Nationwide, the vast majority of people with substance abuse disorders do not receive treatment for their addiction. The Los Angeles County Department of Public Health’s Division of Substance Abuse Prevention and Control (SAPC) is working to enhance access to substance use disorder (SUD) care to address the treatment gap. The FUSE Executive Fellow will map the spectrum of screening, intake, and admissions policies and procedures for the County’s SUD provider network, identify practical approaches SAPC can take to reduce barriers and increase the accessibility of care provided by the provider network and develop an implementation plan to equip providers across the network.

Fellowship Dates: July 24, 2023 – July 22, 2024

ABOUT THE FUSE EXECUTIVE FELLOWSHIP

FUSE is a national nonprofit working to expand social and economic opportunities, particularly for communities that have been limited by a history of systemic and institutionalized racism. FUSE partners with local governments and communities to more effectively address pressing challenges by placing experienced professionals within city and county agencies. These FUSE Executive Fellows lead strategic projects designed to advance racial equity and accelerate systems change. Since 2012, FUSE has led over 250 projects in 40 governments across 20 states, impacting the lives of 25 million people.

When designing each fellowship project, FUSE works closely with government partners and local stakeholders to define a scope of work that will achieve substantive progress toward regional priorities. FUSE then conducts an individualized search for each project to ensure that the selected candidate has at least 15 years of professional experience, the required competencies for the role, and deep connections to the communities being served. They are data-driven and results-oriented and able to effectively manage complex projects by developing actionable roadmaps and monitoring progress to completion.

Executive Fellows are hired as FUSE employees and embedded in government agencies for at least one year of full-time work. Throughout their fellowships, they receive training, coaching, and professional support from FUSE to help achieve their project goals. FUSE Executive Fellows bring diverse perspectives and new approaches to their projects. They build strong relationships with diverse arrays of stakeholders, foster alignment within and across various layers of government, and build partnerships between governments and communities.

PROJECT CONTEXT

Approximately one in four people will experience a substance use disorder (SUD) in their lifetime, including 2.5 million Los Angeles County (LAC) residents. The Substance Abuse and Mental Health Services Administration estimates that approximately 95% of those who need specialty SUD treatment do not receive it. In addition, Black and Hispanic individuals seeking SUD treatment are less likely to receive SUD treatment than White individuals. This majority of individuals who need SUD treatment but do not think they need or want it and thus do not engage with services is broadly referred to as “the 95%” for the purposes of this project.

SAPC promotes and manages the County’s SUD prevention, harm reduction, and treatment service networks. In addition to its administrative and financial oversight of the LAC specialty SUD system, SAPC operates a Substance Abuse Service Helpline(SASH) to connect individuals to publicly funded SUD treatment in LAC. SAPC’s vision is to engage the 95% of people who need but are not receiving SUD treatment by lowering barriers to access, equipping providers with best practices, and treating patients at all points along the substance use recovery spectrum.

Executing this vision includes promoting harm reduction, culturally competent treatment, and admission of patients who are not yet ready for abstinence. The 2022 National Drug Control Strategy has highlighted untreated addiction (including lowering barriers and promoting harm reduction) as one of the two priorities for federal-level approaches to substance use prevention.

While SAPC oversees the provider network, each agency and practitioner make decisions about admissions and the delivery of clinical care that align with their treatment philosophy. Any systemic change that SAPC aims to achieve, therefore, will come through influence, best practice curation and guidance to the contracted provider network actually admitting patients and delivering care.

Los Angeles County will partner with FUSE to facilitate practical action toward SAPC’s vision of engaging the 95% of people who need SUD treatment but are not interested or think they need it. The FUSE Executive Fellow will develop a comprehensive understanding and map of the spectrum of screening, intake, and admissions policies across the SAPC provider network, identify practical ways in which SAPC can enhance patient access including provider network implementation of low-barrier approaches for initiating treatment, and develop an operational plan that includes a suite of recommendations and best practices at the provider- and plan-level to lower barriers to SUD treatment entry. As a result of this work, Los Angeles County residents with SUDs will be able to better access clinically effective SUD care irrespective of their readiness for abstinence.

PROJECT SUMMARY & POTENTIAL DELIVERABLES

The following provides a general overview of the proposed fellowship project. This project summary and the potential deliverables will be collaboratively revisited by the host agency, the fellow, and FUSE staff during the first few months of the fellowship.

Starting in July 2023, the FUSE Executive Fellow will meet and cultivate deep relationships with a broad range of stakeholders, including Los Angeles County officials (e.g., SAPC), the prevention, harm reduction, and treatment provider networks that works with SUD-impacted individuals (including a range of provider sizes and approaches), and members of the public (with an emphasis on BIPOC communities). The Executive Fellow will seek to understand the strengths, weaknesses, resources, opportunities, and aspirations that will shape the implementation of SAPC’s vision for low-barrier treatment. The Executive Fellow will also review the available best practices for culturally responsive, low-barrier SUD treatment in communities similar to Los Angeles County.

Next, the Executive Fellow will develop a deep understanding and map the spectrum of intake, screening, and admissions policies and procedures across SAPC’s SUD provider network. The map should include information about what level of commitment to abstinence is required of prospective patients (i.e., full sustained abstinence from all intoxicants vs. still using tobacco and/or cannabis products vs. still using a broader range of intoxicants including alcohol) prior to initiating treatment, cultural facilitators for patient success (e.g., services provided in the patient’s preferred language and cultural responsiveness), and other relevant intake and admission factors (e.g., residential, outpatient, and/or field-based approaches). This map should illustrate and describe the system-level barriers and facilitators for entry into treatment throughout the SAPC treatment network.

Informed by the listening tour, best practices research, and admissions policy map, the Executive Fellow will develop an implementation plan for SAPC to promote facilitators and lower barriers to SUD treatment delivered to its network and an implementation plan for providers expanding treatment access. This plan should address which barriers and facilitators SAPC should prioritize and the mechanisms SAPC can use to enhance SUD treatment access throughout the treatment provider network.

By July 2024, the Executive Fellow will have worked with SAPC on the following:

• Conduct a Stakeholder Listening Tour – Develop relationships with stakeholders in Los Angeles County government, the provider network, and the public to understand the resources, constraints, opportunities, threats, and aspirations impacting SAPC’s vision. Conduct best practices research related to low-barrier SUD treatment.
• Admissions Policy Map – Create a detailed map of the spectrum of relevant admissions policies within the SUD treatment provider network, including the level of sobriety, cultural competence, and other barriers to entry into treatment.
• Practical Approaches to Influencing the Network – Identify practical recommendations for SAPC on how to encourage/incentivize/require providers to establish lower barriers and increase facilitators to SUD treatment.
• Implementation Plan for Providers and SAPC – Develop a practical operational plan focused on implementing low-barrier approaches to SUD treatment across the provider network. This implementation plan will be informed by best practices to engage SUD patients in a financially, clinically, and operationally sustainable and appropriate manner. This will include recommendations on the provider- and plan-level interventions to achieve this aim of better serving the 95%. At the provider-level, this will include an understanding of how to leverage current policies to treat a spectrum of clients at different stages of recovery and abstinence, how to operationalize policies that consider the interests of both individuals clients and their peers, and inclusive approaches to SUD treatment for BIPOC individuals. The operational plan should also include recommendations focused on SAPC’s processes at the plan level to identify options for SAPC to better engage the 95% within its system.

KEY STAKEHOLDERS

• Executive Sponsor – Gary Tsai, Director; Department of Public Health, Substance Abuse Prevention, and Control
• Project Supervisor – Michelle Gibson, Deputy Division Director; Department of Public Health, Substance Abuse Prevention, and Control

FUSE is an equal-opportunity employer with core values of diversity, equity, and inclusion. We encourage candidates from all backgrounds to apply for this position.

QUALIFICATIONS

In addition to the qualifications listed below, a background in social services delivery and complex systems change is strongly preferred for this project.

• Synthesizes complex information into clear and concise recommendations and action-oriented implementation plans.
• Develops and effectively implements both strategic and operational project management plans.
• Generates innovative, data-driven, and result-oriented solutions to difficult challenges.
• Responds quickly to changing ideas, responsibilities, expectations, trends, strategies, and other processes.
• Communicates effectively both verbally and in writing, and excels in both active listening and conversing.
• Fosters collaboration across multiple constituencies in order to support more effective decision making.
• Establishes and maintains strong relationships with a diverse array of stakeholders, both inside and outside of government, and particularly including community-based relationships.
• Embraces differing viewpoints, tolerates ambiguity, and implements strategies to find common ground.Demonstrates confidence and professional diplomacy, while effectively interacting with individuals at all levels of various organizations.

Salary: Executive Fellows are FUSE employees and receive an annual base salary of $80,000. Fellows can also access various health, dental, and vision insurance benefits. Compensation for this year of public service is not intended to represent market-rate compensation for the experienced professionals in our program.