people that they are valued and ▪ lack of health insurance coverage. worth traveling to. Technology offers further opportunities for Co-locating outreach and engagement services with engaging with and supporting young people, wherever they other programming, such as those related to recreation, are. Young People in Recovery, Youth ERA, the Steve Fund, employment, or education, may help mitigate these and the YBMen Project have all developed innovative online challenges. Several multi-service organizations that focus programming for young adults. Task 8 Issue Brief 4 Train all staff in trauma-informed care and to understand the context of personal and historical trauma

Adopting a trauma-informed Black Caucus, 2019; Motley & Banks, 2018). approach is critical for Organizations seeking to engage and serve treatment and recovery Black young adults with mental illness or support practitioners working substance use disorder may increase their with any community that may effectiveness by adopting universal precautions, Cultivate and practice have experienced direct, understanding the importance of addressing collective, intragenerational, trauma, and presuming that all individuals cultural humility or historical trauma, served have a history of traumatic stress (Biggs Practitioners, outreach workers, and other staff must be including young adults who et al., 2013; Rich, 2016). identify as Black. mindful of who and what they represent. This means that In addition, for many Black people, addiction or they must be aware of how they self-identify as well as how A culturally affirming, trauma-informed mental illness may be just one source of turmoil others identify them. Many staff may view their role and approach that responds to the unique experienced by their family. Historical and image differently than how the individual or community experiences of Black young adults must also intergenerational trauma leaves many marks views them and require ongoing encouragement and attend to historical and persistent cultural on individuals and communities, including support to recognize and challenge any preconceived trauma. To truly implement trauma-informed, effects on health, mental health, and substance notions that they may hold about the community they culturally affirming or informed care, it is use. Research suggests that recovery is best engage with (Hankerson et al., 2015; L. Albright, personal essential to design all services (including framed within the larger structure of liberation communication, July 25, 2018). These are elements of outreach, treatment, and recovery support) and personal and cultural survival. To be cultural humility, which Waters and Asbill (2013) define as: using a trauma-informed lens. Trauma- personally and culturally meaningful, the informed organizations also provide trauma “The ability to maintain an interpersonal stance recovery stories of Black young adults may training for all staff—not only clinicians need to be nested within their larger history that is other-oriented (or open to the other) in and direct support practitioners, but also and contemporary experience as a people relation to aspects of cultural identity that are most receptionists, security personnel, and any (Kalathil et al., 2011; Mohatt et al., 2014; White et important to the [person].” others who interact with individuals served. al., 2006). Developed by the Association of Black Unlike cultural competence, which strives to build an Psychologists and the Community Healing Research shows that Black young people understanding of different cultures to better and more Network, Emotional Emancipation Circles is experience more frightening or threatening appropriately provide services, cultural humility encourages a culturally specific approach designed to be experiences than do their peers (CLASP, personal reflection and growth around culture to increase delivered by Black people for Black people. 2018; Morsy & Rothstein, 2019). More than 60 practitioners’ awareness (Campinha-Bacote, 2018; Tervalon This is just one example of how organizations percent of African American men have directly & Murray-Garcia, 1998; Yeager & Bauer-Wu, 2013). Staff or communities can provide a safe space for experienced a traumatic event in their lifetime should maintain a culturally open perspective and strive discussing racism and historical trauma in ways and in general, Black communities experience to feel comfortable with “not knowing,” and engaging trauma disproportionately when compared that promote participants’ mental health (Grills with communities from a place of “informed not-knowing” with other communities (Congressional et al., 2016; Volpe, n.d.). (Alegria et al., 2010; Tremblay, 2002). Providing Culturally Responsive Recovery Supports: Recommendations for Engaging Black Young Adults Task 8 Issue Brief 5 Cultivate a staff team representative of populations served Provide space to play Many Black young adults report a preference In addition to treatment and recovery services and recovery on and off the courts. Other activities for service practitioners who either share their supports, young adults need space to play, have fun, might focus on building connections within. During racial or ethnic background or and relax. As one Black young adult stated: our listening session, one young woman stated have a deep understanding of that painting and writing poetry were critical for the experience of being a Black “Recovery means changing your whole life sustaining her recovery. Several programs offer young adult (Congressional experience, including the people you used to creative writing or storytelling workshops. Another Black Caucus, 2019; Hayes et hang out with and the places you used to go young adult emphasized that it was vital for her to al., 2011; Townes et al., 2009). The staffing of many of the to hang out.” be able to connect with a community of other young organizations offering mental people in recovery: Another young adult asked: health and substance use services “How are we having fun? Where are we “It’s important to have those spaces where to Black people, however, rarely reflect this ethnic and racial composition showing up and enjoying our lives as young you can identify with different parts of (Chung, 2017; McGuire & Miranda, 2008; New, people? Where can I play without substances? yourself, not just as an ‘addict’ or ‘alcoholic,’ 2016). Organizations seeking to support Black That’s such a huge thing.” because there’s so much discrimination. Now young adults more effectively must prioritize recruitment and retention of Black staff and It is important to provide recovery-oriented I can be a climber or an athlete too.” strive to develop staff that represent the opportunities for creative expression, socializing, Creating space for young people to play cultivates different Black communities that they serve exercise, play, and other activities oriented toward (African American, Caribbean, African, and young people. Activities and program offerings a community based on common interests, and one others). In addition, service providers should should be diverse and culturally appropriate to the that is not based solely on shared experiences of develop capacity to implement culturally interests and social expectations of Black young recovery. To sustain recovery, young adults need specific or informed practices and increased adults. One service provider described creating a access to social environments where they can feel understanding of racism and its impact on the basketball mentorship program that coaches young safe, connect to others, and be their authentic selves people they seek to support. adults in sportsmanship and skills that support without fear of discrimination or misunderstanding.

Providing Culturally Responsive Recovery Supports: Recommendations for Engaging Black Young Adults Task 8 Issue Brief 6 Figure 2. Ladder of Youth Voice; Fletcher, 2011

8. Youth/Adult Equity

7. Completely Youth-Driven

6. Youth/Adult Equality

5. Youth Consulted

4. Youth Informed

3. Tokenism

2. Decoration

1. Manipulation

Honor youth voice and choice Meaningful involvement of young Black people with lived experience of recovery and resilience improves service quality and outcomes, and supports vital cultural change and knowledge development within and across systems. Roger Hart’s Ladder of Youth Voice (see figure 2) provides an enduring and useful framework for thinking about the stages of engaging young people in decisionmaking about programs, policies, and services that affect them. Authentic engagement means much more than ‘decorating’ spaces with Black young people or seeking their input on occasion; it requires recognizing young Black adults as the experts on their own Adapted by Adam Fletcher (2011) from work by Roger Hart, et al. (1994) experience, supporting their development as leaders, and trusting them to lead decisionmaking at the individual, program, and community levels. Organizations seeking to improve services and support for this population should start by engaging the young Black people whom they already serve, or hope to serve, in their change efforts.

Providing Culturally Responsive Recovery Supports: Recommendations for Engaging Black Young Adults Task 8 Issue Brief 7 Prioritize the safety of Black young adults in your program and in your community Black young adults face greater risks to their safety than other young adults (CLASP, 2018; Sered, 2015). Organizations seeking to engage and support them must take steps to learn about the very real risks that they face within and outside of their treatment and recovery support settings, and the many ways that prolonged, multifaceted experiences of lacking safety affect young Black adults. The Robert Wood Johnson Foundation’s 2016 Moving Toward Healing: Trauma and Violence and Boys and Young Men of Color advised organizations to Understand the role of faith and “. . . recognize the grinding weight of everyday violence and spirituality in recovery pathways toxic stress on boys and young men of color. Many . . . are never free of the effects of trauma. They live in conditions Black faith institutions and their leaders held in that space with something- characterized by neighborhood poverty, implicit and explicit have historically played a key role in bigger-than-me.” responding to community concerns. People racism, lack of resources, and exposure to violence in their in or seeking recovery often look to their For some Black young adults, including family and communities” (Rich, 2016). faith community for spiritual leadership and some with nonconforming gender and Recognizing and acknowledging the ongoing stress of facing these risks guidance. For example, when asked what sexual identities, religious institutions is crucial. Situating services and supports in areas where Black young recovery looks like for him, one Black young may be a source of isolation, shame, and adults feel safe and are safe is even more essential. A recent study in adult in recovery responded that confusion (Fields et al., 2016; Quinn et documented that young Black males feel less safe when they travel al., 2016). Several Black young adults to neighborhoods with a larger white population than they usually “Recovery looks like church.” mentioned that others have told them to “just pray it away.” Others said that they experience (Grabmeier, 2018). Other young people may encounter He said that most of his peers began felt their struggles with mental illness or barriers to engaging in programs or services such as safety risks related their recovery journey by reaching out to substance use could not be reconciled to the neighborhoods that they must pass through to reach the service religious or spiritual institutions and leaders with the values they were taught in setting or a lack of safe walking routes. In some areas, young people for help. Another young person said that may face risks from the other people served by an organization. Safety- church or other religious spaces. It is focused organizations explore these possibilities with the young adults “Recovery is a space where it is just important for service providers to contact they seek to serve and adapt locations and scheduling to accommodate between me and something-bigger- faith communities to build bridges; offer their safety needs. Ensuring that the physical environment also feels resources; provide information about than-me. When I’m white-knuckling safe—with adequate lighting, functioning bathroom locks, and enough mental health, substance use, and recovery; staff—is equally important. While many young adults may minimize it alone in my apartment, when the and raise awareness about services worries about their own safety, most appreciate genuine and well- phone is too heavy to call my sponsor available to young people (Annie E. Casey placed concern. or friends who understand, I can be Foundation, 2005).

Providing Culturally Responsive Recovery Supports: Recommendations for Engaging Black Young Adults Task 8 Issue Brief 8 Learn about young adults’ families and create opportunities for their involvement

Families—both of origin and of choice—play Some organizations or practitioners working critical roles in the lives of young adults. While with young adults hesitate to engage families 18- to 25-year-olds are adults, many of them still due to concerns about privacy or beliefs rely upon parents or other family for practical, about the families’ functioning and how this material, and emotional support. More than affects the young adult. Many young adults one-third of Black young adults live with a have complicated or difficult relationships parent (Fry, 2016; Newman et al., 2018). Despite with family members, including those who the important roles of family members, many may struggle with their own mental illness or providers of treatment and recovery supports substance use disorder. Working with each for young adults do not regularly engage young young adult to think through when and how adults’ families or explore their potential as to engage which members of their families Provide young adult peer recovery assets. As Jane Walker and Malisa honors their connections and their knowledge support services Pearson (2018) of the Family-Run Executive about what is best for them. Supporting young Director Leadership Association wrote, adults in thinking through who to include in Young adult peer support workers who reflect the their treatment and recovery support, and in characteristics, lived experience, and recovery pathways “Many programs that work with young what ways, helps them learn to navigate difficult of Black young adults are critical for building rapport, adults with mental health needs have no decisions and conversations—important skills connection, and engagement. Young adults who have specific process for involving families in for developing and protecting the relationships “been there” can provide hope, practical assistance, supporting their young adults, and some they value and the relationships they need. and a model of life in recovery to young adults who are even consider families an impediment Young adults are the experts on their own struggling. As one young adult in recovery said, families and asking them who they would to the young adults’ recovery and like to involve aligns with good practice and “Peer support is so important! Okay, I have a independence.” person-centered care and adheres to privacy problem, now what? Is there someone who requirements. Given how dynamic family Partners, siblings, extended family, close relationships can be, particularly during young is going to help me live day-to-day without friends, and others most important to young adulthood, asking about family involvement substances? Is there someone who is going to adults may also be tremendous assets for young repeatedly—even when working with young invest in my dreams and help me reach them? adults. Encouraging their involvement with people who initially elect not to include young adults’ treatment and recovery supports Is there anyone to share this journey with? family members—supports young people in and offering information or supports for them Community, peer support, and access are so reconsidering options and identifying resources demonstrates concern and regard for young important.” and supports over time. adults as whole people with full lives outside Emerging evidence on the effectiveness of young adult of the treatment or service setting. It also peer support is promising. Studies suggest that young encourages family members to learn more about people who had access to peer support services were the young adult’s treatment and recovery, and more satisfied with services than were those who did not to support the efforts that they are making. have access to it (Jackson et al., 2015; Radigan et al., 2014).

9 Task 8 Issue Conclusion References

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