Abstract
The opioid crisis in the United States continues to expose longstanding disparities in access to and quality of care for marginalized populations. In response, a Colorado health system engaged with HealthTeamWorks to conduct a comprehensive assessment to evaluate organizational readiness, workforce capacity, and equity in opioid use disorder (OUD) treatment. This paper presents a case study of the assessment process, including its methodology, stakeholder engagement strategy, data collection, and implementation of recommendations. The findings provide insights into effective strategies for embedding equity in behavioral health systems and serve as a model for other health systems seeking to enhance diversity, inclusion, and cultural responsiveness in substance use care.Â
Keywords
Opioid Use Disorder, Health Equity, Workforce Capacity, Behavioral Health, Emergency DepartmentÂ
Introduction
The opioid epidemic has amplified the need for equitable access to evidence-based substance use treatment, particularly among underserved communities. Despite expanded access to medications for opioid use disorder (MOUD) and behavioral health integration, disparities persist across race, ethnicity, geography, and socioeconomic status. Addressing these disparities requires an intentional focus on workforce diversity, stigma reduction, and culturally responsive care delivery.Â
In 2021, a Colorado health system initiated a six-month evaluation to assess its organizational capacity to deliver equitable OUD services. Supported by the Colorado State Opioid Response (SOR) grant and facilitated by HealthTeamWorks, the project focused on emergency department (ED) linkage, peer support integration, and systemic barriers to access. This paper details the work process, methods, and outcomes of this initiative as a model for health systems seeking to enhance behavioral health equity.Â
Methodology
The methodology of the assessment was grounded in a participatory and systems-based approach that emphasized inclusivity, transparency, and data-driven insights. The process began with project planning and stakeholder identification, where the team defined goals, deliverables, and accountability structures. A central feature was the creation of a Behavioral Health Diversity and Inclusion Workgroup composed of more than 30 staff members from across the health system, selected for their diverse roles and lived experiences.Â
Stakeholder engagement was foundational to the project’s integrity and relevance. HealthTeamWorks facilitated monthly convenings of the workgroup and designed a collaborative environment that allowed participants to co-create the inquiry process. This engagement ensured that the assessment reflected the on-the-ground realities of those delivering and receiving OUD-related services.Â
A systems lens was applied to understand not only individual-level interactions but also organizational infrastructure, policy alignment, and community context. This required the integration of multiple data sources—qualitative and quantitative—into the evaluation. The methodological approach was iterative, responsive to stakeholder feedback, and grounded in equity principles. By weaving together institutional review, qualitative inquiry, and geospatial data, the methodology was designed to surface actionable insights that extended beyond compliance into systemic transformation.Â
Project Design and Timeline
The initiative spanned from January to June 2021 and followed a phased workplan consisting of six major stages:Â
Timeline | Phase | Activities |
January–February 2021 | Project Planning and Stakeholder Identification | Project launch; stakeholder recruitment; initial workgroup meetings; interview planning; deployment of Facility Behavioral Health Tracker |
March 2021 | Stakeholder Engagement and Interview Process | Interview administration; demographic and policy review; initiation of GIS mapping; data collection on MOUD access through EDs |
April 2021 | Data Review and Gap Analysis | Completion of interviews; thematic analysis; refinement of the Facility Tracker; preparation of Regional Transformation presentation |
May 2021 | Thematic Analysis and Synthesis of Findings | Stakeholder review of themes and draft recommendations; alignment sessions with leadership; internship framework design |
June 2021 | Decision Making-Support | Final synthesis of findings; stakeholder decision-making sessions; development of implementation recommendations and final report |
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Stakeholder Engagement Strategy
The project centered a participatory approach by recruiting a Behavioral Health Diversity and Inclusion Workgroup. Over 30 members representing various departments within the Colorado health system joined, offering perspectives from clinical, administrative, and community outreach roles. HealthTeamWorks facilitated monthly meetings and interviews with workgroup members and additional stakeholders.Â
Data Collection and Analysis
Data collection was multifaceted and strategically layered to capture both operational realities and experiential knowledge. The core of qualitative data collection was a series of 28 structured interviews conducted with members of the Diversity and Inclusion Workgroup and other key stakeholders within the health system. These interviews explored perceptions and experiences related to stigma, workforce representation, culturally responsive care, and the integration of peer support roles. Interviews were conducted using a standardized guide, and responses were recorded, coded, and thematically analyzed.
In parallel, a demographic review was conducted using patient data from emergency departments across multiple sites. This analysis assessed the alignment—or misalignment—between the racial, ethnic, and linguistic backgrounds of staff and the populations they served. This lens was critical in identifying opportunities to increase representation and cultural concordance within the workforce.
Policy and initiative mapping formed another key component of the data strategy. The evaluation team reviewed existing policies, procedures, and programming housed in the Behavioral Health Clinical Council SharePoint site and the Facility Behavioral Health Tracker. These tools provided a system-level view of the health system’s current initiatives related to OUD, including MOUD deployment, naloxone distribution, and suicide prevention efforts.
Lastly, the use of Esri GIS mapping software offered a geographical perspective. It allowed evaluators to visualize community demographics surrounding the health system’s hospitals and assess service delivery in the context of regional health equity.
The integration of these data sources enabled triangulation, strengthening the validity of findings and ensuring that both qualitative insights and empirical trends were considered in the final analysis.
Results
The results of the assessment illuminated several systemic and structural challenges, as well as clear areas of opportunity. One of the most prominent findings was the lack of alignment between staff demographics and patient populations. This discrepancy underscored a need for targeted recruitment and retention strategies to diversify the behavioral health workforce, particularly in ED settings where time-sensitive, high-impact care is delivered.
Another critical theme was stigma—both perceived and enacted. Stakeholders shared personal and professional observations about the way stigma manifests in clinical interactions and organizational culture. This included stigma associated with substance use disorders, mental health conditions, and intersecting identities such as race, gender, and sexual orientation. These perspectives were synthesized into an OUD Stigma Report Card, which served as a feedback tool and foundation for future training.
Participants also emphasized the importance of integrating peer support specialists into emergency departments. Peer support was seen as a crucial bridge to care, particularly for patients who may not trust traditional providers or who face language and cultural barriers. Despite support for this model, gaps in formalized pathways and partnerships to onboard peer staff were identified.
Finally, the assessment revealed fragmentation in policy and initiative implementation. While innovative programs existed, there was limited standardization across facilities, and many staff were unaware of system-wide resources available to support OUD care. Enhanced utilization of tools like the Behavioral Health Tracker was recommended to improve coordination, monitoring, and transparency.
These results culminated in the following suite of recommendations aimed at embedding equity into workforce development, policy alignment, and care delivery models:
- Establish internship pathways through academic partnerships (e.g., University of Denver) to foster interest in behavioral health careers among underrepresented students.
- Formalize contracts with outpatient treatment programs employing diverse peer support specialists.
- Standardize Emergency Department MOUD workflows across the Colorado health system’s facilities.
- Use GIS and EHR data to inform targeted outreach and service design.
The findings informed leadership decision-making and laid the groundwork for longer-term transformation efforts.
Discussion
This case study underscores the value of a structured, participatory assessment process for advancing behavioral health equity. Key to the project’s success was the integration of qualitative stakeholder insights with data-driven tools, allowing for both human-centered and systemic analysis. By intentionally examining diversity and inclusion within OUD services, the Colorado health system laid the groundwork for sustainable, equity-informed transformation.
Conclusion
The OUD Diversity and Inclusion Assessment illustrates how health systems can critically evaluate and transform their capacity to deliver equitable care. With a focus on workforce inclusion, stakeholder voice, and data-informed decision-making, the process offers a replicable model for integrating equity into behavioral health and substance use care.
Acknowledgements
This work was made possible through funding from the Colorado State Opioid Response (SOR) program. We extend our gratitude to HealthTeamWorks, the Colorado health system’s leadership, and the Behavioral Health Diversity and Inclusion Workgroup for their commitment to this project. Â
