New $1.12M grant combines disease prevention, employment support and recovery

A pair of East Carolina University outreach initiatives that work to reduce communicable disease and help employ people in recovery in eastern North Carolina recently received a $1.12 million, three-year expansion grant that will combine the programs under one umbrella.

Dr. Leigh Atherton, associate professor and chair of the Department of Addictions and Rehabilitation Studies, oversees a team of 15 faculty, staff and students that operates two programs supporting disease prevention and recovery.

Members of the Project Engage ENC team sit outside of their mobile Outreach and Engagement Lab, a recreational vehicle that serves as a counseling space away from ECU’s Health Sciences Campus.

In 2021, ECU received a federal grant to fund Engage Eastern North Carolina, which helps enhance workforce development for people in recovery. The grant-funded program has helped workers and businesses navigate the challenges of employing those in recovery, oftentimes involving employment specialists and treatment teams to identify and modify potential problem behaviors.

By 2022, Atherton landed another federal grant that would allow his team of students and program employees to provide HIV and hepatitis C testing and coordination of care in eastern North Carolina. An overlapping program also worked to find treatment options for those willing.

While the communicable diseases that Atherton’s team are working to abate can be treated, their spread continues, especially in communities already experiencing significant health disparities. The most recent state report suggests more than 37,000 North Carolinians are infected with HIV, with 1,400 new cases in 2023.

The new grant funding — a targeted capacity expansion grant — will extend both existing grants as models for outreach and treatment.

“We aren’t really doing anything new, we’re continuing to receive funding to grow our effective model into more areas,” Atherton said.

Building the Workforce

The workforce side of the new grant funding employs individual placement and support, an evidence-based model that relies on program support staff working closely with employees and employers. Thus far, the program has helped nearly 80 people in recovery choose, get and keep jobs.

“These are individuals who would have a more difficult time finding and keeping employment,” Atherton said.

Frustration tolerance, focus and attention are degraded during active use, Atherton said. Even in sustained, long-term recovery, if the employee doesn’t actively work to rebuild interpersonal and professional skills, difficulties on the jobsite are much more common than for those not in recovery.

Members of Project Engage ENC participate in an outreach event.

A good example is an employer who recently called Atherton’s team about a new hire whose behavior would normally result in that worker being let go. But because there is an interlocutor from the program trained to identify problems and help the employee to address troublesome behaviors, the issue was resolved. The employee kept his job, and the employer didn’t need to endure the challenge of hiring and training a new employee.

“This is a hallmark of why enhanced employment services work, particularly for a population that is more likely to have on-the-job issues. It takes a team that understands addiction to address conflict and work with the employer,” Atherton said.

Atherton said those in recovery often make stellar employees as they are often actively working on themselves.

“We now know how to help guide individuals and we even tell partners in the community, ‘Hey, if you have a client that you’re working with refer them over here,’” Atherton said.

In the immediate post-COVID era, employers were desperate for workers, but now that issues of employment have returned to relative normality, those same employers have more choices.

State and county vocational rehabilitation programs offer many of the same services as Engage ENC. But because Atherton has grant funding, his team has the flexibility to help workers who have less severity or co-occurring disorders, especially in the very rural areas of eastern North Carolina. This is important as the eligibility requirements for state-funded services can be restrictive.

“Our data is demonstrating that the employment rate for those that have just substance use or otherwise do not qualify for state-funded services are still getting a significant benefit when it comes to employment and psychosocial outcomes,” Atherton said.

Treatment for Transmissible Disease

Atherton has been working in the addiction and recovery field for a long time. The benefit he’s seen from the initiative results from emphasis on outreach to vulnerable populations at high risk for HIV and hepatitis C. Counseling and referral to treatment can be very difficult for the underinsured, or uninsured, in rural areas.

Dr. Leigh Atherton, associate professor and chair of the Department of Addictions and Rehabilitation Studies, recently received a $1.12 million, three-year expansion grant that works to reduce disease and employ those in recovery.

If the pandemic had any redeeming quality, it was in getting everyone comfortable with engaging others online, Atherton said. The program brings together virtually doctors, treatment providers and community organizations that work with individuals who have an increased risk of contracting hepatitis C, a game-changer in a region of the state where primary care is tough to receive, let alone specialty care like treatment for infectious disease.

Atherton’s program is very active in Pitt, Beaufort, Martin and Lenoir counties, but also has connections in Washington and Bertie counties. With the new funding the program is adding Green, Hyde and Tyrrell counties. The expansion allows Engage ENC to increase its reach by deploying a mobile clinic for outreach, testing and treatment services.

“We have a mobile clinic where we can provide services on the fly in a safe, secure area. For example, in Hyde County, we have developed relationships with community partners that will let us use their parking lot,” to meet with clients, Atherton said.

In multiple counties, the team is working with local health departments to host drop-in clinics to bridge gaps that “can sustain beyond us,” Atherton said. The balancing act for the ECU program is providing support so that local and county organizations can get up and running and not overstepping and creating a dependency on outside help, he said.

Finding those in need of testing and treatment requires trust from those actively using substances as well as the community-based organizations that act as middlemen. Building bridges, and ensuring they aren’t burned along the way, takes time and being present, which is one reason that long-term funding has been so helpful.

“We go to the shelters, to soup kitchens, medical clinics and syringe services programs. Those partners have developed a strong relationship with the people that they work with, and by inviting us in, they’re sending the message that we can be trusted,” Atherton said.

That trust builds access and credibility, which are crucial elements of any effort to get people healthy and meaningful work that benefits them and the communities they live in.

“Developing and maintaining meaningful relationships with our community partners built upon mutual trust is essential to meeting the needs of those we serve,” Atherton said. “Engage ENC projects are a shining example of ECU’s commitment to community engagement and engaged scholarship.”

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