RecoverLA, A Los Angeles County Guide to Substance Use Disorder Prevention and Treatment Resources

The Los Angeles County Department of Public Health (DPH) protects health, prevents disease, and promotes health and well-being for over 10 million residents of Los Angeles County (LAC). LAC is the most heavily populated county in the nation, accounting for nearly 27 percent of California's population, and with a racially and ethnically diverse population. It is also one of the nation's largest counties, encompassing over 4,000 square miles that range from dense urban areas to rural areas in the deserts and mountains. There are over 40 public health programs within LAC-DPH that plan, develop, and implement public health services.  

LAC-DPH's Substance Abuse Prevention and Control Division (DPH-SAPC) leads and facilitates the delivery of a full spectrum of prevention, harm reduction, treatment, and recovery support services proven to reduce the impact of substance use, abuse, and addiction in LAC. DPH-SAPC works to increase substance use treatment service access and availability and eradicate stigma and barriers that contribute to use and misuse of substances among youth and young adults residing in cities and communities in LAC.  

According to the Center for Disease Control's (CDC) Wonder Tool, there were 2,133 deaths for all drug overdoses in LAC in 2020. LAC-DPH's July 2021 analysis of local health data reported that there was a 52% increase in accidental drug overdose deaths during the 10 months of the pandemic (March to December 2020) compared to the same period in 2019. While an estimated 8.8% of the LAC population, or over 697,000 individuals, have a substance use disorder or SUD, most people who have an SUD do not receive SUD treatment. According to SAMHSA's 2020 National Survey on Drug Use and Health, about 94% of people aged 12 or older who had a SUD in the past year did not receive treatment. Reasons for not receiving SUD treatment include not having health care coverage/high cost of treatment, not finding a program that offered the type of treatment they wanted and concern about the negative perception of seeking and receiving treatment. These common reasons support the need for resources that reduce these barriers to treatment. 

DPH-SAPC is addressing challenges related to local SUD resource and service awareness and referral coordination through the implementation of RecoverLA, a user-focused, community-responsive, mobile-friendly SUD and overdose (OD) prevention resource and referral support guide. As a large county with a complex public health service delivery structure, residents, community agencies, and public entities are often unaware of existing SUD resources, resulting in barriers to lifesaving prevention, treatment, and harm reduction services. Through RecoverLA, DPH-SAPC increased coordination and referrals to SUD prevention and treatment services within high opioid-related morbidity areas; increased linkages to medications for addiction treatment (MAT); and worked to decrease SUD and opioid associated ED visits, hospitalizations, and deaths in LAC. While RecoverLA's online platform is publicly available, RecoverLA was designed for agencies that serve individuals at high-risk for opioid OD and SUD.  

The goals of RecoverLA are to connect the community with SUD information and resources in LAC, dispel myths and misunderstandings about SUD, and seek SUD treatment. The objective of RecoverLA is to facilitate and increase awareness and referral coordination to overdose prevention and SUD services and resources in LAC.  

The development and launch of RecoverLA included a series of activities in collaboration California Institute for Behavioral Health Solutions (CIBHS), Kluge Strategic, Inc. (Kluge), and Fraser Media. In early 2020, DPH-SAPC staff attended meetings in high-priority areas throughout LAC to inform community stakeholders about the RecoverLA development process. Participants included community-based organizations, health centers, and clinics, and other community partners dedicated to improving the health and wellbeing of LAC residents. Utilizing the data collected from the engagement sessions, Kluge designed and developed the resource guide and mobile application. Upon the completion and after the launch of RecoverLA, DPH-SAPC hosted community launch and focused trainings events for key stakeholders in priority geographic areas.  

With the expertise of DPH-SAPC's Health Outcomes and Data Analytics (HODA) team, HODA conducted data monitoring, quality assurance, and evaluation activities. RecoverLA is provided in 13 different languages broadening the access to communities and populations that face barriers to accessing SUD care. 

The efforts from the development and launch of RecoverLA supported the increase in awareness of SUD topics, such as SUD prevention and treatment, and referral and linkage support services among staff in community organizations based on pre- and post-survey questionnaires. During the period of November 2019 and July 2021, DPH SAPCs 24/7 Substance Abuse Service Helpline (SASH) and Client Engagement and Navigation Services (CENS) used for assessment and referral to treatment saw an increase from 38 to 44 percent of clients who were connected to SUD treatment from community organization referrals. 

As a public health practice, RecoverLA is successful at providing a user-friendly tool to establish a linkage to SUD prevention and treatment services in a mobile-friendly format. It also provides users greater flexibility in accessing and leveraging SUD-related resources in various settings. As SUDs are complex, chronic health conditions, it is critical that patients have all available treatment options at their disposal to address those complex conditions. Readily available information and resources encourages and empowers users to learn more information about SUDs and provides direct access towards resources and getting treatment. By leveraging DPH-SAPC's vast provider and partner network and additional community engagement activities, DPH-SAPC promotes and evolves the resource tool to gain further insight to the adoptability and use of RecoverLA. 

Additional information on SAPC and RecoverLA can be found here: http://publichealth.lacounty.gov/sapc/; and https://www.recoverla.org/ (site works best on a mobile device). 

According to provisional data released in November 2021 from CDC's National Center for Health Statistics, drug overdose deaths in the United States rose to over 100,000 during the 12-month period ending in April 2021. With California having the 4th highest number of drug overdose deaths in the nation, LA County also saw a 52% increase in accidental drug overdose deaths during the 10 months of the COVID-19 pandemic (March to December 2020) compared to the same period in 2019. Further, drawing from the California Department of Public Health Vital Records Business Intelligence System Plus (VRBIS) Drug Overdose Mortality Data 2015-2018 and LAC Internal Services Department (ISD) midyear population estimates 2015-2018, DPH-SAPC prioritized interventions in LAC Service Planning Area (SPA) 1 and SPA 4. The main audiences for the RecoverLA include community-based organizations (CBO), health centers, emergency departments (ED), first responders, law enforcement, faith-based organizations (FBO), local cities, individuals with SUDs or those at risk, and the general public. 

SPA 1 (the Antelope Valley region) is geographically LAC's largest and most remote region. SPA 1 has had a less developed health service infrastructure, including SUD and mental health. In 2018, SPA 1 had LAC's highest opioid prescription rate, opioid OD death rate per 100,000 (6.4), prescription opioid OD-related hospitalization rate (17.6), and prescription opioid OD-related ED visit rate (18.3). One of the top 5 causes of premature death (death before age 75) in SPA 1 is drug overdose. SPA 1 has a 45% Latino, 35% White, 16% Black, 4% Asian, 0.4% American Indian, and 0.2% Native Hawaiian and Other Pacific Islanders (NHOPI) population. SPA 4 (Central Los Angeles) has LAC's second highest opioid OD death rate (6.0) and high heroin OD-related ED visit (12.3) and heroin OD-related hospitalization rates (2.4). SPA 4 is a highly diverse region centrally located in the heart of LAC and includes, among others, communities like Hollywood, Skid Row, Downtown, Koreatown, and Westlake. SPA 4 has a 52% Latino, 25% White, 18% Asian, 5% Black, 0.2% American Indian, and 0.1% NHOPI population. Drug overdose is a leading case of premature death in SPA 4. 

In LAC, an estimated 8.8% of the population, or over 697,000 individuals, have a SUD. As RecoverLA continues to be established and as access to RecoverLA's mobile application is publicly available beyond LAC, determining reach within our focused population was difficult to identify. SUDs are complex, chronic health conditions. As such, the treatment of SUDs often requires varied strategies to facilitate recovery. LAC currently provides multiple pathways to access substance treatment including SASH, Connecting to Opportunities for Recovery and Engagement (CORE) Centers, CENS, and SUD providers or self-referrals.  It is critical that patients have all available treatment options at their disposal to address these complex conditions. While these options provide SUD resources and increase treatment service availability, navigating a complex and fragmented health care system, in combination with social stigma and inequitable access to care, exacerbate issues related to the provision and receipt of care. RecoverLA provides SUD education, treatment information, and provider availability and locations improving access to SUD care and in a timely manner. Thus, RecoverLA narrows the gaps for populations that experience barriers to SUD care and addresses the common barriers to treatment, whether it is not finding a program that offered the type of treatment they wanted and concerns about the negative perception of seeking and receiving treatment. 

RecoverLA's mobile-friendly platform is a new and innovative multi-use tool to support community-based organizations (CBO), health centers, emergency departments (ED), first responders, law enforcement, faith-based organizations (FBO), local cities, individuals with SUDs or those at risk, and their caregivers. Addressing health equity concerns of access to culturally responsive SUD resources, barriers to treatment that disproportionally impact communities of color, and limited access to technology was central to the development of RecoverLA. RecoverLA is a Progressive Web App (PWA), which makes it easily accessible across any mobile device—without the need to download any native applications. PWA uses existing Service & Bed Availability Tool (SBAT) Application Programming Interface (API) for added functionality to the Find a Provider tool across mobile devices (i.e., phones, tablets), making it more accessible for users to request, search and filter using existing public data related to SUD treatment provider contact information, services, and availability. Users can filter by population (i.e., LGBTQ+, older adults, veteran), services (i.e., outpatient, residential), languages, bed availability, and more. RecoverLA's mobile application is also offered in 13 other languages including Farsi, Hmong, and Russian, expanding the accessibility towards SUD resources. 

In addition, RecoverLA harnesses the power of technology to provide LAC residents with synchronous communication of service bed availability as well as a robust digital resource library at their fingertips. There is a critical window of time between when someone with a SUD needs help and seeks help. RecoverLA maximizes this critical window and removes a common barrier to recovery – accessing treatment when it is most needed. RecoverLA's Find a Provider tool helps people find SUD services for themselves, clients, or loved ones. It is a mobile version of DPH-SAPC's SBAT that provides a dashboard of available substance use services throughout LAC, including outpatient and intensive outpatient treatment, different levels of residential treatment, withdrawal management, Opioid Treatment Programs, Recovery Bridge Housing, and DUI programs. RecoverLA provides an innovative centralized platform that can connect LA County residents to all local SUD-related prevention and treatment resources including LA County's SASH and CENS.  

In addition to its availability as a PWA, RecoverLA was also designed and printed as a pocket guide that includes a resource directory as tear-out pages that can be shared or distributed to reach residents without broadband internet access or mobile devices. The combination of a pocket-sized SUD resource guide and mobile application gives users greater flexibility accessing and leveraging these resources. Instant access to SUD treatment resources establishes linkages to care for communities and populations who generally have difficulty accessing services and overall, empower individuals to make safer choices. The county and national data sources provided illustrate the need to remove barriers associated with SUD treatment service access by informing and motivating the patient. These barriers can be further addressed through continued promotion and engagement of RecoverLA and provide a centralized pathway to access SUD treatment. 

The goals of RecoverLA are to connect the community with SUD information and resources in LAC, dispel myths and misunderstandings about SUD, and seek SUD treatment. The main objective of RecoverLA is to increase awareness and referral coordination to overdose prevention and SUD services and resources. 

In December 2019, DPH-SAPC was awarded a grant from the National Association of County and City Health Officials (NACCHO), with support from the Centers for Disease Control and Prevention (CDC), National Center for Injury Control and Prevention (NCIPC) to build capacity for local health department (LHDs) serving large jurisdictions and with a high burden of drug overdose deaths. As a large county with a complex public health service delivery structure, residents, community agencies and public entities are often unaware of SUD resources, resulting in barriers to lifesaving prevention, treatment, and harm reduction services. In response, DPH-SAPC developed and promoted RecoverLA, a user-focused, community-responsive, SUD and OD prevention resource and referral support guide with accompanying mobile app. The initial timeline to develop and launch RecoverLA was slated to begin in December 2019 with a launch date in June 2020. Due to the COVID-19 pandemic, DPH resources were reallocated to address the pandemic resulting in delaying the launch of RecoverLA to April 2021. 

To achieve RecoverLA's goal and objective, the development and launch of RecoverLA included a series of activities in collaboration with CIBHS, Kluge, and Fraser Media. DPH-SAPC collaborated with community-based organizations, health centers, and clinics, and other community partners dedicated to improving the health and wellbeing of LAC throughout this period as key stakeholders in informing the development and adoptability of RecoverLA's mobile application.  

In early 2020, DPH-SAPC staff attended Health Neighborhood Meetings in high-priority areas throughout LAC to inform community stakeholders about RecoverLA. Health Neighborhood meetings are coordinated by the Los Angeles Department of Mental Health and include participants from community-based organizations, health centers, and clinics, and other community partners from areas with high densities for OD. DPH-SAPC staff reached out to Health Neighborhood meeting coordinators located in SPAs where there was the most need for SUD treatment services determined by county and state database.  Health Neighborhood coordinators accommodated DPH-SAPC to facilitate 25-minute engagement sessions about the development of the RecoverLA resource guide and mobile application.  

DPH-SAPC utilized an existing partnership with CIBHS to assist in planning, facilitating the community sessions and launch events, sourcing and contracting vendors, including translators and invoicing for RecoverLA. DPH-SAPC staff developed SUD content based on feedback from questionnaires obtained during the input and engagement sessions and general information.  

Kluge facilitated virtual sessions with DPH-SAPC to aid in determining the look and feel of the resource guide, app, and promotional cards, and desired mobile application functionality. The collaboration led to the creation of the final resource guide, branding, and visual concepts. Kluge also provided monitoring and tracking efforts on all website activity and worked with DPH IT for hosting and maintenance. Kluge collaborated with a local printer to print and ship 2,000 resource guides. DPH-SAPC retained approximately 350 copies and is planning to distribute them during in-person outreach post-pandemic. 

DPH-SAPC developed a distribution plan to disseminate physical copies of the resource guide to community stakeholders who had attended Health Neighborhood meetings and other vital community partners, including the LA Police Department, LA Fire Department, Sheriff's Department, and LAC hospitals and health centers. DPH-SAPC prioritized the stakeholders based on their involvement with vulnerable populations to receive the SUD guide. This included those who provided services to individuals with mental health conditions, food insecurity, traditionally high utilization of community hospitals, health clinics, and in the criminal justice system.  

DPH-SAPC consulted with DPH's Technical Consultation Committee (TCC) to create the mobile application, ensure integration of the mobile-friendly SBAT, and transfer of hosting and maintenance activities. The TCC consists of DPH IT experts from Infrastructure and Operations, Security, Business Development, and Application Development.   

DPH-SAPC staff returned to the Health Neighborhood meetings to promote the resource guide and mobile app through a series of launch events and promotional campaigns. DPH-SAPC, CIBHS, and Kluge conducted three virtual community training sessions across prioritized geographic areas most impacted by the War on Drugs. Each event included approximately 30 community stakeholder groups for a combined total of roughly 90 stakeholders to learn about the use of the RecoverLA mobile application. DPH-SAPC staff was able to secure an hour on the agenda of each meeting for the purpose of introducing and demonstrating the use of the app. This constituted almost the entirety of each Health Neighborhood meeting and was made possible through the relationships that DPH-SAPC had established at the beginning of 2020. This allowed for a more thorough and comprehensive demonstration of the app during each launch event.  CIBHS and Kluge led an interactive demonstration to highlight various features of the app while providing participants with a real-time opportunity to navigate the features of the mobile app on their own.  CIBHS and Kluge also created and conducted a scavenger hunt” activity to access SASH, SBAT, and Find a Provider tool to encourage utilization and improve comfortability in using the mobile application. Additionally, CIBHS and DPH-SAPC developed and gathered qualitative data via surveys and questionaries for community feedback and training sessions. 

DPH-SAPC's data monitoring and quality assurance efforts were supported by DPH-SAPC's HODA team. HODA monitored Med-Cal claims data, California Outcome Measurement System (CalOMS) data collected via Sage, SAPC's SUD information system, and transferred full Sage data to DPH-SAPC Data Warehouse. The HODA team monitored data to ensure data quality and provided ongoing trainings or technical assistance to our treatment providers. Additionally, HODA ran periodic analysis to check any data quality issues in Sage to ultimately improve data collection efforts.  

DPH-SAPC utilized the NACCHO grant award to create the RecoverLA SUD resource guide and mobile application. DPH-SAPC invested $252,000 for Contractual costs which included the mobile application design and development, project discovery and branding, pocket guide design, media buyer, and to hire a resource and training coordinator. An additional $182,000 was invested toward Other costs including digital programmatic ads, social media ads, search engine ads, and printed material. 

The goals of RecoverLA are to direct the community to SUD information and resources in LAC, dispel myths and misunderstandings about SUD, and seek SUD treatment. The objective of RecoverLA is to launch a LAC SUD resource guide and mobile app to increase awareness and referral coordination to overdose prevention and SUD services and resources.  

DPH-SAPC developed an Evaluation and Performance Measurement Plan inclusive of project goals and objectives to identify short, medium, and long-term outcomes as a result of launching RecoverLA. DPH-SAPC's short-term outcomes include gathering community feedback on community needs related to SUD resource guide content and to increase community engagement and awareness of county SUD resources. In the development of the SUD resource guide and mobile application, DPH-SAPC staff attended Health Neighborhood meetings in high-priority areas throughout LAC to inform community stakeholders. CIBHS assessed the participants' knowledge at each Health Neighborhood meeting using polling questions. Polling questions were also disseminated at the end of the launch event. DPH-SAPC received 80 community feedback surveys from focus groups comprised of potential users about the contents and design related to the resource guide. Once the SUD resource guide was developed, 1,610 guides were distributed to the community during the campaign period. Further, DPH-SAPC, CIBHS, and Kluge were able to conduct three virtual community training sessions across prioritized geographic areas. Each event included approximately 30 community stakeholder groups for a combined total of roughly 90 stakeholders to learn about the use of the RecoverLA mobile application. CIBHS and Kluge led an interactive demonstration to highlight various features of the app while providing participants with a real-time opportunity to navigate the features of the mobile app on their own.  CIBHS and Kluge also created and conducted a scavenger hunt” activity that encouraged participants to search for answers to questions that could be found in the mobile application, such as Identify one location where someone can access syringe exchange services” to motivate utilization and become comfortable with the application while also allowing them to ask questions if they encountered challenges. In total, 111 individuals attended RecoverLA training and awareness sessions.  

Further, DPH-SAPC aimed to increase the number of referrals to SASH/CENS from community organizations and overall increase the percentage of clients connected to SUD treatment from community members and organizations. In review of the SASH/CENS service log, 22,097 calls/visits occurred to SASH/CENS for assessments and referral to treatment from community members and organizations. In addition, compared to the baseline of 38%, the percentage of clients connected to SUD treatment from community organization referrals increased to 44% based on service log, claims, and the CalOMS data by July 2021. 

To support data evaluation activities, DPH-SAPC's HODA conducted data monitoring and quality assurance efforts utilizing Med-Cal claims data, California Outcome Measurement System (CalOMS) data collected via Sage, SAPC's SUD information system, and transferred full Sage data to DPH-SAPC Data Warehouse. HODA not only ensured data quality but also provided ongoing trainings and technical assistance to our treatment providers for support. HODA ran periodic analysis checks on data quality issues in Sage to ultimately improve data collection efforts. Additionally, DPH-SAPC collaborated with CIBHS to develop and gather qualitative and quantitative data via surveys and questionnaires from the engagement sessions, key stakeholder trainings, and virtual launch events to provide resource guide and mobile application engagement and adoptability feedback. The HODA team reviewed and analyzed the qualitative and quantitative data from the questionnaires and surveys to help better address the needs of that RecoverLA can meet including identifying challenges and barriers to SUD treatment, common misunderstandings about SUDs, and information that should be included in RecoverLA's guide. 

In addition, DPH-SAPC collaborated with Fraser Media to review, analyze, and report on data collected from digital campaign efforts of RecoverLA. The evaluation of the media campaign included reviewing key performance indicators (KPI) such as impressions, Clickthrough Rate (CTR), and Cost Per Click (CPC) across the different digital platforms. The media campaign utilized Google, Facebook/Instagram, LinkedIn, Twitter, programmatic banners, and native advertising to promote RecoverLA.  In review of the KPI, ongoing optimization across the RecoverLA platform increased website visits throughout the campaign. The evaluation of CPC across the various digital platforms revealed Twitter had a high CPC. As a result of the RecoverLA mobile application campaign, RecoverLA was able to garner 47,888 clicks and delivered 21,365,336 impressions. Combined with their low engagement percentage, Fraser Media did not recommend to further utilize Twitter as a viable community engagement platform for RecoverLA for future promotional campaigns. Because native advertising is known for increasing community engagement and optimize campaign performance, with additional funding, Fraser Media recommended to place more emphasis on native advertising to further engage the public. 

As a public health practice, RecoverLA is successful at providing a user-friendly tool to establish a linkage to SUD prevention and treatment services. The SUD pocket guide and mobile application provides users greater flexibility in accessing and leveraging SUD-related resources in various settings. As SUDs are complex, chronic health conditions, the treatment of SUDs often requires varied strategies to facilitate recovery. It is critical that patients have all available treatment options at their disposal to address those complex conditions. A readily available pocket guide and mobile application encourages and empowers users to learn more information about SUDs and provides direct access towards resources and getting treatment. By leveraging LAC-DPH-SAPC's vast provider and partner network and additional community engagement activities, we will be able to continue promoting the resource tool and gain further insight to the adoptability and use of RecoverLA. During the development and initial launch of RecoverLA, there have been a number of lessons learned related to partner collaboration and community engagement.  

To support the launch of RecoverLA, DPH-SAPC launched a media campaign to highlight the County's efforts to raise awareness of available and accessible SUD resources through the utilization of digital platforms, programmatic banners, and native advertisements. For future campaigns, if additional funding allows, diminishing the use of Twitter and increasing native advertisement could improve community engagement of RecoverLA. 

In efforts to gather community input and engagement information, DPH-SAPC recognized challenges in community partners had limited time and were presented with an abundance of resources. While community partners are often initially excited about an additional resource, because of the number of available resources and limited time, this may decrease engagement and adoptability of the tool overtime. While the initial plan in 2020 was to continue providing updates about RecoverLA, due to changing priorities impacted by the COVID-19 pandemic, connecting with community stakeholders proved difficult. DPH-SAPC recognized the necessity to identify additional community-based organizations within LA County specifically serving vulnerable, high-needs population; and continue strengthening relationships with existing partners to maintain community presence and disseminate SUD information through ongoing community meetings to sustain the adoption of RecoverLA.  

To further ensure continuous improvement of RecoverLA platform, DPH-SAPC plans to leverage the state and federal government's commitment to address behavioral health needs. Specifically, DPH-SAPC identified Substance Abuse Prevention and Treatment Block Grant (SABG) funding to support continued and focused outreach engagement activities in the South Los Angeles, Central Los Angeles, and Antelope Valley regions of Los Angeles County. DPH-SAPC hired a project manager to further promote RecoverLA through increased community engagement and outreach activities. DPH-SAPC will specifically engage organizations directly supporting LGBTQ+, PEH, Black, Latino, and undocumented communities. DPH-SAPC further plans to collaborate internally to maintain and update SUD resources and information and collect and evaluate data to meet ensure RecoverLA meets community needs. With the number of community-based and social service organizations interested in utilizing a centralized resource to navigate a large and complex SUD system, there is tremendous potential to increase engagement and adoptability of RecoverLA. 

While an evaluation and performance measurement plan were established and concluded, a cost/benefit analysis has yet to be completed. As RecoverLA continues to be established, a thorough cost/benefit analysis and additional retrospective activities will be completed to fully understand the impact of RecoverLA in meeting community need to enhance accessible SUD prevention and treatment resources. Overall, DPH-SAPC hopes to utilize RecoverLA as a tool to decrease overdoses and SUD overall through reducing stigma towards SUDs and barriers to SUD treatment access for LAC residents.