It’s Wednesday morning, and Brian Morris, a recovery coach and mental health and substance use disorder (SUD) access coordinator, rallies a team in a virtual meeting to discuss plans to help an Island resident deemed to be at elevated risk due to substance use.
The approaching busy season brings with it higher rates of substance use disorder and addiction emergencies, according to an assessment by UMass Medical School’s Rural Scholars program, which studied Martha’s Vineyard’s SUD and addiction services. The assessment cites increasing emergency room visits year after year, with the summer months being significantly more dangerous for individuals struggling with SUD.
Morris is hoping to change that with the introduction of the HUB Table. Initially conceptualized in Canada, HUB Table is an “evidence-based, rapid intervention, designed to identify at-risk individuals or families and link them to a consortium of health and human service providers because they are deemed to be at elevated risk,” Morris said.
The hub and spoke model, which Morris is planning to incrementally introduce on a greater scale to the Island, consists of more direct accessibility, in conjunction with the goal of highlighting some of the often surreptitious, but ubiquitous issues that underpin many SUD cases. Issues like homelessness, lack of healthcare, and food insecurity are all factors that highlight the economic inequality that contributes to the inability to seek out and continue with treatment.
Morris plans to optimize community resources and improve the ways in which the recovery and treatment processes work. In the past, he said, the Island’s resources have been less interconnected, with communication among services rarely occurring effectively. He hopes that with the development and eventual expansion of the HUB Table, Martha’s Vineyard residents with family or friends struggling with SUD or dealing with such issues themselves will be able to access resources in what he describes as a less intimidating and more efficient way.
In a mission to acknowledge the importance of confidentiality and destigmatization, the HUB Table is tailored to its specific geographic location, keeping in mind the demographic and socioeconomic realities of the Island.
The HUB Table consists of a broad range of trained individuals, all of whom represent a “spoke” of Island resources. It includes employees from Martha’s Vineyard Community Services, Island Health Care, and M.V. Hospital. Each meeting is also made up of recovery coaches, SUD and mental health counselors, clinicians, housing agencies, and Island Food Pantry representatives, Vineyard House employees, spiritual leaders, and typically one or two law enforcement officials.
Edgartown Police Chief Bruce McNamee, who has worked closely with Morris on bringing this model to the Island, says addressing crises related to substance use beforehand is essential. McNamee is aware of the skepticism and reluctance many feel when confronted by police, especially when in a vulnerable position. Similar to Morris’ mantra of “treatment, not punishment,” Chief McNamee stresses the distinction between what the police are very much needed for, and when other professionals, such as SUD counselors and mental health clinicians, are needed.
Referring to HUB Table situations, McNamee is clear with that distinction. “We’re not there looking for informants. We’re not there trying to develop criminal intelligence on the Island; it’s truly to put someone who needs a service and marry them up with a person whose job is to provide it.”
This underscores the focus of the HUB mission: communication among various agencies, in order to provide services that may otherwise be unavailable or feel unattainable.
“The Island police here are big advocates of the HUB. We’re all looking to see this [program] address people before they’re in an acute crisis,” said McNamee. “It has all the mechanisms in place.”
The program works as a “four-filtered process,” with the protected health information (PHI) of at-risk individuals remaining completely anonymous until a decision is made whether to move forward with their case. At that point, only the three or four individuals chosen to work the case learn the identity of the individual, and immediately begin to mobilize for same-day intervention.
Allie Hunter, former executive director of PAARI (Police Assisted Addiction and Recovery Institute), has been familiar with the protocols and structure of HUB for years. Hunter works among the Martha’s Vineyard HUB Table members in an advisory role, ensuring “fidelity to the model,” and using her vast knowledge to support Morris and his team.
“Typically, all the different providers are in their silos,” Hunter said. “And they don’t have a way to communicate. Most of what they do tends to be reactive. [HUB] provided a way for groups to speak to each other, to be a bit more proactive in the ways they serve individuals.”
In the short time the HUB Table has been operative on the Island, Hunter said, the percentage of individuals’ cases that have been “successfully resolved by connecting that individual to services and reducing risk” far exceeds that of almost any other existing HUB.
“There’s been a lot of things that have set the program up for success,” Hunter said, emphasizing Morris and McNamee’s leadership, along with HUB Table members from different agencies. “All of these groups are really working hard in the best interest of Martha’s Vineyard residents, and this gives them a new and successful way to do that.”
Morris has yet to run a HUB Table during the summer, since the inception of the model on the Island was just before the beginning of the COVID-19 pandemic, forcing the program to take a temporary backseat. Primarily taking place remotely, the program began picking up momentum, with hopes to return to in-person meetings by summer.
“We have a very unique problem here. It intensifies as the weather gets warmer,” said Morris. “This is a resort Island, there’s no getting around that. A lot of people come here to party. A lot of people know how to do it responsibly; some don’t. I never did. That’s going to be the test of whether we are scalable.”
The program is there “to open the door for someone” said Morris, as he knocked on wood. “They just have to walk through it.”
With the emphasis on urgency and absolute anonymity, the HUB program is directly available to anyone who needs it.
HUB Table facilitator and coordinator Brian Morris can be reached at firstname.lastname@example.org, or 508-964-0940.