Begin the Turn

A community-based outreach and mobile care recovery program in urban Philadelphia serves people with addictive disorders

Developed by the Center for Urban Bioethics at Temple University in Philadelphia, Begin the Turn provides mobile outreach and recovery services in an urban area for those with addictive disorders and at risk for overdose. It is intended to  make opioid use disorder (OUD) treatment and recovery resources more available to traditionally underserved populations, helping to reduce health disparities. The multidisciplinary outreach team consists of three physicians (one the program director), three outreach workers with lived experience in addiction, a case manager, and a program coordinator. Services include harm reduction education, counseling, case management, and buprenorphine treatment for OUD, and are provided in a van that houses a waiting room, clinical and counseling areas, and a bathroom. Medical care is also available for skin infections and other conditions resulting from injection drug use. Program participants are linked to treatment and social services essential to beginning and maintaining recovery. 

Although not yet formally evaluated for outcomes, implementation evaluations (here and here) suggest that the program is reaching the intended target population, providing them with low barrier access to critical services that were formerly out of reach and difficult to navigate. A news story interviewing the program director is available here.

Understanding the critical needs of the community is key in developing a program that will have maximum impact. 

Continuum of Care
Treatment
Recovery
Harm Reduction
Type of Evidence
Peer-reviewed
Response Approach
Medications for Opioid Use Disorder
Outreach
Post-overdose response
Recovery coaching
Peer-reviewed Article

Evidence of Program Effectiveness

"A community board that oversaw program development ensured that the initiative remained community oriented and built systems that were both needed and desired by potential participants."  O'Gurek et al., 2020

"Among the 147 individuals who received care, the mean age was 39.6 years and median onset of opioid use was 21 years of age. Among study participants, 67.3% (n = 99) reported IV use, 91.9% (n = 135) reported previous experiences with addiction treatment, and 49.7% (n = 73) had previously suffered an overdose. Adverse Childhood Experiences surveys demonstrated a mean score of 4.6 (n = 141), with 63.1% (n = 89) having a score of 4 or greater. The percentages of patients retained in care at 1, 3, and 5 months were 61.2%, 36.6%, and 27.6%, respectively...The program serves a population with high rates of trauma and overdose. The program can serve as a model for treatment for this population." O'Gurek et al. 2021