Social Work Practice and Opioid Overdose Outreach Podcast

Editor's note: This text-based course is a transcript of the Social Work Practice and Opioid Overdose Outreach Podcast, presented by Allison Stone, MSW LMSW, and Benjamin T. Bencomo, DSW LISW, LCSW.

Learning Outcomes

• After this course, participants will be able to:
  • Explain social work’s role in the opioid epidemic.
  • Dermine how best to implement an opioid overdose outreach program in their community.
  • Identify positives and negatives associated with overdose outreach programming.

Dr. Bencomo: Hello, everyone, and welcome. My name is Dr. Ben Bencomo, and I am thrilled to host this Continued Social Work podcast. I'm very excited about my guest for today. About a month ago I had the pleasure of attending and presenting at an NASW conference, and my guest today was one of the presenters, along with her partner at that same conference. The incredible work that she and her partner are doing to serve her home community of Las Cruces, New Mexico I  found to be incredibly exciting and inspiring and ahead of its time. After getting to be present and witness her presentation I just knew that I had to reach out to Allison to ask her if she would join me on the Social Work podcast. So without further ado, my guest today is Allison Stoner. 

Allison is a licensed master social worker in the state of New Mexico. She works with the Las Cruces Fire Department as a leader of the opioid overdose outreach program under the mobile integrated healthcare umbrella. This program identifies overdoses through the 911 system, then offers in-home outreach to patients and their impacted support systems. She and her partner, a paramedic, follow up with those involved to provide Narcan, Narcan education, community resources, and even make referrals to treatment if needed.

The aspect of the job that Allison values the most is being able to meet people where they are, both emotionally and literally in their homes or in the field. She believes integrated healthcare holds immense opportunity for social workers. Allison has previous practicum experience with the mobile integrated healthcare program and as a high school social worker. Prior to coming to New Mexico for graduate school, Allison also served as a Peace Corps volunteer in Ukraine. 

Allison, thank you so much for being here. It's a pleasure to have this conversation with you today.

Allison: Thank you so much for having me, it's a pleasure to be here.

Dr. Bencomo: Thank you. Allison, I guess if you're ready, we'll just jump right into it. Would you be able to share with our listeners a little about your path to social work?

Allison: Sure, I am actually originally from California. I grew up in the Bay Area and I went to school in California on the Central Coast. I got my undergrad degree in sociology.  I originally chose sociology because I really didn't know what I wanted to do. I had no definitive career path at that time, but I had to declare a major, so sociology seemed like it would open doors for teaching, for social work, for just a variety of opportunities, which is really what I was looking for at the time. 

I didn't know exactly what to do. So, I had the opportunity through sociology to declare kind of a concentration in social work, and that really was sort of the catalyst for my interest in potentially the opportunities that social work had. When I graduated, I was still not quite ready to sort of define a career path, so I ended up applying for the Peace Corps and going to Ukraine for two years. 

Over the course of that experience I thought a lot about what would I want my next step to look like, a potential long-term career. I then settled into the idea of social work and came to New Mexico State for graduate school. I am so grateful that I did because it's been wonderful so far. I am new to the field. I just graduated in May of last year but it's been moving forward ever since, no looking back. It's been more than I ever could have hoped for.

Dr. Bencomo: That's awesome. Well, on behalf of the social work profession, and I'm sure the community that you serve, we're glad that you found your way to social work.

I often discuss or have conversations in my classroom with my students about the multitude of practice options available for social workers. However, I must say, your current position and setting isn't one that comes up a lot. I think it isn't one necessarily that a lot of social workers even think of as an option for a practice location or social work practice opportunity. So is your current position with the Las Cruces Fire Department something that you envisioned as a possibility when you began your studies in social work?

Allison: Not even a little bit. I had no idea that this sort of an opportunity would come up and would come up so quickly in my career. Really all of my past experiences working have been focused on youth. If I had any idea of what my long-term career would look like, I absolutely would have said, "Oh, I'll definitely be working with youth or with little kids." But after I did my practicum year as a school social worker, that was kind of the benefit for me of not really having, I didn't really know too much about the Las Cruces community yet, since I was new here for grad school. And one of my, you know, practicum coordinators said, "Oh, the Las Cruces Fire Department takes social work students. Are you interested in that? It is a really unique experience." And having, for me having really no background of, or idea of what that might look like, I was just intrigued at the possibility of doing something so different. And so, yeah, I did not know that I would end up doing this work. Even when I started as a practicum student, I had no idea that I would find this to be a longer-term work, but I am just very glad that I did. And yeah, it is definitely an integrated experience for sure.

Dr. Bencomo: Absolutely, that is fantastic. Allison, one of the experiences that I and many of the attendees at the conference where you and your partner spoke at, were surprised to learn that this was even an option that this opportunity for social work intervention in communities. I think it is so ahead of its time that now the specific program that you had is the opioid overdose outreach program. I heard you and your partner refer to it as the Triple O program, which may be a little bit easier off the tongue, but the Triple O program with the Las Cruces Fire Department, I think that it's been celebrated really as a forward-thinking initiative, partnering social workers and firefighter paramedics. Can you tell me a little bit more about the Triple O program and how it came to be?

Allison: Yeah, so the Triple O program, it really started actually as an offshoot of the Las Cruces Fire Department's mobile integrated healthcare program. I know it gets pretty complicated, there's a lot of acronyms. But mobile integrated healthcare started about five or six years ago by one of our paramedic firefighters who was tasked with the job of addressing frequent 911 utilizers. When the program was first coming to fruition, he looked at addresses that had repeat calls. We have had some folks in the community who call 911 close to a 1,000 times a year. Then he sort of started doing some analysis of what was driving the calls, what is being overlooked for these folks that they are needing to rely on the 911 system for their basic needs is what was happening pretty frequently. 

And so that program worked for, you know, again a couple of years, and then they brought in social work students to that program. And it has sort of just blossomed and has become a very, I think, fundamental program for the community. And so with all that being said, the Triple O program is actually a grant-funded program. And so mobile integrated healthcare a couple of years ago, looking at just the opioid epidemic said, "What can we do to address this now growing, ever present problem also in the Las Cruces community with just the amount of overdoses that we're seeing?" And so they applied for that funding and it was really sort of, the grant was kind of placed in Los Cruces Fire Department's lap because they were looking to provide funding. It is a grant through SAMHSA and they wanted to offer funding to first responder agencies to really do this work and to, you know, they already have kind of boots on the ground, have pretty good rapport in the community. And so to be able to provide funding for this sort of work and for the overdose outreach, that is really how it came to fruition.

Dr. Bencomo: That is fantastic. It seems like just one of those programs that was meant to be, I am glad that you were able to be there. So, were you completing your social work internship during that time when the program was first launched?

Allison: So COVID did end up throwing this program really out of whack. That funding, we received that funding prior, a couple years prior, but then there was, because of COVID it just got delayed and it got pushed back. And so I was sort of, I was not really a part of writing the grant application, but I knew that it was being talked about, and then it did start, really boots on the ground started in January of this year. So I did get to see it sort of taking off while I was a student and now I am fully, fully immersed.

Dr. Bencomo: That is fantastic, thank you. What are the main aims of the Triple O program?

Allison: You know, something that I love about it is how dynamic it is and that those goals are sort of ever changing to really meet the need of the community. But I would say that in general those goals are to reduce and prevent overdose-related deaths by offering Narcan, Narcan education, building rapport with individuals in the community, both in terms of clients and stakeholders. A huge goal of our program is to just continually approach folks with no judgment to lessen the stigma that surrounds use of opiates and other substances, and then to refer and connect individuals to treatment services if that is something that they are looking for. I talk about it pretty frequently. I know that for me, as somebody who has a lot of privilege, it can be difficult for me to navigate the healthcare system. And so to be able to really work with stakeholders in the community, to have a good understanding of, these are our treatment options, these are the processes, these are some of the barriers. And then to be able to take that information to clients and to really serve as an advocate is a huge goal of this program. And if somebody is looking for that level of service, that we are able to advocate on their behalf, that we hopefully have some answers to some of those ever present questions of how to navigate the systems and those, so that that is really what drives our service and our practice.

Dr. Bencomo: That is great. I think that having you as an advocate and an ally during really a, one of the most critical moments in a person's life when they have reached out via 911 because of an emergency related to overdose, not only for the client that you are serving, but for those around them as well, I think is probably incredibly powerful to be able to be there in that moment and serve as their partner and advocate in that way. That is fantastic.

Allison: Yeah, and I would also say that even though it is not necessarily one of our definitive goals, just being a part of mobile integrated healthcare, we are also able to really address other needs of individuals if there are other needs present. So the mobile integrated healthcare side is really intensive case management. And we as kind of an offshoot of that, whether that is us referring somebody to that program or doing the work ourselves, if we respond to an individual initially because of a potential overdose, but we quickly come to find that they are also lacking consistent housing or access to food. We really try to meet as many needs as we can, assuming that it is within our scope of practice. And if it is not, then again, those connections to service providers are so beneficial that we can refer to other services that those individuals might need.

Dr. Bencomo: Absolutely, yeah, thank you. You mentioned a little bit earlier that the Triple O program is grant funded through a SAMHSA grant. Would you be able to provide just a little bit more detail? Is that a multi-year grant? Is this, are there plans for this program moving forward in the years to come? Or what are you and your colleagues thinking in that regard, in regard to funding of the program?

Allison: Yeah, absolutely. So through SAMHSA the grant that we received is a First Responders-Comprehensive Addiction and Recovery Act, it is FR-CARA is the name of the grant that we receive. And it is multi-year, as I said, the implementation of the program really started at the start of this year, but had been sort of in programmatic in growth, I guess, for a little bit before the start of this year. And we are funded through October of 2023 through the grant, and it is definitely, we are talking all the time about how are we going to make sure that this is a program that is sustained because of the benefit for the community, because of just the response that we have had from folks in our community to be able to do this work. 

We are a little bit undefined at this time if we will continue to pursue grant funding for it, or if it's something that can pretty easily just be absorbed into city funding for the fire department. Both are on the table, and I think both are viable options. You know, it is really a benefit that there is not too much cost to this type of work. It is the grant, you know, we are so fortunate to have the grant and the grant provides the funding for the Narcan that we are able to distribute. The grant funds my position currently. The grant funds cost for the paramedic who is partnered with me. That being said, the fire department is definitely looking to make these positions full time. And that is something that the city of Las Cruces has responded well to. And we think that would be, you know, that it would be long-term sustainable to just make these positions full time and to ensure that the work continues to happen.

Dr. Bencomo: Yeah, that is great. I am glad that you all are already having those conversations and looking about long-term sustainability. When we talk about opioid addiction and opioid use, and we look at long-term cost, cost savings, cost analysis, I hope that this is something that is able to be sustained long term in that regard. Because, you know, like you mentioned, this really is a low-cost initiative that not only is a great service to the community, but also one that could possibly be cost saving in long term for the community.

Allison: Absolutely.

Dr. Bencomo: Allison, would you be willing to tell us a little bit about the structure of your team, about the staff within the Las Cruces Fire Department?

Allison: Sure, yeah. So again, I would start back, it is kind of a tiered program and I would go back to initially referencing mobile integrated healthcare. So, what started as one paramedic firefighter grew to a paramedic firefighter with two master's level social work interns, and now has expanded and has two paramedic firefighters full time. One of which is sort of, he really is our coordinator. That was my partner who spoke with me, Paul, at the conference. He is our overseer and also really responsible for the creation and initial implementation. And then I have a paramedic partner who has partnered more full time with me, specifically doing the work that I am doing.

I was the first social worker hired full time by the fire department, which is quite an honor, but I have been very fortunate that we have hired on another full-time social worker in, it was the end of last year. And so she is really working, still focused with the mobile integrated healthcare program. I am working very specifically with the opiate overdose outreach program, and then we do continue to have social work interns as well. And so that really is the extent of our staff, which I kind of flip flop back and forth. If you think about the growth that we've had in the past couple of years, it seems exponential. And then when I also talk about, "Well, this is, you know, a four to six person staff," for the amount of visits that we are doing within the community it is still a pretty small program. And so we do anticipate and will be seeing more growth, which is very, very fortunate. The city of Las Cruces did sort of task and request that the fire department heads a mobile crisis response team. So that is also in the works and will be implemented out from underneath the mobile integrated healthcare umbrella. But so then in terms of just sort of my day-to-day practice, I am partnered, as I have mentioned now a couple times with a paramedic firefighter and we are a two person team. And that is really, we are doing the work for the opiate overdose outreach program.

Dr. Bencomo: That is great. Itis great that you have been able to so quickly add another social work position. And I hope that that momentum keeps moving forward to where you can continue to expand the program and serve even more members of your community. Allison, so you and your partner go out and begin your day. Can you tell us what does a typical workday look like for you working in the Triple O program?

Allison: Yeah, I think part of what I enjoy so much is that it is hard to say if there is ever a typical day, but there are a few pieces of our day that are pretty typical every day, if that makes sense? Most mornings we will come into the office and we will use the 911 call data to actually look for potential overdoses. So one of the huge benefits of being within the fire department is that, you know, anytime that there is a call to 911 for a potential overdose, fire crews are responding. And so then in our program we look at those calls from the day or a couple days prior, and we look

through the patient care reports anytime there is a call that is maybe an overdose related. And so we are looking at CPR calls, we are looking at unconscious and unresponsives. 

We are looking at calls that get labeled as overdoses, definitely. And then we sort of read through those reports and we get a general idea of when overdoses did occur. We then sort of formulate that as our target population for the day that we will try to make visits to those folks that we have now identified these potential overdoses. And then we do just go into the field and make contact, whether that is at that person's home or whether we are responding to, you know, a community agency, whatever it might be, we are then trying to make contact with the individuals involved. And so sometimes that is knocking on the door and saying, "Hey, we saw that this may have happened." And the person that we're speaking to is the client or the patient themselves. Sometimes it is a family member, sometimes it is a friend. And then just depending on what sort of contact we do make with those folks will impact or influence what services we are offering.

If somebody is ready and willing to chat with us about the use that they have been experiencing, then we will go from start to finish of, "Would you like Narcan? Would you like this list of resources? Would you like us to call a treatment provider?" And then it is really just dependent on kind of our work together in collaboration with them as the individual to decide what the next steps will be. And that might include, you know, us literally driving somebody to an intake somewhere. It could be a phone call that we make with that individual, or it can be as simple as just handing a Narcan kit that has a dose of Narcan, it has a rescue breather mask. 

We give the training on how to utilize the Narcan. The paramedic will, you know, sort of walk somebody through what rescue breaths look like, how to position the person's body if they are experiencing an overdose, and really just give sort of that education that is hopefully lifesaving if the person were to need those services again. So that is kind of, that is the basis of what we do. And then from there, you know, sometimes as I mentioned, our work can be, it can be a five minute interaction, or we can work with somebody for a month at a time trying to get them linked into the services that they are interested in and are wanting. So then we have some days where we are making phone calls on behalf of somebody to agencies, or as I said, you know, taking somebody to an appointment in order to get a medical clearance before they can go to the next step. So every day is different. And that I think is part of what makes this job so enjoyable is the variance of interactions that I get to have with community members, with service providers and always working, you know, kind of towards a common goal.

Dr. Bencomo: I did not fully realize the first time that I was able to listen to you and your partner speak the amount of follow up that you all are able to do. And so if you would not mind a little bit explaining, so after you make initial contact with a family, with a person in crisis, then, and you offer your contact information, then they are able to contact you. And I did not realize that you were able to help with transportation to treatment and different opportunities like that. Is that something that is also included in the grant? Is it something that the family would be responsible for paying for, or is it just that continued supportive services? Is that built into the Triple O program?

Allison: That is a great question. That is again kind of one of the benefits of being with the fire department is that the Las Cruces Fire Department at this time does not bill for any services. If somebody in the community has a heart attack and the squad ambulance responds and they transport an individual to the hospital, currently there is no bill for that person, and the same applies for our services. That includes the Triple O program, that includes mobile integrated healthcare. So yeah, there is no cost associated. The Narcan is free. That is sort of just the beautiful nature of the fire department services at this time. And so, yeah, that is definitely a benefit. It makes the barriers to our service a lot less than can sometimes happen with service providers. And then in terms of the transportation we can, and we do offer that, as I mentioned, we're only a two person team with one vehicle. So we will almost always try to link folks in with other transportation services, if at all possible. But we do have the immense benefit of being able to provide those rides if, you know, sometimes transportation is the biggest barrier. And if we can eliminate that by giving somebody a ride to a treatment provider, then that is something that we are very fortunate to be able to do.

Dr. Bencomo: That is great. That really is fantastic. What a service to your community. Allison, can you tell us about a call that you remember responding to that you think might have had a different outcome had you not been there as a social worker to assist in that moment?

Allison: I think one specific call is tough, but I think that I am continually impressed, overwhelmed by, influenced, all the full spectrum of emotions and feelings that go along with the integration of a paramedic and a social worker, that it just surprises me every time how we see the same situation, the same scene in very, very different ways. And so I think of just kind of in the natural nature of our response, the way that our team operates, you know, we might go in and as I said, the paramedic will say, "Okay, this is how you use your Narcan. This is how you use the rescue breather." While I am thinking, "Well, okay, what maybe caused this, right?" What are maybe some of, we think about person and environment perspective. And we think of ACEs and we think of trauma. 

I feel so fortunate that we are able to really holistically work with folks because of the scopes of our difference, the differences in our scope of practice. And so I think that there are a few clients that maybe stick out, specifically where we had gone in with sort of the initial goal of, "Okay, we're going to give Narcan, we're going to give training." And then, and we're going to assume that that's kind of what this person wants. And then to be able to do that and having the fire department logo on our uniforms, it really, I think provides a sense of security and openness to folks to have conversations with us. 

And then the social work perspective for me, I start asking a little bit, not, start asking more questions that are aligned with that person environment perspective, that are aligned with knowing that, most folks who are using substances are using substances because of trauma or because of underlying conditions. And so then to be able to ask those questions of individuals to help us create a more holistic treatment plan. I really think that that is the beauty of our integrated teams.

Dr. Bencomo: What a great example of partnering between the professions. Whereas your partner has their expertise and their knowledge and their own really goals for supporting the client in that moment, you bring the social work piece and you bring that side of being able to look at what are some of the environmental factors, that systems' perspective, that person and environment, what's contributing to the challenges and how can you provide support on more of an ongoing basis to the client and to the people around them. That is fantastic.

Allison: Thank you.

Dr. Bencomo Ben: Allison, what would you say are a few of the challenges that you have experienced associated with this work?

Allison:  It is a good question. First and foremost, I just feel so fortunate, you know, kind of going back to some of the discussion that we had earlier if I ever expected to be in this position. And the answer was, I had no idea. But to be sort of involved in this program that has a big influence in terms of medical systems, because it is the fire department and they are running constant EMS calls. So it just immediately opened my mind and provided me so much education on barriers within the medical system. And that I would say is one of the constant and consistent challenges of this work is the systemic barriers. 

I think that there have been so many situations and so many clients where we walk into a situation, that individual is more than willing to talk with us. They give us so much information about themselves, about what they want, their autonomy, their choice, whatever services it is that they might be interested in. And we say, "Okay." And it looks like initially there should be such a clear path that this person is in this situation. Maybe they are mobility limited and they want to continue living in their home. And it seems like, all right, easy breezy, we link in personal care services and everybody wins. And then you have the barrier of, "Oh, but this is a person who is on Medicare. So personal care services are not going to be covered. So how are they going pay for it?" 

There are definitely times when I have felt we have just watched sort of a perfect outcome snowball and spiral and slide out of our reach. And that is very frustrating. So I think that that is definitely one of the continual challenges, and there are so many of those instances, right? The medical systems in general can be difficult to navigate, and so the systemic barriers are definitely one of the most consistent challenges. 

I think this is also just emotionally difficult work at times. I think that the systemic barriers contribute to that. I never expected to be, something that I didn't mention in terms of a typical day. We are not responding immediately at this time to any 911 call for overdose. But if we happen to be out and about in the community, which we are for a large chunk of most of our days, and we hear that there is a call for an overdose or an overdose-related situation, then we will typically respond. I am working with a paramedic. So the paramedic has their full scope of practice to be able to provide care in potentially life threatening situations. And I really admire that that is something that both of the paramedics that I have worked with, their sort of sense of duty to respond to those calls while we are in the community is very high. And I really respect that. 

I think that responding to a call as it is occurring, it's a very vulnerable time potentially for the patient or for the folks on the scene who are maybe involved, maybe it is family, but that is also a really good time to have conversations about what are the next steps. But in that nature, you know, we are responding at times to calls that are occurring and are very heavy. And there is a lot of loss involved with overdose-related work. And so I am just so fortunate to have clinical supervision that helps me sort of process through things that I am seeing that I did not necessarily anticipate that I would be seeing when starting a social work career.

I am very appreciative of our team and the way that we can consistently check in with each other, making sure that we are supporting one another. That is a challenge, but then again the flip side of all of these challenges are some of the joys. And so being able to maybe impact or have influence in terms of thinking a little bit bigger than just within our immediate team. I have had the opportunity to be sort of a piece of the peer support program within the Las Cruces Fire Department, and to enhance the care that we are providing for ourselves, providing for our clients, providing for the Las Cruces Fire Department, and then ultimately all of those pieces having a positive impact hopefully on the community is something that is an opportunity for me to be a part of that.

Dr. Bencomo: Absolutely, yeah, thank you. You spoke about the systemic barriers. I think that that is definitely something that should serve as I think a call to action for all of us as social workers is looking at what are those barriers to treatment and to support, and what is keeping the members of our community from accessing those services and being able to really engage in their own recovery in a meaningful way when they are ready to do so, right? And so, I think that that is a good reminder, a good reminder for all of us as social workers that there's still quite a bit of work to do in this area. You spoke about the emotional toll as being a challenge. I am happy to hear that you are able to reach out and get really good clinical supervision and have good support from your team. Allison, what do you do for your own self-care to help just keep your batteries charged to keep going the next day?

Allison: This is actually something that I heard from one of my professors when I was in  sociology, in my undergrad, and she was a social work practitioner and she said, "Every day I come home, and the first thing that I do is I take my uniform off and I change into something that reminds me of who I am as a person that is not associated with the uniform." And that is something that I have absolutely maintained. 

It is a very therapeutic process for me to say, "Okay, my uniform from today is going in the wash. And if I have to pull it out tomorrow, I'll pull it out tomorrow. But for right now I am getting home and I am removing the work day from myself. And I am starting my home day." That feels like a very important separation for me, and it is something that I have really valued to have that sort of guidance from that professor years and years ago. 

I have a dog that I love and is the best emotionally. She absorbs any of my sadness or my bad feelings and greets me with joy every day when I get home. That is  a huge benefit for me. My dog and I really like to do a lot of things outside. That is where I certainly feel the most grounded; hiking or walking. It is a good physical, mental, all around activity for us to sort of end the day or process the day in those ways.

I also reach out to friends. I talked earlier about the stigma with substance use. I think that there is still an immense amount of stigma, even in the social work community to talk about burnout and to talk about those really heavy days. So, I feel very grateful to my community of friends and supports that if I really do feel something weighing on me after a tough work day, that I have places that I can go and process that safely. Again,  clinical supervision is huge, but also to just sort of process that as a human with friends who I care about and who care about me.

Dr. Bencomo: Right, what a great self-care regime that you have going on. I think that a lot of times we can get so encompassed in the work that we are doing and it becomes such a big part of who we are, but not losing sight of the fact that we are people first, that is I think one of the lessons that I have taken from one of my professors many, many years ago, we will not say how many years ago, but lets just say several years ago. 

I remember one of my professors came in, introduced himself and then said, "This is my name. I'm your professor for this class, but I'm not a social worker." And being the little arrogant undergrad that I was, I think at the time, I thought, "Well then why are you teaching my class, my social work class?" And he went on to say, "Social work is my profession, and I love it. And I love doing it, and I would not choose to do anything else in the world. And it is why I get up every day, but it does not, it is not who I am. Who I am is a friend and a father and a member of my community." And just went on to talk about all the different aspects that made him who he was. And so I appreciate that that is something that, a similar experience that you had with your professor of the physical reminder of, "Okay, well, I am taking my uniform off and I am back to who I am." And so taking care of yourself I think is something that is going to help, not only with your longevity, but the quality of your work and everything that you are continuing to do. So good job, great work.

Allison: Thank you. That was a beautiful sentiment by your professor too. I enjoyed that very much.

Dr. Bencomo: Allison, a little bit earlier you talked about stigma. I wonder, have you encountered a lot of community support or pushback from the community for the Triple O program? I know that stigma is something that is a part of the national conversation when we think about supporting people who are struggling through an addiction. And so that is my question for you is, have you encountered a lot of community support? Have you felt that pushback from the community in any way?

Allison: That is a good question. I think overall this program has been supported probably even beyond what I could have hoped for. That is not to say that there are not still moments or challenges also associated with, yeah with addiction works with substance use disorders. I am hopeful that we as a society will just continue to move away from that, but it certainly still exists. But overall the support from the community has been really incredible. And I think another kind of, not necessarily a daily focus of our work, but one of the most enjoyable focuses of our work, we oftentimes, I mentioned that we use the 911 system and the 911 data to sort of find our list of individuals or our list of clients. We also get fire crews who respond to these scenes, who then come to us and say, "Hey, this is what we saw. This is the position that this individual is in, can you go and respond? We think that they have a lot of unmet needs." 

I have learned, and I only have such a brief time in the fire department, but learning about fire department culture has been a really unique and valuable experience. I really appreciate the moments where from the social work perspective, I can maybe challenge a little bit of the stigma that might exist for some of our fire crews. And if somebody comes to me and says, "This frequent flyer, this, you know, this, this and this," I feel very privileged to have this space to hold how it feels for them as a responder who has responded to a really tough situation for the sixth time, and to wish that that was different. And then also hold the space to say, "You know that there are immense barriers in our community. Let us sort of reframe the way that you are maybe talking about this person and let us see if we can sort of meet in the middle." 

I love those conversations. I love learning about their perspective versus my perspective. And yeah, so all of that to say that the community in general has been very supportive. The fire department has been immensely supportive and there will always be areas of growth to continue having those conversations to address stigma, to always use people first language, and to just continue to enhance the care that we're offering for folks in our community. And I would say that the same applies to treatment providers and service providers in our community. I am, again, on that two-sided coin. I am one, always wishing that we had more, more services, more, yeah, just more opportunities for treatment, that the wait lists were not so long, et cetera, et cetera. But then also saying, "Wow." Like to talk with the service providers in this community to see the care that they have for these individuals to always also want to be providing more, has been something that is just, it really fills my cup at the end of the day to know that even though there are those systemic barriers, even though we might always be wanting or needing more, the work that is being done and the folks that I am so honored to work with who are doing that work is just incredibly wonderful. And that is usually what I am left with at the end of the day.

Dr. Bencomo: That is great. What a great example of that cross profession collaboration and being able to share your perspective while honoring the perspective that your partners within the Las Cruces Fire Department have as well.

Being able to look at things in a different way and have those courageous and respectful conversations in a way that helps really everyone to continue to grow in regard to their ability to serve their community. 

I am happy to hear that that has been your experience and that you have had that experience within the community as well. That I feel like you are a really good ambassador for this type of work and for the social work profession in general, and a good example of how this can be successful when we honor that and respect the different professional abilities of all of our colleagues. And then what we can bring to the table as well, and helping to maybe to have that conversation on the larger community level, I think is going to be really impactful moving forward. So thank you for that work as well.

Allison: Thank you, I appreciate that very much.

Dr. Bencomo: Allison, I wonder, while maintaining confidentiality, of course, I wonder if you would be able to tell us about a particular case that you were able to follow from response to outcome just over time, and how that case played itself out?

Allison: Sure, I thought, I have been thinking about this and if I wanted to end with a, a client that really highlights some of the challenges, or if I want to choose a client that really highlights the success. So I might give you a little bit of both.

Dr. Bencomo: Little bit of both, I think that is okay.

Allison: Yeah, so we had an individual who was referred to us from a fire crew and they referred this individual because they said that they have financial concerns. Also, I am surprised with myself that this has not come up earlier. Although we are the opiate overdose outreach program, we are really serving as the overdose outreach program, because we do have a lot of folks in the Las Cruces community who are using opiates, but most of our services and most of our treatment providers will address any range of a substance use disorder. And so we quickly said why we are very grateful to have the resources to do opiate-specific work, but why would we keep ourselves limited to just that when we can provide services to anyone experiencing any substance-related disorder or concern or difficulty, and lets make sure that we are responding to anyone who is potentially in need of these services. 

So this particular client had an alcohol use disorder, financial concerns, housing concerns, mobility concerns, and this crew was just genuinely concerned about their overall wellbeing. So we responded and quickly sort of identified a needs assessment and where some of the greatest areas of risk were. And then working with this client ultimately came to the conclusion that, "All right, we want to address the substance use disorder first." That this individual was really wanting to detox from alcohol, go to a longer term treatment, and then come back, you know, maybe for themselves feeling a little bit better equipped to address the financial concern, the housing concern, et cetera, et cetera. 

So talk about barriers. This individual had very limited mobility in their legs. And so we did call to a couple of the service providers in the Las Cruces area. Both of which said, "You know, we maybe can take this individual, but it sounds like there is such a potential for medical need that we do not really think that our service can provide the level of care that they may need." And so we said, "Okay, let's look into the greater state of New Mexico." And I then spoke with four different facilities in Albuquerque. Three of which said the same thing, "That the mobility is going be too much of a risk, that we cannot accept this individual." And then one who said, "The level of mobility is no problem, but are they having an acute psychiatric need?' And having done this work for a while, I understand that that is really a question that is asking, "Is this person immediately having a risk to themselves or others," to which this person, you know, fortunately was not, but then that made that facility inaccessible at that time. And so then we said, "Okay, we are almost out of options. How can we still meet the need of this client with, with them asking for detox?" And so then we turned to the hospitals and we said, "We have this person who is actively seeking this treatment, who this person has been in the ICU for detox-related symptoms before, can we please bring them, knowing that this is a needed service?" And they said, "Well, you absolutely can bring them, but this person is going to have to have an immediate medical need when you do." Meaning that they will already have to be having symptoms of withdrawal, tremors, seizures before they would be able to admit them for detox. So that is a really hard conversation to have with a client. To say, "Hey, you've been in this before, you know your body, you know how your body feels. And, you know, we are essentially asking you to put yourself in pain, in potential harm, in order for us to get you the treatment that you really need." And so with the absolute strength of the client, it did take a little while, but we did get there and they did end up going inpatient in the hospital to receive that service.

Dr. Bencomo: That is awesome, that is amazing. I am glad that that was the final outcome. I think that it speaks to many of the systemic barriers that you were speaking to earlier, but also to the fact that you all were not willing to give up on that and you were willing to continue to advocate for what that client needed.

Allison: Yeah, absolutely. That really is one of the joys of the job is to be able to meet people in the middle and to provide that advocacy, like I said, and, you know, to hopefully just sort of soften the edges of how sharp and how difficult these institutions can be at times.

Dr. Bencomo: Yeah, absolutely. Allison, what are your hopes for the Triple O program moving forward, and what are your hopes for maybe how social workers across the country can learn from this experience, can work alongside first responders to respond to the needs of people that are living with mental health and addictions in their own communities? So first, what are your hopes for the Triple O program? And then, what are your hopes for how similar programs can come to fruition in communities across the country?

Allison: Sure, I think for the Triple O program, especially, I am hoping for sustainability. And again, however that comes to fruition, I would say that I am open to, but to make sure that this work continues. I do not think that this is a problem or epidemic that is just going to dissolve. So to continue these services for folks, to continue and to grow the amount of outreach, that is certainly one of my hopes. 

I am also hopeful that with the potential for more social workers there will be potential for more in-home treatment versus in-home connection to treatment. I think that to be able to provide a little bit more counseling services, that would be a skillset that I have, and that I could utilize, but that we just currently with this two person team, you know, I cannot realistically have every client that we take on devote an hour a week to therapeutic services. So I would really like to see an opportunity for that. And I think an opportunity for in-home treatment of any kind is something that I hope to see, whether that is through the Las Cruces Fire Department or a growth of service providers in the community, whatever that might be. I am such an advocate for in-home in-field services, meeting the individual where they are, that is, I think so beneficial and I have seen that work so well. So that is definitely something that I am hopeful for. And then in terms of my hopes for social workers working alongside first responders, I think that collaboration is absolutely beautiful. I think that it has grown me so much as a social worker to learn from the first responders and it has offered them a lot of insight from what I am able to provide. 

I strongly believe that the integrated approach to healthcare and to individuals offers the most holistic treatment. I think that is what everybody wants for clients and for individuals to really be able to address extensive concerns, all within one team. That’s the goal. And yeah, so that is a hope of mine. 

I would just really advocate for anyone who is interested in this, for social workers, especially, who are interested in this type of work to take that step, however scary it may be. I think that this is sort of a natural trend that is occurring across the nation, for social workers to be a little bit more involved in things like crisis response, to be involved in fire departments and police departments. And so just knowing the experience that I had, I would really advocate for anybody who thinks this might seem unattainable, but really, really cool to take the potential risk and just even propose it as a concept. Because, I do think that we are moving towards this type of service as being more of the norm, which is really exciting to me.

Dr. Bencomo: Absolutely, I think the excitement is something that I share as well. It is in listening to your story and in listening to the work that you all are doing. I think it gives us hope for how we can continue to collaborate with our colleagues from other professions to continue to serve our communities in a different way. I think finding that common ground that you spoke of, because we all have the same end goal that we are trying to work toward.

Being able to remember that and respect each other's way of looking at and supporting the communities, I think is where we start. Where we start to have these conversations and where we start to look at, how can we replicate these? I hope that this is a program that is replicated in communities across the nation. It is really exciting to think about that, to think that this could be a possibility. Allison, what is something that you wish you knew when you started working in social work, or what guidance would you offer to others knowing what you have learned so far?

Allison: That is a good question. I think that I wish that I would have been a little bit more bold. I think hand in hand with what guidance I would offer, I know that I still feel a lot of imposter syndrome, being new to the profession.

I think that I am constantly questioning myself. I think that that is good, but I also think that that is something that we all need to talk about a little bit more. What is it that makes us feel that way or makes me feel that way? And so I think that sort of my guidance is to address that and own that and say, "Even if I am new to this profession, even if I have worked with kids my entire life and now I am working with substance use, that does not devalue the experiences that I can contribute and that I can bring to the table." So, I would really encourage everyone in social work to take those risks and to honor yourselves and the skills that you have and that you are continuing to develop. 

And, I think, especially because I am so recently graduated, I really would speak to students and say, 'If you are feeling anxious about your practicum experiences, that you have to just take the risks now and you will absolutely learn from them. And if it does not fit, move on to something else."

Dr. Bencomo: What great advice, yes. I think that we all, regardless of whether we are new to the profession or have been social workers for decades, we are all lifelong learners. And so we all can continue to grow in regard to our professional skills and abilities. But yet we all have something to contribute, and contribute is something that you definitely have to the Las Cruces Fire Department and to the city of Las Cruces. And for that, Allison, I want to thank you for the work that you are doing, the incredible work that you are doing through the Triple O program and with the Las Cruces Fire Department. 

And I also want to thank you for being our guest on this podcast today, what a great conversation. And I wish you and the program continue growth moving forward. Thank you.

Allison: Thank you so much for having me. It was really enjoyable, and I appreciate the conversation so much.

References

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